simplecare-2019-brochure

SMALL GROUP PLANS 2019

Good health begins with good choices.We want coverage to be as simple and clear as possible. 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 care insurance in NorthGeorgia. Our Board of Directors includes physicians and community leaders who work together to promote aquality 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 tollfree at (855) 299-3087.1 SimpleCare Questions... Call us at (866) 403-2785 Visit AlliantPlans.com Contact your broker

Robust Networks Important Terms to KnowAlliant Health Plans has a robust network that includes more than 17,000 providers. Some Copaymentplans offer a national network that is available to members who may reside or travel outsideof Alliant’s primary market. Your cost of the service being recieved. Copays count toward the out-of-pocket maximum but not towards the deductible.24/7 Access to your HealthRecord and Plan Information Copayments are included in most of our plans.In today’s fast-moving society, easy acces to information is the key to quality health care. DeductibleAlliant provides all members access to their plan information through the member portalPHRAnywhereTM. This portal not only helps you manage your health plan benefits by pro- The amount you pay before any Health Plan payment isviding quick access to current information, but also stores medical information in a secure applied. Deductibles are paid first, and then coinsurance isonline vault. applied. There is a maximum dollar amount you would haveNew Mobile Member App to pay in any given calendar year.Alliant has now released a mobile app – available on the App Store or Google Play – with your Coinsuranceplan information, claim information, ID card and Provider Search. Search Alliant Health Plans todownload the Mobile Member App today! The portion where we share the covered costs with you. This amount is expressed as a percentage and is applied after theOnline Access to Plan Information deductible is met (For example, Alliant pays 80% and youLooking for a form or Summary of Benefits and Coverage? Visit AlliantPlans.com for general pay 20%).plan information, forms, how to find a provider and lots more! Out-of-Pocket Maximum The maximum amount of money you will pay out-of-pocket during a calendar year. It may include deductibles, copays 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.SimpleCare Questions... Call us at (866) 403-2785 Visit AlliantPlans.com Contact your broker 2

Choose the right plan for your small group.Health care reform, also known as the Affordable Care Act (ACA), established metal levels to indicate the value of yourinsurance coverage: platinum, gold, silver and bronze. All plans cover the same essential health benefits, but your costshare 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 pre- fer 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 - 2019 Benefit Year 79 10 COUNTY RATE AREA 132 Banks 10 2 Catoosa 7 Chattooga 13 Rating Areas are Dade 7 identified by large Dawson 10 white numbers and Fannin 9 correspond to the DOI Rating Floyd 13 Area Map. Franklin 10 Gilmer 13 Gordon 13 Habersham 10 Hall 10 Hart 10 Lumpkin 10 Murray 9 Pickens 13 Polk 13 Rabun 10 Stephens 10 Towns 10 Union 10 Walker 7 White 10 Whitfield 9SimpleCare Questions... Call us at (866) 403-2785 Visit AlliantPlans.com Contact your broker 4

