1. Clinical Administrator’s Committee Meeting 2015 Marketplace/Healthcare Exchange Open Enrollment December 23, 2014 Presented by Andrew Johnson, Senior Director Accounts Receivable Management and Rose Webb, Manager Patient Services, Self Pay Collections, Pre-Service Financial Counseling & Certified Application Counselors 1

2. WHAT is the Marketplace/Healthcare Exchange ? The Health Marketplace offers affordable health insurance to legal U.S. residents who don’t have insurance through a job or government program. All of the plans in the Marketplace must cover the same basic health services, and are limited in how much they can charge you for that coverage. Some people may even qualify for discounts from the U.S. government to purchase one of these plans. 2

3. WHO qualifies for the Marketplace/Healthcare Exchange ? Lawful residents of the U.S. who don’t have health insurance through their job or government programs such as Medicare and Medicaid can purchase a Marketplace plan. If you earn between 100 and 400% of the Federal Poverty Level, you are eligible for financial assistance, or discounts on what you pay for your plan. The Marketplace can also help determine if you are eligible for other health insurance programs, such as Medicaid. 3

4. Open Enrollment November 15, 2014 through February 15, 2014 4

5. Resources Directly enroll by visiting www.healthcare.gov or call the hotline at 1-800-318-2596 www.healthcare.gov 5

6. Resources Wuphysicians.wustl.edu Patient Resources>Accepted Health Insurance>Health Exchange Marketplans Effective 1/1/2015 6

7. Resources Washington University School of Medicine Certified Application Counselors Certified Application Counselors (CAC) certified by Centers for Medicare & Medicaid Services Trained and certified to help customers determine the plan that best fits their needs: Insurance costs or provider network? Dedicated Customer Service phone number for WUMS CAC’s 314- 273-0880. Email address PBSteam@wusm.wustl.edu.PBSteam@wusm.wustl.edu Available at two locations during Open Enrollment period: Center for Advanced Medicine, Third Floor 4240 Duncan Ave. By appointment or walk in. 7

8. Resources 8

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10. Missouri Exchange Insurance Plans Missouri Exchanges (Eastern Missouri area) -- Washington University Physicians and Barnes-Jewish Hospital participate the following Exchange and Small Business Exchange options in Eastern Missouri: 10 Exchange Plan Washington University Physicians Barnes-Jewish Hospital myCigna (all plans) YES Coventry Focused Care (all plans) YES Coventry One PPO (all plans) YES United Healthcare Compass (all plans) YES Coventry One CareLink (not any product option with Carelink in the name) NO Anthem BCBS Pathway/Pathway X (not any Anthem Pathway product) NO

11. Illinois Exchange Insurance Plans Illinois Exchanges (Metro East area) – Washington University Physicians and Barnes- Jewish Hospital participate in the following Exchange options: 11 Exchange Plan Washington University PhysiciansBarnes-Jewish Hospital Assurant Health (all plans)YES Blue Cross Blue Shield IL (all plans through Blue Card Program) YES Coventry One PPO (all plans) YES Coventry Focused Care (all plans)YES Coventry One Care LinkNO Land of Lincoln Mutual (Through agreement with PHCS)YES Health Alliance ConnectNO

12. Enrollment reminder 12 PATIENTS/CONSUMERS MUST ENROLL BY DECEMBER 15, 2014 TO BE ELIGIBLE FOR BENEFITS ON JANUARY 1, 2015

13. Recommended Policy Regarding Non-PAR Patients 13 Non-PAR ( insured ) patients should not be scheduled for an office appointment until an Single Patient Agreement is executed with the patient’s health insurance carrier.

14. RECOMMENDED policy for New Patients regarding Non Participating insurance plans Any New patient seeking an appointment with WUSM should be rescheduled and the patient directed to go back to his/her PCP or the Plan for assistance to an In-Network Provider for their care. If the patient is unaware that WUSM is not participating in the non-contracted plan and appears in the office with a “new ID Card,” ask the patient if they would like to reschedule their appointment after they speak to their PCP or with customer service (phone number on the back of their ID Card) about seeking care within the Plan’s provider network. If no referral is necessary and the plan is not contracted, ask them to consider contacting their plan so they may be advised of the breakdown of benefits In-Network vs. Out-of -Network. This will enable the patient to make an informed financial decision before making the appointment. The patient may prefer to go In-Network to receive a better benefit level, which reduces their out of pocket expense. Refer patient to wuphysicians.wustl.edu website for a list of participating insurance plans. Refer patient to CAC for assistance. NOTE: Patient can change plans during Open Enrollment. Department may want to reschedule if patient chooses a WUSM participating provider. 14

15. RECOMMENDED policy regarding Established Patients regarding Non Participating insurance plans Inform the patient that WUSM is not contracted with the plan. Ask if the appointment they want to schedule with the physician is a follow up visit from their last visit. Check if prior authorization from your pre-cert staff occurred (with the new plan) for the visit prior to the appointment. If precertification has not been acquired, ask the precertification staff if this visit is Urgent. SPA may be obtained IF Urgent visit/services are needed. If the service is not urgent, direct the patient back to their plan to find a Network provider for their best benefit level. 15

16. REMEMBER Multiple WUSM departments could have relationships with the patient. Check with your department for specific guidelines. Recommend involve other departments in the communication loop if your department requires the services of other providers at WUSM. Contact your direct supervisor if any questions. 16

17. QUESTIONS? 17