1. NMHIX Healthcare Guide Training Roswell: Thursday, November 14, 2013 1

2. Presbyterian was founded in 1908 to serve tuberculosis patients and has grown to become the state’s largest healthcare provider. Because it is community owned, Presbyterian is dedicated to being a good steward of local healthcare resources. Who we are Improving health for over 105 years Our hospitals, physicians, caregivers and insurance plans work together as an integrated delivery system to serve more than 660,000 New Mexicans. 2

3. Working Together As the most preferred healthcare organization in New Mexico, Presbyterian offers you the value that comes with our integrated system of physicians, hospitals, and health plan – all working together to keep you healthy and provide new and innovative services. Delivery System Delivery System Medical Group Medical Group Health Plan Health Plan 3

4. Presbyterian Hospitals Our hospitals, physicians, caregivers and insurance plans serve more than 700,000 New Mexicans. Hospitals Albuquerque Presbyterian and Presbyterian Kaseman Hospitals Clovis Plains Regional Medical Center Española Presbyterian Española Hospital Rio Rancho Presbyterian Rust Medical Center Ruidoso Lincoln County Medical Center Socorro Socorro General Hospital Tucumcari Dan C. Trigg Memorial Hospital Delivery System Delivery System 4

5.  Offers care at more than 30 different locations throughout the state.  16 clinic locations in the Albuquerque metro area  Our clinics handle more than 1,100,000 patient visits.  Fastest growing physician group, employing nearly 500 practitioners Presbyterian Medical Group Medical Group Medical Group 5

6. Presbyterian has the state’s largest health plan, with approximately 400,000 members. We offer a full spectrum of health insurance choices to meet the diverse needs of all New Mexicans. n Medicare Advantage Plans n Medicaid (Centennial Care) n Individual Plans n Group Products (fully insured and self-funded (ASO) Our Health Plan Health Plan Health Plan Presbyterian Health Plan, Inc. Presbyterian Insurance Company, Inc. 6

7. Best Health Plan Presbyterian Source: Research & Polling, Inc. 7

8. Presbyterian Individual & Family Plans in the Marketplace Plans to choose from: Gold A, B, C Silver A, B, C, D Bronze A, B, C Catastrophic Native American (on exchange) Members within 138%-250% of FPL may qualify for benefit subsidies available in Silver plans. (12 benefit subsidy plans) All Individual & Family Plans offer: A fitness center membership at no charge The only Individual & Family Plans in NM that provide access to Presbyterian’s network High-deductible health plans include a health savings account at no additional charge, administered by HealthEquity ® 8

9. Gold Plans PlansGold AGold BGold C Benefits with copayments ($) are not subject to deductible Deductible $0$250$1,000 Primary Care Provider & Behavioral Health Visit $1520%$0 Specialist Visit $5020%$25 Diagnostic Services (Lab & X-Ray) $020%$0 Hospital Inpatient 30%20% Rx – Generic (preferred) $1020%$5 Rx- Brand Name (preferred) $5020%$25 9

10. Silver Plans PlansSilver ASilver B*Silver CSilver D Benefits with copayments ($) are not subject to deductible Deductible $250$1,300$2,500$5,000 Primary Care Provider & Behavioral Health Visit 50%25%$10$5 Specialist Visit 50%25%$60$50 Diagnostic Services (Lab & X-Ray) 50%25%$0 Hospital Inpatient 50%25%20% Rx – Generic (preferred) 50%25%$10$5 Rx- Brand Name (preferred) 50%25%$75$50 10 * HDHP – Qualified High Deductible Health Plan. See HealthEquity flyer for details.

11. Bronze Plans PlansBronze A*Bronze B*Bronze C Benefits with copayments ($) are not subject to deductible Deductible $2,500$4,000$6,350 Primary Care Provider & Behavioral Health Visit 50%20%$45 Specialist Visit 50%20%0% Diagnostic Services (Lab & X-Ray) 50% 20% 0% Lab - $0 Hospital Inpatient 50%20%0% Rx – Generic (preferred) 50%20%0% Rx- Brand Name (preferred) 50%20%0% 11 * HDHP – Qualified High Deductible Health Plan. See HealthEquity flyer for details.

