2020-simplecare-brochure

SMALL GROUP PLANS 2020

Good health begins with good choices. We want coverage to be as clear and understandable as possible. Whatever your budget, we can help find the right health plan for you and your employees. For over 20 years, Alliant Health Plans has been a leading provider of health insurance in North Georgia. Our Board of Directors include physicians and community leaders who work together to promote a quality health care experience. With Alliant Health Plans, you are guaranteed: Local Customer Service Our customer service representatives - located in our corporate office in Dalton, GA - are ready to assist you. No Charge for Preventive Care Preventive care is always covered at 100% in all of our plans, using In-Network providers. No Medical Qualifications No matter what, you will never deal with a “pre-existing condition” waiting period. 24-Hour Nurse Advice Line Not feeling well at 2 a.m.? Call our 24-hour Nurse Advice Line toll free at (855) 299-3087. Only PPO Plans You have a choice in which provider you use. 1 SimpleCare Questions? Call us at (866) 403-2785 Visit AlliantPlans.com Contact your broker

Robust Networks Important Terms to Know Alliant Health Plans has a robust network that includes more than 17,000 providers. Copayment Subscribers who reside outside of Alliant Plans have access to a national provider net- work at no extra charge. Additional plans are available that provide national network Your cost of the service being received. Copayments count access to all members of the group. toward the out-of-pocket maximum but not towards the deductible. Copayments are included in most of our plans. 24/7 Access to your Health Record and Plan Information Deductible In today’s fast-moving society, easy access to information is the key to quality health The amount you pay before any Health Plan payment is care. Alliant provides all members access to their plan information through the applied. Deductibles are paid first, and then coinsurance is member portal PHRAnywhereTM. This portal not only helps you manage your health applied. There is a maximum dollar amount you would have plan benefits by providing quick access to current information, but also stores medical information in a secure online vault. to pay in any given calendar year. Mobile Member App Coinsurance Each member has access to a free Alliant mobile app that holds plan and claim information, The portion where we share the covered costs with you. ID card and a Provider Search tool. Search Alliant Health Plans on the App Store or Google This amount is expressed as a percentage and is applied Play, to download the Mobile Member App today! after the deductible is met (For example, Alliant pays 80% Online Access to Plan Information and you pay 20%). Looking for a form or Summary of Benefits and Coverage? Visit AlliantPlans.com for Out-of-Pocket Maximum general plan information, forms, how to find a provider and lots more! The maximum amount of money you will pay out-of- pocket during a calendar year. It may include deductibles, copayments and coinsurance but is in addition to your regular monthly premium. After you reach your out-of- pocket maximum, you would pay nothing for additional covered In-network medical expenses for the rest of the calendar year. Premium The total amount you pay to obtain and keep your health insurance active. 2 SimpleCare Questions? Call us at (866) 403-2785 Visit AlliantPlans.com Contact your broker

Choose the right plan for your business. Health care reform, also known as the Affordable Care Act (ACA), established metal levels to indicate the value of your insurance coverage: platinum, gold, silver and bronze. All plans cover the same essential health benefits, but your cost share is different. Small group plans are categorized by metal levels. Find out what type of plan is right for you. P Platinum: This is the highest level with both the highest premium and the richest benefits. Good for people who frequently receive medical services and are willing to pay more each month for the lowest ongoing health care costs. G Gold: Gold has a higher level of benefits than silver but also a higher monthly premium. Beneficial for people who receive medical services regularly and who are okay with a higher monthly premium in order to have more costs covered. S Silver: This level has slightly higher monthly premiums than bronze but also richer benefits. Beneficial for people who want to keep monthly premiums and out-of-pocket costs balanced. B Bronze: This level has the lowest monthly premium but also the highest out-of-pocket costs. Beneficial for people who prefer lower monthly premiums and don’t expect to need a lot of medical service. 3 SimpleCare Questions? Call us at (866) 403-2785 Visit AlliantPlans.com Contact your broker

Marketing and Rating Areas for SimpleCare - 2020 Benefit Year 79 10 COUNTY RATE AREA 13 Banks 10 2 Barrow 2 Catoosa 7 Rating Areas are Chattooga 13 identified by large Dade 7 white numbers and Dawson 10 correspond to the DOI Rating Fannin 9 Area Map. Floyd 13 Franklin 10 Gilmer 13 Gordon 13 Habersham 10 Hall 10 Hart 10 Jackson 2 Lumpkin 10 Murray 9 Pickens 13 Polk 13 Rabun 10 Stephens 10 Towns 10 Union 10 Walker 7 White 10 Whitfield 9 4 SimpleCare Questions? Call us at (866) 403-2785 Visit AlliantPlans.com Contact your broker

