INFORMED CHOICES CONFIDENT DECISIONS · 2017. 10. 4. · Available Counties: Broome County, Cayuga...

A nonprofit independent licensee of the Blue Cross Blue Shield Association

Available Counties: Broome County, Cayuga County, Chemung County, Cortland County, Onondaga County, Schuyler County, Steuben County, Tioga County, Tompkins County

A five step guide to help you understand your health insurance and enrollment options for 2018.

CENTRAL NEW YORK REGION

INFORMED CHOICESCONFIDENT DECISIONS

Call today to get your FREE health plan evaluation. Enroll by December 15th for coverage starting in January. Open Enrollment ends January 31, 2018.

To learn more about your plan options, visit ChooseExcellus.com/2018Coverage

STEP 1: GETTING STARTEDHealth care coverage is one of the most important decisions you make. How do you choose an insurance plan without fear or worry? Protect yourself and your family with the compassion of the cross and the security of the shield. You can feel confident in your decision when you have the right information and the right people to guide you. We’ve been here over 80 years helping people find health insurance that best fits their needs and budgets.

This 5-step guide will help you shop and compare your coverage options for 2018. Once you’ve chosen a plan, you can enroll directly with us, or through the NY State of Health Marketplace where financial help may be available. Call today to get started with your free health plan evaluation or to schedule a one-on-one appointment. We’re here to help you every step of the way.

Here are a few questions to ask yourself before making this important choice.

1. What are the health care needs of my household?

Take an evaluation of the number of doctor visits, hospital visits and the prescriptions that you and your family have needed over the last year.

Doctor Visits ____________________

Hospital Visits ___________________

Prescriptions ____________________

2. How do I want to manage my costs?

Determine if you are comfortable with a deductible and a lower monthly cost or if you would rather pay more per month for lower and more predictable costs when getting care.

3. Can I get financial help?You may be eligible for financial assistance based on your household income and size. Find out how much at ChooseExcellus.com/2018Coverage or call our dedicated Insurance Agents.

Estimated Tax Credit $______________

4. How do I know if my doctor accepts the plan I am choosing?

Ask your doctor if he/she accepts the health insurance company you’re considering. Excellus BCBS plans are accepted by 100% of hospitals and 99% of doctors in your area.

5. How often do I travel outside of my town?

Our BlueCard® program* gives you access to care when you travel in the United States, Canada, Mexico, Puerto Rico, the US Virgin Islands, Guam, and the Mariana Islands. You can also fill a prescription while traveling, using our National Pharmacy Network.

You’ll also have coverage for non- emergency care 24/7 for you and your family with our telemedicine program powered by MDLIVE. See a board-certified doctor by phone or video on your schedule, anytime, anywhere.

5 Questions to Ask Before You Buy.

*BlueCard® applies to metal level plans and Base only. It does not apply to Essential Plan.

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Want help? We’re here for you. Call our dedicated insurance agents at: 1-866-613-8506 1

STEP 2: GET HELP PAYING FOR YOUR PLAN.

It’s time to start rethinking affordable health care. You might be surprised to know that you may be able to get money towards your monthly payment through something called a tax credit. Eligibility is based on your household income and size. The chart below shows estimated eligibility.

Financial help is only available when you buy a plan on the NY State of Health Marketplace. You may also qualify for cost-sharing reductions which will reduce how much you’ll pay for out-of-pocket costs when you get care.

*Source: 2017 Federal Income Guidelines: Department of Health and Human Services. Full calculator available at https://aspe.hhs.gov/poverty-guidelines

We can answer your questions and estimate your tax credit:

1-866-613-8506 or ChooseExcellus.com/2018Coverage

Financial Assistance Eligibility by Annual Income Level*

Family Size Annual Income Eligibility for Tax Credits

$24,121 - $48,240

$32,481 - $64,960

$40,841 - $81,680

$49,201 - $98,400

$57,561 - $115,120

$65,921 - $131,840

$74,281 - $148,560

$82,641 - $165,280

2 To learn more about your plan options, visit ChooseExcellus.com/2018Coverage

Follow the path and get a first look at the plan that might be right for you or your family.

