Covered CaliforniaTM KWCakmµviFIbegIáteLIgedayrdækalIh½Vrj:a EdlGac[GñkeRbob

eFob nigTijKeRmagFanar:ab;rgsuxPaBÉkCn nigTTYl)anCMnYyhirBaØvtßúedIm,Ibg;éfø;

Fanar:ab;rgsuxPaB ebIGñkmanKuNsm,tþi;.

karENnaMenHnwgCYyGñkyl;dwgkan;Etc,as;GMBICeRmIsrbs;Gñk

nigcuHeQµaHkñúgKeRmagsuxPaBEdls½kþismnwgtRmUvkarrbs;GñkbMput.

BinitüemIlfaetIelakGñkGacmansiT§iTTYl)anCMnYyhirBaØvtßúb¤y:agNa³

CMhanTI 1:GñkGacTTYl)anCMnYykñúgkarbg;éfø;Fanar:ab;rgsuxPaBebIGñkmanKuNsm,tþi

karmanFanar:ab;rgsuxPaBFanaCUnGñknUvPaBs¶b;suxpøÚvcitþ RbsinebImanGVIEdlminrMBwgTukekIteLIg b:uEnþeyIgPaKeRcInRBYy

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R)ak;cMNUlrbs;Gñkkan;EtTabGñkGacTTYl)annUvCMnYyhirBaØvtßúkan;EteRcInBI Covered California .

ebIGñkminmanKuNsm,tTTYl)anCMnYyhirBaØvtßúeT Gñkk¾GaccuHeQµaHkñúgKeRmag;Fanar:ab;rgsuxPaBtamry³ Covered California.

sUmemIltaragxageRkamb¤cUleTA Shop and Compare Tool enA CoveredCA.com edIm,IEsVgyl;faetIKeRmag

rbs;GñkGaccMNayb:unµan nigedIm,IsikSafaetIGñkmanKuNsm,tþiTTYl)ansRmab;CMnYyhirBaØvtßú b¤ Medi-Cal b¤y:agna.

sRmab;karFanar:ab;rg

Edlcab;epþImenAéf¶TI

1 Exmkra qñaM 2016

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1

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elakGñkGacmansiT§iTTYl)an Medi-Cal

1

3

5

2

4

$16,243

$27,725

$39,206

$16,243 – $47,080

$27,725 – $80,360

$39,206 – $113,640

$21,984

$33,466

$21,984 – $63,720

$33,466 – $ 97,000

elakGñkGacmansiT§iTTYl)anCMnYy hirBaØvtßú edIm,ITijFanara:b;rgtamry³ Covered California

karENnaMGMBImYyCMhanmþg

karcuHeQµaHkñúgKeRmagFanar:ab;rg suxPaBEdlmanKuNPaB

(smÁal;³ {Shop and Compare Tool}manCaPasa Gg;eKøs)

NOV JAN

311

បœ œក%រចុះ *+, ះ-. ក/ុង ខែ វិច5ិ%ថ7ៃ ទ ី1 ខែ មក< =>ំ2015  31,  2016.

2

karcuHeQµaHkñúgKeRmagFanar:ab;rgsuxPaBEdlmanKuNPaB

CMhanTI 2: EsVgrkCeRmIsFanar:ab;rgrbs;Gñk.Covered Californiapþl;CUnnUvKeRmagsuxPaBCaeRcIn dUecñHGñkGaceRCIserIsKeRmagmYyEdlbMeBjnUv tRmUvkarsuxPaB nigfvikarbs;Gñk)anl¥bMput.

munnwgGñkeRCIserIsKeRmagsuxPaBrbs;Gñk sUmBicarNaktþaTaMgenH³etIkarFanar:ab;rgkRmitNaEdlGñk nigRKYsarGñkRtUvkar? Covered Californiapþl;CUnnUvKeRmagsuxPaBCa eRcInsRmab;eRCIserIs Ep¥kelIsßanPaBsuxPaB nighirBaØvtßúTaMgmUlrbs;Gñk. enHKWCaGVIEdlGñkKYrBicarNa enAeBlGñkeRCIserIsKeRmagmYy³

• kRmiténkarFanar:ab;rg³• eRCIserIs Platinum b¤ Gold…RbsinebIGñknwgRtUvkarkarEfTaMeRcIn. KeRmagTaMgenHmanéfø

Fanar:ab;rgRbcaMExx<s; dUecñH eBlGñkRtUvkaresvaevC¢sa®sþ GñkGacbg;R)ak; kan;Ettic.• eRCIserIs Silver b¤ Bronze…RbsinebIGñkmansuxPaBl¥ nigminRtUvkarkarEfTaMeRcInenaHeT.

