Health Insurance Information Update 2015 Presented by Contracted

Health Insurance Information Update 2015 Presented by:

Contracted Health Plans Medicare -Brand New Day -Central Health -Easy Choice -SCAN -Caremore -Health Net -United Health Care -Anthem Blue Cross -Blue Shield of CA -Care 1 st -Citizens Choice Covered CA Exchange Individual -Anthem Blue Cross -Blue Shield -Health Net -Molina -L. A. Care -Kaiser OFF Exchange Individual - Anthem Blue Cross Blue Shield Aetna Cigna Humana Golden Rule Assurant Kaiser United Health Care SHOP Plans (Small Health Options Program) - Health Net SHARP Kaiser Blue Shield Group Plans (Small Health Options Program) - Health Net SHARP Anthem Blue Cross Blue Shield Cigna Aetna See. Change Health United Health Care Kaiser Blue Shield

Covered California The Affordable Care Act, also known as Obamacare, aims to improve the health of Californians by increasing access to health care services. These include free preventive screenings and affordable options for quality health care for you and your family through the Covered California health insurance marketplace and the expansion of the Medi-Cal program. Who is Eligible? - U. S. Citizens and persons lawfully present in California with income above 138% of the federal poverty level ($15, 856 for and individual. ) - Financial assistance in the form of tax credits and discounts on monthly premiums will be available to persons whose incomes are up to 400% of the federal poverty level, or $94, 200 for a family of four.

Medicare Utilization *The Average Medicare Member • sees a Primary Care • sees a Specialist 10. 0 6. 85 3. 15 times a year The Average Medicare Payment = $65 per visit 65 x 6. 85 = $445. 25 /12 (months) = ** $37. 09 pm/pm * Utilization per / 1000 ** Without a copay

Competitive Capitation Payment for all covered services for which Primary Care Physician is the responsible party, under each participating Health Plan, shall be made at a fixed capitation rate according to the following schedule: Medicare Advantage Enrollees • $120. 00 pm/pm on Avg. Medi-Medi Enrollees - When Enrollee is assigned to the same PCP & IPA for both product lines • $150 pm/pm on Avg. Medi-Medi Enrollees - When Enrollee is NOT assigned to the same PCP & IPA for both product lines • Will revert to appropriate Medicare Advantage or Medi-Cal Only Compensation

Maverick Medical Group Senior Enrollment $200 Bonus! • 50 Seniors Enrolled to Qualify • Must stay effective for 6 Months • Annual Health Assessment Form 1500 MUST be completed 100 Enrollments X $200 = $20, 000 *Paid at 20 Member Increments

PRO FORMA SHEET Based on Medicare & Medi-Medi Conversion Enrollment IPA Conversion Maverick Bonus 100 x $200 = $20, 000. 00 Medicare 50 x $120 pm pm = $6, 000. 00 x 12 (months) = $72, 000. 00 Medi-Medi 50 x $150 pm pm = $7500. 00 x 12 (months) = $90, 000. 00 Fee for Service (Medicare) 50 x $ 37. 09 pmpm = $ 1, 854. 50 x 12 (months) = $22, 254. 00

Cal Medi-Connect A Cal Medi. Connect plan is a Medicare/Medi-Cal plan that will manage your Medicare and Medi-Cal benefits. Enrolling in a Cal Medi. Connect plan means that you keep your Medicare and Medi-Cal benefits with no extra cost but you must use your Cal Medi. Connect providers. You can also get additional transportation and vision benefits. The Cal Medi-Connect program aims to improve care coordination for dual eligible beneficiaries and drive high quality care that helps people stay health and in their homes for as long as possible. Additionally, shifting services out of institutional settings and into the home and community will help create a person-centered health care system that is also sustainable.

Cal Medi. Connect Plans Los Angeles County Health Net Molina Health Plan L. A. Care Anthem Blue Cross Care 1 st Kaiser Permanente

Is your practice generating the income you want? Become one of the many physicians that have maximized their income and grown their practice. We offer all the things you need to INCREASE the financial performance of your practice, including: • High capitation rates – some of the best in the market. • Managed care program • Membership retention program • Marketing that drives patients to your office • Ensure compliance with strict adherence to HIPAA & CMS rules & regulations. Federal & State guidelines & disenrollment follow up.

Physician and Medical Group Establish Patient Base Increase Generate Significant Revenue and Income