Think about everyone for whom you need coverage. Do you or they frequently

go to the doctor or hospital?

YES

YES YES NO NO

NODo you take prescription drugs? Do you take prescription drugs?

Consider Platinum or Gold.

Consider Gold or Silver.

Consider Gold.

Consider Silver or Bronze.

ESSENTIALPLAN

BASE (CATASTROPHIC)

BRONZE SILVER GOLD PLATINUM

Monthly cost

Cost when you get care

Good option if you…

need low-cost coverage. Eligibility for this plan is based on your household income and size*

need low-cost protection in the event of a catastrophic injury or illness

use health care services infrequently

need to balance your monthly premium with your out-of-pocket costs

want to save on monthly premiums while keeping your out-of-pocket costs low

may use a lot of health care services and want predictable, lower out-of-pocket costs for routine care

STEP 3: LET US HELP YOU FIND THE RIGHT PLAN. Choosing the right health insurance for you and your family is an important decision. We understand, and we want you to feel confident in your choice. Plan levels are Bronze, Silver, Gold and Platinum. There is also a Base plan available to people under age 30 and people of any age with a hardship exemption from the requirement to have health insurance. Eligibility for the Essential Plan is based on your household size and income. The benefits are essentially the same in every plan but the monthly and out-of-pocket costs differ. Preventive care is free no matter which plan you choose.

*other eligibility guidelines apply


We make it easy for you to evaluate your plan options with our comparison chart. View plan options on pages 4 - 9. Select the options that may fit your needs and fill in the information in the chart below. You can use the definitions below to understand some of the key plan terms.

Words you should know. Deductible The amount of money you have to pay before the health insurance company will make any payment towards health care services.

Example: If you have a $500 deductible, you pay 100% of your first $500 in medical bills before your insurance pays anything.

Copay This is a fixed amount you pay each time you use a medical service, like a doctor’s visit or prescription refill.

Example: If your prescription drug coverage includes a $20 copay, you pay $20 for each prescription you fill and your insurance company pays the balance.

Premium The amount of money you pay to a health insurance company each month for your coverage.

Coinsurance Coinsurance is similar to a copay, but instead of a fixed-dollar amount, you pay a percentage of the total bill.

Example: If your coinsurance on a $100 bill is 15%, that means you pay $15 and your insurance company pays the rest.

Out-of-pocket maximum An annual limit on the amount of money that you would have to pay for health care costs, not including your monthly premiums.

Health Savings Account (HSA) An HSA is a tax-free funding account owned by you that helps you pay for qualified medical expenses such as lab fees, prescription drugs, contact lenses, chiropractor visits and more. To learn more about your HSA options contact your financial advisor.

Find out what your real monthly cost could look like.

Deductible

Copay

Coinsurance

Out-of-Pocket Maximum

Monthly Premium

- Estimated Tax Credit

Estimated Premium

Fill in your plan choice.PLAN 1 PLAN 2 PLAN 3

STEP 4: COMPARE YOUR OPTIONS.

Certified Health Insurance Plan Options

See more Silver plan options on the next page

All of the Standard plans are required by New York State. The benefits and out-of-pocket costs for the Standard plans will be the same for all health insurance companies. Provider networks will differ by insurance company.

Part of the Affordable Care Act is intended to improve dental coverage for children, including preventive, routine and some major dental coverage. Individuals purchasing medical coverage outside of the NY State of Health Marketplace, are required to purchase a medical plan with pediatric dental included, or a qualified stand-alone plan. By purchasing a medical plan with dental included, you can be sure your children will receive comprehensive coverage overseen by our staff of medical management experts, and both medical and pediatric dental services will count towards your out of pocket maximums.

