Small Group Plans 2021There is a maximum dollar amount you would have to pay in any given calendar...

Small Group Plans 2021

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For over 20 years, Alliant Health Plans has been a leading provider of health insurance in Georgia. Our Board of Directors includesphysicians and community leaders who work together to promote a quality health care experience.

Alliant Health Plans guarantees:

Local Customer ServiceOur customer service representatives - located in our corporate office inDalton, GA - are ready to assist you.

No Charge for Preventive CarePreventive Care is always covered at 100% in all of our plans, usingIn-Network providers.

No Medical QualificationsNo matter what, you will never deal with a “pre-existing condition” waiting period.

24-Hour Nurse Advice LineNot feeling well at 2 a.m.? Call our 24-hour Nurse Advice Line toll free at(855) 299-3087.

Only PPO PlansYou have a choice in which provider you use.

Good health begins with good choices.We want coverage to be as clear and understandable as possible. Whatever your budget, we can help find the right health plan for youand your employees.

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SimpleCare Questions? Call us at (866) 403-2785 Visit AlliantPlans.com Contact your broker

CopaymentYour cost of the service being received. Copayments count toward the out-of-pocket maximum but not towards the

deductible. Copayments are included in most of our plans.

DeductibleThe amount you pay before any Alliant payment is applied. Deductibles are paid first, and then coinsurance is applied.

There is a maximum dollar amount you would have to pay in any given calendar year.

CoinsuranceThe portion where we share the covered costs with you. This amount is expressed as a percentage and is applied

after the deductible is met (For example, Alliant pays 80% and you pay 20%).

Out-of-Pocket MaximumThe maximum amount of money you will pay out-of-

pocket during a calendar year. It may include deductibles, copayments and coinsurance but is in addition to your regular monthly premium. After you reach your out-of-pocket maximum, you would pay nothing for additional covered In-network medical expenses for the rest of the

calendar year.

PremiumThe total amount you pay to obtain and keep your health

insurance active.

Robust NetworksAlliant Health Plans has a robust network of local providers across Georgia. Alliant is committed to expanding and strengthening its network. Subscribers who reside outside of Alliant’s network area have access to a national provider network at no extra charge. Additional plans are available that provide national network access to all members of the group.

24/7 Access to Your Health Plan InformationEasy access to your health plan information when you need it. Alliant’s Member Portal gives you access to temporary ID cards, deductible accumulations, medical claims and Explanation of Benefits (EOBs). Log in for the most current information on your health plan.

Mobile Member AppAlliant has a mobile app – available on the App Store or Google Play – with claims and plan information, Explanation of Benefits (EOB), ID card and a Provider search tool. Search for Alliant Health Plans to download the Mobile Member App today!

Online Access to Plan InformationLooking for a form or Summary of Benefits and Coverage? Searching for a doctor?Visit AlliantPlans.com

Important Terms to Know

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Choose the right plan for your business.

Small group plans are categorized by metal levels. Find out what type of plan is right for you.

Health care reform, also known as the Affordable Care Act (ACA), established metal levels to indicate the value of your insurance coverage: platinum, gold, silver and bronze. All plans cover the same essential health benefits, but your cost share is different.

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G

Platinum: This is the highest level with both the highest premium and the richest benefits. Good for people who frequently receive medical services and are willing to pay more each month for the lowest ongoing health care costs.

Gold: Gold has a higher level of benefits than silver but also a higher monthly premium. Beneficial for people who receive medical services regularly and who are okay with a higher monthly premium in order to have more costs covered.

Silver: This level has slightly higher monthly premiums than bronze but also richer benefits. Beneficial for people who want to keep monthly premiums and out-of-pocket costs balanced.

Bronze: This level has the lowest monthly premium but also the highest out-of-pocket costs. Beneficial for people whoprefer lower monthly premiums and don’t expect to need a lot of medical service.

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B

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Marketing and Rating Areas 2021 Benefit Year - County Map

4 Questions? Call us at (866) 403-2785 Visit AlliantPlans.com Contact your brokerSimpleCare

Rating Areas are identified by large white numbers andcorrespond to the

DOI Rating Area Map.