Small Group Plans 2019 Single Network Option Plan Marketing Name In-Network Out-of-NetworkSimpleCare Platinum PPO 50080SimpleCare Platinum PPO 50082 Coinsurance Plan Deductible Out-of-Pocket ER Urgent PCP Specialist Mental Health/ (You Pay) Coinsurance Deductible Out-of-Pocket CreditableSimpleCare Platinum PPO 50084 Pays After Individual/ Maximum Care Visit Visit Substance Abuse Visit Rx Generic/Preferred/ Plan Pays Individual/ Maximum CoverageSimpleCare Gold PPO 50086 Deductible $30 (Pass / Fail)SimpleCare Gold PPO 50088 100% Family Individual/Family $100 $75 $15 $30 $15 Brand/Specialty After Deductible Family Individual/FamilySimpleCare Gold PPO 50090 100% $30 $15 60% PassSimpleCare Gold PPO 50092 100% $500 / $1,750 / $100 $75 $15 $55 $15 $10/$35/$70/25% 60% $20,000/ No PassSimpleCare Gold PPO 50094 80% $1,000 $3,500 $55 $25 ($400 max) 60% $40,000 Maximum PassSimpleCare Silver PPO 50056 85% $750 / $1,500 / $100 $75 $15 $55 $25 60% $20,000/ PassSimpleCare Silver PPO 50058 90% $1,500 $3,000 $55 $25 $10/$35/$70/25% 60% $40,000 No PassSimpleCare Silver PPO 50060 80% $1,100 / $1,100 / 80% $75 $25 $55 $25 ($400 max) 60% $20,000/ Maximum PassSimpleCare Silver PPO 50062 100% $2,200 $2,200 $70 $25 60% $40,000 PassSimpleCare Silver PPO 50064 70% $1,250/ $5,500 / 85% $75 $25 $70 $35 $10/$35/$70/25% 60% $20,000/ No PassSimpleCare Silver PPO 50066 70% $2,500 $11,000 $70 $35 ($400 max) 60% $40,000 Maximum PassSimpleCare Silver PPO 50068 80% $1,500 / $5,750 / 90% $75 $25 $70 $35 60% $20,000/ PassSimpleCare Silver PPO 50070 80% $3,000 $11,500 $70 $35 $10/$35/$70/25% 60% $40,000 No PassSimpleCare Bronze PPO 50072 90% $2,000 / $5,500 / 80% $75 $25 $70 $35 ($400 max) 60% $20,000/ Maximum PassSimpleCare Bronze PPO 50074 90% $4,000 $11,000 $70 $35 60% $40,000 PassSimpleCare Platinum Copay 50096 90% $2,500 / $5,000 / 100% $75 $25 $70 $35 $10/$35/$70/25% 60% $20,000/ No PassSimpleCare Gold Copay 50098 90% $5,000 $10,000 90% $35 ($400 max) 60% $40,000 Maximum PassSimpleCare Silver Copay 50100 90% $3,100 / $3,100 / 70% $75 $35 90% 60% $20,000/ Pass 70% $6,200 $6,200 $10/$35/$70/25% 60% $40,000 No Fail 85% $3,500 / $7,900 / 70% $75 $35 ($400 max) 60% $20,000/ Maximum Fail 80% $7,000 $15,800 60% $40,000 Pass 60% $4,000 / $7,900 / 80% $75 $35 $10/$35/$70/25% 60% $20,000/ No Pass $8,000 $15,800 ($400 max) 60% $40,000 Maximum Pass $4,500 / $7,900 / 80% $75 $35 $20,000/ $9,000 $15,800 $10/$35/$70/25% $40,000 No $5,000 / $7,900 / 90% $75 $35 ($400 max) $20,000/ Maximum $10,000 $15,800 $40,000 $5,500 / $7,900 / 90% $75 $35 $25/$50/$100/25% $20,000/ No $11,000 $15,800 ($400 max) $40,000 Maximum $6,000 / $7,900 / 90% $75 $35 $20,000/ $12,000 $15,800 $25/$50/$100/25% $40,000 No $6,500 / $7,900 / 90% $75 $35 ($400 max) $20,000/ Maximum $13,000 $15,800 $40,000 $7,000 / $7,900 / 90% $75 90% $25/$50/$100/25% $20,000/ No $14,000 $15,800 ($400 max) $40,000 Maximum $7,500 / $7,900 / $20,000/ $15,000 $15,800 $25/$50/$100/25% $40,000 No $7,000 / $7,900 / ($400 max) $20,000/ Maximum $14,000 $15,800 $40,000 $7,000 / $25/$50/$100/25% $20,000/ No $0 / $14,000 ($400 max) $40,000 Maximum $0 $7,900 / $20,000/ $0 / $15,800 $25/$50/$100/25% $40,000 No $0 $7,900 / ($400 max) $20,000/ Maximum $0 / $15,800 $40,000 $0 $25/$50/$100/25% No ($400 max) Maximum $25/$50/$100/25% No ($400 max) Maximum 10% No Maximum 70% $75 70% 70% 70% 30% No $225 $10 $5 $10 $5 $5/$15/$30/$75 Maximum $500 $75 $15 $30 $15 $10/$25/$50/50% No ($400 max) Maximum $750 $75 $45 $75 $45 $25/$50/$75/$250 No Maximum No MaximumWhere 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 2019 Dual Network Plan Marketing Name In-Network Out-of-NetworkSimpleCare Platinum PPO 80040SimpleCare Platinum PPO 80042 Coinsurance Plan Deductible Out-of-Pocket ER Urgent PCP Specialist Mental Health/ (You Pay) Coinsurance Deductible Out-of-Pocket CreditableSimpleCare Platinum PPO 80044 Pays After Individual/ Maximum Care Visit Visit Substance Abuse Visit Rx Generic/Preferred/ Plan Pays Individual/ Maximum CoverageSimpleCare Gold PPO 80046 Deductible $30 (Pass / Fail)SimpleCare Gold PPO 80048 100% Family Individual/Family $100 $75 $15 $30 $15 Brand/Specialty After Deductible Family Individual/FamilySimpleCare Gold PPO 80050 100% $30 $15 60% PassSimpleCare Gold PPO 80052 100% $500 / $1,750 / $100 $75 $15 $55 $15 $10/$35/$70/25% 60% $20,000/ No PassSimpleCare Gold PPO 80054 80% $1,000 $3,500 $55 $25 ($400 max) 60% $40,000 Maximum PassSimpleCare Silver PPO 80096 85% $750 / $1,500 / $100 $75 $15 $55 $25 60% $20,000/ PassSimpleCare Silver PPO 80098 90% $1,500 $3,000 $55 $25 $10/$35/$70/25% 60% $40,000 No PassSimpleCare Silver PPO 80100 80% $1,100 / $1,100 / 80% $75 $25 $55 $25 ($400 max) 60% $20,000/ Maximum PassSimpleCare Silver PPO 80102 100% $2,200 $2,200 $70 $25 60% $40,000 PassSimpleCare Silver PPO 80104 70% $1,250 / $5,500 / 85% $75 $25 $70 $35 $10/$35/$70/25% 60% $20,000/ No PassSimpleCare Silver PPO 80106 70% $2,500 $11,000 $70 $35 ($400 max) 60% $40,000 Maximum PassSimpleCare Silver PPO 80108 80% $1,500 / $5,750 / 90% $75 $25 $70 $35 60% $20,000/ PassSimpleCare Silver PPO 80110 80% $3,000 $11,500 $70 $35 $10/$35/$70/25% 60% $40,000 No PassSimpleCare Bronze PPO 80112 90% $2,000 / $5,500 / 80% $75 $25 $70 $35 ($400 max) 60% $20,000/ Maximum PassSimpleCare Bronze PPO 80114 90% $4,000 $11,000 $70 $35 60% $40,000 PassSimpleCare Platinum Copay 80116 90% $2,500 / $5,000 / 100% $75 $25 $70 $35 $10/$35/$70/25% 60% $20,000/ No PassSimpleCare Gold Copay 80118 90% $5,000 $10,000 $35 ($400 max) 60% $40,000 Maximum PassSimpleCare Silver Copay 80120 90% $3,100 / $3,100 / 70% $75 $35 60% $20,000/ Pass 70% $6,200 $6,200 $10/$35/$70/25% 60% $40,000 No Fail 85% $3,500 / $7,900 / 70% $75 $35 ($400 max) 60% $20,000/ Maximum Fail 80% $7,000 $15,800 60% $40,000 Pass 60% $4,000 / $7,900 / 80% $75 $35 $10/$35/$70/25% 60% $20,000/ No Pass $8,000 $15,800 ($400 max) 60% $40,000 Maximum Pass $4,500 / $7,900 / 80% $75 $35 $20,000/ $9,000 $15,800 $10/$35/$70/25% $40,000 No $5,000/ $7,900 / 90% $75 $35 ($400 max) $20,000/ Maximum $10,000 $15,800 $40,000 $5,500 / $7,900 / 90% $75 $35 $25/$50/$100/25% $20,000/ No $11,000 $15,800 ($400 max) $40,000 Maximum $6,000 / $7,900 / 90% $75 $35 $20,000/ $12,000 $15,800 $25/$50/$100/25% $40,000 No $6,500 / $7,900 / 90% $75 $35 ($400 max) $20,000/ Maximum $13,000 $15,800 $40,000 $7,000 / $7,900 / $25/$50/$100/25% $20,000/ No $14,000 $15,800 ($400 max) $40,000 Maximum $7,500 / $7,900 / $20,000/ $15,000 $15,800 $25/$50/$100/25% $40,000 No $7,000/ $7,900 / ($400 max) $20,000/ Maximum $14,000 $15,800 $40,000 $7,000 / $25/$50/$100/25% $20,000/ No $0 / $14,000 ($400 max) $40,000 Maximum $0 $7,900 / $20,000/ $0 / $15,800 $25/$50/$100/25% $40,000 No $0 $7,900 / ($400 max) $20,000/ Maximum $0 / $15,800 $40,000 $0 $25/$50/$100/25% No ($400 max) Maximum $25/$50/$100/25% No ($400 max) Maximum 90% $75 90% 90% 90% 10% No Maximum 70% $75 70% 70% 70% 30% No $225 $10 $5 $10 $5 $5/$15/$30/$75 Maximum $500 $75 $15 $30 $15 $10/$25/$50/50% No ($400 max) Maximum $750 $75 $45 $75 $45 $25/$50/$75/$250 No Maximum No MaximumWhere coinsurance exists, benefits are first subject to the plan deductible.SimpleCare Questions... Call us at (866) 403-2785 Visit AlliantPlans.com Contact your broker 6

