Health Exchange ID Card Guide - Strategic Healthcare Partners...Introduction For 2015, Health...

Health Exchange ID Card Guide

2015 Georgia

2

Table of Contents Introduction .................................................................................................................................................. 3

Suggested HIX Financial Class and Payor Codes ........................................................................................... 6

Alliant Health Plans ....................................................................................................................................... 7

Assurant Health ............................................................................................................................................. 8

Blue Cross Blue Shield Healthcare Plan of Georgia ....................................................................................... 9

Cigna Health and Life Insurance Company ................................................................................................. 11

Coventry Health Care of Georgia ................................................................................................................ 12

Humana Employers Health Plan of Georgia ................................................................................................ 13

Kaiser Foundation Health Plan of Georgia .................................................................................................. 14

AmBetter by Peach State Health Plan......................................................................................................... 15

Time Insurance ............................................................................................................................................ 16

UnitedHealthcare of Georgia ...................................................................................................................... 17

National Enrollment Highlights ................................................................................................................... 18

Regional Marketplace Enrollment Data ...................................................................................................... 19

HIX Payors by Georgia County .................................................................................................................... 20

HIX Plan by Payor/Network ........................................................................................................................ 37

Georgia Counties by HIX Payor/Network .................................................................................................... 42

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Introduction

For 2015, Health Exchange (HIX) products and plans expanded considerably with the entrance of several new plans that previously did not offer HIX products. Small, sub-networks were created to limit provider participation in the HIX products, in urban markets especially, and some commercial payors discounting current commercial rates to achieve lower reimbursement for their HIX products. All in all, understanding the HIX market has been much like “hitting a moving target.” With our feet squarely in the HIX world, there is some new terminology to understand, member identification cards to recognize, and operational processes that must be followed to ensure financial stability. This guide is intended for educational purposes within your organization, so please share it with your business office, registration, surgical and procedure scheduling, and any other department that intake patients or assists with setting up post-discharge care. Operational processes that you likely already have in place are now even more important to follow (see outlined below). It is also important to know if your organization is “in network” or “out-of-network” with the HIX plans. You cannot assume that if you participate in a payor’s commercial plan that your organization is automatically “in network” with the HIX. Several of the payors have created narrow networks specially for their HIX members. For example, Pathway for BCBS, Compass for UHC, and HMOx for Humana, require you to confirm your organization’s participation. In many cases, dependent upon the plan, there are no out-of-network benefits. You’ll want to know your network participation status prior to rendering services so that you may collect payment from the patient. Verification of benefits and coverage are essential. When a patient presents a health insurance ID card (which we know is not proof of insurance anyway), there are three essential steps to take prior to rendering services:

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1. Verify eligibility by contacting the health plan using online verification services directly with the plan or other third party vendors, or via telephone. Be sure to either print the verification, if done online, or record the name, telephone number, date and time of the individual with whom you spoke, if done via telephone. It is important to note that HIX members have a grace period if they fail to pay their premiums, during which time the health plan will continue to indicate their eligibility for services. It is very likely you’ll need to prove that you verified eligibility in order to receive payment.

2. Verify benefits via online or other third party vendors. HIX plans must

offer “essential” health benefits, but in some cases may offer additional benefits. There is also a wide range of patient financial responsibility (deductibles, copayments, coinsurances), depending upon the specific plan chosen and even within the range of health care services to be received. You’ll need to have the benefit details available as you move to step 3.

3. Collect the patient’s liability PRIOR to rendering services (except in cases of emergency). All of the HIX plans have a deductible, with some of them as high as $6,000. If not collected “up front,” it is very likely you’ll collect as little as 10% of what is due afterwards. Get your money now.

Set up Health Exchange as a separate Financial Class. Although it is still somewhat difficult to determine the difference between typical commercial and HIX ID cards, we do still suggest that you do two things to be able to track, report, and analyze the impact of HIXes on your organization:

1. Set up Health Exchange as a separate Financial Class. You already have classes set us as Medicare, Medicaid and Commercial. Be sure to distinguish this one as well. Additionally, build the specific Payor Codes (we included a suggested listing in this document) in your patient accounting systems.

