2018 SimpleCare Brochure

Small Group Plans2018 Plan Information

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 20 years, Alliant Health Plans has been a leading provider of health care insurance in North Georgia. Our Board of Directors includes physicians and community leaders who work hard to deliver the best care.With Alliant Health Plans, you are guaranteed:Local Customer ServiceOur customer service representatives - locatedin our corporate office in Dalton GA - are readyto assist you.No Charge for Preventive CarePreventive care is always covered at 100%on all of our plans, using our In-Networkproviders.No Medical QualificationsNo matter what, you will never deal with a“pre-existing condition” waiting period.24-Hour Nurse Advice LineNot feeling well at 2 a.m.? Call our 24-hour NurseAdvice Line tollfree at (855) 299-3087.Additional BenefitsAlliant has selected Dominion National asits partner to offer you dental plans.Please look for more informationon dental plan options in thisbooklet.2 Questions? Call us at (800) 811-4793 Visit AlliantPlans.com Contact your broker

Important Terms to KnowRobust Networks CopaymentAlliant Health Plans has a robust network that includes more Your cost share of the service beingthan 17,000 area providers. All plans include access to the full received. Copays count toward the out-Alliant network. Some plans offer a secondary national network. of-pocket maximum but not towardsThis network is available to supplement network access needs the deductible. Copayments arefor members who may be outside of Alliant’s primary market. included in most of our plans.24/7 Access to your Health DeductibleRecord and Plan Information The amount you pay before any HealthIn today’s fast-moving society, easy access to information is the key Plan payment is applied. Deductiblesto quality health care. Alliant provides all members access to their are paid first, and then coinsurance isplan information through the member portal PHRAnywhereSM. applied. All SimpleCare plans have aThis portal not only helps you manage your health plan benefits, deductible. There is a maximum dollarbut stores medical information in a secure online vault. amount you would pay in any given calendar year.Coverage at Your Fingertips CoinsuranceNever forget your ID card again. When you download the ‘AlliantID Card Mobile’ app on your mobile device, you gain access The portion where we share theto your digital insurance card and covered costs with you. This amountAlliant’s provider directory–with is expressed as a percentage and isjust one touch. The mobile app is applied after the deductible is metavailable for Apple and Android (For example, Alliant pays 80% andoperating systems. you pay 20%).Online Access to Plan Information Out-of-Pocket MaximumLooking for a form or Summary of Benefits and Coverage? The maximum amount of money youVisit AlliantPlans.com for general plan information, forms, will pay out-of-pocket during a calendarhow to find a provider and lots more! year. It includes 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 plan year. Premium The total amount you pay to obtain and keep your health insurance active.Questions? Call us at (800) 811-4793 Visit AlliantPlans.com Contact your broker 3

Choose the right plan for your small group.Small group plans are categorized by metal levels. Find out what type of plan is right for you.Healthcare reform, also known as the Affordable Care Act (ACA), established metal levels toindicate the value of your insurance coverage: Platinum, Gold, Silver and bronze. Small groupplans offer the required essential health benefits, however your cost share is different. Platinum: This is the highest level with both the highest premium and the P 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. Gold: Gold has a higher level of benefits than silver but also a higher monthly G 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. Silver: This level has slightly higher monthly premiums than bronze but alsoS richer benefits. Beneficial for people who want to keep monthly premiums and out-of-pocket costs balanced. Bronze: This level has the lowest monthly premium but also the highest out-B of-pocket costs. Beneficial for people who prefer lower monthly premiums and don’t expect to need a lot of medical services.4 Questions? Call us at (800) 811-4793 Visit AlliantPlans.com Contact your broker

P Metal Levels S B G Platinum Silver Bronze Gold $$ $Monthly Cost $$$$ $$$ $$ $$Cost When You $$ $$ Get Care $ $ $$ $$$ Out-of-Pocket Maximum ExpensesQuestions? Call us at (800) 811-4793 Visit AlliantPlans.com Contact your broker 5

