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2020 Kaiser Plus Plan Member Guide Kaiser Permanente California, Colorado, Georgia, the Mid-Atlantic states (Maryland, Virginia, Washington, D.C.), Oregon and Southwest Washington

2020 Kaiser Plus Plan Member Guide - Amazon Web …...2020 Kaiser Plus Plan Member Guide Kaiser Permanente California, Colorado, Georgia, the Mid-Atlantic states (Maryland, Virginia,

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Page 1: 2020 Kaiser Plus Plan Member Guide - Amazon Web …...2020 Kaiser Plus Plan Member Guide Kaiser Permanente California, Colorado, Georgia, the Mid-Atlantic states (Maryland, Virginia,

2020 Kaiser Plus Plan Member GuideKaiser PermanenteCalifornia, Colorado, Georgia, the Mid-Atlantic states (Maryland, Virginia, Washington, D.C.), Oregon and Southwest Washington

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What’s Inside

Use this guide to make the most of your medical plan. Inside, you’ll find information about:

Key Plan Features Your Prescription Drug Coverage

Your Health Savings Account The Kaiser Plus Plan in Action

Health Savings Account Tips Helpful Tools at Your Fingertips

Make the Most of Your Healthcare Contacts by Region

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Qualified Status Changes

The coverage you chose during your enrollment period is for all of 2020 unless you have a qualified status change, such as marriage, the birth of a child or your spouse/domestic partner losing or gaining medical coverage. If you have a qualified status change, you have 31 days to update your coverage at UPoint > Life Changes.

Visit UPoint to learn about Health Insurance Portability and Accountability Act (HIPAA) Special Enrollment Rights that may allow you to change your coverage (for example, add a dependent) outside of your enrollment period if you qualify.

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Overview

Everything You Love about Kaiser Permanente, PLUS...

The Kaiser Plus plan is a high-deductible HMO plan that combines everything you love about Kaiser Permanente with the money-saving power of a health savings account. Contributing to a health savings account is voluntary.

Your Medical ID Card

If you’re a new Kaiser Plus plan member, you’ll receive a Kaiser Permanente ID card in the mail.

If you’re already a Kaiser Plus plan member, you can continue using your current Kaiser Permanente ID card.

If you lose your ID card, call Member Services to request a new one. See p. 12 for your region’s phone number. You can also access your ID card through the Kaiser Permanente app.

Take Charge of Your Health Online

Register on the Kaiser Permanente website, kp.org, to securely:

• Make appointments.

• Email your doctor’s office.

• Refill most prescriptions.

• View your medical records and most lab results.

• Find details of your plan coverage.

• Pay your medical bills.

Registering Is EasyGo to kp.org/register and follow the prompts. You need your medical or health record number, which you can find on your Kaiser Permanente medical ID card.

Access Your Information on the Go

After registering on kp.org, download the Kaiser Permanente app from the App Store® or Google Play™. You need your kp.org user ID and password to activate the app. Use the app to access your medical ID card information and other kp.org features on the go.

Coverage That’s Got Your Back

You’re covered for a variety of health services, such as chiropractic care, acupuncture, addiction treatment, infertility treatment, speech therapy, physical therapy and applied behavior analysis (ABA) therapy. See what else is covered in the Summary of Benefits and Coverage (SBC) at Total Rewards Library > Plan Documents.

Chiropractic Care

Speech Therapy

Acupuncture Physical Therapy

ABA Therapy

Addiction Treatment

Infertility Treatment

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Find details about your coverage in your region’s Summary of Benefits and Coverge (SBC) at https://my.kp.org/mckessoncorp.

Kaiser Plus Plan by the Numbers

Take a look at the chart to see the Kaiser Plus plan’s annual deductible, coinsurance, out-of-pocket maximum and health savings account contribution limit for your coverage level.