New York State has identified the fitness facility reimbursement program as a required essential benefit that must be included for all plans, therefore the ExerciseRewards™ program cannot be removed from the plans. The rates shown do not include coverage for dependents through age 29 or pediatric dental benefits.

* Some benefits, such as pediatric vision and durable medical equipment may have different coinsurance amounts**An HSA or Health Savings Account is a tax-free funding account owned by you that helps you pay for qualified medical expenses such as lab fees, prescription drugs, contact lenses, chiropractor visits and more. ~Any one person insured on a family plan will not pay more than $7,350 in compliance with the Affordable Care Act

Dependent through 29 rates available upon request.

4 Need more information or help enrolling? Call our dedicated insurance agents at 1-866-613-8506.

Get up to $400 or $600 a year toward qualified fitness facility dues and/or fitness classes with our ExerciseRewards™ Program

Get access to more top-quality doctors, hospitals and pharmacies locally and nationwide

Plan Benefits & Features

Base (Catastrophic) Must be under age 30

or qualify for a hardship exemption

Bronze Standard HSA (HSA** qualified)

Bronze StandardBronze Select

(HSA** qualified)Silver Standard

Tax Credit Available Not applicable Yes Yes Yes Yes

Single Deductible (the deductible amount must be met first unless indicated otherwise)

$7,350 $5,500 $4,000 $5,000 $2,000

Family Deductible (the deductible amount must be met first unless indicated otherwise)

$14,700 $11,000 $8,000 $10,000 $4,000

Coinsurance 0% 50% 50% 50% 0%*

Single Out-of -pocket Maximum $7,350 $6,550 $7,150 $6,550 $6,750

Family Out-of -pocket Maximum $14,700 $13,100 $14,300 $13,100 $13,500

Preventive Care (Immunization, screenings)

$0 for most preventive services, not subject to

the deductible


the deductible


the deductible


the deductible


the deductible

Doctor Visit

1st three visits are covered in full and not subject to

the ded. Once you meet the deductible amount, visits

are covered in full Once you reach thedeductible amount you

will pay 50% coinsurance(a percentage of cost for

services)

Once you reach thedeductible amount you


services)

Once you reach the deductible amount you

will pay 50% coinsurance (a percentage of cost for

services)

$30

Specialist Visit

Once you meet the deductible amount, then these services are

covered in full

$50

Hospital Services $1,500

Emergency Room $250

Lab Work $30/$50

X-Ray $30/$50

Prescription Drugs

Once you meet the deduct-ible amount, then you pay:

$10 for generic$35 for brand

$70 for preferred brand





$10 for generic40% for brand

50% for preferred brand

You pay:$10 for generic$35 for brand

$70 for preferred brand(not subject to the deductible)

Telemedicine - MDLIVE Program Included Included Included Included Included

Pediatric Vision Covered* Covered* Covered* Covered* Covered*

Rates Through NY State of Health

Single $262.84 $468.23 $495.86 $458.40 $657.17

Single + Spouse $525.68 $936.47 $991.73 $916.79 $1,314.34

Single + Child(ren) $446.83 $795.99 $842.97 $779.28 $1,117.18

Single + Spouse + Child(ren) $749.10 $1,334.47 $1,413.22 $1,306.43 $1,872.93

Child Only NA $192.91 $204.29 NA $270.75





* Some benefits, such as pediatric vision and durable medical equipment may have different coinsurance amounts**An HSA or Health Savings Account is a tax-free funding account owned by you that helps you pay for qualified medical expenses such as lab fees, prescription drugs, contact lenses, chiropractor visits and more.

Sign up for email updates and see how much you save at ChooseExcellus.com/2018Coverage 5

Need help choosing the right plan for you? Call our dedicated Insurance Agents at 1-866-613-8506.

