1. 1
Lots of changes have happened in health
care. We’re here to help you understand what
it means and what you may need to do.
The Affordable Care Act (ACA) makes health
insurance available to more people, so more
people will be able to get the care they need.
And most people are required to have health
insurance coverage. Depending on your
situation, you may be able to get financial
assistance to help pay for your health plan.
Here’s what’s inside:
• How does health insurance help me?
• How does health insurance work?
• What do I need to do?
• Can I get help to pay for my health plan?
Health Care Reform
and YOU.
We’re with you every step of the way—
any time you need us.
Talk to us one-on-one for answers to your
specific health insurance questions. We can
explain your options and help you through the
next steps you may need to take. And we can
help you enroll in a new ACA plan and seek
financial assistance if you need it.
Visit: 4821 US Highway 98 W, Suite 103
Santa Rosa Beach, FL 32459
Click: garrett@fuller.insure
Call: Fuller Insurance at 850-622-5283 to
speak to your local insurance agent

2. 2
How does a health insurance plan
help me?
Health care is something all of us need at some point.
And it can be expensive. So health insurance pays part of
the cost when you’re sick or hurt—sometimes a big part.
• Health insurance helps pay part of your costs for
doctor or hospital visits, prescription drugs, tests,
maternity care and other medical services you may
need.
• It may protect you from high costs when you need
medical care.
• Most health plans also include preventive services
to keep you healthy, like annual checkups,
mammograms and vaccines at no cost.
How does health insurance work?
• Health insurance is a contract between you and your
insurance company.
• You buy a health plan from the company. They agree
to pay some of your medical costs when you are sick.
• After you enroll, you pay a monthly bill to keep your
health plan. This is called a premium.
What’s new and what it means to you.
Florida Blue is here to help you understand how the law impacts things for you and your family.
• You may have to pay part of the cost for health care
services.
• The health insurance company will pay a part of the
cost for your medical services.
• Florida Blue contracts directly with the federal
government to offer you the new ACA plans.
What do I need to do?
How the law may change things for you depends on
your situation.
The choices available to you are based on what kind
of health insurance you may have today. Which of the
following describes you?
“I don’t have health insurance.”
• Most people must have a health plan. If you do not,
you may have to pay a fee.
• You will be able to buy a new Florida Blue health
plan directly from Florida Blue between October 1,
2015 and January 31, 2016.
• You may also qualify for financial assistance to pay
your premium. You may enroll in plans with financial
assistance from November 1, 2015 until January 31,
2016.
What does it mean?
Copay: A flat fee (for example,
$15) that you may pay for
covered health care services.
Coinsurance: This is the
percentage (%) that you
must pay for covered health
services after you meet the plan
deductible. It is also called
‘cost sharing’.
Deductible: This is the dollar
amount that you must pay
each year before insurance
begins to pay for certain
health care services. You pay
the plan deductible first, then
coinsurance (%) may apply.
Covered Services or Coverage: The services that are eligible to be paid for
by your health plan are ‘covered services.’
Premium: Your premium is the regularly scheduled amount of money you
must pay to keep your insurance plan in effect.
Note: If you qualify for financial assistance, you may be eligible for a smaller
copay, coinsurance or deductible, so you pay less out of your pocket. Call us
to find out. 1-888-387-4962.
How the Deductible Works for Covered Services
You Pay for Services,
up to Plan Deductible
You
Pay
Florida Blue
Pays
Meet
Out-of-pocket
Maximum