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• KeRmagFanar:ab;rgGb,brma k¾manCUnGñkmanGayuticCag 30 qñaM b¤GñkEdlGacbBa¢ak;faBYkeKkMBugCYbkarlM)ak. KeRmagTaMgenHmanéføTijFanar:ab;rgRbcaMExTab nigkarBarBIkrNIesNarIyUGaRkk; .GñkminGaceRbICMnYyhirBaØvtßúedIm,ICYybg;KeRmagFanar:ab;rgGb,brmaeT.

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taragmin)anbBa©ÚlRKb;GRtashFanar:ab;rg nigtémørYmcMENk eBleTAeBTümþgTaMgGs;eT. sRmab;B½t’maneBjeljsUm cUleTA www.CoveredCA.com* sRmab;KeRmag BronzetémøRtUvbg;RbcaMqñaM muneBlFanar:ab;rgbg;[RtUv)anelIkElgsRmab;CMnYbEfTaMbzmcMnYnbIdgdMbUg. CMnYbbEnßmRtUvKitéføRKb;cMnYndl;bg;RKb;témøRtUvbg;RbcaMqñaM muneBlFanar:ab;rgbg;[.** SilverKWCakRmitEtmYyKt; EdltémøRtUvbg;RbcaMqñaM muneBlFanar:ab;rgbg;[rbs;Gñk nigcMNayepSgeTotGacmancMnYnTab Ep¥kelIR)ak;cMNUlkñúgRKYsarrbs;Gñk .

sþg;darplRbeyaCn_énkarFanar:ab;rgtamkRmit

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*témørYmcMENk eBleTAeBTümþg² sRmab;karEfTaMbnÞan;

témørYmcMENk eBleTAeBTümþg² sRmab;fñaM Generic

cMNayecjBIehae):AGtibrmaRbcaM qñaMsRmab;RKYsar **

témørYmcMENkeBleTACYbBinitü EfTaMsuxPaBbzm

témørYmcMENkeBleTAeBTümþg² sRmab;bnÞb;seRgÁaHbnÞan;

cMNayecjBIehae):AGtibrma RbcaMqñaMsRmab;mnusSmñak;

$2,250**

$45

$90

$250

$6,250

$12,500 $8,000

KµantémøRtUvbg;RbcaMqñaMeT

$20

$40

$150

$4,000

KµantémøRtUvbg;RbcaMqñaMeT

$35

$60

$250

$6,200

$12,400

Bronze Fanar:ab;rg 60%éncMNay®bcaMqñaM

Silver Fanar:ab;rg 70%éncMNay®bcaMqñaM

Gold Fanar:ab;rg 80%éncMNay®bcaMqñaM

Platinum Fanar:ab;rg 90%éncMNay®bcaMqñaM

$6,000

$70

$120

$15 $15 $5

$6,500

$13,000

ebIGñkmanKuNsm,tþiTTYl)an Medi-Cal:Medi-Cal KWCakmµviFIFanar:ab;rg suxPaB saFarN³Edl beRmIBl rdæénrdækalIhV½rj:aEdlmanR)ak; cMNUlTab.

RbsinebIGñkmanKuNsm,tþisUm cUleTA CoveredCA.comb¤kariyal½yesvakmµsgÁmkic©enA kñúgtMbn;rbs;Gñk edIm,Idak;BaküsMu. Gñkk¾GaceFVIkarCamYyGñkRbwkSakar cuHeQµaH b¤Pñak;gar EdlmanTTYl sÁal;eday Covered California edIm,ITTYl)anCMnYycuHeQµaHkñúg Medi-Cal.

sRmab;karBnül;eBjeljGMBIkRmitepSg²énkarFanar:ab;rgnigedIm,IEsVgrkCeRmIsrbs;Gñk sUmcUleTA www.CoveredCA.com.

karENnaMGMBImYyCMhanmþg

Full cost up todeductibleFull cost up to$500 deductible

etImanbNþajGñkpþl;esvaGVIxøHkñúgtMbn;rbs;Gñk? Covered California Gac[GñkeRCIserIs nigTijKeRmag

Fanar:ab;rgÉkCnBIGñkpþl;esvaEfTaMsuxPaBEdlGaceCOTukcitþ)an. xN³EdlRkumh‘unFanar:ab;rgTaMg

Gs;pþl;CUnkRmiténkarFanar:ab;rgdUcKña BYkeKpþl;CUnRbePTKeRmag nig bNþajGñkpþl;esvaEfTaMepSgBIKña

(RKUeBTü nigmnÞIreBTükñúgtMbn;rbs;GñkEdlTTYlyknUvkarFanar:ab;rgrbs;Gñk). RbsinebIGñkcg;bnþCYbRKUeBTü

bc©úb,nñrbs;Gñk sUmEsVgrkfaetIKeRmagmYyNaEdlbBa©ÚlRKUeBTüenaHCasmaCikkñúgbNþajrbs;BYkeK.