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Central New York Region:Broome CountyCayuga CountyChemung County

Cortland County Onondaga CountySchuyler County

Steuben CountyTioga CountyTompkins County

Plan Benefits & FeaturesSilver Select

(HSA** qualified)Gold Standard Gold Select Platinum Standard Platinum Select

Tax Credit Available Yes Yes Yes Yes Yes

Single Deductible (the deductible amount must be reached first unless indicated otherwise)

$2,250 $600 $750 $0 $0

Family Deductible (the deductible amount must be reached first unless indicated otherwise)

$4,500 $1,200 $1,500 $0 $0

Coinsurance 20%* 0%* 0%* 0%* 0%*





the deductible


the deductible


the deductible


the deductible


the deductible

Doctor Visit

Once you meet the deductible amount, then you pay coinsurance or a

percentage of cost for these services

$25 $25 $15 $15

Specialist Visit $40 $40 $35 $25

Hospital Services $1,000 $750 $500 $750

Emergency Room $150 $250 $100 $150

Lab Work $25/$40 $40 $15/$35 $25

X-Ray $25/$40 $40 $15/$35 $25

Prescription Drugs

Once you meet the deductible amount, then you pay:









You pay: $10 for generic $35 for brand





Single $600.76 $774.52 $750.60 $902.42 $882.56

Single + Spouse $1,201.52 $1,549.05 $1,501.20 $1,804.85 $1,765.13

Single + Child(ren) $1,021.29 $1,316.69 $1,276.02 $1,534.12 $1,500.36

Single + Spouse + Child(ren) $1,712.16 $2,207.40 $2,139.20 $2,571.91 $2,515.30

Child Only NA $319.10 NA $371.80 NA


Base (Catastrophic) Must be under age 30

or qualify for a hardship exemption

Bronze Standard HSA (HSA** qualified)

Bronze StandardBronze Select

(HSA** qualified)Silver Standard

Tax Credit Available Not applicable Yes Yes Yes Yes


$7,350 $5,500 $4,000 $5,000 $2,000


$14,700 $11,000 $8,000 $10,000 $4,000

Coinsurance 0% 50% 50% 50% 0%*





the deductible


the deductible


the deductible


the deductible


the deductible

Doctor Visit

1st three visits are covered in full and not subject to

the ded. Once you meet the deductible amount, visits

are covered in full Once you reach thedeductible amount you


services)

Once you reach thedeductible amount you


services)

Once you reach the deductible amount you

will pay 50% coinsurance (a percentage of cost for

services)

$30

Specialist Visit

Once you meet the deductible amount, then these services are

covered in full

$50

Hospital Services $1,500

Emergency Room $250

Lab Work $30/$50

X-Ray $30/$50

Prescription Drugs








$10 for generic40% for brand

50% for preferred brand






Single $262.84 $468.23 $495.86 $458.40 $657.17

Single + Spouse $525.68 $936.47 $991.73 $916.79 $1,314.34

Single + Child(ren) $446.83 $795.99 $842.97 $779.28 $1,117.18

Single + Spouse + Child(ren) $749.10 $1,334.47 $1,413.22 $1,306.43 $1,872.93

Child Only NA $192.91 $204.29 NA $270.75


Plan Benefits & Features CNY Preferred Gold** Available in Onondaga & Lewis Counties Only

CNY Preferred Silver** Available in Onondaga & Lewis Counties Only

Tax Credit Available Yes Yes


$600 $2,000


$1,200 $4,000

Coinsurance 0%* 0%*

Single Out-of -pocket Maximum $6,350 $6,850

Family Out-of -pocket Maximum $12,700 $13,700


$0 for most preventive services, not subject to the deductible $0 for most preventive services, not subject to the deductible

Doctor Visit $25 $30

Specialist Visit $40 $50

Hospital Services $750 $1,250

Emergency Room $150 $250

Lab Work $40 $50

X-Ray $40 $50

Prescription Drugs





Telemedicine - MDLIVE Program Included Included

Pediatric Vision Covered* Covered*


Single $688.44 $577.04

Single + Spouse $1,376.89 $1,154.08

Single + Child(ren) $1,170.36 $980.97

Single + Spouse + Child(ren) $1,962.07 $1,644.56

Child Only NA NA





* Some benefits, such as pediatric vision and durable medical equipment may have different coinsurance amounts

**Cost share shown applies when a Crouse, St. Joseph’s Hospital or Lewis County Hospital provider or facility is used. Not all physicians are in the Tier 1 network. Check our “Find a Provider” tool to make sure your physician is in the Tier 1 network.


