1. CareSource and the
Health Insurance Marketplace

2. CareSource Face-to-face Hand-in-hand Heart-to-heart
It’s not just about making a change. It’s about making a difference.
Every number on a spreadsheet and every digit that moves a graph up or down is a living, breathing human being who deserves our attention.
We made the decision 28 years ago that health care reform is not as much about laws and legislation as it is about caring and compassion; not as much about policies and politics as it is about principle and practice; not as much about process and profit as it is about purpose and people.
Face-to-face
Hand-in-hand Heart-to-heart 2

3. 1.8M Our MISSION members CARESOURCE
To make a lasting difference in our members' lives by improving their health and well-being.
CARESOURCE
A non-profit managed care health plan founded in 1989.
Regionally based with a 28-year history of serving populations across multiple states and insurance products.
Committed to the Marketplace, our members needs, helping them understand and use their health insurance.
1.8M
members 3

4. CareSource’s Commitment to the Marketplace
Competitive premiums
Updates to benefit design from consumer feedback
Enhanced network of healthcare providers
Partnered with state and federal officials to support the Health Insurance Marketplace 4

5. What is the Marketplace?
The Health Insurance Marketplace is an online store where you can shop, compare and purchase your health insurance plan. You’re able to review doctors, facilities and prescription drugs covered for each plan.
If you don’t have health insurance through a job, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or another source that provides qualifying health coverage, the Health Insurance Marketplace can help get you covered. 5

6. 2018 Health Insurance Marketplace Subsidies
Marketplace subsidies are available to individuals and families based upon household dynamics. The Health Insurance Marketplace determines available subsidies based on factors including household size and income. Subsidies come in two forms: Advance Premium Tax Credits (APTCs) for reduced premiums and Cost-sharing Reduction subsidies (CSRs) for reduced out-of-pocket costs. 6

7. COST SHARING REDUCTIONS (CSR)
A CSR is a discount that lowers the amount owed for any deductibles, copayments and coinsurance. If an individual qualifies for a CSR, they must enroll in a plan that is in the Silver category to get the discount. This discount is what makes the Silver plans so cost effective.
What you need to know about CSRs:
To see if you qualify, apply on HealthCare.gov
Household size and income falls below a certain level
An example of who qualifies for assistance is a family of four with a household income of $60,750.*
*Source: As of October 9, 2017 7

8. ADVANCE PREMIUM TAX CREDITS (APTCs)
- An APTC is a tax credit taken in advance, in whole or in part, to lower monthly premium payments.
PREMIUM $334.21
= $168.29
Average APTC
= $165.92
Average Monthly Premium
Numbers represent CareSource’s 2017 Kentucky Marketplace members. Average only, individual and family premiums will vary. 8

9. New Timeline for 2018 Open Enrollment
November 1 – December 15, 2017
For January 1 effective date (must make first premium payment)
After December 15, 2017, you can only enroll if you qualify for one of the Health Insurance Marketplaces “Special Enrollment Period” (SEP) events.
How to Enroll:
Visit: CareSource.com/marketplace or HealthCare.gov
Call:

10. Special Enrollment Period
Available year-round for people who qualify.
*After December 15, 2017 you can only enroll if you have a qualifying life event.
Examples of the most common life qualifying events include:
Loss of qualifying health coverage
(i.e. when their carrier has left the service area or loss of employer based coverage)
Change in household size
Change in primary place of living
Change in eligibility for Marketplace coverage or help paying for coverage
*Federal and state law limit enrollment into CareSource plans to designated time periods within a calendar year (“open enrollment”), unless you qualify for a special enrollment period. The 2018 plan year open enrollment period for all CareSource plans will end December 15th, CareSource does not determine whether you will qualify for a special enrollment period. Please contact the Health Insurance Marketplace for greater detail on special enrollment periods.

11. HealthCare.gov

12. Consider This…
It is easy to underestimate how much medical care can cost:
A broken leg can cost up to
$7,500 to fix.
The average cost of a 3-day hospital stay is around $30,000.
Comprehensive cancer care can cost hundreds of thousands of dollars.
Having health coverage can help protect you from high, unexpected costs like these.
Source: healthcare.gov/why-coverage-is- important/protection-from-high-medical-costs/

13. CareSource 2018 Marketplace Coverage Area: Kentucky
Providing coverage in 61 of 120 Counties
Member Services
(TTY or 711)
Coverage area subject to change
Same Counties as 2017
- No Changes

14. GOLD PLANS CareSource Gold *Deductible $1,500 *Out-of-pocket max
$5,000
Primary care visit copay
$10
Emergency room visit copay after deductible OR % coinsurance after deductible
20%**
Urgent care visit copay
$75
Generic drug copay/mail order
$10/$25
Pediatric dental exam/cleaning
$35
*Family is 2 x Individual
**After deductible
Adult Dental and Vision plans with optional fitness center membership benefit available

15. CareSource Federal Simple Choice Silver
SILVER PLANS
Most popular Silver plan
CareSource Federal Simple Choice Silver
CareSource Silver
CareSource Low Premium Silver
*Deductible
Medical
$3,500
Pharmacy
$500
$3,900
$6,150
*Out-of-pocket max
$7,350
$7,300
Primary care visit copay
$30
$10
$20
Emergency room visit copay after deductible OR
% coinsurance after deductible
20%**
$500**
$400**
Urgent care visit copay
$75
$100
Generic drug copay/mail order
$15/$37.50
$10/$25
$20/$50
Pediatric dental exam/cleaning $0
15%**
*Family is 2 x Individual
**After deductible
Adult Dental and Vision plans with optional fitness center membership benefit available 15