Compare our plansPlans available only OFF the Marketplace.Bronze and Silver plans have the Alliant network. Gold and Platinum plans have the Alliant network plus the PHCS wrap network.IN-NETWORK BENEFITS SimpleCare SimpleCare 50156 50172Primary Care Office Visit Silver BronzeSpecialist Office VisitUrgent Care $35 0%Outpatient Mental/Behavioral Health $70 0%Outpatient Rehabilitation * $75 $75Substance Abuse Disorder Inpatient * $35 0%Children’s Dental Check-up * 30% 0%Skilled Nursing Facility * 30% 0%Emergency Room Visit * 30% 0%Emergency Transportation/Ambulance * 30% 0%Coinsurance 30% 0% 30% 0%Deductible (Individual/Family) 30% 0%Out-of-Pocket Maximum (Individual/Family) (includes deduct- $3,650 $7,350 $7,300 $14,700ible) $7,350 $7,350 $14,700 $14,700PRESCRIPTION DRUG BENEFITS $15 0%Generic $50 0%Preferred Brand $100 0%Non-Preferred 25% ** 0%Specialty Drugs * 60% 40%OUT-OF-NETWORK BENEFITS $20,000 $20,000 $40,000 $40,000Coinsurance N/A N/ADeductible (Individual/Family)Out-of-Pocket Maximum (Individual/Family)*Coinsurance after Deductible ** 25% Coinsurance after Deductible, $400 per Rx Maximum ***HSA Eligible Plans Contact your broker6 Questions? Call us at (800) 811-4793 Visit AlliantPlans.com

SimpleCare SimpleCare SimpleCare SimpleCare SimpleCare 80140 80148 90176 90178 *** 90180 *** Gold Gold Platinum Silver Bronze $25 0% $15 $55 0% 0% 0% $30 $75 0% 0% 0% $75 $25 0% 0% 0% $15 10% 0% 0% 0% 0% 10% 0% 0% 0% $300 10% 0% 0% 0% 0% 10% 0% 0% 0% $30 10% 0% 0% 0% $100 10% 0% 0% 0% 0% 0% 0% 10% 0% 0% $1,500 $2,000 0% 0% $500 $3,000 $4,000 $4,000 $6,650 $1,000 $5,000 $2,000 $8,000 $13,300 $1,750 $10,000 $4,000 $4,000 $6,650 $3,500 $8,000 $13,300$10 $10 0% 0% 0%$35 $35 0% 0% 0%$70 $70 0% 0% 0%25% ** 25% ** 0% 0% 0% 40% 40% 40% 40% 40%$20,000 $20,000 $20,000 $20,000 $20,000$40,000 $40,000 $40,000 $40,000 $40,000 N/A N/A N/A N/A N/A*Coinsurance after Deductible ** 25% Coinsurance after Deductible, $400 per Rx Maximum ***HSA Eligible PlansQuestions? Call us at (800) 811-4793 Visit AlliantPlans.com Contact your broker 7

DOMINION NATIONALEffective January 1, 2018, Alliant Health Plans will offer dental plans to employers! Alliant haspartnered with Dominion National to bring you another highly requested benefit. DominionNational is a leading dental insurer and administrator of dental benefits providing access toover 9,000 PPO dentists in Georgia, and over 290,000 dentists nationally.Choose between four dental plan options and give your employees a reason to smile.The benefits of the Choice PPO plan include: • Maximum access, convenience and flexibility nationwide (over 9,000 in Georgia)1 • Significant out-of-pocket savings if using an in-network dentist • Diagnostic and Preventive Care does not count toward the Annual Maximum • Extra cleaning for diabetics and expectant mothers • No waiting periods1. Dominion National Internal Performance Report, July 2017. Participating providers are subject to change. Dental plans are underwritten by Dominion National Insurance Company and administered by Alliant Health Plans. This policy includes limitations, exclusions and terms under which the policy may be continued in force or discontinued. For costs and complete coverage, call (800) 811-4793.8 Questions? Call us at (800) 811-4793 Visit AlliantPlans.com Contact your broker