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Plan Benefits & Features Silver StandardSilver Standard

(200-250% FPL**)Silver Select

(HSA*** qualified)Silver Select

(200-250% FPL**)

Tax Credit Available Yes Yes Yes Yes


$2,000 $1,650 $2,250 $2,250


$4,000 $3,300 $4,500 $4,500

Coinsurance 0%* 0%* 20%* 20%*

Out-of -pocket Maximum $6,750 $5,550 $6,350 $3,750

Family Out-of -pocket Maximum $13,500 $11,100 $12,700 $7,500


$0 for most preventive services, not subject to the deductible





Once you meet the deductible amount, then you pay

coinsurance or a percentage of cost for these services

Once you meet the deductible amount, then you pay

coinsurance or a percentage of cost for these services


Hospital Services $1,500 $1,500


Lab Work $30/$50 $30/$50

X-Ray $30/$50 $30/$50

Prescription Drugs











Telemedicine - MDLIVE Program Included Included Included Included

Pediatric Vision Covered* Covered* Covered* Covered*


Single $657.17 $657.17 $600.76 $600.76

Single + Spouse $1,314.34 $1,314.34 $1,201.52 $1,201.52

Single + Child(ren) $1,117.18 $1,117.18 $1,021.29 $1,021.29

Single + Spouse + Child(ren) $1,872.93 $1,872.93 $1,712.16 $1,712.16

Child Only $270.75 $270.75 NA NA

Below are additional Silver plan options that include cost-sharing reductions that reduce how much you pay when you get care. Eligibility is based on your Federal Poverty Level (FPL) which is determined by household income and size.


New York State has identified the fitness facility reimbursement program as a required essential benefit that must be included for all plans, therefore the ExerciseRewards program cannot be removed from the plans. The rates shown do not include coverage for dependents through age 29 or pediatric dental benefits.

Only Silver Select meets the IRS requirements for pairing with a health savings account. Subsidized health plans are not eligible for health savings accounts.


** Federal Poverty Level (FPL) is the minimum yearly income that a person or family needs in order to provide for their basic needs. The Department of Health and Human Services determines the FPL annually. Find out your estimated FPL using our tax credit calculator at ChooseExcellus.com/2018Coverage

***An HSA or Health Savings Account is a tax-free funding account owned by you that helps you pay for qualified medical expenses such as lab fees, prescription drugs, contact lenses, chiropractor visits and more.

All of the Standard plans are required by New York State. The benefits and out of pocket costs for the Standard plans will be the same for all health insurance companies. Provider networks will differ by insurance company.



Get up to $400 or $600 a year toward qualified fitness facility dues and/or fitness classes with our ExerciseRewards™ Program

Get access to more top-quality doctors, hospitals and pharmacies locally and nationwide


New York State has identified the fitness facility reimbursement program as a required essential benefit that must be included for all plans, therefore the ExerciseRewards program cannot be removed from the plans. The rates shown do not include coverage for dependents through age 29 or pediatric dental benefits.

Only Silver Select meets the IRS requirements for pairing with a health savings account. Subsidized health plans are not eligible for health savings accounts.