Small Group Plans 2020 Single Network Option In-Network Out-of-Network We Pay You Pay We Pay You Pay Plan Marketing Name Coinsurance Deductible Out-of-Pocket ER Urgent PCP Specialist Mental Health/ Rx Generic/Preferred/ Coinsurance Deductible Out-of-Pocket Creditable After Individual/ Maximum Care After Individual/ Maximum Coverage SimpleCare Platinum PPO 50080 $150 $75 Visit Visit Substance Abuse Visit Brand/Specialty (Pass / Fail) SimpleCare Platinum PPO 50082 Deductible Family Individual/Family $150 $75 Deductible Family Individual/Family SimpleCare Platinum PPO 50084 100% $150 $75 $20 $40 $20 $15/$35/$70/25% 60% No Maximum Pass SimpleCare Gold PPO 50086 100% $500/ $2,000/ 20% $75 $20 $40 ($400 max) 60% $20,000/ No Maximum Pass SimpeCare Gold PPO 50088 100% $1,000 $4,000 15% $75 $20 $40 60% $40,000 No Maximum Pass SimpleCare Gold PPO 50090 80% $750/ $2,500/ 10% $75 $30 $60 $20 $15/$35/$70/25% 60% $20,000/ No Maximum Pass SimpleCare Gold PPO 50092 85% $1,500 $5,000 20% $75 $30 $60 ($400 max) 60% $40,000 No Maximum Pass SimpleCare Gold PPO 50094 90% $2,250/ $2,250/ 10% $75 $30 $60 60% $20,000/ No Maximum Pass SimpleCare Silver PPO 50056 80% $4,500 $4,500 30% $75 $30 $60 $20 $15/$35/$70/25% 60% $40,000 No Maximum Pass SimpleCare Silver PPO 50058 90% $1,000/ $6,750/ 30% $75 $30 $60 ($400 max) 60% $20,000/ No Maximum Pass SimpleCare Silver PPO 50060 70% $2,000 $13,500 20% $75 $40 $80 60% $40,000 No Maximum Pass SimpleCare Silver PPO 50062 70% $1,500/ $5,750/ 20% $75 $40 $80 $30 $15/$35/$70/25% 60% $20,000/ No Maximum Pass SimpleCare Silver PPO 50064 80% $3,000 $11,500 10% $75 $40 $80 ($400 max) 60% $40,000 No Maximum Pass SimpleCare Silver PPO 50066 80% $2,000/ $5,500/ 10% $75 $40 $80 60% $20,000/ No Maximum Pass SimpleCare Silver PPO 50068 90% $4,000 $11,000 10% $75 $40 $80 $30 $15/$35/$70/25% 60% $40,000 No Maximum Pass SimpleCare Silver PPO 50070 90% $2,500/ $5,000/ 10% $75 $40 $80 ($400 max) 60% $20,000/ No Maximum Pass SimpleCare Bronze PPO 50072 90% $5,000 $10,000 10% $75 $40 $80 60% $40,000 No Maximum Pass SimpleCare Bronze PPO 50074 90% $3,000/ $5,500/ 30% $75 $40 $80 $30 $15/$35/$70/25% 60% $20,000/ No Maximum Pass SimpleCare Platinum Copay 50096 90% $6,000 $11,000 $225 $10 10% 10% ($400 max) 60% $40,000 No Maximum Fail SimpleCare Gold Copay 50098 70% $3,500/ $8,150/ $500 $75 30% 30% 60% $20,000/ No Maximum Fail SimpleCare Silver Copay 50100 85% $7,000 $16,300 $750 $75 $30 $15/$35/$70/25% 60% $40,000 No Maximum Pass 80% $4,000/ $8,150/ ($400 max) 60% $20,000/ No Maximum Pass 60% $8,000 $16,300 60% $40,000 No Maximum Pass $4,500/ $8,150/ $30 $15/$35/$70/25% $20,000/ $9,000 $16,300 ($400 max) $40,000 $5,000/ $8,150/ $20,000/ $10,000 $16,300 $40 $30/$55/$100/25% $40,000 $5,500/ $8,150/ ($400 max) $20,000/ $11,000 $16,300 $40,000 $6,000/ $8,150/ $40 $30/$55/$100/25% $20,000/ $12,000 $16,300 ($400 max) $40,000 $6,500/ $8,150/ $20,000/ $13,000 $16,300 $40 $30/$55/$100/25% $40,000 $7,000/ $8,150/ ($400 max) $20,000/ $14,000 $16,300 $40,000 $7,500/ $8,150/ $40 $30/$55/$100/25% $20,000/ $15,000 $16,300 ($400 max) $40,000 $7,000/ $8,150/ $20,000/ $14,000 $16,300 $40 $30/$55/$100/25% $40,000 $7,000/ ($400 max) $20,000/ $0/ $14,000 $40,000 $0 $8,150/ $40 $30/$55/$100/25% $20,000/ $0/ $16,300 ($400 max) $40,000 $0 $8,150/ $20,000/ $0/ $16,300 $40 $30/$55/$100/25% $40,000 $0 ($400 max) $40 $30/$55/$100/25% ($400 max) 10% 10% ($400 max) 30% 30% ($400 max) $5 $10 $5 $5/$15/$30/$75 $15 $30 $15 $10/$25/$50/50% ($400 max) $50 $80 $50 $30/$50/$75/$250 Where coinsurance exists, benefits are first subject to the plan deductible. 5 SimpleCare Questions? Call us at (866) 403-2785 Visit AlliantPlans.com Contact your broker