2. Train and retrain your staff to correctly select the Financial Class and Payor

Code within your system. This is also an opportunity to re-emphasize verifying eligibility and benefits and collecting patient liability. For example, you need to be able to differentiate Humana National POS (a commercial product) from Humana HMOx (a health exchange product), for which your organization may have differing participation status.

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New Terminology: o On Exchange: health insurance purchased with the assistance of a

governmental subsidy. o Off Exchange: health insurance purchased without subsidy. o Narrow Network: a smaller version or subset of an existing payor

network, typically with lower reimbursement.

Suggested HIX Financial Class and Payor Codes

Financial Class Payor Code Health Exchange Alliant HIX Health Exchange Assurant HIX Health Exchange BCBS HIX Health Exchange Cigna HIX Health Exchange Coventry HIX Health Exchange Humana HIX Health Exchange Kaiser HIX Health Exchange AmBetter HIX Health Exchange UHC HIX

7

Alliant Health Plans (available in the following counties ONLY: Banks, Barrow, Bartow, Carroll,

Catoosa, Chattooga, Cherokee, Dade, Dawson, Fannin, Floyd, Forsyth, Franklin, Gilmer, Gordon, Habersham, Hall, Haralson, hart, Heard, Jackson, Lumpkin,

Murray, Pickens, Polk, Rabun, Stephens, Towns, Union, Walker, White, Whitfield)

Network(s) Accessed: Alliant Health Plans

Payor's Provider Directory: http://www.alliantplans.com/directory.php

8

Assurant Health (available state-wide)

Network(s) Accessed: Aetna PPO

Payor's Provider Directory: http://www.aetna.com/docfind/jsp/rdIndex.jsp?site_id=asa&langpref=en

Note: Time Insurance issued under Assurant Health

9

Blue Cross Blue Shield Healthcare Plan of Georgia (available state-wide)

Continued…

10

Network(s) Accessed: BCBS HMO, BCBS PPO

Payor's Provider Directory: https://www.bcbsga.com/health-insurance/provider-directory/

searchcriteria?qs=*QwFs+r/6hJpykm79eloplg==&brand=bcbsga

https://www.bcbsga.com/health-insurance/provider-directory/�

11

Cigna Health and Life Insurance Company

(available in the following counties ONLY: Barrow, Bibb, Chattooga, Cobb, Dekalb, Floyd, Fulton, Gordon, Gwinnett, Laurens, Rockdale, Twiggs, Walton)

Network(s) Accessed: Cigna LocalPlus

Payor's Provider Directory: http://ifphcpdir.cigna.com/web/public/ifpproviders?

12

Coventry Health Care of Georgia (available in the following counties ONLY: Appling, Baker, Berrien, Bibb, Bryan, Chatham, Chattahoochee, Cherokee, Clinch, Coffee, Crawford, Dawson, DeKalb, Dougherty, Echols, Effingham, Emanuel, Forsyth, Fulton, Gwinnett, Hall, Harris, Houston, Jones, Lanier, Lee, Liberty, Lowndes, Marion, Monroe, Muscogee, Newton, Peach, Rockdale, Stewart, Sumter, Terrell, Twiggs, Wayne, Worth)

Network(s) Accessed: Coventry HMO

Payor's Provider Directory: http://www.coventryone.com/individual-health-insurance/georgia/education

-and-resources/tools/find-a-doctor/index.htm

http://www.coventryone.com/individual-health-insurance/georgia/education�

http://www.coventryone.com/individual-health-insurance/georgia/education�

13

Humana Employers Health Plan of Georgia

HMOx: (available Atlanta, Columbus, Macon, Savannah ONLY)

POS: (available state-wide) 9CDMNRU0AHLOU0CGIMNST0AELT 0CDINST0ADEMSTY 0EPQST02EMNQ 06BIKNU029DEMNU 03/02ASY0MR 039DP 013CL012AE 059R03:DR-0135030123:08