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(EPOs). RbePTKeRmagTaMgenHkMNt;BIRKUeBTü nigmnÞIreBTüEdlGñkGaceTACYb)an nigBIrebobEdlGñkeRbIR)as;esva

suxPaBmYycMnYn.

• HMOs Fanara:b;rgEtkareTACYbRKUeBTü nigmnÞIreBTükñúgbNþajrbs;KeRmagb:ueNÑaH.

HMOs CaerOy²tRmUv[smaCikTTYl)ansMbuRtbBa¢ÚnBI evC¢bNÐitEfTaMsuxPaBbzm edIm,IeTACYbGñkÉkeTs.

• PPOs bg;éføeTACYbRKUeBTükñúg nigeRkAbNþajrbs;KeRmag b:uEnþsmaCikbg;cMNaykan;Etx<s; sRmab;karEf

TaMsuxPaBenAeRkAbNþaj .

• CaTUeTA EPOs minFanar:ab;rgkarEfTaMeRkAbNþajrbs; KeRmageT b:uEnþsmaCikGacminRtUvsMbuRtbBa¢Ún edIm,IeTA

CYbGñkÉkeTskñúgbNþaj .

mansar³sMxan;RtUvcgcaMfa PPOs HMOs nig EPOs minsuT§EtdUcKñaeT .

RtUvR)akdc,ab;faGñk)anTTYlral;B½t’manlm¥itGMBIKeRmag — dUcCafaetIRKUeBTünigmnÞIreBTüGVIRtUv)an

Fanar:ab;rg nigfaetInwgRtUvcMNayb:unµanedIm,IeTACYb RKUeBTüeRkAbNþaj — muneBlGñkeFVIkareRCIserIs .

CMhanTI 3: RbmUlB½t’manEdlGñkRtUvkar . eBlGñkeRCIserIsKeRmagEdls½kþismcMeBaHGñk vaCaeBlevlaRtUvcab;epþImdMeNIrkarcuHeQµaH.

RtUvR)akdc,as;faGñkRkdasRtwmRtUv nigB½t’manrYcral; enAeBlGñkdak;BaküsMu .

TM

3

* PsþútagcMNUlbc©úb,nñrbs;;smaCikRKYsar

TaMgGs;Edldak;BaküsMu . (R)ak;cMNUl

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lixitRbkas Bn§b:ueNÑaH.) RKYsarRtUv)an

kMNt;niymn½yfaCamnusSEdlRbkas

Bn§CaemRKYsar nigral;GñkkñúgbnÞúkTaMgGs;

Edl)anGHGagkñúglixitRbkasBn§rbs;

buKÁlenaH . RbsinebIGñkminRbkasBn§

eT GñkenAEtGacmanKuN sm,tþiTTYl)an

karFanar:ab;rgeday\tKitéfø b¤témøTab

tamry³ Medi-Cal.

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n_minRsbc,ab;Gacdak;BaküsMu)an .

GñkGacdak;BaküsMu[kUnrbs;Gñk ebIeTaH

bIGñkminmansiTi§TTYl)ankarFanar:ab;

rgk¾eday.

karTTYl)ankarFanar:ab;rg

minRtwmEtCaCeRmIsl¥bMput

sRmab;suxPaBGñkeT —

KWvaCac,ab; .

GtþsBaØaN - b½NÑebIkbrrdækalIh½Vrj:a GtþsBaØab½NÑ rdækalIh½Vrj:a

lixitqøgEdnGaemrik b¤TRmg;epSgeTogén

b½NÑsmÁal;GtþsBaØaN.

PsþútagénsBaöati b¤vtþman®sbc,ab; - lixitqøgEdn Gaemrik b½NÑsñak;enARsbc,ab;

b¤ÉksarsBa¢atUbnIykmµ

B½t’mansþIBIR)ak;cMNUl* –lixitRbkasBn§ qñaM 2015

snøwkebIkR)ak;fµI² nig/b¤EbbbT W-2

elxsnþisuxsgÁm** (RbsinebICaBlrdæGaemrik)

