How to enroll in the Health Insurance Marketplace online:
1. Go to HealthCare.gov, click “Apply now,” and choose the state you reside in.
2. Create an account. You'll create a username (can be your email address), password, and three security
questions.
3. Open your email. There should be an email from the Health Insurance Marketplace with the subject
“Marketplace Account Created.” Click the long link in this email to confirm your account.
4. Log in at healthcare.gov. Click the words “Apply and shop for coverage for me and/or my family” in the white
box.
5. The first step is to verify your identity. Fill out the rest of your personal information and answer the questions,
which are generated from your credit report.
6. Next, fill out information on everyone applying for health insurance, and everyone in your tax household. To
qualify for tax credits, you must file taxes in 2014, and you must file jointly with your spouse. If you are in the
process of getting a divorce, plan to file jointly, then update the Marketplace when the divorce is finalized to
change your status.
7. In the income section, answer the questions based on each household member's expected income for 2014. If
you don't know what will happen, base it on your current situation and update the Marketplace later in the year
if your income situation changes.
8. At the “review your application” screen, print or save your application – you will not be able to see it once it has
been submitted. If you need to change anything, be aware that you will need to go through the questions again
from that point forward.
9. Sign your application by typing your name.
10. Your eligibility notification will be a PDF that will open in a separate window. It will tell you what tax credits you
are eligible for, if any, and whether you need to do anything to finalize your application, such as sending in
income or identity verification information.
11. On the next screen, click the green “set” buttons in order. You will decide how you will use your premium,
answer a question about your tobacco habits, and decide whether all family members will choose the same or
different plans. Then you can choose a health plan.
12. To choose a health plan, decide what level plans you want to look at. Be aware that depending on your income
you may be offered Silver plans that have lower deductibles than Gold plans. If you need more information on
benefits, you can click on “summary of benefits” (note that for lower deductible Silver plans these will not be
correct), or (in New Hampshire) go to Anthem.com to see their descriptions of the plans, using their quote tool
on the homepage. You can also call them at 1-888-557-8432, or chat with a representative on their website by
starting to use the quote tool and clicking “Live chat” at the top.
13. Once you have finalized your enrollment online, pay your first month's premium. Click the link on the final
screen to pay online or print out a page to mail in with the first payment.
14. If your income changes during the year, or you have another qualifying life event, log in to your account to report
it. Click on your application and then on “Report a life change.”
How to enroll in the Health Insurance Marketplace over the phone:
1. Make sure you have these pieces of information at hand:
1. Social security number and date of birth for every person applying
2. Expected 2014 income for each member of the household, based on past taxes, W2s, paystubs, or your own
calculations.
3. Information on employer coverage offered to any person applying for health insurance, including what it
would cost to insure that person.
2. Call 1-800-318-2596 and answer the questions the representative asks.
3. When you get to the point of choosing a plan, if you have access to the internet you can go to HealthCare.gov
and click “See plans before I apply” or go to Anthem.com to follow along with the representative's plan
descriptions.
4. Before you hang up, make sure you write down your application number, the name of the plan you've chosen,
the cost of the plan, and the plan's start date.
MY HEALTH INSURANCE MARKETPLACE INFORMATION
To access the Marketplace, go to HealthCare.gov or call 1-800-318-2596.
You can use the call center to update your account even if you applied online, and vice versa.
