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1 Molina Marketplace We have a plan to keep you healthy. WASH IN R INDE NF EALTHP LA ON H GT
2 Access. Quality. Commitment. With Washington Healthplanfinder, you have a choice. Molina Healthcare is the answer. Here is why you should join our extended family. Experience you can trust We have more than 30 years of experience caring for individuals and their families. This includes providing health insurance in 10 states for more than 1.8 million members. flexibility you want Because we offer care through Medicare, Medicaid and the Health Insurance Marketplace, we can cover each member in your family. This makes it convenient and easy for you and your family. About Molina Healthcare. Our company was created more than 30 years ago by Dr. C. David Molina. Dr. Molina was an emergency room doctor who believed that everyone should have access to high-quality care. Today, we provide medical services through Medicaid, Medicare and the Health Insurance Marketplace. Because we treat our members like family, we make sure they get the care they need, close to home. About Washington Healthplanfinder. Washington Healthplanfinder offers access to health care for everyone. Whether you are an individual or have a large family. Whether you are sick or healthy. No matter what, you now have access to affordable Molina Healthcare insurance through Washington Healthplanfinder. A commitment to your community We provide health education, programs and services to create a healthier community. Call us for more information: (888)
3 Molina Marketplace Molina offers a variety of plans to fit your needs. Molina Healthcare plans are designed to meet your family s unique needs and budget. Talk to family members and friends you trust before you make a decision. Value Monthly Premiums Co-payments May be ideal for: Silver Best Lower Lower Gold Better Higher Moderate Members who want low monthly premiums and co-payment costs. Higher income members who can afford moderate monthly premiums and co-payments. This is a plan overview. For complete details, see our 2014 Benefits At-A-Glance insert in this brochure. All of our plans meet the standards of the Affordable Care Act. Each plan includes these essential health benefits: Regular office visits Lab and radiology testing Mental health and substance abuse services Emergency services Prescription drug coverage Hospital care Maternity and newborn care Help recovering from injury Free preventive and wellness services Pediatric services, including vision care Coverage that goes beyond the doctor s office. We know every member has different needs. That s why we offer more than just access to doctors. We offer a wide range of services for our members, such as: 24-hour Nurse Advice Line Call the line, anytime. Our nurses are ready to answer your medical questions. PERSONAL Care Management Our skilled health care staff is here to help you with your chronic medical issues like asthma, diabetes and high blood pressure so you can live a healthier life. Rides to your medical appointments We make it easier to for you to get to your appointment. We offer our Silver plan members up to 4 low-cost rides per month. Online Member Services Change your address, phone number, even your primary care doctor. You can also sign up to receive alerts and appointment reminders. It s all at MyMolina.com, 24 hours a day. Pregnancy Program You have a friend at every stage of pregnancy. With our Motherhood Matters, we re here to support you and your baby s health. Dedicated Customer Support Our friendly staff speaks several different languages. We re here to answer your questions from 8:00 a.m. to 5:00 p.m., Monday through Friday. Quality Health and Wellness Programs Have an important health screening coming up? We ll remind you. Need help scheduling an appointment or getting there? We can help. We ll also let you know about health events in your area and put you in touch with the right people for social services like counseling and housing assistance. Call us for more information: (888)