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COUNTY RATE AREAAtkinson 11

Baker 1Baldwin 16

Banks 10

Barrow 2

Bibb 12

Bleckley 12

Burke 5

Calhoun 1

Carroll 4

Catoosa 7

Chattahoochee 8

Chattooga 13

Clarke 2

Clay 1

Clinch 15

Coffee 11

Colquitt 15

Columbia 5

Crawford 12

Crisp 1

Dade 7

Dawson 10

Decatur 15

Dodge 12

COUNTY RATE AREADooly 12

Dougherty 1

Elbert 2

Fannin 9

Floyd 13

Franklin 10

Gilmer 13

Glascock 5

Gordon 13

Greene 2

Habersham 10

Hall 10

Hancock 16

Haralson 4

Harris 8

Hart 10

Heard 4

Houston 12

Jackson 2

Jeff Davis 11

Jefferson 5

Jenkins 5

Jones 12

Lee 1

Lincoln 5

COUNTY RATE AREALumpkin 10

Macon 8

Madison 2

Marion 8

McDuffie 5

Meriwether 8

Mitchell 1

Monroe 12

Morgan 2

Murray 9

Muscogee 8

Oconee 2

Oglethorpe 2

Peach 12

Pickens 13

Polk 13

Pulaski 12

Putnam 12

Quitman 8

Rabun 10

Randolph 1

Richmond 5

Schley 1

Stephens 10

Stewart 8

COUNTY RATE AREASumter 1

Talbot 8

Taliaferro 5

Taylor 8

Telfair 11

Terrell 1

Towns 10

Troup 8

Twiggs 12

Union 10

Upson 8

Walker 7

Walton 3

Warren 5

Washington 16

Webster 8

Wheeler 11

White 10

Whitfield 9

Wilcox 12

Wilkes 5

Wilkinson 16

Worth 1

Marketing and Rating Areas 2021 Benefit Year - County List

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Where coinsurance exists, benefits are first subject to the plan deductible.

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Plan Marketing Name

SimpleCare Platinum PPO 50080



SimpleCare Gold PPO 50086

SimpeCare Gold PPO 50088




SimpleCare Silver PPO 50056








SimpleCare Bronze PPO 50072


SimpleCare Platinum Copay 50096

SimpleCare Gold Copay 50098

SimpleCare Silver Copay 50100 Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

$4,000/ $8,000

$80 $40$30/$55/$100/25%

($400 max)

$80 $40$30/$55/$100/25%

($400 max)

10%

$40$30/$55/$100/25%

($400 max)

$80 $40$30/$55/$100/25%

($400 max)

60%$20,000/$40,000

$8,550/$17,100

30% $75 $40 $80 $40$30/$55/$100/25%

($400 max)60%

$20,000/$40,000

60%$20,000/$40,000

Creditable Coverage

(Pass / Fail)

Fail

Fail

Small Group Plans

In-Network Out-of-Network

CoinsuranceAfter

Deductible

Deductible Individual/

Family

Out-of-Pocket Maximum

Individual/FamilyER

Urgent Care

PCPVisit

SpecialistVisit

Mental Health/ Substance Abuse Visit

Rx Generic/Preferred/ Brand/Specialty

CoinsuranceAfter

Deductible


Family


Individual/Family

2021Single Network Option

We Pay We PayYou Pay You Pay

No Maximum

$3,500/ $7,000

$8,550/$17,100

30% $75 $40 No Maximum$80

No Maximum

$750/ $1,500

$2,500/$5,000

$150 $75 $20 $40 $20$15/$35/$70/25%

($400 max)60%

$20,000/$40,000

No Maximum

$500/ $1,000

$2,000/$4,000

$150 60%

No Maximum

$5,000/ $10,000

$8,550/$17,100

20% $75 $40 $80 $40$30/$55/$100/25%

($400 max)60%

$20,000/$40,000

No Maximum

$4,500/ $9,000

$8,550/$17,100

20% $75 $40

60%$20,000/$40,000

No Maximum

$6,000/ $12,000

$8,450/$16,900

5% $75 $40 $80 $40$30/$55/$100/25%

($400 max)60%

$20,000/$40,000

No Maximum

$5,500/ $11,000

$8,550/$17,100

10% $75 $40

No Maximum

$15$10/$25/$50/50%

($400 max)

10%10%

($400 max)

60%$20,000/$40,000

No Maximum

$7,000/ $14,000

$8,200/$16,400

5% $75 $40 $80 $40$30/$55/$100/25%

($400 max)60%

$20,000/$40,000

No Maximum

$6,500/ $13,000

$8,200/$16,400

5% $75 $40

60%$20,000/$40,000

No Maximum

$7,000/ $14,000

$8,550/$17,100

30% $75 30% 30% 30%30%

($400 max)60%

$20,000/$40,000

No Maximum

$7,550/ $15,100

$8,550/$17,100

10% $75 10%

60%$20,000/$40,000

No Maximum$0/$0

$8,550/$17,100

$500

$20,000/$40,000

$75 $20 $40 $20$15/$35/$70/25%

($400 max)

