New York’s only CO-OP.

• Consumer Operated and Oriented Plan

• 501(c)29 non-profit organization, a signature program of the Affordable Care Act

• Over half our board are enrollees, elected by enrollees

• Monitored and audited by state and federal government

• Profits are mandated to go toward lowering premiums and improving benefits

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Our focus is where is should be

— on our members.

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Our regulatory oversight.

• Certificate of authority under article 43 of the New York State Insurance Law

• Certified as a Qualified Health Plan on the New York State Health Benefit Exchange for 2014 and 2015

• Contracts with U.S. Center for Consumer Information and Insurance Oversight — stipulates how we operate and how funds are used

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Our partners. NetworkMagnaCare ExtraAdditional PCMH-certified FQHCs and ACOsMore than 70,000 providers

Medical and Claims ManagementThe POMCO Group (URAC Accredited)Based in Syracuse, NY

Pharmacy Benefits ManagerUS Script (URAC Accredited)

Billing and EnrollmentMorneau-Shepell

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The Counties we Serve. Albany OntarioBronx OrangeChautauqua OrleansColumbia PutnamDelaware QueensDutchess RensselaerErie RocklandEssex SaratogaGreene SchenectadyHamilton Staten IslandKings SuffolkManhattan SullivanMonroe UlsterNassau WarrenNiagara WashingtonOnondaga Westchester

Our products.

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• All products meet or exceed requirements for Essential Health Benefits under the Affordable Care Act and New York State

• All preventive services recommended by the U.S. Preventive Services Task Force are available at no charge

• The drug formulary includes at least two choices in every category, as required in the Essential Health Benefits package

PrimarySelectBenefit Design Highlights

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PrimarySelect.Our Signature Programs

• Builds a beneficial, proactive relationship between each member and his/her preferred providers

PLUS

Removes barriers of access for important treatments

• $0 co-pays for primary physician visits, and selected mental health and diabetes support services

• Reduction of co-insurance to improve access to care

• Back-end deductible for Platinum, Gold and Silver metal tiers; co-pays for physician visits applied to deductible

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Deductibles and Maximums Platinum Silver

• Deductible (Single) $0 $2000

• Max Out of Pocket Limit (Single) $1400 $6350

• Cost Sharing (Co-Insurance) 20% 20%

Cost Sharing-Medical Services Platinum Silver

• Inpatient/SNF/Hospice-Facility (per admission)

Coinsurance after Deductible is Met

• Physician/Surgeon Fee (Inpatient)- (Co-Pay after Deductible)

$100 $100

• Outpatient Facility Coinsurance after Deductible is Met

• Surgeon (Outpatient) Coinsurance after Deductible is Met

• Primary Care (Member selected) $0 $0

• Other Primary Care $15 $30

• Specialist $75 $75

• PT/OT/ST $30 $30

• ER (Co-Pay after Deductible) $250 $250

• Ambulance (Co-Pay after Deductible) $100 $150

• Urgent Care (Co-Pay after Deductible) $100 $100

PRIMARYSELECT

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Outpatient Services Platinum Silver

• Diagnostic and Routine Lab and Pathology

$75 $75

• Diagnostic and Routine Imaging $75 $75

Mental/Behavioral Healthcare (Selected)

$0 $0

Diabetic Care and Supplies $0 $0

• Chemotherapy $15 $30

• Radiation Therapy $15 $30

• Dialysis $15 $30

• Home Health Care $15 $30

Prescription Drugs Platinum Silver

Tier 1 (Selected Generics) $0 $0

• Tier II (Other Generics)-After Deductible $35 $35

• Tier III (Brand and Specialty)- After Deductible

$70 $70

PRIMARYSELECT

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Enhanced member support.

Discounted access to:

• Fitness centers throughout the state

• 40 different types of complementary and alternative providers, including nutritionists, massage therapists, and mind-body practitioners

Patient support program:

• Wellness Navigators to help link members to well-matched providers and community resources

• Reminders, notifications and alerts for both preventive and chronic care needs

• Linkage to case management for high-risk members

CompetitiveAdvantage

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Image FPO

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Our niche.We are focused on the small business market that has not received sufficient attention from health insurers.

• 9 plans statewide serving small groups on the New York Exchange

• Consumer Operated and Oriented (CO-OP) Plan

• Members vote for Board and make decisions

• Reasonable administrative expenses

• Right-sized, resourceful organization

• Benefits decrease barriers and increase access to care

• Primary physician relationship encouraged

Members represent members.