Network(s) Accessed: Humana and ChoiceCare

Payor's Provider Directory: https://www.humana.com/finder/medical?pageId

=218190c361cc4a02b986ae9bc242c847

https://www.humana.com/finder/medical?pageId�

14

Kaiser Foundation Health Plan of Georgia

(available in the following counties ONLY: Barrow, Bartow, Butts, Carroll, Cherokee, Clayton, Cobb, Coweta, Dawson, Dekalb, Douglas, Fayette, Forsyth, Fulton, Gwinnett, Hall, Haralson, Heard, Henry, Lamar, Meriwether, Newton,

Paulding, Pickens, Pike, Rockdale, Spalding, Walton)

Network(s) Accessed: Kaiser

Payor's Provider Directory: https://healthy.kaiserpermanente.org/health/care/consumer/locate-our-

services/doctors-and-locations/!ut/p/c5/04_SB8K8xLLM9MSSzPy8xBz9CP0

os3g3r2B_JydDRwOLUGMXA89QZzdns0BPQwMDA30v_aj0nPwkoMpwk

F68asHyBsaegWB59wAzAwNPC-8Q7zBLb2MDAyOoPA7gaKDv55Gfm

6pfkB0c5FHuqAgALrzoAg!!/dl3/d3/L2dJQSEvUUt3QS9ZQnZ3

LzZfRkpTT0JCMUEwMEZEOTBJNjdKQzBIMDMwMDU!

/?_ga=1.225050906.1801368350.1382973808

https://healthy.kaiserpermanente.org/health/care/consumer/locate-our-�

https://healthy.kaiserpermanente.org/health/care/consumer/locate-our-�

15

AmBetter by Peach State Health Plan (available in the following counties ONLY: Barrow, butts, Chattahoochee,

Cherokee, Clarke, Clayton, Dekalb, Elbert, Fayette, Forsyth, Fulton, Greene, Gwinnett, Harris, Henry, Jackson, Madison, Marion, Muscogee, Oconee,

Spalding, Talbot, Walton)

Network(s) Accessed: Peach State Health Plan

Payor's Provider Directory: http://apps.pshpgeorgia.com/findadoc/showNetwork?prodId=37

16

Time Insurance

See Assurant

17

UnitedHealthcare of Georgia (Available state-wide)

Network(s) Accessed: UHC PPO and HMO

Payor's Provider Directory: http://www.providerlookuponline.com/uhc/po7/Search.aspx

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National Enrollment Highlights

ASPE Issue Brief, December 30, 2014. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation. http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Dec2014/ib_2014Dec_enrollment.pdf

http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Dec2014/ib_2014Dec_enrollment.pdf�

19

Regional Marketplace Enrollment Data

Description GA SC AL FL US Total Number of Individuals Determined Eligible to Enroll through the Marketplace for 2015

250,766

96,032

88,942

833,380

4,376,414

Eligible to Enroll with Financial Assistance 200,426

77,154

68,026

721,666

3,562,522

Determined or Assessed Eligible for Medicaid/CHIP by the Marketplace

22,298

6,647

3,434

48,812

453,026

Total Number of Individuals Who Have Selected a 2015 Marketplace Plan

187,654

75,075

64,926

673,255

4,048,861

New Consumers (Percent of State TotalThat Selected Plan)

55% 57% 47% 49% 50%

Consumers Reenrolling (Percent of State Total That Selected Plan)

45% 43% 53% 51% 50%

ASPE Issue Brief, December 30, 2014. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation. http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Dec2014/ib_2014Dec_enrollment.pdf

http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Dec2014/ib_2014Dec_enrollment.pdf�

20

HIX Payors by Georgia County

County Payor/Network Plan Type

Appling

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Coventry Health Care of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Atkinson Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Bacon Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Baker


Baldwin Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Banks

Alliant Health Plans PPO Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Barrow

Alliant Health Plans PPO Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Cigna Health and Life Insurance Company PPO Humana Employers Health Plan of Georgia, Inc. POS Kaiser Foundation Health Plan of Georgia HMO Peach State Health Plan HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Bartow

Alliant Health Plans PPO Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Kaiser Foundation Health Plan of Georgia HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Ben Hill Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

