2018 Monthly Premiums

Transcription

1 2018 Monthly Premiums This chart shows monthly premium rates. Rates are based on geographic area, age, and family size. When you re ready to enroll or want to see if you qualify for a subsidy, visit or call (TTY: 711). Age Rate 1 To find your monthly rate as an individual: You 56 $ Look at the first column to narrow down your plan type Bronze, Silver, Gold, or Catastrophic. +Spouse 54 $ Find the name of the plan you re interested in and scan the row to the right until you find the rate that matches the column with your age. If you want to see other plan rates you may be eligible for, look up +Dependent 1 20 $280 or down within your age column to compare prices. +Dependent 2 18 $260 +Dependent 3 14 $200 To find your monthly rate as a family: 1. Follow steps 1 and 2 above for each person in your family. 2. Add the rates together. If you are purchasing a policy including more than three children under 21, only the rates for the first three children are included in your total. AGE +Dependent 4 12 Free $200 Total Family Rate $1,630 The above example is for illustrative purposes only Local Value Simple Saver 3 $ $ $ $ $ $ $ $ $ $ $ $ EPO AmeriHealth Advantage $25/$50 4 $ $ $ $ $ $ $ $ $ $ $ $ EPO Tier 1 Advantage $50/$75 5 $ $ $ $ $ $ $ $ $ $ $ $ EPO AmeriHealth Advantage $15/$35 4 $ $ $ $ $ $ $ $ $ $ $ $ EPO HSA Tier 1 Advantage $50/$75 5 $ $ $ $ $ $ $ $ $ $ $ $ HMO Local Value $50/$75 3 $ $ $ $ $ $ $ $ $ $ $ $ EPO HSA Local Value $50/$75 3 $ $ $ $ $ $ $ $ $ $ $ $ HMO Regional Preferred $50/$75 $ $ $ $ $ $ $ $ $ $ $ $ EPO Regional Preferred $30/$60 $ $ $ $ $ $ $ $ $ $ $ $ HMO Regional Preferred $15/$30 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $733.71

2 AGE Local Value Simple Saver 3 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ EPO AmeriHealth Advantage $25/$50 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ EPO Tier 1 Advantage $50/$75 5 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ EPO AmeriHealth Advantage $15/$35 4 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ EPO HSA Tier 1 Advantage $50/$75 5 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ HMO Local Value $50/$75 3 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ EPO HSA Local Value $50/$75 3 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ HMO Regional Preferred $50/$75 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, EPO Regional Preferred $30/$60 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1, HMO Regional Preferred $15/$30 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, $1,426.49

3 AGE Local Value Simple Saver 3 $ $ $ $ $ $ $ $ $ $ $ $ EPO AmeriHealth Advantage $25/$50 4 $ $ $ $ $ $ $ $ $ $ $ $ EPO Tier 1 Advantage $50/$75 5 $ $ $ $ $ $ $ $ $ $ $ $ EPO AmeriHealth Advantage $15/$35 4 $ $ $ $ $ $ $ $ $ $ $ $ EPO HSA Tier 1 Advantage $50/$75 5 $ $ $ $ $ $ $ $ $ $ $ $ HMO Local Value $50/$75 3 $ $ $ $ $ $ $ $ $ $ $ $ EPO HSA Local Value $50/$75 3 $ $ $ $ $ $1, $1, $1, $1, $1, $1, $1, HMO Regional Preferred $50/$75 $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, EPO Regional Preferred $30/$60 $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, HMO Regional Preferred $15/$30 $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $2, $2, $2, $2, You do not need to include rates for more than three children under age Catastrophic plans are only available for qualifi ed individuals. 3 The Local Value Network is not available in Hunterdon County. 4 AmeriHealth Advantage plans are only available to individuals based in the following counties: Atlantic, Burlington, Camden, Cape May, Essex, Gloucester, Hudson, Mercer, Middlesex, Monmouth, Ocean, Somerset, and Union. Members can obtain services within the listed counties at the Tier 1 level. AmeriHealth Advantage members can also access Tier 2 providers within the AmeriHealth New Jersey Local Value network. AmeriHealth Advantage Tier 1 hospitals are subject to change. 5 Tier 1 providers are an enhancement to your benefi ts. Tier 2 providers are AmeriHealth New Jersey Local Value network providers AmeriHealth November