No Maximum

$1,000/ $2,000

$6,750/$13,500

20% $75 $30 $60 $30$20/$45/$70/25%

($400 max)60%

$20,000/$40,000

No Maximum

$2,250/ $4,500

$2,250/$4,500

$150 $75 $20 $40 $20$15/$35/$70/25%

($400 max)60%

$20,000/$40,000

$20,000/$40,000

No Maximum

$2,000/ $4,000

$5,500/$11,000

10% $75 $30 $60 $30$20/$45/$70/25%

($400 max)60%

$20,000/$40,000

No Maximum

$1,500/ $3,000

$5,750/$11,500

15% $75 $30 $60 $30$20/$45/$70/25%

($400 max)60%

$20,000/$40,000

$75 $15 $30

No Maximum

$3,000/ $6,000

$5,500/$11,000

10% $75 $30 $60 $30$20/$45/$70/25%

($400 max)60%

$20,000/$40,000

No Maximum

$2,500/ $5,000

$5,000/$10,000

20% $75 $30 $60 $30$20/$45/$70/25%

($400 max)60%

60%$20,000/$40,000

No Maximum$0/$0

$8,550/$17,100

$750 $75 $50 $80 $50 $30/$50/$75/$250 60%$20,000/$40,000

$0/$0

$8,550/$17,100

$225 $10 $5 $10 $5 $5/$15/$30/$75

70%

90%

60%

90%

85%

95%

90%

85%

80%

100%

100%

100%

95%

95%

90%

80%

80%

70%

70%

90%

80%


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Plan Marketing Name



















SimpleCare Platinum Copay 80116

SimpleCare Gold Copay 80118

SimpleCare Silver Copay 80120

$6,500/$13,000

$8,200/$16,400

5% $75 $40 $80

$5,500/$11,000

$8,550/$17,100

100%

100%

$75 $40

$6,000/$12,000

$8,450/$16,900

5%

$50 $80

$75 10%

$50

10%

$1,000/$2,000

$6,750/$13,500

20%

10%

$75

95%

70%

95%

95%

90%

$8,200/$16,400

5%

$7,000/$14,000

$8,550/$17,100

90%$7,550/$15,100

$8,550/$17,100

10%

$7,000/$14,000

80%$2,500/$5,000

$5,000/$10,000

20%

90%

80%

80%

90%

Small Group Plans

$40

70%$3,500/$7,000

$8,550/$17,100

30% $75 $40 $80 $40

70%$4,000/$8,000

$8,550/$17,100

30%

$5,000/$10,000

$8,550/$17,100

20%

85%

80%

$40$30/$55/$100/25%

($400 max)60%

$20,000/$40,000

$40$30/$55/$100/25%

($400 max)60%

$20,000/ $40,000

$75

$75 $30

$30/$55/$100/25%($400 max)

$75 $30

$20,000/$40,000

No Maximum

60%

Fail

Fail

$75 $40 $80 $40$30/$55/$100/25%

($400 max)60%

$40$30/$55/$100/25%

($400 max)

$30/$55/$100/25%($400 max)

60%

60%

60%

$40$30/$55/$100/25%

($400 max)

$80

$75

No Maximum$75 $30$60$30

$60 $30$20/$45/$70/25%

($400 max)60%

$30$20/$45/$70/25%

($400 max)60%$30 No Maximum

$30$20/$45/$70/25%

($400 max)$60

$60

$8,550/$17,100

$500 $75 $15 $30 $15$10/$25/$50/50%

($400 max)

$5 $5/$15/$30/$75

$75 $40 $80

$75 $40

$3,000/$6,000

$5,500/$11,000

$1,500/$3,000

$5,750/$11,500

15%

$60

$40 $80

$4,500/$9,000

$8,550/$17,100

20% $80

$75 $40 $80

$20$15/$35/$70/25%

($400 max)60%

$20,000/$40,000

$20,000/$40,000

$75 $20 $40$2,250/$4,500

$150

$20,000/$40,000

$20/$45/$70/25%($400 max)

60%$20,000/$40,000

$30$20/$45/$70/25%

($400 max)

$2,000/$4,000

$5,500/$11,000

10%

Out-of-NetworkWe Pay We Pay

$500/$1,000

$2,000/$4,000

$2,250/$4,500

CoinsuranceAfter

Deductible


Family


Individual/Family

$750/$1,500

$2,500/$5,000

$150 $75 $20 $40 No Maximum

No Maximum

100%

$20,000/$40,000

No Maximum

30% 30%30%

($400 max)60%

60%$20,000/$40,000

No Maximum

60%$20,000/$40,000

$20,000/$40,000

10%10%

($400 max)60%

$40

$30/$55/$100/25%($400 max)

60%$20,000/$40,000

No Maximum

No Maximum

No Maximum

60%$20,000/$40,000

No Maximum

No Maximum

$20,000/$40,000

No Maximum

No Maximum

60%$20,000/$40,000

No Maximum

60%

$20,000/$40,000

Pass

$30/$50/$75/$250

85%$0/$0

$8,550/$17,100

$225 $10 $5 $10

90%$0/$0

60%$0/$0

$8,550/$17,100

$750

2021Dual Network Option

CoinsuranceAfter

Deductible


Family


Individual/Family

Creditable Coverage

(Pass / Fail)