Health Savings Account

Deductible

CoinsuranceOut-of-Pocket

MaximumEE Contribution* McKesson

ContributionNetwork

You Pay

EE** $0 - $2,800 $750 $2,125 20% $4,625

EE + SP/DP** or EE + Child(ren)

$0 - $6,000 $1,100 $4,250† 20% $9,250††

EE + Family** $0 - $5,600 $1,500 $4,250† 20% $9,250††

* These amounts are the IRS limit minus McKesson’s annual contribution. Putting money in a health savings account is voluntary. You choose how much to put in, up to the annual IRS limit shown in the chart. You can put in up to 1/12 of the annual limit each month. If you’re age 55 or older in 2020, you can make catch-up contributions of up to $1,000 ($83.33 per month). Avoid tax penalties by making sure you don’t put more in your account than the IRS monthly or annual limit. McKesson and Fidelity don’t monitor your contributions for you. For more information on health savings accounts, go to www.mckesson.com/totalrewardslibrary > Financial Health.

** EE = employee. SP/DP = spouse/domestic partner. † There’s an embedded individual deductible of $2,800. This means that if one person in a family meets the $2,800 deductible before the $4,250 family

deductible is met, that person will have met the individual deductible and begin paying coinsurance for covered services. †† There’s an embedded individual out-of-pocket maximum of $4,625. Once an individual meets the individual out-of-pocket maximum of $4,625, the plan

pays 100% of all eligible expenses for that person, even if the family out-of-pocket maximum of $9,250 hasn’t been met.

Key Plan Features

The Kaiser Plus plan is available in California, Colorado, Georgia, the Mid-Atlantic states (Maryland, Virginia, Washington, D.C.), Oregon and Southwest Washington. The plan features:

Comprehensive coverage for medical care and prescription drugs.

A deductible you pay for eligible expenses, including prescription medications, before coinsurance kicks in.

An opportunity to contribute to a health savings account. McKesson contributes to your account too. See the chart below.

An out-of-pocket maximum that limits how much you pay for covered services (medical and prescription medications) each year. Your deductible and coinsurance payments count toward your out-of-pocket maximum. After you reach the out-of-pocket maximum, you won’t have to pay for eligible expenses for the rest of the year.

Preventive care covered at 100%. Preventive care services include well visits and physicals, qualifying immunizations and screenings, age appropriate preventive mammograms and colonoscopies. Certain preventive medications are also covered at 100%. See p. 9.

Coinsurance after meeting the deductible. Coinsurance is the percentage you and the plan each pay when you’re sharing costs. When coinsurance kicks in, you pay 20% and the plan pays 80%.

TIP In most cases, you need to use Kaiser Permanente providers for your coverage to apply. Emergency care is covered everywhere in the world. See p. 8.

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5 Reasons to Love Your Health Savings Account

You call the shots when it comes to spending, investing or saving the money in your health savings account.

The health savings account is a powerful financial tool that you can use to save money for eligible medical, prescription drug, dental and vision expenses. Here are the top five reasons to put money in a health savings account.

McKesson contributes to your account each year you’re enrolled in the Kaiser Plus plan. The contribution puts the “Plus” in the plan’s name. McKesson chips in between $750-$1,500 to your health savings account depending on who you cover.

You get three tax breaks.

There’s no deadline to spend your money. The money in your account carries over each year and is yours to keep whether you change medical plans, leave McKesson or retire.

You can invest the money in your account to help meet long-term financial goals and build a nest egg for healthcare expenses in retirement. Fidelity offers a variety of investment options, such as mutual funds and bonds. Always talk to your financial advisor before investing.

First breakYou may pay less taxes by lowering your taxable income with before-tax or tax-deductible contributions to your account.*

Second breakYou aren’t taxed on withdrawals you make to pay eligible medical, prescription drug, dental and vision expenses.

Third breakYour account’s interest, dividends and capital gains aren’t taxed, unless you live in one of the few states that tax them.**

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4.

3.

2.

5.

$750 Employee Only

$1,100 Employee + Spouse/Domestic Partner or Employee + Child(ren)

$1,500 Employee + Family

* As of 2019, California and New Jersey tax the money you and McKesson put in a health savings account. If you live in one of these states, you may need to pay state income tax on the money you and McKesson contribute to your health savings account.