**Cost share shown applies when a Crouse, St. Joseph’s Hospital or Lewis County Hospital provider or facility is used. Not all physicians are in the Tier 1 network. Check our “Find a Provider” tool to make sure your physician is in the Tier 1 network.† Federal Poverty Level (FPL) is the minimum yearly income that a person or family needs in order to provide for their basic needs. The Department of Health and Human Services determines the FPL annually. Find out your estimated FPL using our tax credit calculator at ChooseExcellus.com/2018Coverage

All of the Standard plans are required by New York State. The benefits and out of pocket costs for the Standard plans will be the same for all health insurance companies. Provider networks will differ by insurance company.



Plan Benefits & Features CNY Preferred Silver** Available in Onondaga & Lewis Counties Only

CNY Preferred Silver** (200-250% FPL†)

Tax Credit Available Yes Yes


$2,000 $2,000


$4,000 $4,000

Coinsurance 0%* 0%*

Single Out-of -pocket Maximum $6,850 $4,850

Family Out-of -pocket Maximum $13,700 $9,700


$0 for most preventive services, not subject to the deductible $0 for most preventive services, not subject to the deductible



Hospital Services $1,250 $1,250


Lab Work $50 $30

X-Ray $50 $50

Prescription Drugs

You pay: $10 for Tier 1 $45 for Tier 2 $90 for Tier 3



Telemedicine - MDLIVE Program Included Included

Pediatric Vision Covered* Covered*


Single $577.04 $577.04

Single + Spouse $1,154.08 $1,154.08

Single + Child(ren) $980.97 $980.97

Single + Spouse + Child(ren) $1,644.56 $1,644.56

Child Only NA NA


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Annual Income Eligibility for Essential Plan

Household Size Essential Plans 1 & 2 (139%-200%FPL) Essential Plans 3 & 4 (under 100%-138% FPL***)

$16,644 - $24,120 $0 - $16,643

$22,412 - $32,480 $0 - $22,411

$28,181 - $40,840 $0 - $28,180

$33,949 - $49,200 $0 - $33,948

$39,717 - $57,560 $0 - $39,716

$45,486 - $65,920 $0 - $45,485


Essential Plan 1(151% - 200% FPL)

Essential Plan 1 Plus Vision and Dental

(151% - 200% FPL)


Essential Plan 2 Plus Vision and Dental

(139% - 150% FPL)


Essential Plan 4(Below 100% FPL)

Deductible $0 $0 $0 $0 $0 $0

Coinsurance 0% 0% 0% 0% 0% 0%

Out-of -pocket Maximum $2,000 $2,000 $200 $200 $200 $0


$0 for most preventive services






Doctor Visit $15 $15 $0 $0 $0 $0

Specialist Visit $25 $25 $0 $0 $0 $0

Hospital Services $150 $150 $0 $0 $0 $0

Emergency Room $75 $75 $0 $0 $0 $0

Lab Work $25 $25 $0 $0 $0 $0

X-Ray $25 $25 $0 $0 $0 $0

Adult Vision Exam Not Available $15 Not Available $0 $0 $0

Glasses and Contact Lenses Not Available 10% Not Available $0 $0 $0

Adult Dental Coverage Included Not Available Yes Not Available Yes Yes Yes

Prescription Drugs













Telemedicine - MDLIVE Program $10 $10 $0 $0 $0 $0


Single $20 $47.62 to $47.79† $0 $32.07 to $32.24† $0 $0

Essential Plans - Rates as low as $0 a month for eligible individuals Eligibility is based on your household size and income.** Essential Plan 1 and 2 will now offer packages with and without vision and dental benefits. If you choose to enroll in a plan that includes this coverage, there is an added monthly cost. Vision and dental benefits are always included with Essential Plan 3 and 4. To find out if you qualify for the Essential Plan, call our dedicated insurance agents.