16. BRONZE PLANS NEW for 2018 $4,000 $6,650 $7,250 $6,550 $7,350 50%** $35
CareSource HSA Bronze
CareSource Federal Simple Choice Bronze
CareSource Bronze
*Deductible
$4,000
$6,650
$7,250
*Out-of-pocket max
$6,550
$7,350
Primary care visit copay
50%**
$35
$30
Emergency room visit copay after deductible OR % coinsurance after deductible
40%**
Urgent care visit copay
$75
Generic drug copay/mail order
50%/50%**
$35/$87.50
$25/$62.50
Pediatric dental exam/cleaning
$20
*Family is 2 x Individual
**After deductible
Adult Dental and Vision plans with optional fitness center membership benefit available 16

17. 2018 CareSource Marketplace Bronze
CareSource Bronze
A health plan in the Bronze level may be a good choice for you if you don’t expect to have many doctor appointments or need many prescription drugs.
Generally, plans in the Bronze category have the lowest premiums (your monthly insurance bill) but the highest deductibles and other out-of-pocket costs
New for 2018 – Bronze HSA. A CareSource Marketplace plan is designed to be compatible with a tax advantaged Health Savings Account (HSA). This plan is considered a high deductible health plan (HDHP). Having money in an HSA may help offset your medical costs, including deductibles. While CareSource doesn’t offer HSA’s, we can help educate you on how to get an HSA. Plus, more information is available on Healthcare.gov and from your preferred bank.
CareSource Federal Simple Choice Plans
These plans allow easier comparisons across insurers by having generally consistent benefit levels. However, differences exist with the additional
benefits, including provider networks, monthly premiums and medications covered. 17

18. ENHANCED BENEFITS PACKAGE
These are our metal level plans PLUS dental and vision benefits for adults over the age of 21. If you choose a Dental and Vision plan, you pay one premium for health, dental and vision coverage. Choosing a Dental and Vision plan adds dental and vision coverage, but does not change your medical benefits.
Dental Services copay $0 - $5
Vision annual exam copay $0
Active&Fit® program 18

19. ACTIVE&FIT® PROGRAM*
Access to a network of contracted fitness centers for the benefit year for a one-time fee (annually) of $100
Multi-Fitness center access. Members may register for and use more than one fitness center in a given month.
The option to purchase up to 2 home fitness kits for just $10 per benefit year (20 to choose from) to work out at home
The Active&Fit Connected!™ tool, a fun and easy way to track your exercise at a fitness center or through a wearable fitness device or app**
An online newsletter 4 times a year
Other web tools like a fitness center search, online classes, and more!
The Active&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Active&Fit, Active&Fit Connected!, and the Active&Fit logo are federally registered trademarks of ASH.
* Limitations and Exclusions apply to the Active and Fit Program. Full details are available in the applicable 2018 CareSource Marketplace plan Evidence of Coverage or by calling CareSource. 19
**Purchase of a wearable fitness device or app is not included

20. MYidealDOCTOR™ Your 24/7/365 On-Demand Physician
Do you need a doctor, but it’s after hours, or you can’t get an appointment soon enough? Consider telemedicine! Get 24/7/365 access to board certified doctors for consulting, diagnosing and prescribing via interactive audio or video.
MYidealDOCTORTM is a registered trademark of MYidealDOCTOR, LLC 20

21. PHARMACY COVERAGE NETWORK PHARMACIES
In order to have your prescriptions covered by CareSource, you must get them filled at a pharmacy in our network. Our network includes many major pharmacies, including those listed below, plus many smaller pharmacies, over 67,000 in network nationally.
Costco
CVS
Discount Drug Mart
Kmart
Kroger
Meijer
Rite-Aid
Sam’s Club
Target
Walmart 21

22. HOW TO ENROLL Visit CareSource.com/marketplace or HealthCare.gov
Call
What You Will Need:
Collect the following information for each family member you are enrolling before starting your eligibility form on the Health Insurance Marketplace:
Social Security number or document number for legal immigrants
Employer and income information, for example, wage and tax statements from pay stubs or W-2 forms
If currently covered by health insurance, the policy number
If eligible for employer health insurance coverage (even if the coverage is through another person, for example, a spouse or a
parent), information about the employer’s health insurance plan
Need help to enroll or choose a plan? Our Member Services staff will be happy to help you! Just call toll-free Open enrollment begins on November 1, 2017. 22

23. Common Insurance Terms
Copay – Your copayment (copay) is the fixed amount you must pay for a covered health care service.
Coinsurance - Coinsurance is the percentage of a covered health care service that you must pay once you have paid your deductible.
Deductible - The amount you pay for covered health care services before your insurance plan starts to pay.
Drug formulary - A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits.
Premium - The amount you pay for your health insurance every month. 23

24. CareSource is a Qualified Health Plan Issuer in the Health Insurance Marketplace.
CareSource plans have exclusions, limitations, reductions, and terms under which the policy may be continued in force or discontinued. Premiums, deductibles, and copays may vary based on individual circumstances. Benefits and costs may vary based upon plan selection. For costs and complete details of coverage, please review the CareSource Evidence of Coverage and Schedule of Benefits documents at CareSource.com/marketplace.
CareSource complies with applicable state and federal civil rights laws and does not discriminate on the basis of age, gender, gender identity, color, race, disability, national origin, marital status, sexual preference, religious affiliation, health status, or public assistance status.
Si usted o alguien a quien ayuda tienen preguntas sobre CareSource, tiene derecho a recibir esta información y ayuda en su propio idioma sin costo. Para hablar con un intérprete, llame al
如果您或者您在帮助的人对 CareSource 存有疑问，您有权 免费获得以您的语言提供的 帮 助和信息。 如果您需要与一 位翻译交谈，请致电
KY-EXCM-0098c 24

25. © 2017 CareSource. All Rights Reserved
Confidential & Proprietary