** As of 2019, California, New Hampshire, New Jersey and Tennessee tax health savings account interest, dividends and capital gains. New Hampshire and Tennessee only tax dividend and interest earnings after a certain dollar amount, depending on whether you’re filing individually or jointly. If you live in one of these states, talk to your tax advisor.

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TIP If you haven’t already accepted the Terms & Conditions on UPoint, when you log on to www.netbenefits.com, you can expect to see the word Open in the Health Savings Account box. Click it and follow the prompts to activate your account.

Health Savings Account Tips

IRS Contribution Limits

The IRS limits how much you can put into your health savings account. Keep in mind that any contribution McKesson makes to your health saving account also counts toward the IRS limits. This is how much you can contribute after getting McKesson’s contribution for 2020:

If you’re eligible for a health savings account for only part of the year, be sure to stay at or under the monthly IRS limit to avoid taxes and penalties. You can find the annual and monthly limits in the Health Savings Account FAQs at www.mckesson.com/totalrewardslibrary > Financial Health.

If you’re 55 or older in 2020, you can contribute up to an additional $1,000 ($83.33 per month).

Activate Your Account

If you’ve never activated your health savings account before, you’re missing out on all the benefits your account has to offer. Here’s what you need to do if you already accepted the Health Savings Account Terms & Conditions on UPoint:

1. Log on to www.netbenefits.com.

2. Click Activate in the Health Savings Account box.

3. Follow the prompts to activate your health savings account.

If you enrolled during Annual Enrollment (November 4-15, 2019), the last day you can activate your account and still get McKesson’s contribution is March 30, 2020.

If you enrolled after Annual Enrollment, you need to activate your account within 90 days of the day your coverage starts to get McKesson’s contribution. 90

days

March 30

2020

Employee Only Coverage$2,800/year $233.33/month

Employee + Family Coverage$5,600/year$466.66/month

Employee + Spouse/Domestic Partner or Employee + Child(ren) Coverage

$6,000/year $500.00/month

Update Your Contribution Amount Anytime on UPoint You can start, stop or change your health savings account contributions anytime during the year. Click the HSA Contribution tile on UPoint or call the HR Support Center at 855.GO.MCKHR (855.466.2547) and press 1. Your changes are applied to your remaining pay periods for the year as soon as administratively possible.

Check Out the Health Savings Account FAQsYou’ll find details about eligibility, investment options, contribution limits and just about anything else you ever wanted to know about how health savings accounts work. Go to Total Rewards Library > Financial Health > Health Savings Account FAQs.

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Health Savings Account Tips

What can I pay for with my health savings account?

Technically, you can withdraw money from your health savings account for any reason. If you use it to pay for an eligible healthcare expense, such as a doctor’s visit or a lab test, your withdrawal is tax-free. If you withdraw money for an ineligible expense, you’ll pay a 20% penalty tax on top of normal income tax.

If you’re 65 or older, the 20% penalty tax doesn’t apply, but you’ll still need to pay income taxes on ineligible expenses.

See a list of eligible expenses at www.mckesson.com/totalrewardslibrary > Financial Health.

Paying With Your Health Savings Account

Once you activate your health savings account, Fidelity mails you a health savings account debit card, which you can swipe at your provider’s office.

• If you pay out of pocket for an eligible expense, you can reimburse yourself later from your health savings account at www.netbenefits.com or through the Fidelity mobile app.

• If your expense is eligible under IRS rules, you’re not taxed on your withdrawal.

• Be sure to keep all your receipts in case you’re ever audited by the IRS.

What if I have an HSA-compatible healthcare flexible spending account (FSA) too?

A good rule of thumb is to use your HSA-compatible healthcare FSA to pay for eligible dental and vision expenses and your health savings account to pay for eligible medical and prescription drug expenses. That’s because your FSA is a “use-it-or-lose-it” account, which means you need to spend your balance by December 31 of each year, or you lose it.