4 Language Taglines and Nondiscrimination Notice Language Assistance Services Spanish: ATENCIÓN: Si habla español, cuenta con servicios de asistencia en idiomas disponibles de forma gratuita para usted. Llame al (TTY: 711). Chinese: 注意 : 如果您讲中文, 您可以得到免费的语言协助服务 致电 Korean: 안내사항 : 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다 번으로전화하십시오. Portuguese: ATENÇÃO: se você fala português, encontram-se disponíveis serviços gratuitos de assistência ao idioma. Ligue para Gujarati: ચન : જ તમ જર ત બ લત હ, ત ન: ભ ષ સહ ય સ વ ઓ તમ ર મ ટ લ છ ક લ કર. Vietnamese: LƯU Ý: Nếu bạn nói tiếng Việt, chúng tôi sẽ cung cấp dịch vụ hỗ trợ ngôn ngữ miễn phí cho bạn. Hãy gọi Russian: ВНИМАНИЕ: Если вы говорите по-русски, то можете бесплатно воспользоваться услугами перевода. Тел.: Polish UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer Italian: ATTENZIONE: Se lei parla italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero Arabic: ملحوظة: إذا كنت تتحدث اللغة العربية فإن خدمات المساعدة اللغوية متاحة لك بالمجان. اتصل برقم French Creole: ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele AmeriHealth 2017 November Tagalog: PAUNAWA: Kung nagsasalita ka ng Tagalog, magagamit mo ang mga serbisyo na tulong sa wika nang walang bayad. Tumawag sa French: ATTENTION: Si vous parlez français, des services d'aide linguistique-vous sont proposés gratuitement. Appelez le Pennsylvania Dutch: BASS UFF: Wann du Pennsylvania Deitsch schwetzscht, kannscht du Hilf griege in dei eegni Schprooch unni as es dich ennich eppes koschte zellt. Ruf die Nummer Hindi: य द : य द आप ह द ब लत ह त आपक लए म त म भ ष सह यत स व ए पल ह क ल कर German: ACHTUNG: Wenn Sie Deutsch sprechen, können Sie kostenlos sprachliche Unterstützung anfordern. Wählen Sie Japanese: 備考 : 母国語が日本語の方は 言語アシスタンスサービス ( 無料 ) をご利用いただけます へお電話ください Persian (Farsi): توجه: اگر فارسی صحبت می کنيد خدمات ترجمه به صورت رايگان برای شما فراھم می باشد. با شماره تماس بگيريد. Navajo: D77 baa ak0 n7n7zin: D77 saad bee y1n7[ti go Diné Bizaad, saad bee 1k1 1n7da 1wo d66, t 11 jiik eh. H0d77lnih koj Urdu: توجہ درکارہے: اگر آپ اردو زبان بولتے ہيں تو آپ کے لئے مفت ميں زبان معاون خدمات دستياب ہيں کال کريں Mon-Khmer, Cambodian: ស ត ចប រ មណ របស ន ប អនកន យ ន- ខមរ ខមរ ន ជ ន យ ផនក ន ងមនផ តល ជ នដល កអនក យ ត គ ត ថ ល ទ រសពទ ទ លខ (OVER)

5 Language Taglines and Nondiscrimination Notice Discrimination is Against the Law This Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. This Plan does not exclude people or treat them differently Smoking because of race, Cessation color, national Resource origin, age, Guide disability, or sex. This Plan provides: Free aids and services to people with disabilities to communicate effectively with us, such as: qualified sign language interpreters, and written information in other formats (large print, audio, accessible electronic formats, other formats). Free language services to people whose primary language is not English, such as: qualified interpreters and information written in other languages. If you need these services, contact our Civil Rights Coordinator. If you believe that This 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 our Civil Rights Coordinator. You can file a grievance in the following ways: In person or by mail: ATTN: Civil Rights Coordinator, 1901 Market Street, Philadelphia, PA 19103, By phone: (TTY: 711) By fax: , By civilrightscoordinator@1901market.com. If you need help filing a grievance, our Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, , (TDD). Complaint forms are available at AmeriHealth 2017 October