4 2014 Benefits At-A-Glance Molina Marketplace WASHINGTON HEALTHPLANFINDER Silver MSW-100 Silver MSW-150 Silver MSW-200 Silver MSW-250 Gold MGW-001 Features 5 Annual Deductible (individual/family) $50/$100 1 $100/$200 1 $1,400/$2,800 1 $1,700/$3,400 1 $200/$400 1 Prescription Drug Deductible (individual/family) $10/$20 2 $30/$60 2 $30/$60 2 $200/$400 2 $40/$80 2 Annual Out-of-Pocket Maximum (individual/family) $2,250/$4,500 $2,250/$4,500 $5,200/$10,400 $6,350/$12,700 $6,350/$12,700 Benefits Office Visits 3 Preventive Care Prenatal Visits Well-child Visits Family Planning Primary Care $3 co-pay $15 co-pay No Charge $20 co-pay $30 co-pay $15 co-pay Specialty Care $8 co-pay $30 co-pay $50 co-pay $60 co-pay $45 co-pay Other Practitioner Care $8 co-pay $30 co-pay $50 co-pay $60 co-pay $45 co-pay Habilitative Care 5% coinsurance 20% coinsurance 30% coinsurance 30% coinsurance 20% coinsurance Rehabilitative Care 5% coinsurance 20% coinsurance 30% coinsurance 30% coinsurance 20% coinsurance Mental Health Services $8 co-pay $30 co-pay $50 co-pay $60 co-pay $45 co-pay Substance Abuse services $8 co-pay $30 co-pay $50 co-pay $60 co-pay $45 co-pay Emergency and Urgent Care Emergency Room 6 $100 co-pay $150 co-pay $250 co-pay $250 co-pay $250 co-pay Urgent Care $15 co-pay $30 co-pay $60 co-pay $75 co-pay $60 co-pay Pediatric Vision Services 7 Vison Exam Glasses Contacts Prescription Drugs Formulary Generic Drugs $3 co-pay $8 co-pay No Charge $10 co-pay $20 co-pay $15 co-pay Formulary Preferred Brand Drugs $8 co-pay $20 co-pay $40 co-pay $55 co-pay $45 co-pay Formulary Non Preferred Brand Drugs 5% coinsurance 20% coinsurance 30% coinsurance 30% coinsurance 20% coinsurance Specialty Drugs 5% coinsurance 20% coinsurance 30% coinsurance 30% coinsurance 20% coinsurance Outpatient Hospital/Facility Services Laboratory Services $3 co-pay $15 co-pay $20 co-pay $30 co-pay $15 co-pay Radiology Services $8 co-pay $30 co-pay $50 co-pay $60 co-pay $45 co-pay Specialized Scanning Services (CT, MRI PET Scans) 5% coinsurance 20% coinsurance 30% coinsurance 30% coinsurance 20% coinsurance Medical/Surgical Services 5% coinsurance 20% coinsurance 30% coinsurance 30% coinsurance 20% coinsurance Inpatient Hospital Services Medical/Surgical, Maternity Care, Mental Health, Substance Abuse, Skilled Nursing Facility 5% coinsurance 20% coinsurance 30% coinsurance 30% coinsurance 20% coinsurance Hospice Care No Charge Transportation Assistance Emergency Transportation - Ambulance $100 co-pay $150 co-pay $250 co-pay $250 co-pay $250 co-pay Non-Emergency Medical Transportation to and from Medical Appointments 4 $5 per round trip $10 per round trip $10 per round trip $10 per round trip $10 per round trip Health and Wellness Education Services 24-Hour Nurse Advice Line Weight control program Motherhood Matters SM, mothers-to-be program Tobacco counseling, smoking cessation program No Charge 1. Applies Only to Outpatient Hospital/Facility and Inpatient Hospital/Facility Services 2. Applies only to Non-Preferred Brand Name drugs and Specialty drugs 3. Some Outpatient Professional Services not listed, are not Co-payment based and require a Coinsurance Cost Share 4. Non-Emergency Medical Transportation services are limited to four (4) round trips per month 5. Certain benefits require Prior Authorization prior to obtaining services 6. This cost does not apply, if admitted directly to the hospital for inpatient services (refer to Inpatient Hospital Services, for applicable Cost sharing for you) 7. Applicable to Dependent Children through age 18 This 2014 Benefits At-A-Glance is intended to be a summary of coverage benefits that lists some features of our plan, and does not list or describe all benefits covered under a specific product or every limitation or exclusion. Please consult the Molina Healthcare of Washington, Inc. Agreement and Individual Policy for a detailed description of benefits, exclusions and limitations HIM0913WA
5 WASHINGTON HEALTHPLANFINDER For more than 30 years, we ve been a part of your community. Now we invite you to join our extended family. Call us toll free at (888) HIM0913WA Product offered by Molina Healthcare of Washington, Inc., a wholly owned subsidiary of Molina Healthcare, Inc. This is a solicitation for insurance and an agent may contact you. MP 0100 Approval: 9/19/13
6 Mercado de Seguros Médicos de Molina Estás en familia. Tenemos un plan para mantenerlo saludable WASH IN R INDE NF EALTHP LA ON H GT
