Ambetter IPA Training  Who is Ambetter  Our plans  Value added benefits  Member experience 1

Who is Ambetter? Ambetter from Coordinated Care plans offer competitive affordable premiums Lowest cost in counties with Ambetter Focusing on enrolling members who receive Health Insurance Premium Tax Credits (HIPTC)/Cost Sharing Reductions – Income below 250% or 300% for tribal members Good choice for individuals and families going back and forth between Washington Apple Health and Qualified Health Plan. 2

Local, Helpful, Affordable Local presence– customer service by people that live and work in the community Easy to understand and helpful, from enrollment through membership Ambetter helps our members navigate their healthcare Medical management programs 24/7 Nurse advice line 3

Who is Coordinated Care? Offer Washington Apple Health (Medicaid) coverage statewide as Coordinated Care. Located in Tacoma and have staff across Washington – we are local! Innovative programs that focus on empowering members to get well and stay well Committed to providing helpful customer service and materials that make accessing benefits easier.

Ambetter in 16 Counties 2014 counties Adams Benton Chelan Douglas Franklin Grant King Snohomish Spokane Thurston Walla Walla Yakima Additional counties added for 2015 Lewis Stevens Jefferson Lincoln 5 Note: We have exited Grays Harbor and Skagit counties. Those members will need to choose a new health plan.

Ambetter Plan Designs 6

Network Design Important: If you client has a provider that they want to see, make sure they are in-network before choosing Ambetter. Also check the Preferred Drug List ( PDL) 2015 posted by 11/15 Provider Directory and PDL at call Select network of high quality providers. Ambetter is an Health Maintenance Organization ( HMO). No out-of-network benefits. 7

Ambetter Plan Offerings We are going to focus on Silver and Balanced Care. Check our site for specific plan information. Essential Care & Bronze Balanced Care & Silver Gold 8

Ambetter Essential Care and Bronze Lower monthly premiums with highest out of pocket costs and highest deductibles. Lowest priced plan Optional adult vision No cost share reductions available at this level Essential Care is the closest plan we have to catastrophic coverage. It only includes preventative and generic prescriptions prior to meeting $6500 deductible. Ambetter Bronze includes: preventative, 3 free office visits and generic prescriptions without having to meet the $6000 deductible. 9

Ambetter Silver and Balanced Care (Silver) Best choice if your client is eligible for a health insurance premium tax credit Only plan tier that qualifies for health insurance premium tax credit and cost sharing reduction Best balance of premium and out-of-pocket costs Office visits covered by co-pay. Could be as low as $1 for highly subsidized members 10

Ambetter Silver vs Balanced Care 11

Gold Gold plans offer peace-of-mind for your clients that are willing to pay higher monthly premiums to help limit out-of-pocket costs to cover their healthcare needs Includes 3 free PCP visits Optional adult vision No cost sharing reductions available at this level 12

Vision Benefits Pediatric Vision (Up to 19 years of age) In-network Only Exams and Eyewear: –Routine Eye Exam (1 visit per year) 100% covered –Eyeglasses (frames) (1 item per year) 100% covered Lenses (per pair): –100% covered Contact Lenses: –Contact lenses (in lieu of glasses) 100% covered Adult Vision (Ages 19 years of age and older) In-network Only Exam: $20 copay –Routine Eye Exam (1 visit per year) 100% covered after copay Eyeglasses and Lenses: $20 copay –Eyeglasses (frames) (1 item per year) Covered up to $130 after copay –Lenses 100% covered after copay –Contact Lenses and Fitting: $20 Copay –Contact lenses (in lieu of glasses) Covered up to $130 after copay –Contact lens fitting 100% covered after copay –Specialty lens fitting Covered up to $50 after copay Ambetter offers optional Vision coverage. Benefits include : 13 Note: We have added optional adult vision but dental coverage for adults is not available on any plan on wahealthplanfinder.org Vision coverage is not available on the Balanced Care

Product I Medical EHB (includes Pediatric Vision) (No Dental) Product II Medical EHB (Includes Pediatric Vision) (No Dental) Plus Adult Vision Gold Silver (all AV levels) Bronze 2015 WA Product Portfolio 14 Ambetter Gold Ambetter Silver Ambetter Bronze Ambetter Balanced Care Ambetter Essential Care Ambetter Gold + Vision Ambetter Silver + Vision Ambetter Bronze + Vision Ambetter Essential Care + Vision No outline denotes a new plan for 2015

Ambetter’s Value Added Benefits My Health Pays Program Gym Reimbursement Program 24/7 Nurse Advice Line Health Management Programs Start Smart for Your Baby 15

Use the $125 to pay for out-of-pocket costs such as copays, deductibles or monthly premium payments. *Does not work on pharmacy copays. Each member will receive a My Health Pays Visa ® and can earn up to $125 that will be loaded onto it for eligible expenses. Card must be activated online and benefits are effectuated with the plan effective date. Here’s how it works: –Completing their Welcome Survey($50) –Getting their Annual Wellness Exam ($50) –Getting their annual flu shot ($25) My Health Pays Program 16

Earn up to $240 per member annually by going to the gym eight times a month. Ambetter’s gym membership benefits program makes it easier for your clients to stay in shape and stay healthy. With Ambetter, they can earn: –$20 on their My Health Pays card when they visit a gym of their choice at least eight times a month. –Get discounts on gym membership fees at approved locations. We’ve partnered with gyms and health clubs across Washington at Globalfit.com Gym Reimbursement Program 17

“I went to the doctor. Now I have a follow-up question.” “I’m pregnant and am having stomach pains. What should I do?” “My son has a fever. Do I need to go to the ER?” 24/7 Nurse Advice Line The Nurse Advice Line is open 24/7 year round. Sometimes, members may not be sure if they need to go to the emergency room. Calling the Nurse Advice Line will help members decide if it’s a real emergency and if they need care right away. 18

Health Management Programs If a member has a chronic condition we provide them with disease management services. Ambetter offers a Health Management Program for these conditions: Asthma Coronary Artery Disease (Adult Only) Depression Diabetes Hypertension (high blood pressure) High Cholesterol Low Back Pain Tobacco Cessation 19

Start Smart For Your Baby 20 Medically proven programs for our pregnant and new moms: Free car seat sent to members home when a “Notification of Pregnancy” is completed at least 6 weeks prior to due date Free high quality electric breast pump Case management and support during pregnancy Educational materials and resources Text4Baby health information texting program

Ambetter Member Portal Access Evidence of Coverage Schedule of Benefits View Claims Deductible status Provider Directory My Health Pays balance Make a payment (coming soon) 21

Ambetter Resources For printable client materials in English and Spanish please visit: Check back soon for new items on the website!

We would love to hear from you and value everything you do for your clients! Contact us Toll free at