“New York State has identified the fitness facility reimbursement program as a required essential benefit that must be included for all plans, therefore the ExerciseRewards program cannot be removed from the plans. **Other eligibility requirements must be met to enroll.***Must be a lawfully present immigrant (“Qualified non-citizen” immigration status without a waiting period; Humanitarian statuses or circumstances (including Temporary Protected Status, Special Juvenile Status, asylum applicants, Convention Against Torture, victims of trafficking); Valid non-immigration visas; Legal status conferred by other laws (temporary resident status, LIFE Act, Family Unity individuals). To see a full list of eligible immigration statuses, please visit the web site at www.healthcare.gov/immigrants/immigration-status// or call the NY State of Health at 1-855-355-5777.) †Rates for this plan will depend on what county you live in.

The benefits and out of pocket costs for the Essential Plans will be the same for all health insurance companies.



Coverage you can count on. More Access100% of hospitals and 99% of doctors in your area accept our plans. Plus our BlueCard® program gives you even more access to care when you travel. Choose the card that can open doors in all 50 states.

More SecurityProviding quality coverage for 80+ years.

More SavingsFree preventive care — includes routine physicals, screenings and vaccinations, plus low-cost generic drugs.

ExerciseRewardsTM Program — Fitness facility and individual fitness class rewards program with reduced fees at participating facilities, with online interactive fitness and wellness tools available at no additional cost. Earn up to $400 or $600 annually. Now you can track your fitness center visits using the ExerciseRewards CheckIn!TM App.

Blue365® — members enjoy exclusive discounts on health and wellness products and services

from fitness to healthy eating to personal care, including vision and dental discounts.

More ConvenienceMobile App — 24/7 access to your member card, claims, account information, and more.

Online Account — order member cards, track deductibles and out-of-pocket spending, find a health care provider, and access your benefits and claims information.

Telemedicine powered by MDLIVE — See a board-certified doctor by phone or video on your schedule, anytime, anywhere, including from your own home.

Pharmacy Home DeliverySave time and money by having your prescriptions delivered right to your home.*

Your enrollment checklist. Get ready to enroll by having the following information available:

Email address (you are required to provide an email address to enroll in the NY State of Health Marketplace)

Proof of U.S. citizenship or legal status in the form of birth certificate, “Green Card” or passport

Social Security card

Information about others you plan to enroll (spouse, children, their birth dates, Social Security numbers)

Termination letter if you recently lost coverage

Policy number(s) for any current health insurance

Most recently completed tax return and/or your last 30 days of pay stubs. You will need to project your annual household income for the year ahead. You can refer to your tax return to help you estimate that amount.

Savings

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In-Network Out-of-Network

$Deductible


*Certain prescription drugs may be ordered through pharmacy home delivery supplier at two and a half copays for a 90 day supply.

The ExerciseRewards Program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). ExerciseRewards and ExerciseRewards CheckIn! are trademarks of ASH and used with permission herein. The ExerciseRewards CheckIn! App is not available with the Essential Plan. Consult a physician before beginning or changing your exercise or fitness routine.

Your enrollment checklist. Get ready to enroll by having the following information available:

CALL 1-866-613-8506

CLICK ChooseExcellus.com/2018Coverage

VISIT Excellus BCBS Resource Center221 South Warren Street, Syracuse, NY 13202Call 1-800-234-4781 for hours or to schedule an appointment

STEP 5: ENROLLING IS QUICK AND EASY.

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https://www.ExcellusBCBS.com/

When you can enroll.

Annual Open Enrollment Period: November 1, 2017 - January 31, 2018

Special Enrollment Period: Certain life events such as a pregnancy, adopting a baby, aging off a parent’s plan, getting a divorce or losing coverage through an employer may qualify you for a Special Enrollment Period (SEP). Generally with an SEP, you have 60 days to get coverage.

Enrollment is available for the Essential Plan, Medicaid and Child Health Plus all year long.

Notice of Nondiscrimination

Our Health Plan complies with federal civil rights laws. We do not discriminate on the basis of race, color, national origin, age, disability, or sex. The Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

The Health Plan:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:

o Qualified sign language interpreters o Written information in other formats (large print, audio, accessible electronic formats, other formats)

• Provides free language services to people whose primary language is not English, such as: o Qualified interpreters o Information written in other languages

If you need these services, please refer to the enclosed document for ways to reach us.