7 Acceso. Calidad. Compromiso. Con Washington Healthplanfinder, usted tiene opciones. Molina Healthcare es la solución. Son muchas las razones por las cuales usted debería unirse a nuestra familia. EXPERIENCIA EN LA CUAL PUEDE CONFIAR. Contamos con más de 30 años de experiencia cuidando a individuos y a sus familias. Brindamos seguros médicos en 10 estados a más de 1.8 millones de miembros. LA FLEXIBILIDAD QUE USTED DESEA. Como ofrecemos cuidados a través de Medicare, Medicaid y el Mercado de Seguros Médicos, podemos brindarle cobertura a cada miembro de su familia de una manera fácil y conveniente. UN COMPROMISO CON SU COMUNIDAD. Proporcionamos programas, servicios y educación de la salud, para crear una comunidad más sana. Acerca de Molina Healthcare. Nuestra empresa fue creada hace más de 30 años por el Dr. C. David Molina. Como médico de la sala de emergencias, el Dr. Molina creía que el acceso a la atención médica de calidad debería ser para todos. Hoy en día, ofrecemos servicios médicos a través de Medicaid, Medicare y el Mercado de Seguros Médicos. Tratamos a nuestros miembros como familia y nos aseguramos de que reciban el cuidado que necesitan, cerca de sus hogares. Acerca de Washington Healthplanfinder. Washington Healthplanfinder les ofrece a todos acceso a la atención médica. Sin importar si ha tenido un seguro médico anteriormente. Individual o para una familia grande. Enfermo o sano. No importan cuales sean sus circunstancias, ahora tiene acceso al seguro médico económico de Molina Healthcare, a través de Washington Healthplanfinder. Para más información comuníquese con nosotros al: (888)
8 Molina le ofrece una variedad de planes para satisfacer sus necesidades. Los planes de salud de Molina Healthcare están diseñados para cumplir con las necesidades únicas y el presupuesto de su familia. Hable con familiares y amistades de confianza antes de tomar una decisión. Mercado de Seguros Médicos de Molina VALOR PRIMAS MENSUALES CO-PAGOS PUEDE SER IDEAL PARA: PLATA El mejor Bajo Bajo ORO Mejor Alto Moderado Miembros que desean primas mensuales y costos de copagos bajos. Miembros con ingresos más altos que pueden pagar primas mensuales y copagos a un precio razonable. Este es un resumen del plan. Para detalles completos, consulte el Resumen de Beneficios, Año 2014, incluido en este folleto. Todos nuestros planes de salud cumplen con las normas de la Ley del Cuidado de Salud a Bajo Precio. Cada plan de salud incluye estos beneficios médicos esenciales: Consultas regulares Pruebas de laboratorio y radiología Servicios de salud mental y abuso de sustancias Servicios de emergencia Cobertura de medicamentos recetados Hospitalización Cuidado de maternidad y del recién nacido Ayuda de recuperación de lesiones Servicios gratuitos de prevención y bienestar Servicios pediátricos, incluyendo cuidado de la vista Una cobertura que ofrece mucho más que las consultas médicas. Sabemos que cada miembro tiene distintas necesidades. Por esa razón, ofrecemos más que sólo acceso a médicos. Ofrecemos una amplia variedad de servicios para nuestros miembros, como: LÍNEA DE CONSEJOS DE ENFERMERAS 24 HORAS AL DÍA. Comuníquese a cualquier hora. Nuestras enfermeras están listas para contestar sus preguntas médicas. ADMINISTRACIÓN DE CUIDADO PERSONAL. Nuestro personal médico especializado está aquí para ayudarle con problemas médicos crónicos como asma, diabetes y alta presión arterial, para que pueda vivir una vida más saludable. TRANSPORTE A SU CITAS MÉDICAS Le facilitamos el trasporte a sus citas médicas. Nuestros miembros del plan de Plata tienen hasta 4 viajes a bajo costo por mes. SERVICIOS PARA MIEMBROS POR INTERNET. Puede cambiar su dirección, número de teléfono y hasta su médico de cuidados primarios. También puede inscribirse para recibir alertas y recordatorios para sus citas. Todo en MiMolina.com, 24 horas al día. PROGRAMA DE EMBARAZO. Está acompañada en cada etapa de su embarazo. Con nuestro programa Motherhood Matters, estamos aquí para apoyar su salud y la de su bebé. APOYO DEDICADO AL CLIENTE. Nuestro personal amable habla diferentes idiomas. Estamos aquí para contestar sus preguntas de 8:00 a.m. a 5:00 p.m., de lunes a viernes. BIENESTAR Y ATENCIÓN MÉDICA DE CALIDAD Tiene un examen médico importante dentro de poco tiempo? Se lo recordaremos. Necesita ayuda para programar o para llegar a una cita? Le podemos ayudar. También le informaremos sobre eventos de salud en su área y le pondremos en contacto con las personas correctas para los servicios sociales como el asesoramiento y ayuda con alojamiento. Para más información comuníquese con nosotros al: (888)