High Deductible Small Group Health Plans 2019 Single Network Option In-Network Out-of-Network Plan Marketing Name Coinsurance Plan Deductible Out-of-Pocket ER Urgent PCP Visit Specialist Mental Health/ (You Pay) Coinsurance Deductible Out-of-Pocket Creditable Pays After Individual/ Maximum Care Visit Substance Abuse Rx Generic/Preferred/ Plan Pays Individual/ Maximum CoverageSimpleCare Silver HDHP 90078 Deductible (Pass / Fail)SimpleCare Silver HDHP 90079 100% Family Individual/Family Visit Brand/Specialty After Deductible Family Individual/FamilySimpleCare Bronze HDHP 90080SimpleCare Bronze HDHP 90081 80% $4,000 / $4,000 / 100% 0% 60% $20,000/ No PassSimpleCare Gold HDHP 90086 $8,000 $8,000 $40,000 MaximumSimpleCare Gold HDHP 90087 100% $3,000 / $6,000 / $6,000 $12,000 80% 20% 60% $20,000/ No Pass 70% $6,750 / $6,750 / $40,000 Maximum $13,500 $13,500 100% $6,250 / $6,750 / 100% 0% 60% $20,000/ No Fail $12,500 $13,500 $40,000 Maximum 70% $2,100 / $2,100 / $4,200 $4,200 70% 30% 60% $20,000/ No Fail $6,250 / $6,750 / $40,000 Maximum $12,500 $13,500 100% 0% 60% $20,000/ No Pass $40,000 Maximum 70% 30% 60% $20,000/ No Pass $40,000 MaximumHigh Deductible Small Group Health Plans 2019 Dual Network In-Network Out-of-Network Plan Marketing Name Coinsurance Plan Deductible Out-of-Pocket ER Urgent PCP Visit Specialist Mental Health/ (You Pay) Coinsurance Deductible Out-of-Pocket Creditable Pays After Individual/ Maximum Care Visit Substance Abuse Rx Generic/Preferred/ Plan Pays Individual/ Maximum CoverageSimpleCare Gold HDHP 90076 Deductible (Pass / Fail)SimpleCare Gold HDHP 90077 100% Family Individual/Family Visit Brand/Specialty After Deductible Family Individual/FamilySimpleCare Silver HDHP 90088SimpleCare Silver HDHP 90089 80% $2,100 / $2,100 / 100% 0% 60% $20,000/ No PassSimpleCare Bronze HDHP 90090 $4,200 $4,200 $40,000 MaximumSimpleCare Bronze HDHP 90091 100% $1,500 / $3,000 / $3,000 $6,000 80% 20% 60% $20,000/ No Pass 80% $4,000 / $4,000 / $40,000 Maximum $8,000 $8,000 100% $3,000 / $6,000 / 100% 0% 60% $20,000/ No Pass $6,000 $12,000 $40,000 Maximum 70% $6,750 / $6,750 / $13,500 $13,500 80% 20% 60% $20,000/ No Pass $6,250 / $6,750 / $40,000 Maximum $12,500 $13,500 100% 0% 60% $20,000/ No Fail $40,000 Maximum 70% 30% 60% $20,000/ No Fail $40,000 MaximumWhere 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