There’s no deadline to spend the funds in your health savings account, so it makes sense to use your FSA first for eligible dental and vision expenses, then use your health savings account if your FSA funds run out.

Watch a short video about the difference between health savings accounts and FSAs at www.mckesson.com/totalrewardslibrary > Financial Health.

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What to Do in an Emergency

If you have an emergency, call 911 or go to the nearest emergency room. You pay for emergency care like any other eligible expense. If coinsurance applies, you pay 20% of the cost whether your care is from a network or out-of-network provider.

What’s an Emergency?

An emergency is a severe medical condition (including severe pain, unexpected symptoms during an illness or after a serious accident) that would cause a reasonable person to expect that the absence of immediate medical attention will result in placing the health or survival of the individual in serious jeopardy, seriously impair bodily functions or cause serious dysfunction to a bodily organ or part. Examples include coughing or vomiting up blood, chest pain or severe shortness of breath, major injury or broken bones, sudden or unexplained loss of consciousness or symptoms that may be life-threatening or disabling.

Get the Specs on Healthcare Costs

Understand the costs for scheduled services before your visit. You can get a personalized cost estimate based on your plan benefits and whether or not you’ve met the annual deductible. If you haven’t already, register for an account on the Kaiser Permanente website (kp.org) and go to kp.org/costestimates to get started.

Go to kp.org/getcare to learn about your non-emergency care options.

Make the Most of Your Healthcare

Get Advice 24/7

Connect with a licensed healthcare provider who can answer your questions, find the right care and schedule appointments. Call the number on your medical ID card.

Video Visits

See a doctor without leaving home. Call your doctor’s office to find out if video visits are an option for you.

Urgent Care

Visit a Kaiser Permanente facility that offers urgent care services to treat non-emergency symptoms, such as a swollen ankle, urinary tract infection or rash.

Outside of routine and specialized medical care, Kaiser Permanente offers a range of services that can help you live a healthier life.

Non-Emergency Care Options

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Your Prescription Drug Coverage

No-Cost Preventive Medications

If your medication is on the Kaiser Permanente preventive care drug list, you don’t pay anything for it. Find the list at https://my.kp.org/mckessoncorp > Understanding your costs.

Non-Preventive Medications

After meeting the deductible, you’re responsible for paying a certain percentage for non-preventive medications. Your share of the cost depends on where you live. Check the Summary of Benefits and Coverage (SBC) at https://my.kp.org/mckessoncorp.

Kaiser Permanente Mail Order ProgramSkip waiting in line and get your medications delivered straight to your mailbox. If you take a certain medication on a regular basis, you can refill your prescription online or by phone and have it delivered by mail. Call your local Kaiser Permanente pharmacy or, once you’re registered on kp.org, go to kp.org/rxrefill to learn more.

Kaiser Permanente administers your prescription drug coverage. Medications need to be prescribed by a Kaiser Permanente doctor and filled at a Kaiser Permanente pharmacy for your coverage to apply.

Coverage with You in Mind

Your prescription coverage has safeguards that help you save money and live a healthier life. Following the plan’s rules and the Centers for Disease Control’s (CDC) best practice guidelines for opioid care help ensure you get the most appropriate and cost-effective treatment. Learn more about your prescription coverage at https://my.kp.org/mckessoncorp.

You pay the full cost of prescription medications when you use out-of-network pharmacies.

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Example

Let’s take a closer look at how the Kaiser Plus plan works.

Meet Kathy

Kathy enrolls in the Kaiser Plus plan with Employee Only coverage during Annual Enrollment and activates her health savings account with Fidelity (see p. 6). Her coverage begins January 1, 2020, and McKesson’s contribution of $750 is added to her health savings account during the first week of January. She also sets a monthly contribution of $200 to be automatically deducted from her paycheck and deposited to her health savings account.

By April, Kathy has $1,550 in her health savings account ($200 x 4, plus $750 from McKesson).

One April morning, Kathy wakes up feeling under the weather and makes an appointment to see her doctor. Let’s see how the Kaiser Plus plan works to cover her care.