You Pay

$20,000/$40,000

No Maximum

No Maximum

No Maximum

$20,000/$40,000

No Maximum

$20,000/$40,000

No Maximum

$20,000/$40,000

No Maximum

30% $75 30%

10% $75 $30

$150 $75 $20 $40 $20

$20$15/$35/$70/25%

($400 max)60%

$20,000/$40,000

$15/$35/$70/25%($400 max)

60%

ERUrgent

CarePCPVisit

SpecialistVisit

Mental Health/ Substance Abuse Visit


You Pay

In-Network

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

Pass

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Plan Marketing NameMental Health/

Substance Abuse Visit

SimpleCare Gold HDHP 100012


SimpleCare Silver HDHP 100014


SimpleCare Bronze HDHP 100016


Plan Marketing NameMental Health/

Substance Abuse Visit







100%

80%

100%

100%$2,500/$5,000

$2,500/$5,000

0% after deductible is met 60%

Pass

$20,000/$40,000

No Maximum

$20,000/$40,000

No Maximum

No Maximum

No Maximum

Pass60%$20,000/$40,000

60%$20,000/$40,000

60%$20,000/$40,000

High Deductible Small Group Health PlansHSA Eligible

In-Network Out-of-Network

CoinsuranceAfter

Deductible


Family


Individual/FamilyER

Urgent Care

PCP VisitSpecialist

VisitRx Generic/Preferred/

Brand/Specialty

CoinsuranceAfter

Deductible

2021Single Network Option

100%$2,500/$5,000

$2,500/$5,000

70%$6,250/$12,500

$6,900/$13,800

30% after deductible is met 30% 60%

100%$6,900/$13,800

$6,900/$13,800


100%$4,500/$9,000

$4,500/$9,000

0% after deductible is met

80%$3,000/$6,000

$6,000/$12,000


60%

$20,000/$40,000

No Maximum

No Maximum

20% No Maximum

0%

No Maximum

20% No Maximum

0% 60%$20,000/$40,000



Individual/Family


80%$1,500/$3,000

$3,250/$6,500


High Deductible Small Group Health PlansHSA Eligible

CoinsuranceAfter

Deductible


Family


Individual/FamilyER

Urgent Care

PCP VisitSpecialist

Visit

30% 60%$6,250/$12,500

In-Network

$6,900/$13,800


CoinsuranceAfter

Deductible


Family

Fail

Fail

Fail

Fail

2021Dual Network Option

Creditable Coverage

(Pass / Fail)

Pass

Pass60%$20,000/$40,000

No Maximum

We Pay

No Maximum

60%$20,000/$40,000

60%$20,000/$40,000

No Maximum$20,000/$40,000

20%

We Pay

70%

Creditable Coverage

(Pass / Fail)

Out-of-Network

60%$20,000/$40,000

0%

$6,900/$13,800


$4,500/$9,000

$4,500/$9,000


$3,000/$6,000

$6,000/$12,000


$6,900/$13,800

You Pay You Pay

We Pay We PayYou Pay You Pay


Family


Individual/Family

80%$1,500/$3,000

$3,250/$6,500


Pass

Pass

Pass

Pass

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2021 SimpleCare Plans - Network OptionsPlans are offered with one of the following network options:

SINGLE NETWORK OPTIONSubscribers (and all dependents) are assigned a network based on the residential address of the subscriber.• Subscribers who reside within the Alliant Network Area are assigned the Alliant network.• Subscribers who reside outside the Alliant Network Area are assigned the PHCS* Primary network; this assignment does not provide access to the Alliant network.

DUAL NETWORK OPTIONSubscribers (and all dependents) are assigned both the Alliant network plus the PHCS* network. Network assignment is not dependent upon residential address.

*Carveouts apply (a limited number of providers/facilities are not accessible). Visit AlliantPlans.com to view carveout information.

SUBSCRIBER resides within

Alliant Network Area

SUBSCRIBER resides OUTSIDE of

Alliant Network Area

AHP Network/No PHCS PHCS* Primary/No AHP

Small Group Plans

50000 Series

80000 Series

90000 Series

Large Group Plans

All Members

AHP Network + PHCS*

100000 Series

• Single Network Option • Dual Network Option

Single Network Option Dual Network Option

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10 Questions? Call us at (866) 403-2785 Visit AlliantPlans.com Contact your brokerSimpleCare

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Alliant Network AreaThe Alliant Network Area is defined by the Georgia and Tennessee counties shown below.

Bradley

Bledsoe FranklinHamilton

MarionMcMinn Meigs

Polk RheaSequatchie

Tennessee Counties

All Georgia Counties

Small Group Plans 2021There is a maximum dollar amount you would have to pay in any given calendar...

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