Small Group Plans 2020 Dual Network Option In-Network Out-of-Network We Pay You Pay We Pay You Pay Coinsurance Plan Marketing Name Deductible Out-of-Pocket ER Urgent PCP Specialist Mental Health/ Rx Generic/Preferred/ Coinsurance Deductible Out-of-Pocket Creditable After Individual/ Maximum Care After Individual/ Maximum Coverage SimpleCare Platinum PPO 80040 Deductible $150 $75 Visit Visit Substance Abuse Visit Brand/Specialty (Pass / Fail) SimpleCare Platinum PPO 80042 Family Individual/Family $150 $75 Deductible Family Individual/Family SimpleCare Platinum PPO 80044 100% $150 $75 $20 $40 $20 $15/$35/$70/25% 60% No Maximum Pass SimpleCare Gold PPO 80046 100% $500/ $2,000/ 80% $75 $20 $40 ($400 max) 60% $20,000/ No Maximum Pass SimpleCare Gold PPO 80048 100% $1,000 $4,000 85% $75 $20 $40 60% $40,000 No Maximum Pass SimpleCare Gold PPO 80050 80% $750/ $2,500/ 90% $75 $30 $60 $20 $15/$35/$70/25% 60% $20,000/ No Maximum Pass SimpleCare Gold PPO 80052 85% $1,500 $5,000 80% $75 $30 $60 ($400 max) 60% $40,000 No Maximum Pass SimpleCare Gold PPO 80054 90% $2,250/ $2,250/ 90% $75 $30 $60 60% $20,000/ No Maximum Pass SimpleCare Silver PPO 80096 80% $4,500 $4,500 70% $75 $30 $60 $20 $15/$35/$70/25% 60% $40,000 No Maximum Pass SimpleCare Silver PPO 80098 90% $1,000/ $6,750/ 70% $75 $30 $60 ($400 max) 60% $20,000/ No Maximum Pass SimpleCare Silver PPO 80100 70% $2,000 $13,500 80% $75 $40 $80 60% $40,000 No Maximum Pass SimpleCare Silver PPO 80102 70% $1,500/ $5,750/ 80% $75 $40 $80 $30 $15/$35/$70/25% 60% $20,000/ No Maximum Pass SimpleCare Silver PPO 80104 80% $3,000 $11,500 90% $75 $40 $80 ($400 max) 60% $40,000 No Maximum Pass SimpleCare Silver PPO 80106 80% $2,000/ $5,500/ 90% $75 $40 $80 60% $20,000/ No Maximum Pass SimpleCare Silver PPO 80108 90% $4,000 $11,000 90% $75 $40 $80 $30 $15/$35/$70/25% 60% $40,000 No Maximum Pass SimpleCare Silver PPO 80110 90% $2,500/ $5,000/ 90% $75 $40 $80 ($400 max) 60% $20,000/ No Maximum Pass SimpleCare Bronze PPO 80112 90% $5,000 $10,000 90% $75 $40 $80 60% $40,000 No Maximum Pass SimpleCare Bronze PPO 80114 90% $3,000/ $5,500/ 70% $75 $40 $80 $30 $15/$35/$70/25% 60% $20,000/ No Maximum Pass SimpleCare Platinum Copay 80116 90% $6,000 $11,000 $225 $10 90% 90% ($400 max) 60% $40,000 No Maximum Fail SimpleCare Gold Copay 80118 70% $3,500/ $8,150/ $500 $75 70% 70% 60% $20,000/ No Maximum Fail SimpleCare Silver Copay 80120 85% $7,000 $16,300 $750 $75 $30 $15/$35/$70/25% 60% $40,000 No Maximum Pass 80% $4,000/ $8,150/ ($400 max) 60% $20,000/ No Maximum Pass 60% $8,000 $16,300 60% $40,000 No Maximum Pass $4,500/ $8,150/ $30 $15/$35/$70/25% $20,000/ $9,000 $16,300 ($400 max) $40,000 $5,000/ $8,150/ $20,000/ $10,000 $16,300 $40 $30/$55/$100/25% $40,000 $5,500/ $8,150/ ($400 max) $20,000/ $11,000 $16,300 $40,000 $6,000/ $8,150/ $40 $30/$55/$100/25% $20,000/ $12,000 $16,300 ($400 max) $40,000 $6,500/ $8,150/ $20,000/ $13,000 $16,300 $40 $30/$55/$100/25% $40,000 $7,000/ $8,150/ ($400 max) $20,000/ $14,000 $16,300 $40,000 $7,500/ $8,150/ $40 $30/$55/$100/25% $20,000/ $15,000 $16,300 ($400 max) $40,000 $7,000/ $8,150/ $20,000/ $14,000 $16,300 $40 $30/$55/$100/25% $40,000 $7,000/ ($400 max) $20,000/ $0/ $14,000 $40,000 $0 $8,150/ $40 $30/$55/$100/25% $20,000/ $0/ $16,300 ($400 max) $40,000 $0 $8,150/ $20,000/ $0/ $16,300 $40 $30/$55/$100/25% $40,000 $0 ($400 max) $40 $30/$55/$100/25% ($400 max) 90% 10% ($400 max) 70% 30% ($400 max) $5 $10 $5 $5/$15/$30/$75 $15 $30 $15 $10/$25/$50/50% ($400 max) $50 $80 $50 $30/$50/$75/$250 Where coinsurance exists, benefits are first subject to the plan deductible. 6 SimpleCare Questions? Call us at (866) 403-2785 Visit AlliantPlans.com Contact your broker