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Berrien


Bibb

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Cigna Health and Life Insurance Company PPO Coventry Health Care of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Bleckley

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Brantley


Brooks Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Bryan

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Coventry Health Care of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Bulloch


Burke


Butts

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Kaiser Foundation Health Plan of Georgia HMO Peach State Health Plan HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Calhoun Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO

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UnitedHealthcare of Georgia, Inc. HMO

Camden


Candler


Carroll


Catoosa

Alliant Health Plans PPO Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Charlton Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Chatham

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Coventry Health Care of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Chattahoochee

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Coventry Health Care of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Peach State Health Plan HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Chattooga

Alliant Health Plans PPO Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Cigna Health and Life Insurance Company PPO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Cherokee

Alliant Health Plans PPO Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Coventry Health Care of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. HMO

23

Humana Employers Health Plan of Georgia, Inc. POS Kaiser Foundation Health Plan of Georgia HMO Peach State Health Plan HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Clarke

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Peach State Health Plan HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Clay Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Clayton


Clinch


Cobb

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Cigna Health and Life Insurance Company PPO Humana Employers Health Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Kaiser Foundation Health Plan of Georgia HMO Time Insurance (Assurant via Aetna network) PPO

Coffee


Colquitt Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Columbia


Cook Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

24

Coweta

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Kaiser Foundation Health Plan of Georgia HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Crawford


Crisp Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Dade


Dawson

Alliant Health Plans PPO Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Coventry Health Care of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Kaiser Foundation Health Plan of Georgia HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Decatur Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Dekalb

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Cigna Health and Life Insurance Company PPO Coventry Health Care of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Kaiser Foundation Health Plan of Georgia HMO Peach State Health Plan HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Dodge Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Dooly Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

25

Dougherty


Douglas

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Kaiser Foundation Health Plan of Georgia HMO Time Insurance (Assurant via Aetna network) PPO

Early Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Echols


Effingham


Elbert

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Peach State Health Plan HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Emanuel


Evans


Fannin


Fayette


26

Floyd

Alliant Health Plans PPO Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Cigna Health and Life Insurance Company PPO Humana Employers Health Plan of Georgia, Inc. POS Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Forsyth

Alliant Health Plans PPO Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Coventry Health Care of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Kaiser Foundation Health Plan of Georgia HMO Peach State Health Plan HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Franklin


Fulton


Gilmer


Glascock


Glynn


Gordon Alliant Health Plans PPO Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Cigna Health and Life Insurance Company PPO

27

Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Grady Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Greene


Gwinnett


Habersham


Hall

Alliant Health Plans PPO Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Coventry Health Care of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Kaiser Foundation Health Plan of Georgia HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Hancock


Haralson


Harris Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Coventry Health Care of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS

28

Peach State Health Plan HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Hart


Heard


Henry


Houston

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Coventry Health Care of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Irwin Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Jackson

Alliant Health Plans PPO Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Peach State Health Plan HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Jasper Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Jeff Davis Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Jefferson Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Time Insurance (Assurant via Aetna network) PPO

29

UnitedHealthcare of Georgia, Inc. HMO

Jenkins


Johnson


Jones


Lamar

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Kaiser Foundation Health Plan of Georgia HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Lanier


Laurens

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Cigna Health and Life Insurance Company PPO Humana Employers Health Plan of Georgia, Inc. POS Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Lee


Liberty


Lincoln


Long Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS

30


Lowndes


Lumpkin


Macon Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Madison


Marion

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Coventry Health Care of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Peach State Health Plan HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Mcduffie


Mcintosh


Meriwether

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Kaiser Foundation Health Plan of Georgia HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Miller Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Mitchell Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Monroe Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO

31

Coventry Health Care of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Montgomery Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Morgan


Murray


Muscogee

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Coventry Health Care of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Peach State Health Plan HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Newton

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Coventry Health Care of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Kaiser Foundation Health Plan of Georgia HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Oconee


Oglethorpe


Paulding

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Kaiser Foundation Health Plan of Georgia HMO Time Insurance (Assurant via Aetna network) PPO

Peach Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Coventry Health Care of Georgia, Inc. HMO

32

Humana Employers Health Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Pickens

Alliant Health Plans PPO Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Kaiser Foundation Health Plan of Georgia HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Pierce Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Pike

