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The overview explains the Affordable Care Act’s key objectives, including expanded access, improved affordability, dependent coverage to age 26, preventative care at 100%, and insurer minimum loss ratio requirements. It summarizes marketplace and exchange operations, eligibility verification, plan enrollment, and financial assistance through advanced premium tax credits and cost-sharing reductions, including income-based thresholds and plan year considerations.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":11,"@type":70,"position":76},"https://docshare.wps.com/template/presentations/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/2024-provider-orientation-our-networks/302923/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/2024-provider-orientation-our-networks/302923.png","ImageObject",442,249,{"name":88,"@type":89},"Nguyễn Văn Học","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-29","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":47},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is the Health Insurance Marketplace and how do people use it?","Question",{"text":108,"@type":109},"It is a service available in every state to help people shop for and enroll in affordable health insurance. It provides plan shopping and enrollment through websites, call centers, and in-person help.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What does the Affordable Care Act (ACA) focus on in this orientation?",{"text":113,"@type":109},"The materials list key objectives to increase access to quality health insurance and improve affordability. They also include parameters like dependent coverage to age 26, no lifetime maximum benefits, and preventative care covered at 100%.",{"name":115,"@type":106,"acceptedAnswer":116},"How do members get financial assistance when purchasing marketplace insurance?",{"text":117,"@type":109},"Financial assistance comes through Advanced Premium Tax Credits (APTC) and Cost-Sharing Reductions (CSR). Eligibility is tied to household income ranges relative to the Federal Poverty Level.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},302923,1790141770,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":8,"category_name":11,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":47,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":135,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":141},1374402739827,"https://ap-avatar.wpscdn.com/avatar/14000c97e7351f1a627?x-image-process=image/resize,m_fixed,w_180,h_180&k=1787885694763230660","Confidential and Proprietary Information  \n1  \n~~  ~~OVERVIEW~~  ~~AGENDA~~  ~~  \n• Who We Are  \n• Affordable Care Act  \n• The Health Insurance Marketplace  \n• Our Networks  \nWHAT YOU NEED TO KNOW  \n• Key Contact Information  \n• Provider Manual  \n• Provider Engagement  \n• Public Website and Secure Portal  \n• Verification of Eligibility, Benefits and Cost Shares  \n• Referrals  \n• Prior Authorization  \n• Claims, Billing and Payments  \n• Complaints, Grievances and Appeals  \n• Specialty Companies and Vendors  \nQUESTIONS & ANSWERS  \n2  \nConfidential and Proprietary Information  \n2024 Provider Orientation  \nOVERVIEW  \nConfidential and Proprietary Information  \nWe provide market-leading, affordable health insurance on the marketplace.  \n\\#1 carrier  \non the health  \ninsurance marketplace  \n3.3M+  \nmembers insured  \n2014  \nYear that Ambetter began  \n29  \nstates  \nLOCAL APPROACH TO CARE  \nAmbetter delivers high quality, locally-based healthcare services to its members, with our providers benefiting from enhanced collaboration and strategic care coordination programs.  \nWe  \n• Target a focused demographic  \n• Lower income, underinsured and uninsured  \n4  \nConfidential and Proprietary Information  \n~~  ~~WE~~ ~~ARE~~ ~~PROUD~~ ~~TO~~ ~~BE~~ ~~YOUR~~ ~~PARTNER~~  ~~  \n• The Ambetter plan design philosophy is to provide affordable care to individuals or families that need to purchase healthcare coverage on their own.  \n• Our products focus on various cost shares—many with low or no copay amounts—to meet the  \nbudgets and utilization needs of these consumers. This gives our members the peace of mind that they have full comprehensive medical coverage.  \n• Additionally, the emphasis on reducing barriers and improving access to care mitigates the risk of individuals showing up without insurance (uncompensated care) . Ambetter’s generous cost-sharing initiatives lower patient financial responsibility while also reducing the amount that providers need to collect at time of service.  \n• Most importantly, Ambetter plans encourage members to establish relationships with their primary care providers to achieve favorable health outcomes.  \n5  \nConfidential and Proprietary Information  \n~~  ~~AFFORDABLE~~ ~~CARE~~ ~~ACT~~  ~~  \nAFFORDABLE CARE ACT (ACA): Key Objectives  \n• Increase access to quality health insurance  \n• Improve affordability  \nADDITIONAL PARAMETERS:  \n• Dependent coverage to age 26*  \n• No lifetime maximum benefits  \n• Preventative care covered at 100%  \n• Insurer minimum loss ratio (80%* for individual coverage)  \n*May be greater based on state requirements  \n6  \nConfidential and Proprietary Information  \n~~  ~~AFFORDABLE~~ ~~CARE~~ ~~ACT~~  ~~  \nREFORM THE COMMERCIAL INSURANCE MARKET– MARKETPLACE OR EXCHANGES  \n• No more underwriting – guaranteed issue  \n• There is no longer a Federal tax penalty associated with not having minimum essential coverage. *  \n• Minimum standards for coverage: benefits and cost-sharing limits.  \n• The ACA created premium tax credits (also known as subsidies) and cost-sharing reductions (CSR) to help reduce costs for eligible consumers who buy a plan through the Marketplace.  \n• Subsidies may be available to eligible individuals/families who have a household income between 100 and  \n400 percent of the Federal Poverty Level (FPL), based on the taxpayer’s family size.  \no Currently, the subsidy cap has been eliminated through Plan Year 2025, but that may be extended.  \n• CSRs are available to eligible individuals/families who have a household income between 100 and 250 percent of the FPL, based on the taxpayer’s family size.  \n*States may enact tax penalties for not purchasing insurance  \n7  \nConfidential and Proprietary Information  \nThe Health Insurance Marketplace is a service available in every state that helps people shop for and enroll in affordable health insurance. The Federal Government operates the Marketplace ([HealthCare.gov](HealthCare.gov) ) for most states, but some states run their own Market","cbCaitWk4MeQadwJ","https://ap.wps.com/l/cbCaitWk4MeQadwJ","pdf",1695427,58,"English","# Overview\n## Who We Are\n## Affordable Care Act\n## The Health Insurance Marketplace\n## Our Networks\n# What You Need To Know\n## Key Contact Information\n## Provider Manual\n## Provider Engagement\n## Public Website and Secure Portal\n## Verification of Eligibility, Benefits and Cost Shares\n## Referrals\n## Prior Authorization\n## Claims, Billing and Payments\n## Complaints, Grievances and Appeals\n## Specialty Companies and Vendors\n# Questions & Answers","[{\"question\":\"What is the Health Insurance Marketplace and how do people use it?\",\"answer\":\"It is a service available in every state to help people shop for and enroll in affordable health insurance. It provides plan shopping and enrollment through websites, call centers, and in-person help.\"},{\"question\":\"What does the Affordable Care Act (ACA) focus on in this orientation?\",\"answer\":\"The materials list key objectives to increase access to quality health insurance and improve affordability. They also include parameters like dependent coverage to age 26, no lifetime maximum benefits, and preventative care covered at 100%.\"},{\"question\":\"How do members get financial assistance when purchasing marketplace insurance?\",\"answer\":\"Financial assistance comes through Advanced Premium Tax Credits (APTC) and Cost-Sharing Reductions (CSR). Eligibility is tied to household income ranges relative to the Federal Poverty Level.\"}]","2024 Provider Orientation - Our Networks | PDF",1789798620,20]