High Deductible Small Group Health Plans 2020 HSA Eligible Single Network Option In-Network Out-of-Network We Pay You Pay We Pay You Pay Plan Marketing Name Coinsurance Deductible Out-of-Pocket ER Urgent PCP Visit Specialist Mental Health/ Rx Generic/Preferred/ Coinsurance Deductible Out-of-Pocket Creditable After Individual/ Maximum Care Visit Substance Abuse Brand/Specialty After Individual/ Maximum Coverage SimpleCare Gold HDHP 100012 (Pass / Fail) SimpleCare Gold HDHP 100013 Deductible Family Individual/Family Visit Deductible Family Individual/Family SimpleCare Silver HDHP 100014 60% No Maximum Pass SimpleCare Silver HDHP 100015 100% $2,100/ $2,100/ 0% after deductible is met 0% $20,000/ SimpleCare Bronze HDHP 100016 $4,200 $4,200 60% $40,000 No Maximum Pass SimpleCare Bronze HDHP 100017 $20,000/ 80% $1,500/ $3,000/ 20% after deductible is met 20% 60% $40,000 No Maximum Pass $3,000 $6,000 $20,000/ 60% $40,000 No Maximum Pass 100% $4,500/ $4,500/ 0% after deductible is met 0% $20,000/ $9,000 $9,000 60% $40,000 No Maximum Fail $20,000/ 80% $3,000/ $6,000/ 20% after deductible is met 20% 60% $40,000 No Maximum Fail $6,000 $12,000 $20,000/ $40,000 100% $6,900/ $6,900/ 0% after deductible is met 0% $13,800 $13,800 70% $6,250/ $6,900/ 30% after deductible is met 30% $12,500 $13,800 High Deductible Small Group Health Plans 2020 HSA Eligible Dual Network Option In-Network (You Pay) Out-of-Network We Pay You Pay We Pay You Pay Coinsurance Plan Marketing Name Deductible Out-of-Pocket ER Urgent PCP Visit Specialist Mental Health/ Rx Generic/Preferred/ Coinsurance Deductible Out-of-Pocket Creditable After Individual/ Maximum Care Visit Substance Abuse Brand/Specialty After Individual/ Maximum Coverage SimpleCare Gold HDHP 90076 Deductible (Pass / Fail) SimpleCare Gold HDHP 90077 Family Individual/Family Visit 0% Deductible Family Individual/Family SimpleCare Silver HDHP 90088 100% 20% 60% No Maximum Pass SimpleCare Silver HDHP 90089 $2,100/ $2,100/ 0% after deductible is met 0% $20,000/ SimpleCare Bronze HDHP 90090 80% $4,200 $4,200 20% 60% $40,000 No Maximum Pass SimpleCare Bronze HDHP 90091 $1,500/ $3,000/ 20% after deductible is met 0% $20,000/ 100% $3,000 $6,000 30% 60% $40,000 No Maximum Pass $4,500/ $4,500/ 0% after deductible is met $20,000/ 80% $9,000 $9,000 60% $40,000 No Maximum Pass $3,000/ $6,000/ 20% after deductible is met $20,000/ 100% $6,000 $12,000 60% $40,000 No Maximum Fail $6,900/ $6,900/ 0% after deductible is met $20,000/ 70% $13,800 $13,800 60% $40,000 No Maximum Fail $6,250/ $6,900/ 30% after deductible is met $20,000/ $12,500 $13,800 $40,000 Where coinsurance exists, benefits are first subject to the plan deductible. 7 SimpleCare Questions? Call us at (866) 403-2785 Visit AlliantPlans.com Contact your broker