2018 DENTAL BENEFIT PLANSGROUP DENTAL BENEFIT PLANS CHOICE PPO CHOICE PPO CHOICE PPO 2 3 4 CHOICE PPO 1BENEFIT FEATURES None None None NoneOffice Visit Copayment $50 | $50 2 $50 | $50 2 $50 | $50 2 $50 | $50 2Deductible (x3 Family Max)Annual Maximum $1,000 $1,500 $1,000 $1,500Lifetime Ortho Maximum – ChildLifetime Ortho Maximum - Adult N/A N/A N/A N/AWaiting PeriodsOut-of-Network Reimbursement N/A N/A N/A N/AProvider Network 0 | 0 | 0 | N/A 0 | 0 | 0 | N/A 0 | 0 | 0 | N/A 0 | 0 | 0 | N/ADependent Age/Student Age (up to) PPO Fee PPO Fee PPO Fee PPO FeeDIAGNOSTIC & Access PPO Access PPO Access PPO Access PPOPREVENTIVE CARE network or any network or any network or any network or anyOral Examinations dentist dentist dentist dentistBitewing X-raysFull and Panoramic X-rays 26/26 26/26 26/26 26/26Semiannual Teeth CleaningsTopical Fluoride for Children In- Out-of- In- Out-of- In- Out-of- In- Out-of-Sealants Network Network Network Network Network Network Network NetworkBASIC CARE 100%3 100%3 100%3 100%3 100%3 80%3 100%3 80%3Fillings (Silver) 100%3 100%3 100%3 100%3 100%3 80%3 100%3 80%3Fillings (Composite)Extraction, Erupted Tooth 100%3 100%3 100%3 100%3 100%3 80%3 100%3 80%3MAJOR RESTORATIVE CARE 100%3 100%3 100%3 100%3 100%3 80%3 100%3 80%3Oral Surgery 100%3 100%3 100%3 100%3 100%3 80%3 100%3 80%3Endodontics (Root Canals)Periodontics 100%3 100%3 100%3 100%3 100%3 80%3 100%3 80%3CrownsBridges 80% 80% 80% 80% 80% 60% 80% 60%Implants 80% 80% 80% 80% 80% 60% 80% 60% 80% 80% 80% 80% 80% 60% 80% 60%ORTHODONTICS 50% 50% 50% 50% 50% 40% 50% 40%Children 50% 50% 50% 50% 50% 40% 50% 40%Adults 50% 50% 50% 50% 50% 40% 50% 40% 50% 50% 50% 50% 50% 40% 50% 40% 50% 50% 50% 50% 50% 40% 50% 40% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%2 Deductibles are waived for Diagnostic and Preventive Services (Class I).3 Diagnostic and Preventive Care (Class I) expenses do not apply toward the annual maximum.QQuueessttiioonnss?? CCaallll uuss aatt ((880000)) 881111--44779933 VViissiitt AAlllliiaannttPPllaannss..ccoomm CCoonnttaacctt yyoouurr bbrrookkeerr 9

NOTICE OF NON-DISCRIMINATION10 Questions? Call us at (800) 811-4793 Visit AlliantPlans.com Contact your broker

LANGUAGE ASSISTANCEQuestions? Call us at (800) 811-4793 Visit AlliantPlans.com Contact your broker 11

Keep this checklist in mind when buying health insurance.We strongly encourage you to work with a professional insurance broker. Brokers have a deepunderstanding of this process and can help guide and assist you through enrollment. There is nocost to you for using a professional broker. Here’s a quick list of important things to remember: DECIDE which medical plan works best for your employees. Your members must have minimum essential coverage and maintain it throughout the year (or qualify for an exemption), in order to avoid a penalty for not having insurance. All SimpleCare plans count as minimum essential coverage. DON’T forget dental! Decide if you want to sign up for dental coverage through Dominion National. THINK about your network needs. Make sure your preferred providers and facilities are in the network of whatever plan you choose. SUBMIT your application. Avoid delays in coverage for your employees. This will help to avoid any fees or penalties for non-coverage. PAY your premium before the day your coverage is expected to begin. Your plan benefits will not become effective until Alliant receives and processes your initial payment. 1503 N. Tibbs Rd Dalton, GA 30720 (800) 811-4793 [email protected]