If you believe that the Health Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

Advocacy DepartmentAttn: Civil Rights CoordinatorPO Box 4717Syracuse, NY 13221Telephone number: 1-800-614-6575TTY number: 1-800-421-1220Fax: 315-671-6656

You can file a grievance in person or by mail or fax. If you need help filing a grievance, theHealth Plan’s Civil Rights Coordinator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and HumanServices, Office for Civil Rights, electronically through the Office for Civil Rights ComplaintPortal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services200 Independence Avenue, SWRoom 509F, HHH BuildingWashington, D.C. 202011-800-368-1019, 800-537-7697 (TDD)Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.


B-5495

Attention: If you speak English free language help is available to you. Please refer to the enclosed document for ways to reach us. Atención: Si habla español, contamos con ayuda gratuita de idiomas disponible para usted. Consulte el documento adjunto para ver las formas en que puede comunicarse con nosotros. 注意：如果您说中文，我们可为您提供免费的语言协助。请参见随附的文件以获取我们的联系方式。 Внимание! Если ваш родной язык русский, вам могут быть предоставлены бесплатные переводческие услуги. В приложенном документе содержится информация о том, как ими воспользоваться. Atansyon: Si ou pale Kreyòl Ayisyen gen èd gratis nan lang ki disponib pou ou. Tanpri gade dokiman ki nan anvlòp la pou jwenn fason pou kontakte nou. 주목해 주세요: 한국어를 사용하시는 경우, 무료 언어 지원을 받으실 수 있습니다. 연락 방법은 동봉된 문서를 참조하시기 바랍니다. Attenzione: Se la vostra lingua parlata è l’italiano, potete usufruire di assistenza linguistica gratuita. Per sapere come ottenerla, consultate il documento allegato.

אויפמערקזאם: אויב איר רעדט אידיש, איז אומזיסטע שפראך הילף אוועילעבל פאר אייך ביטע רעפערירט צום בייגעלייגטן דאקומענט צו זען אופנים זיך צו פארבינדן מיט אונז.

নজর দিন: যদি আপদন বাাংলা ভাষায় কথা বললন তাহলল আপনার জনয সহায়তা উপলভয রলয়লে। আমালির সলে যযাগালযাগ করার জনয অনগু্রহ কলর সাংযুক্ত নদথ পড়ুন। Uwaga: jeśli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Patrz załączony dokument w celu uzyskania informacji na temat sposobów kontaktu z nami. تنبيه: إذا كنت تتحدث اللغة العربية، فإن المساعدة اللغوية المجانية متاحة لك. يرجى الرجوع إلى الوثيقة

ة كيفية الوصول إلينا.المرفقة لمعرف Remarque : si vous parlez français, une assistance linguistique gratuite vous est proposée. Consultez le document ci-joint pour savoir comment nous joindre.

سے رابطہ کرنے کے نوٹ: اگر آپ اردو بولتے ہيں تو آپ کے ليے زبان کی مفت مدد دستياب ہے۔ ہم طریقوں کے ليے منسلک دستاویز مالحظہ کریں۔

Paunawa: Kung nagsasalita ka ng Tagalog, may maaari kang kuning libreng tulong sa wika. Mangyaring sumangguni sa nakalakip na dokumento para sa mga paraan ng pakikipag-ugnayan sa amin. Προσοχή: Αν μιλάτε Ελληνικά μπορούμε να σας προσφέρουμε βοήθεια στη γλώσσα σας δωρεάν. Δείτε το έγγραφο που εσωκλείεται για πληροφορίες σχετικά με τους διαθέσιμους τρόπους επικοινωνίας μαζί μας. Kujdes: Nëse flisni shqip, ju ofrohet ndihmë gjuhësore falas. Drejtojuni dokumentit bashkëlidhur për mënyra se si të na kontaktoni.

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