12. Catastrophic and Native American Plans Plans Catastrophic < 30 years of age Native American On Exchange Only Benefits with copayments ($) are not subject to deductible Deductible$6,350$0 Primary Care Provider & Behavioral Health Visit 0%Plan pays 100% Specialist Visit0%Plan pays 100% Diagnostic Services (Lab & X-Ray) 0%Plan pays 100% Hospital Inpatient0%Plan pays 100% Rx – Generic (preferred) 0%Plan pays 100% Rx- Brand Name (preferred) 0%Plan pays 100% 12

13. Free Gym Membership All Individual Plan members (18 and over) will be enrolled in a fitness center membership for no additional cost There are over 8,000 fitness center locations nationwide Locations near Roswell include Curves (Alamogordo) and Ruidoso Physical Therapy Additional locations can be found online at https://phcprime.healthways.com/ https://phcprime.healthways.com/ 13

14. Premium Comparison Roswell Area Plans Gold A $0 Deductible Silver C $2,500 Deductible Bronze C $6,350 Deductible Catastrophic < 30 years of age Age 0-20$173.49$140.29$111.50$79.91 Age 40$349.16$282.34$224.40n/a Age 60$741.49$599.59$476.54n/a 14 Same rate for smoker and non-smoker

15. Advance Premium Tax Credit Savings depends on income and family size The amount you save depends on your family size and how much money your family earns. In general, if your income falls within the following ranges you'll qualify to save money on your premiums in 2014. The lower your income within these ranges, the more you'll save. (The amounts below are based on 2013 numbers and are likely to be slightly higher in 2014.) $11,490 to $45,960 for individuals $15,510 to $62,040 for a family of 2 $19,530 to $78,120 for a family of 3 $23,550 to $94,200 for a family of 4 $27,570 to $110,280 for a family of 5 $31,590 to $126,360 for a family of 6 $35,610 to $142,440 for a family of 7 $39,630 to $158,520 for a family of 8 15

16. Coverage Connector An interactive tool that helps determine where to start looking for health insurance, either through a commercial insurance plan, Medicaid or Medicare programs, or on New Mexico's new health insurance exchange. www.phs.org/coverageconnector 16

17. How to apply? To apply for coverage directly with Presbyterian: Premium tax credits or benefit subsidies will not apply Online at www.phs.org – coming soonwww.phs.org With a paper application – download online at http://docs.phs.org/idc/groups/public/documents/communication/pel_00 169987.pdf http://docs.phs.org/idc/groups/public/documents/communication/pel_00 169987.pdf To apply for Presbyterian coverage in the Marketplace: Online at www.healthcare.govwww.healthcare.gov With a paper application – download online at http://marketplace.cms.gov/getofficialresources/publications-and- articles/marketplace-application-for-family.pdf http://marketplace.cms.gov/getofficialresources/publications-and- articles/marketplace-application-for-family.pdf By phone or with an in-person assister by calling 1-800-318-2596, 24 hours a day, 7 days a week. 17

18. Presbyterian Resources Presbyterian Website – www.phs.orgwww.phs.org Online Provider Directory - https://presbyterianproviderfinder.ipf.vitals.com/search https://presbyterianproviderfinder.ipf.vitals.com/search Coverage Connector (Our Health Insurance Decision Tool) - https://www.phs.org/insurance-plans/all-about-health-care/coverage- connector/Pages/default.aspx https://www.phs.org/insurance-plans/all-about-health-care/coverage- connector/Pages/default.aspx Individual & Family Plan Information - https://www.phs.org/insurance- plans/our-plans/individual-and-family/Pages/default.aspxhttps://www.phs.org/insurance- plans/our-plans/individual-and-family/Pages/default.aspx Formulary (Prescription Drug Coverage) - https://www.phs.org/insurance-plans/our-plans/individual-and- family/Pages/individual-and-family.aspx https://www.phs.org/insurance-plans/our-plans/individual-and- family/Pages/individual-and-family.aspx Call for a Quote: 1-866-869-7737, Weekdays, 8:00 a.m. – 5:00 p.m. 18

19. Questions? 505-Ask-Pres 505-875-7737 1-866-869-7737 iplan@phs.org 19