2019 SimpleCare Plans - Network OfferingsPlans are offered with one of the following network options:• Network 1 – Single Network Option• Network 2 – Dual Network Option Network 1 Network 2 SUBSCRIBER SUBSCRIBER All Members resides within resides OUTSIDE of AHP Network + PHCS* Alliant Network Area Alliant Network Area 90086, 90087, 90088, 90089,90090, 90091 AHP Network/No PHCS PHCS* Primary/No AHP (Default)Small 50000 SeriesGroup 80000 SeriesPlans 90000 Series 90076, 90077, 90078, 90079, 90080, 90081 Large Group PlansNETWORK 1 – SINGLE NETWORK OPTIONSubscribers (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.NETWORK 2 – DUAL NETWORK OPTIONSubscribers (and all dependents) are assigned both the Alliant network plus the PHCS* network. Network assignment is not dependent upon residential address.*Carveouts apply. Visit AlliantPlans.com to view carveout information.SimpleCare Questions... Call us at (866) 403-2785 Visit AlliantPlans.com Contact your broker 8

Alliant Network AreaThe 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 Meigs McMinn Catoosa Elbert Habersham Polk Sequatchie Bradley Chattooga Fannin Hall RabunFranklin Marion Hamilton Polk Cherokee Floyd Hart Stephens Dade Catoosa Murray Fannin Towns Rabun Clarke Forsyth Jackson Towns Union Whitfield Cobb Franklin Lumpkin Union Dade Fulton Walker Gilmer Lumpkin White HabershaSmtephens Madison Walker Chattooga Pickens Gordon Floyd Dawson Banks FranklinHart Hall Bartow Cherokee Forsyth Jackson Madison Elbert Tennessee Counties Polk Cobb Gwinnett Barrow Clarke Bledsoe Franklin Marion Polk Rhea Meigs Sequatchie Paulding Dekalb Bradley Hamilton McMinn Douglas Fulton Walton9 SimpleCare Questions... Call us at (866) 403-2785 Visit AlliantPlans.com Contact your broker