My HealthCare.gov username:___________________________________________________
My HealthCare.gov password:___________________________________________________
Security question 1 answer:_____________________________________________________
Security question 2 answer:_____________________________________________________
Security question 3 answer:_____________________________________________________
Security question 4 answer (only on some applications):_______________________________
To access my email, I go to this website:____________________________________________
Email address:________________________________________________________________
Password:___________________________________________________________________
Application #:_________________________________________________________________
Income calculations for 2014:
List total expected income for each income source for each household member, with any calculations
Update your account if income or household members change
MY HEALTH INSURANCE PLAN INFORMATION
Anthem’s customer service number for New Hampshire Marketplace plans: 1-855-748-1804
Plan name:__________________________________________________________________
Monthly premium after tax credit:___________
Plan start date (effective date):___________
Deductible:________________
Co-insurance (after deductible is reached):________________
Out-of-pocket limit:________________
Office visit co-payment:______________________
Urgent care center (walk-in clinic) co-payment (in addition to billed amount):__________
Emergency room co-payment (in addition to billed amount):____________
Things to know about Anthem's New Hampshire Marketplace plans:
•
•
•
•
•
All preventive care is free on all plans – this includes but is not limited to yearly check-ups,
immunizations, and typical screenings for preventive purposes (not diagnostic).
You do not need to choose a PCP or get referrals, but make sure your providers are in the network.
Each family member uses his or her deductible and out-of-pocket limit separately.
Emergency room, urgent care, and hospitalization co-payments are in addition to money spent towards
deductible; the deductible does not apply to office visit and prescription drug co-payments.
Call Anthem ahead of time before a planned large medical expense, such as surgery or an MRI, to make
sure it is covered and that the provider you are using is in-network.
Next steps to take:
• Pay your first month’s premium. Your enrollment isn’t finalized until you do this. If
you're not sure how to pay and haven't received anything in the mail from the insurance
company within a few weeks of enrollment, call the customer service number listed on
your enrollment confirmation at HealthCare.gov.
• Get your membership card. The insurance company should send this to you, but if it's
been more than a few weeks since you paid your premium and you still haven't received
it, call their customer service number and make sure that you're in their system and they
have your mailing address.
• Make sure you understand how your plan works. If you're not sure, review the plan
details on your HealthCare.gov account, read the benefits package your insurance
company sent, look on the insurance company website, or call them for clarification.
• Find a primary care provider and make appointments for a new patient visit and a
check-up! Your annual physical and any preventive screenings and immunizations should
be covered by your insurance at no cost to you.
The New Hampshire
Health Insurance Marketplace
New, affordable health coverage choices
Enrollment deadline: March 31, 2014
5 things you should know about health care reform
Your coverage is guaranteed. You can’t be turned down
because of your age, gender, pre-existing condition, or other health status
 that
may have made it hard to get coverage before.

You will probably qualify for financial help.
You could
receive tax credits and subsidies that can reduce the amount you pay for
insurance and health care services.
You get preventive care with $0 out-of-pocket costs.
every new plan, you get nationally recommended, covered
 With
preventive care at no out-of-pocket cost to you – no copay, no deductible.
You have choices.
You can select from a range of private plans to fit
 your needs and budget.
If you don’t have a health plan in 2014, you may pay
 a penalty. The penalty in 2014 is 1% of your household income.
Find out more and enroll at
HealthCare.gov or 1-800-318-2596
Questions? Need help? Free assistance is available:
White Mountain Community Health Center in Conway (603) 447-8900
ServiceLink in Tamworth (603) 323-2043
Memorial Hospital in North Conway (603) 356-5461 x2220
Do I qualify for financial assistance?
To learn if you qualify for lower costs on health coverage through the Marketplace, find your
estimated 2014 household income and household size on the chart below. To calculate your
estimated 2014 income, base your estimate on the income you filed on your taxes last year, or on
the income you plan on filing on your taxes this year. To calculate your household size, include
yourself, your spouse, your children who live with you, and anyone you include on your tax return
as a dependent. Do not include people like roommates who are not included on your taxes.
My income is below the ranges on the chart. What does that mean for me?
The New Hampshire state legislature is in the process of expanding Medicaid, which will cover
everyone who makes up to 138% of the federal poverty level. Until Medicaid expansion is in
place, however, people whose incomes are below the range on this chart and who do not already
qualify for Medicaid are not eligible for financial assistance to purchase health insurance.
1. Apply for Marketplace insurance to make sure you really do fall below the cut-off.
2. Watch the news for updates on Medicaid expansion.
3. Apply for Medicaid – the enrollment period is expected to run through May and June, and
once you’ve enrolled, you may be able to start using Medicaid as early as July 1.