éf¶ExqñaMkMeNIt elxkUdhSIúbpÞH

sRmab;smaCikRKYsarmñak;²EdlnwgRtUv)anFanar:ab;rgedayKeRmagsuxPaB (rab;bBa©ÚlTaMgrUbGñk) GñkKYrEtman ³

mü:ageTot cMeBaHral;smaCikkñúgRKYsarTaMgGs;Edldak;BaküsMu GñkKYrdwg³

karcuHeQµaHkñúgKeRmagFanar:ab;rgsuxPaBEdlmanKuNPaBkarENnaMGMBImYyCMhanmþg

RtwmExmkra qñaM 2014 mnusSPaK eRcInRtUv)antRmUv[manFanar:ab; rgsuxPaB b¤bg;Bin½yBn§.

kñúgqñaM 2016 karBin½ynwgmancMnYn 2.5 PaKryén®)ak; cMNUlRKYsarRb caMqñaMrbs;Gñk b¤ $695 s®mab; mnusSeBjv½ymñak; (nig $347.50 sRmab;kumarmñak;e®kamGayu 18 qñaM) KWcMnYnmYyNak¾edayEdlCacMnYn x<s;CageK.

sRmab;B½t’manbEnßm b¤edIm,IEsVgrkCMnYykñúgtMbn; eday\tKitéfø nigrkSasm¶at; sUmTak;Tg ³

CMhanTI 5: rkSaTukB½t’mansMxan; .kñúgkrNIGñkmansMNYrGMBIkarFanar:ab;rgrbs;GñkkñúgeBlGnaKt CakarsMxan; RtUvkSaTuknUvkMNt;RtaeQµaH nig elxmYycMnYnBIkñúgBaküsMu nigKeRmagFanar:ab;rgrbs;Gñk. RtUvR)akdc,as;fa Gñkkt;TukB½t’mansMxan;enH³

elxsmÁal;BaküsMurbs;Gñk

elxkrNIrbs;Gñk eQµaH®kumh‘unFanar:ab;rgsuxPaBrbs;Gñk

B½t’manGMBIKeRmagFanar:ab;rgrbs;Gñk (elxKeRmag elxRkum CaedIm .)

eQµaH nigB½t’manTak;Tgrbs;Gñk®bwkSakarcuHeQµaHEdlmankarTTYlsÁal; (CEC) TIPñak;garFanar:ab;rgEdlman karTTYlsÁal; (CEC) b¤GñkcuHeQµaHtamKeRmag (PEB) Edl)anCYyGñkcuHeQµaH

manGñkbkERbCUnGñkehATUrs½BÞ mkEdlEsVgrkCMnYyCaPasaepSgeTot

4

CMhanTI 6: bg;éføTijFanar:ab;rgrbs;Gñk .

erogral;Ex sUmbg;éføTijFanar:ab;rgrbs;Gñk enAmunéf¶kMNt;eTA[Rkumh‘un Fanar:ab;rgsuxPaBEdlGñkeRCIserIs — minEmnbg;eTA[ Covered California eT .

CMhanTI 4: begáItKNnI nigcuHeQµaH .GñkGaccuHeQµaHkñúgKeRmagrbs;GñktamGuIneFIeNtenA www.CoveredCA.com . GVIEdlGñkRtUveFVI KWbegIátKNnIGñkeRbIR)as;mYy nig GnuvtþtamdMeNIrkarcuHeQµaH edayeRbIR)as;B½t’manEdlGñk)an RbmUlkñúgCMhanTI 3 .

RbsinebIGñkRtUvkarCMnYykñúgkarcuHeQµaH Covered California pþl;CMnYy\tKitéfø nigrkSakarsm¶at;enAEk,rGñk.

edIm,IEsVgrkCMnYykñúgtMbn; sUmcUleTA www.CoveredCA.com/enrollment-assistance nigvaybBa©ÚlelxkUdhSIúbrbs;Gñk . GñkGacTUrs½BÞmkBYkeyIgtamelx (800) 300-1506.

etImansMNYrbEnßmb¤?sUmemIlvIedGU “Welcome

to Answers” enA

CoveredCA.com/FAQs

(smÁal;³ “Welcome to Answers” KWCaesrIvIedGUCUnB½t’man

EdlmanCaPasaGg;eKøsEtb:ueNÑaH)

RbFanbTrab;bBa©Úl³• etI Covered California KWCaGVI?• etIxJúMcuHeQµaHtamrbobNa?• etI Covered California

GacCYyGñkmanGayueRkam 30 qñaM)anedayrbobNa?

• etI Covered California eFVI[Fanar:ab;rgmantémøsmrmü tamrbobNa?

• etI Affordable Care Act pøas;bþÚrFanar:ab;rgsuxPaBtam rbobNa?

CoveredCA.com | (800) 300-1506

TM

karcuHeQµaHkñúgKeRmagFanar:ab;rgsuxPaBEdlmanKuNPaBkarENnaMGMBImYyCMhanmþg