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Kaiser Foundation Health Plan of Georgia HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Polk

Alliant Health Plans PPO Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Pulaski Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Putnam Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Quitman Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Rabun


Randolph Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Richmond


33

Rockdale

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Cigna Health and Life Insurance Company PPO Coventry Health Care of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS Kaiser Foundation Health Plan of Georgia HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Schley Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Screven


Seminole Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Spalding


Stephens


Stewart


Sumter


Talbot


Taliaferro Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS

34


Tattnall


Taylor Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Telfair Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Terrell


Thomas Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Tift Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Toombs Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Towns


Treutlen Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Troup


Turner Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Twiggs

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Cigna Health and Life Insurance Company PPO Coventry Health Care of Georgia, Inc. HMO Humana Employers Health Plan of Georgia, Inc. POS

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Union


Upson Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Walker


Walton

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Cigna Health and Life Insurance Company PPO Humana Employers Health Plan of Georgia, Inc. POS Kaiser Foundation Health Plan of Georgia HMO Peach State Health Plan HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Ware Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Warren


Washington


Wayne


Webster


Wheeler Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

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White


Whitfield


Wilcox Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. HMO Time Insurance (Assurant via Aetna network) PPO UnitedHealthcare of Georgia, Inc. HMO

Wilkes


Wilkinson


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HIX Plan by Payor/Network

Payor/Network Plan Name

Alliant Health Plans

SoloCare - 0040001 SoloCare - 0040002 SoloCare - 0040003 SoloCare - 0040004 SoloCare - 0040006 SoloCare - 0040007 SoloCare - 0040008 SoloCare - 0040009 SoloCare - 0040010 SoloCare - 0040011 SoloCare - 0040012 SoloCare - 0040013 SoloCare - 0040014 SoloCare - 0040015 SoloCare - 0040016 SoloCare - 0040017 SoloCare - 0040019 SoloCare - 0040020 SoloCare - 0040021 SoloCare - 004005

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.

BCBSHP Bronze Pathway X HMO 0 for HSA BCBSHP Bronze Pathway X HMO 20 for HSA BCBSHP Bronze Pathway X HMO 30 for HSA BCBSHP Bronze Pathway X HMO 4300 20 BCBSHP Bronze Pathway X HMO 5500 40 BCBSHP Catastrophic Pathway X HMO 6600 0 BCBSHP Silver Pathway X HMO 10 for HSA BCBSHP Silver Pathway X HMO 2000 25 BCBSHP Silver Pathway X HMO 3000 10 BCBSHP Silver Pathway X HMO 3500 0 BCBSHP Silver Pathway X HMO 3500 25

Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess, a Multi-State Plan

Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan

Cigna Health and Life Insurance Company

myCigna Health Flex 1000 myCigna Health Flex 2000 myCigna Health Flex 3000 myCigna Health Flex 5000 Bronze

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myCigna Health Savings 3400 myCigna Health Savings 6000

Coventry Health Care of Georgia, Inc.

Coventry Bronze $20 Copay HMO Albany Coventry Bronze $20 Copay HMO Atlanta Coventry Bronze $20 Copay HMO Columbus Coventry Bronze $20 Copay HMO Hall Coventry Bronze $20 Copay HMO Macon Coventry Bronze $20 Copay HMO Savannah Coventry Bronze $20 Copay HMO SEGA Coventry Bronze $20 Copay HMO Valdosta Coventry Bronze Ded Only HSA Eligible HMO Albany Coventry Bronze Ded Only HSA Eligible HMO Atlanta Coventry Bronze Ded Only HSA Eligible HMO Columbus Coventry Bronze Ded Only HSA Eligible HMO Hall Coventry Bronze Ded Only HSA Eligible HMO Macon Coventry Bronze Ded Only HSA Eligible HMO Savannah Coventry Bronze Ded Only HSA Eligible HMO SEGA Coventry Bronze Ded Only HSA Eligible HMO Valdosta Coventry Gold $5 Copay HMO Albany Coventry Gold $5 Copay HMO Atlanta Coventry Gold $5 Copay HMO Columbus Coventry Gold $5 Copay HMO Hall Coventry Gold $5 Copay HMO Macon Coventry Gold $5 Copay HMO Savannah Coventry Gold $5 Copay HMO SEGA Coventry Gold $5 Copay HMO Valdosta Coventry Silver $10 Copay HMO Albany Coventry Silver $10 Copay HMO Atlanta Coventry Silver $10 Copay HMO Columbus Coventry Silver $10 Copay HMO Hall Coventry Silver $10 Copay HMO Macon Coventry Silver $10 Copay HMO Savannah Coventry Silver $10 Copay HMO SEGA Coventry Silver $10 Copay HMO Valdosta Coventry Silver $5 Copay 2750 HMO Albany Coventry Silver $5 Copay 2750 HMO Atlanta Coventry Silver $5 Copay 2750 HMO Columbus Coventry Silver $5 Copay 2750 HMO Hall Coventry Silver $5 Copay 2750 HMO Macon Coventry Silver $5 Copay 2750 HMO Savannah Coventry Silver $5 Copay 2750 HMO SEGA Coventry Silver $5 Copay 2750 HMO Valdosta