3. 3
“I’ve had some changes in my life, so my health
plan needs to change, too. Can I get a special
enrollment?”
When you have big changes in your life, you
generally have 60 days to enroll in a health plan
or make changes to the policy you already have.
Here are some of the special enrollment events that
qualify for a change:
• You move to a new area that offers you different
plans
• You get married or have a newly eligible
domestic partner
• You have a baby, adopt a child, or are required
to insure a child because of a court order
• You lost or will lose your health coverage due
to job loss, a decrease in work hours, end of
COBRA coverage, or other reason
• You were not legally present in the United States
and became a permanent resident, received a
visa, or otherwise became legally present
• You lost your coverage because you turned 26
and are no longer covered on a family member’s
policy or you have legally separated from or
divorced your spouse
• There are lots more! Talk to us about your
special situation.
“I buy my own health insurance.”
• You will need to continue to have insurance or
you may have to pay a new fee.
• You’ll have choices of new health plans.
• You may be able to get financial assistance from
the government to pay for part or all of your
health plan.
“I have a health plan through my job.”
• You probably won’t need to do anything. Most
companies will continue to offer insurance.
Check with your benefits administrator.
Unless you have a health plan through your job,
Medicare, Medicaid or other government health
insurance program, you will most likely need to buy
a health plan.
This example shows how financial assistance might
work for a single person, age 49, living in Duval
County with an annual income of $25,000 in 2015.
2016 subsidy amounts will be available in October.
$350 per month
The monthly cost for a health plan
-$221 per month
The part the government pays (the subsidy)
$129 per month
The part you would owe
How a subsidy works
Where can I buy my Florida Blue
Affordable Care Act health plan?
• Individuals and families can buy a plan directly from
Florida Blue starting October 1st. If you qualify for
financial assistance, we can walk you through the
Marketplace and help you shop and enroll in a
Florida Blue Marketplace plan starting November 1.
Either way you’re getting a quality, comprehensive
plan that includes all of the new benefits required by
the Affordable Care Act.
• Unless you qualify for a special enrollment period,
the last day that you can buy a health plan is January
1, 2016, the last day of the government’s open
enrollment period.
Can I get help paying for my
health plan?
If you qualify, you may be able to get financial
assistance from the government (a subsidy) to pay
for your monthly health plan premium bill.
The government will look at things like:
• Your household income
• Your family size and ages
• Where you live
They’ll decide if you qualify for help paying for your
health plan, and how much financial assistance you
can get.
• The financial assistance is paid right to the
insurance company and lowers the cost of your
monthly health plan premium. It does not pay
for your doctor or hospital visits, prescriptions,
etc. You still pay for some of those costs.
• You may also be eligible for a reduction in your
out-of-pocket expenses, like a deductible or
coinsurance. That means you will pay less when
you go to the doctor.
Health insurance coverage pays
some of your medical costs.

4. 4
What are my health plan choices?
• You’ll be able to choose from “metal” plans in four
levels. The plan levels are bronze, silver, gold, and
platinum.
• These plans will offer similar benefits, but they
will have different costs for things like doctor or
hospital visits.
• All plans for individuals and families will include
kid’s vision care and some will include dental care
for kid’s under age 19.* You can also buy a separate
dental plan from Florida Blue.
Before you choose:
• Compare all of your costs, like the monthly health
plan premium, what the plan will pay for your
medical care and what part you will have to pay.
Know all your costs:
• Check to see if your
doctor or clinic is part
of the health plan you
choose.
• Check to see if you’ve
had your plan since
December 31, 2013.
You may be able to
keep it.
• The amount you pay for
health insurance depends
on the type of health plan
you decided to buy for
you and your family.
Will my health affect my insurance
coverage?
• You can buy a health plans even if you are sick or
have had health problems in the past.
• Everyone who applies for health insurance can get
coverage.
• Once you have a health plan, your coverage
cannot be canceled if you have a health problem.
• If you use tobacco, you’ll pay more for your
health plan.
76608-0915R/fuller5273
*Pediatric Dental Benefits end on the last day of the month of the member’s 19th birthday.
Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc., an Independent Licensee of the Blue Cross and Blue Shield Association.
Florida Blue does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in
the administration of the plan, including enrollment and benefit determinations.
This information is for illustrative purposes only and is being provided to help increase understanding of the impacts of some of the provisions of the
Affordable Care Act (ACA). It does not attempt to cover all of the law’s provisions and is not intended as tax or legal advice. We encourage members to
seek professional advice including legal counsel, regarding how the new requirements may affect you.
How can I learn more about how
health care reform affects me?
Florida Blue is here for you every step of the way.
Talk to us, and we’ll answer your questions and help you
find the right kind of health coverage for your family.
Visit: 4821 US Highway 98 W, Suite 103
Santa Rosa Beach, FL 32459
Click: garrett@fuller.insure
Call: Fuller Insurance at 850-622-5283 to
speak to your local insurance agent