In the meantime, you can get affordable health care at White Mountain Community Health Center
through our sliding fee scale. You can continue as our patient once you get Medicaid or health
insurance. Call 447-8900 to learn more.
White Mountain Community Health Center
298 White Mountain Highway (Route 16) • Conway, NH 03818 • (603) 447-8900
Get Covered: A One-Page Guide to the
Health Insurance Marketplace
Here’s a quick look at the most important things to know about the Health Insurance Marketplace.
• The Marketplace helps uninsured people find health coverage.
• When you fill out the Marketplace application we’ll tell you if you qualify for:
– Private insurance plans. We’ll tell you whether you qualify for lower costs based on your
household size and income. If you don’t qualify for lower costs, you can still use the
Marketplace to buy insurance at the standard price. Plans cover essential health benefits,
pre-existing conditions, and preventive care.
– Medicaid and the Children’s Health Insurance Program (CHIP). These programs provide
coverage to millions of families with limited income. If it looks like you qualify, we’ll share
information with your state agency and they’ll contact you. Many but not all states are
expanding Medicaid in 2014 to cover more people.
• No matter what state you live in, you can use the Marketplace. Some states operate their own
Marketplace. In some states, the Marketplace is run by the Federal government.
• Most people must have health coverage in 2014 or pay a fee. If you don’t have coverage in 2014,
you’ll have to pay a penalty of $95 per adult, $47.50 per child, or 1% of your income (whichever
is higher). The fee increases every year. Some people may qualify for an exemption from this fee.
• You’re considered covered if you have Medicare, Medicaid, CHIP, any job-based plan, any
plan you bought yourself, COBRA, retiree coverage, TRICARE, VA health coverage, or some
other kinds of health coverage.
• If you’re eligible for job-based insurance, you can consider switching to a Marketplace plan.
But you won’t qualify for lower costs based on your income unless the job-based insurance
is unaffordable or doesn’t meet minimum requirements. You also may lose any contribution
your employer makes to your premiums.
• Marketplace open enrollment for 2014 ends March 31, 2014. If you missed the deadline,
the next open enrollment will begin in the fall of 2014, but the exact dates are still being
decided.
• If you have a qualifying life event (like moving to a new state, getting married, having a child,
or losing health coverage), you can get a special enrollment period. This means you can
enroll in or change your plan outside open enrollment.
• Ready to apply and enroll, or have questions?
–Visit HealthCare.gov
– Call the Health Insurance Marketplace call center at 1-800-318-2596, 24 hours a day,
7 days a week. TTY users should call 1-855-889-4325.
CMS Product No. 11749
Revised February 2014
Facts about the Premium Tax Credit
Your Credit, Your Choice –
GeT IT Now or GeT IT LaTeR
Need help paying for health insurance premiums?
If you get your health insurance coverage through the Health Insurance Marketplace, you may be eligible for the premium
tax credit. This tax credit can help make purchasing health insurance coverage more affordable for people with moderate
incomes. The open enrollment period to purchase health insurance coverage through the Marketplace for 2014 runs from
October 1, 2013 through March 31, 2014.
The Department of Health and Human Services administers the requirements for the Marketplace and the health plans they
offer. For more information about your coverage options, financial assistance and the Marketplace, visit HealthCare.gov.
The Premium Tax Credit
Eligibility
You may be eligible for the credit if you meet all of the following:
• buy health insurance through the Marketplace;
• are ineligible for coverage through an employer or government plan;
• are within certain income limits;
• file a joint return, if married; and
• cannot be claimed as a dependent by another person.
It’s your choice
If you are eligible for the credit, you can choose to:
• Get It Now: have some or all of the estimated credit paid in advance directly to your insurance company to lower what
you pay out-of-pocket for your monthly premiums during 2014; or
• Get It Later: wait to get the credit when you file your 2014 tax return in 2015.
