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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. and AMGP Georgia Managed Care Company, 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 Nevada: Community Care Health Plan of Nevada, Inc. and Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by either Matthew Thornton Health Plan, Inc. or Anthem Health Plans of New Hampshire, Inc. In 17 southeastern counties of New York: Anthem HealthChoice Assurance, Inc. and Anthem HealthChoice HMO, Inc. In these same counties Anthem Blue Cross and Blue Shield HP is the trade name of Anthem HP, LLC. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield, and its affiliate HealthKeepers, Inc. trades as Anthem HealthKeepers providing HMO coverage, and their 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) underwrites or administers PPO and indemnity policies and underwrites the out-of-network benefits in POS policies offered by Compcare Health Services Insurance Corporation. Compcare underwrites or administers HMO or POS policies. Independent licensees of the Blue Cross Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.

Subsidies are only available for Qualified Health Plans purchased through the Health Insurance Marketplace and State-Based exchanges. Anthem HP, LLC., doing business as Anthem Blue Cross and Blue Shield HP is a Qualified Health Plan issuer that offers such plans through the New York State of Health. Anthem Insurance Companies, Inc., Matthew Thornton Health Plan, Inc., Anthem Health Plans of New Hampshire, Inc., Healthy Alliance Life Insurance Company, Community Insurance Company, and Compcare Health Services Insurance Corporation offer such Plans through the Health Insurance Marketplace. HMO Colorado, Inc. offers such Plans through Connect for Health Colorado. Anthem Health Plans, Inc. offers such Plans through Access Health CT. Anthem Health Plans of Kentucky, Inc. offers such Plans through Kentucky Health Benefit Exchange (Kynect). Anthem Health Plans of Maine, Inc. offers such Plans through CoverME.gov. HMO Colorado, Inc. dba HMO Nevada offers such Plans through Nevada Health Link. HealthKeepers, Inc. offers such plans through the Virginia Insurance Marketplace. Blue Cross Blue Shield Healthcare Plan of Georgia offers such plans through Georgia Access.

*Based on federal and/or state exchange requirements and subject to change. Anthem Blue Cross and Blue Shield and HealthKeepers, Inc. are Qualified Health Plans that in certain geographic areas offer some health plans with a $0 (or $1 per member in Maine and Colorado) premium option (after subsidy applied) through the Health Insurance Marketplace or your state exchange. Anthem health plans with a $0 (or $1) premium option are not available in all areas and eligibility for these plans is based on federal annual income guidelines. Call us for information because not everyone will qualify.

This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, please contact your agent or the health plan.

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