Humana Employers Health Plan Humana Basic 6600/Atlanta HMOx

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of Georgia, Inc. Humana Basic 6600/Columbus GA HMOx Humana Basic 6600/Macon HMOx Humana Basic 6600/National POS - OpenAccess Humana Basic 6600/Savannah HMOx Humana Bronze 4850/Atlanta HMOx Humana Bronze 4850/Columbus GA HMOx Humana Bronze 6300/Atlanta HMOx Humana Bronze 6300/Columbus GA HMOx Humana Bronze 6300/Macon HMOx Humana Bronze 6300/National POS - OpenAccess Humana Bronze 6300/Savannah HMOx Humana Gold 2500/Atlanta HMOx Humana Gold 2500/Columbus GA HMOx Humana Gold 2500/Macon HMOx Humana Gold 2500/National POS - OpenAccess Humana Gold 2500/Savannah HMOx Humana Platinum 1000/Atlanta HMOx Humana Platinum 1000/Columbus GA HMOx Humana Platinum 1000/Macon HMOx Humana Platinum 1000/National POS - OpenAccess Humana Platinum 1000/Savannah HMOx Humana Silver 4250/National POS - OpenAccess Humana Silver 4600/Atlanta HMOx Humana Silver 4600/Columbus GA HMOx Humana Silver 4600/Macon HMOx Humana Silver 4600/Savannah HMOx


KP GA Bronze 4500/50/HSA KP GA Bronze 5000/30%/HSA KP GA Bronze 5000/50 KP GA Catastrophic 6600/0 KP GA Gold 0/20 KP GA Gold 1000/20 KP GA Gold 1500/20 KP GA Silver 1500/30 KP GA Silver 1750/25%/HSA KP GA Silver 2500/30

Peach State Health Plan

Ambetter Balanced Care 1 Ambetter Balanced Care 1 + Vision Ambetter Balanced Care 1 + Vision + Adult Dental Ambetter Balanced Care 2 Ambetter Balanced Care 2 + Vision Ambetter Balanced Care 2 + Vision + Adult Dental Ambetter Balanced Care 3

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Ambetter Balanced Care 3 + Vision Ambetter Balanced Care 3 + Vision + Adult Dental Ambetter Balanced Care 4 Ambetter Balanced Care 4 + Vision Ambetter Balanced Care 4 + Vision + Adult Dental Ambetter Balanced Care 5 Ambetter Balanced Care 5 + Vision Ambetter Balanced Care 5 + Vision + Adult Dental Ambetter Essential Care 1 Ambetter Essential Care 1 + Vision Ambetter Essential Care 1 + Vision + Adult Dental Ambetter Essential Care 2 Ambetter Essential Care 2 + Vision Ambetter Essential Care 2 + Vision + Adult Dental Ambetter Essential Care 3 with 3 Free PCP Visits Ambetter Essential Care 3 with 3 Free PCP Visits + Vision