Report changes in circumstances
If you receive advance payment of the premium tax credit to help pay for your insurance premiums, you should report
changes such as income or family size to your marketplace when they happen in 2014. Reporting changes will make sure
you get the correct amount of the advanced credit. Receiving too much or too little in advance can affect your refund or
balance due when you file your 2014 tax return in 2015.
Claim the credit
Whether you choose to get the credit now or later, you must claim it by filing a federal income tax return.
When you file your 2014 tax return in 2015, you will subtract the total of any advance payments you received during the year
from the amount of the premium tax credit calculated on your tax return. This may affect your tax refund or balance due. If you
are entitled to more credit than you have already received; this will either increase your refund or lower your balance due.
Find out more about more about the premium tax credit at www.IRS.gov/aca
Publication 5120 (9-2013) Catalog Number 65487X Department of the Treasury Internal Revenue Service www.irs.gov
Take care of yourself
Remember to get preventive care
Getting regular checkups and exams can help you stay well and catch problems early. It may even save your life.
Our health plans cover 100% payment of the services listed in this preventive care flier.1 When you get these services
from doctors in your plan’s network, you don’t have to pay anything out of your own pocket. You may have to pay part of
the costs if you use a doctor outside the network.
Preventive versus diagnostic care
What’s the difference? Preventive care helps protect you from getting sick. Diagnostic care is used to find the
cause of existing illnesses.
For example, say your doctor suggests you have a colonoscopy because of your age when you have no symptoms. That’s
preventive care. On the other hand, say you have symptoms and your doctor suggests a colonoscopy to see what’s
causing them. That’s diagnostic care.
Here’s a listing of the types of preventive services we cover. See your benefit plan to learn more.
Child preventive care (birth through 18 years, unless otherwise noted)
Preventive care physical exams are covered. So are the screenings, tests and vaccines listed here. The preventive care
services listed below may not be right for every person. Ask your doctor what’s right for you.
Preventive physical exams
}}
Oral (dental health) assessment when done as part of a
preventive care visit
}}
Screening and counseling for sexually transmitted infections
}}
Vision screening 2 when done as part of a preventive care visit
Screening tests (depending on your age) may include
}}
Behavioral screening and counseling to promote
a healthy diet
}}
Blood pressure
}}
Cervical dysplasia screening
}}
Cholesterol and lipid level
}}
Depression screening
}}
Development and behavior screening
}}
Immunizations
}}
Diphtheria, tetanus and pertussis (whooping cough)
}}
Haemophilus influenza type b (Hib)
Type 2 diabetes screening
}}
Hepatitis A
Fluoride supplements for children from birth through
6 years old6
}}
Hepatitis B
}}
Human papillomavirus (HPV)
}}
Hearing screening
}}
Influenza (flu)
}}
Height, weight and body mass index (BMI)
}}
Measles, mumps and rubella (MMR)
}}
Hemoglobin or hematocrit (blood count)
}}
Meningococcal (meningitis)
}}
HPV screening (female)
}}
Pneumococcal (pneumonia)
}}
Iron supplements for children 0-12 months6
}}
Polio
}}
Lead testing
}}
Newborn screening
Rotavirus
}}
}}
Varicella (chicken pox)
}}
}}
Screening and counseling for obesity
16135ANMENABS Rev. 08/13
Adult preventive care (19 years and older, unless otherwise noted)
Preventive care physical exams are covered. So are the screenings, tests and vaccines listed here. The preventive care
services listed below may not be right for every person. Ask your doctor what’s right for you.