9 Resumen de Beneficios, Año 2014 Mercado de Seguros Médicos de Molina WASHINGTON HEALTHPLANFINDER Plata MSW-100 Plata MSW-150 Plata MSW-200 Plata MSW-250 Oro MGW-001 Opciones 5 Deducible anual (individuo/familia) $50/$100 1 $100/$200 1 $1,400/$2,800 1 $1,700/$3,400 1 $200/$400 1 Deducible de medicamentos recetados (individuo/ familia) $10/$20 2 $30/$60 2 $30/$60 2 $200/$400 2 $40/$80 2 Gasto máximo de su bolsillo cada año (individuo/ familia) $2,250/$4,500 $2,250/$4,500 $5,200/$10,400 $6,350/$12,700 $6,350/$12,700 Beneficios Consultas 3 Cuidados de prevención Consultas prenatales Consultas de bienestar para niños Planificación familiar Cuidados primarios $3 copago $15 copago Ningún cobro $20 copago $30 copago $15 copago Cuidados especializados $8 copago $30 copago $50 copago $60 copago $45 copago Cuidados con otros médicos $8 copago $30 copago $50 copago $60 copago $45 copago Servicios de recuperación de las habilidades 5% coseguro 20% coseguro 30% coseguro 30% coseguro 20% coseguro Servicios de rehabilitación 5% coseguro 20% coseguro 30% coseguro 30% coseguro 20% coseguro Servicios de salud mental $8 copago $30 copago $50 copago $60 copago $45 copago Servicios de abuso de sustancias $8 copago $30 copago $50 copago $60 copago $45 copago Cuidado de Emergencia y Urgencia Sala de Emergencia 6 $100 copago $150 copago $250 copago $250 copago $250 copago Cuidados de urgencia $15 copago $30 copago $60 copago $75 copago $60 copago Servicios pediátricos para la vista 7 Examen de la vista Anteojos Lentes de contacto Medicamentos recetados Medicamentos genéricos $3 copago $8 copago Ningún cobro $10 copago $20 copago $15 copago Medicamentos de marca preferida $8 copago $20 copago $40 copago $55 copago $45 copago Medicamentos de marca no preferida 5% coseguro 20% coseguro 30% coseguro 30% coseguro 20% coseguro Medicamentos de especialidad 5% coseguro 20% coseguro 30% coseguro 30% coseguro 20% coseguro Servicios de atención médica ambulatoria en hospital/centro clínico Servicios de laboratorio $3 copago $15 copago $20 copago $30 copago $15 copago Servicios de radiología $8 copago $30 copago $50 copago $60 copago $45 copago Servicios especializados de imagenología (TC, RMF, PET) 5% coseguro 20% coseguro 30% coseguro 30% coseguro 20% coseguro Servicios médicos/quirúrgicos 5% coseguro 20% coseguro 30% coseguro 30% coseguro 20% coseguro Servicios de hospitalización Médico quirúrgico, cuidado de maternidad, salud mental, abuso de sustancias, centro de 5% coseguro 20% coseguro 30% coseguro 30% coseguro 20% coseguro enfermería especializada. Cuidados paliativos No Charge Servicios de transporte Transporte de emergencia Ambulancia $100 copago $150 copago $250 copago $250 copago $250 copago Transporte para citas médicas no de emergencia 4 $5 por viaje ida y vuelta Servicios de educación para la salud y el bienestar Línea de Consejos de Enfermeras 24 horas al día Programas para el control de peso Programa Motherhood Matters SM para servicios prenatales Programa de consejería para dejar de fumar 1. Se aplica sólo a pacientes ambulatorios en hospital/centros ambulatorios e internados en hospital/centro de servicios 2. Aplicable sólo a medicamentos de marcas no preferidas y medicamentos de especialidad 3. Algunos servicios profesionales ambulatorios no están enumerados, no se basan en el copago y requieren un costo compartido del coseguro $10 por viaje ida y vuelta $10 por viaje ida y vuelta Ningún cobro $10 por viaje ida y vuelta $10 por viaje ida y vuelta 4. Los servicios de transporte médico que no son de emergencia se limitan a cuatro (4) viajes de ida y vuelta por mes 5. Ciertos beneficios requieren una autorización previa antes de obtener los servicios 6. Este costo no se aplica si es internado en el hospital, para servicios de hospitalización (consulte la sección Servicios de hospitalización para ver sus costos compartidos) 7. Aplicable a los niños dependientes hasta los 18 años de edad Este Resumen de Beneficios, Año 2014 es un compendio de los beneficios de cobertura y señala algunas de las opciones de nuestro plan, pero no enumera o describe todos los beneficios cubiertos bajo un producto específico ni cada limitación o exclusión. Por favor, consulte el Contrato y la Evidencia de Cobertura y Divulgación Combinada de Molina Healthcare of Washington, Inc., para una descripción detallada de los beneficios, exclusiones y limitaciones HIM0913WA
10 WASHINGTON HEALTHPLANFINDER Hemos sido parte de su comunidad durante más de 30 años. Ahora, le invitamos a que se una a nuestra familia. Llámenos gratis al (888) HIM0913WA Productos ofrecidos por Molina Healthcare of Washington, Inc., una filial propiedad de Molina Healthcare, Inc. Esta es una solicitud de seguros y un agente pudiese comunicarse con usted. MP 0100 Approval: 9/19/13
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