Ambetter Essential Care 3 with 3 Free PCP Visits + Vision + Adult Dental Ambetter Essential Care 4 with 3 Free PCP Visits Ambetter Essential Care 4 with 3 Free PCP Visits + Vision

Ambetter Essential Care 4 with 3 Free PCP Visits + Vision + Adult Dental Ambetter Secure Care 1 with 3 Free PCP Visits Ambetter Secure Care 1 with 3 Free PCP Visits + Vision

Ambetter Secure Care 1 with 3 Free PCP Visits + Vision + Adult Dental Ambetter Secure Care 2 Ambetter Secure Care 2 + Vision Ambetter Secure Care 2 + Vision + Adult Dental

Assurant Health by Time Insurance (Aetna network)

Assurant Health Bronze Plan 001 Assurant Health Bronze Plan 002 Assurant Health Gold Plan 002 Assurant Health Platinum Plan 002 Assurant Health Silver Plan 001 Assurant Health Silver Plan 002

UnitedHealthcare of Georgia, Inc.

UnitedHealthcare Bronze Compass 4200 UnitedHealthcare Bronze Compass HSA 5000 UnitedHealthcare Bronze Compass HSA 6275 UnitedHealthcare Catastrophic Compass 6600 UnitedHealthcare Gold Compass 1000 UnitedHealthcare Gold Compass HSA 1300 UnitedHealthcare Platinum Compass 250 UnitedHealthcare Silver Compass 2000

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UnitedHealthcare Silver Compass 5000 UnitedHealthcare Silver Compass HSA 3600

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Georgia Counties by HIX Payor/Network

Payor/Network County

Alliant Health Plans

Banks Barrow Bartow Carroll Catoosa Chattooga Cherokee Dade Dawson Fannin Floyd Forsyth Franklin Gilmer Gordon Habersham Hall Haralson Hart Heard Jackson Lumpkin Murray Pickens Polk Rabun Stephens Towns Union Walker White Whitfield

Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. All counties in Georgia

Cigna Health and Life Insurance Company Barrow Bibb Chattooga

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Cobb Dekalb Floyd Fulton Gordon Gwinnett Laurens Rockdale Twiggs Walton

Coventry Health Care of Georgia, Inc.

Appling Baker Berrien Bibb Bryan Chatham Chattahoochee Cherokee Clinch Coffee Crawford Dawson Dekalb Dougherty Echols Effingham Emanuel Forsyth Fulton Gwinnett Hall Harris Houston Jones Lanier Lee Liberty Lowndes Marion Monroe Muscogee Newton Peach

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Rockdale Stewart Sumter Terrell Twiggs Wayne Worth

Humana Employers Health Plan of Georgia, Inc.

Banks Barrow Bartow Bibb Bleckley Brantley Bryan Bulloch Burke Butts Camden Candler Carroll Chatham Chattahoochee Cherokee Clarke Clayton Cobb Columbia Coweta Crawford Dawson Dekalb Douglas Effingham Emanuel Evans Fayette Floyd Forsyth Fulton Glascock Glynn Greene Gwinnett

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Hall Hancock Haralson Harris Heard Henry Houston Jackson Jefferson Jenkins Johnson Jones Lamar Laurens Liberty Lincoln Long Madison Marion Mcduffie Mcintosh Monroe Morgan Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Polk Richmond Rockdale Screven Spalding Stewart Talbot Taliaferro Tattnall Troup Twiggs Walton Warren

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Washington Wayne Webster Wilkes Wilkinson


Barrow Bartow Butts Carroll Cherokee Clayton Cobb Coweta Dawson Dekalb Douglas Fayette Forsyth Fulton Gwinnett Hall Haralson Heard Henry Lamar Meriwether Newton Paulding Pickens Pike Rockdale Spalding Walton

Peach State Health Plan

Barrow Butts Chattahoochee Cherokee Clarke Clayton Dekalb Elbert Fayette Forsyth

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Fulton Greene Gwinnett Harris Henry Jackson Madison Marion Muscogee Oconee Spalding Talbot Walton

Assurant Health by Time Insurance (Aetna network) All counties in Georgia UnitedHealthcare of Georgia, Inc. All counties in Georgia

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