——Counseling related to chemoprevention for women with
Preventive physical exams
Screening tests and services (depending on your age)
may include
a high risk of breast cancer
——Folic acid for women 55 years old or younger6
}}
Aortic aneurysm screening (men who have smoked)
——Primary care intervention to promote breastfeeding3,4
}}
Blood pressure
——Screening and behavioral counseling related to
}}
Bone density test to screen for osteoporosis
}}
Breast cancer, including exam and mammogram
}}
Breastfeeding support, supplies and counseling (female)3,4
}}
Cholesterol and lipid (fat) level
}}
Colorectal cancer, including fecal occult blood test, barium
enema, flexible sigmoidoscopy, screening colonoscopy and
CT colonography (as appropriate)
}}
Contraceptive (birth control) counseling, FDA-approved
contraceptive medical services provided by a doctor, including
sterilization (female), and FDA-approved prescribed or women’s
over-the-counter contraceptives4, 5
alcohol misuse
——Screening and behavioral counseling related to tobacco
use including tobacco cessation products8
——Screening and counseling for interpersonal and
domestic violence
——Screening and counseling for obesity
——Vitamin D for women over 656
}}
Pelvic exam and Pap test, including screening for cervical cancer
}}
Prostate cancer, including digital rectal exam and PSA test
}}
Screenings during pregnancy (including, but not limited
to, gestational diabetes, hepatitis, asymptomatic bacteriuria,
Rh incompatibility, syphilis, iron deficiency anemia, gonorrhea,
chlamydia and HIV)4
}}
Screening and counseling for sexually transmitted infections
}}
Depression screening
}}
Type 2 diabetes screening
}}
Eye chart test for vision2
}}
Hearing screening
}}
Height, weight and BMI
}}
HIV screening and counseling
}}
Diphtheria, tetanus and pertussis (whooping cough)
}}
HPV screening (female)4
}}
Hepatitis A
}}
Intervention services (includes counseling and education):
}}
Hepatitis B
——Behavioral counseling to promote a healthy diet
}}
HPV
——Counseling related to aspirin use for the prevention
}}
Influenza (flu)
}}
Meningococcal (meningitis)
}}
MMR
}}
Pneumococcal (pneumonia)
}}
Varicella (chicken pox)
}}
Zoster (shingles)
of cardiovascular disease including aspirin for men ages
45-79 and women ages 55-796
——Counseling related to genetic testing for women with a
family history of ovarian or breast cancer, including genetic
testing for BRCA 1 and BRCA 2 when certain criteria are met7
Immunizations
This sheet is not a contract or policy with Anthem Blue Cross and Blue Shield. If there is any difference between this sheet and the group policy, the provisions of the group policy will govern. Please see your
combined Evidence of Coverage and Disclosure Form or Certificate for Exclusions & Limitations.
1 The range of preventive care services covered at no cost share when provided in-network are designed to meet the requirements of federal and state law. The Department of Health and Human Services has
defined the preventive services to be covered under federal law with no cost-share as those services described in the U.S. Preventive Services Task Force A and B recommendations, the Advisory Committee on
Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and certain guidelines for infants, children, adolescents and women supported by the Health Resources and Services
Administration (HRSA) Guidelines. You may have additional coverage under your insurance policy. To learn more about what your plan covers, see your certificate of coverage or call the Customer Care number
on your ID card.
2 Some plans cover additional vision services. Please see your contract or Certificate of Coverage for details.
3 Breast pumps and supplies must be purchased from an in-network medical provider for 100% coverage; we recommend using an in-network durable medical equipment (DME) supplier.
4 This benefit also applies to those younger than 19.
5 To get 100% coverage for birth control, you must present a prescription at an in-network pharmacy for a generic drug, a brand-name drug that doesn’t have a generic equivalent, or an OTC item like female
condoms or spermicide. A cost-share may apply for other prescription contraceptives, based on your drug benefits.
6 To get 100% coverage, you will need to present a prescription from a doctor or other health care provider at an in-network pharmacy.
7 Check your medical policy for details.
8 For those 18 years and older. 100% coverage of tobacco cessation products requires a prescription from a doctor that must be presented at an in-network pharmacy. Coverage is provided for select generic
products, brand-name products with no generic alternatives, and FDA-approved over-the-counter products.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado and Nevada: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of
Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area):
RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits
underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In
Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of
Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance
Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue
Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.