2020 SimpleCare Plans - Network Options Plans are offered with one of the following network options: • Single Network Option • Dual Network Option Single Network Option (see map on next page) Dual Network Option SUBSCRIBER SUBSCRIBER All Members resides within resides OUTSIDE of Alliant Network Area Alliant Network Area AHP Network + PHCS* AHP Network/No PHCS PHCS* Primary/No AHP 50000 Series Small 80000 Series Group 90000 Series Plans 100000 Series Large Group Plans SINGLE NETWORK OPTION (see map on next page) Subscribers (and all dependents) are assigned a network based on the residential address of the subscriber. • Subscribers who reside within the Alliant Network Area are assigned the Alliant network. • Subscribers who reside outside the Alliant Network Area are assigned the PHCS* Primary network; this assignment does not provide access to the Alliant network. DUAL NETWORK OPTION Subscribers (and all dependents) are assigned both the Alliant network plus the PHCS* network. Network assignment is not dependent upon residential address. *Carveouts apply (a limited number of providers/facilities are not accessible). Visit AlliantPlans.com to view carveout information. 8 SimpleCare Questions? Call us at (866) 403-2785 Visit AlliantPlans.com Contact your broker

Alliant Network Area The Alliant Network Area is defined by the Georgia and Tennessee counties shown below. Georgia Counties Banks Dawson Gilmer Murray Walton White Barrow Dekalb Gordon Paulding Whitfield Bledsoe Rhea Bartow Douglas Gwinnett Pickens Sequatchie Meigs McMinn Catoosa Elbert Habersham Polk Bradley Chattooga Fannin Hall Rabun Franklin Marion Hamilton Polk Cherokee Floyd Hart Stephens Catoosa Murray Fannin Towns Clarke Forsyth Jackson Towns Dade Union Rabun Whitfield Cobb Franklin Lumpkin Union Dade Fulton Walker Gilmer Lumpkin White HabershaSmtephens Madison Walker Chattooga Pickens Gordon Floyd Dawson Banks FranklinHart Hall Bartow Cherokee Tennessee Counties Forsyth Jackson Madison Elbert Bledsoe Franklin Marion Polk Rhea Meigs Sequatchie Polk Cobb Gwinnett Barrow Clarke Paulding Bradley Hamilton McMinn Douglas Dekalb Walton Fulton Note - See Single Network Option on previous page 9 SimpleCare Questions? Call us at (866) 403-2785 Visit AlliantPlans.com Contact your broker