The Kaiser Plus Plan in Action

1. Kathy visits her doctor and shows her Kaiser Permanente medical ID card.

4. Kathy goes to a Kaiser Permanente pharmacy and fills her prescription. She pays nothing for the medication because it is on the list of no-cost preventive medications.

2. Because this isn’t a preventive visit and Kathy still needs to meet the plan deductible, she pays an estimated cost before seeing her doctor. Kathy can pay out of pocket or use her Fidelity health savings account debit card. Kathy saved McKesson’s contribution and has been contributing to her account since January, so she uses the money in her account to cover the expense.

5. A few weeks later, Kathy gets an Explanation of Benefits (EOB) in the mail, followed by a bill. The EOB is a summary of the services she received at her doctor’s office, the total cost of her visit, how much the plan paid and how much she’s responsible for. The bill shows the total cost of all services received, how much Kathy paid at the time of the visit and any balance she still needs to pay.

3. Kathy’s doctor runs some basic tests and finds that she has high blood pressure. He writes Kathy a prescription for a generic blood pressure medication and suggests she come back for a checkup next month.

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Helpful Tools at Your Fingertips

The Kaiser Permanente website is loaded with helpful tools and resources to support your health. When you have questions or need help making decisions about your care, go to kp.org to use tools such as:

The Health Encyclopedia kp.org/health

Look up a health topic, condition or medical procedure you have a question about.

Interactive Quizzes and Calculators kp.org/calculators

Use a variety of tools to learn about your health, get help making decisions, set goals and take action.

Drug Encyclopediakp.org/medications

Find detailed information about your medications and the possible side effects.

Symptoms Checkerkp.org/symptoms

See what type of care you need based on your symptoms.

Medical Test Directory kp.org/healthdecisions

Learn about common tests and conditions.

Recipeskp.org/foodforhealth

Get tips and ideas for preparing healthy dishes for your family.

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Kaiser Permanente Health Plan of Southern California

800.464.4000

https://my.kp.org/mckessoncorp

Kaiser Permanente Health Plan of Colorado

800.632.9700

https://my.kp.org/mckessoncorp

Kaiser Permanente Health Plan of Georgia

888.865.5813

https://my.kp.org/mckessoncorp

Kaiser Permanente Health Plan of Mid-Atlantic States (Maryland, Virginia, Washington, D.C.)

800.777.7902

https://my.kp.org/mckessoncorp

Kaiser Permanente Health Plan of Northern California

800.464.4000

https://my.kp.org/mckessoncorp

Kaiser Foundation Health Plan of the Northwest (Oregon and Southwest Washington)

800.813.2000

https://my.kp.org/mckessoncorp

Contacts by Region

Contact Kaiser Permanente member services when you have questions about a medical bill, your coverage or any other healthcare concern.

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UPointdigital.alight.com/mckesson Review and manage your benefits.

Total Rewards Librarywww.mckesson.com/totalrewardslibraryFind information 24/7 about health and wellness programs from any device connected to the internet.

Fidelity Investmentswww.netbenefits.com800.544.3716 7:30 a.m. - 7 p.m. CT, M-F. Activate and manage your health savings account.

HR Support Center855.GO.MCKHR (855.466.2547) Press 1 for the McKesson Benefits Center for Health and Vitality questions. Benefit experts are available 7 a.m. - 6 p.m. CT, M-F. Oprime 1 para asistencia en español a través del McKesson Benefits Center.

Resources for Living®888.425.6174 www.resourcesforliving.com(username: mckesson, password: eap)The Employee Assistance Program (EAP) offers free, confidential support 24/7 for everything from child care referrals to addiction counseling. No problem is too big or too small.

YammerJoin the MCK Health FYI group onYammer to share health tips, memesand words of encouragement with your coworkers. Connect to Yammer through Office 365.

August 2020

McKesson reserves the right to modify, terminate or amend benefit plans/provisions at its discretion at any time and for any reason. This document summarizes highlights of some of our benefit plans. This document also serves as a “summary of material modifications” to our benefit plans in accordance with the requirements of the Employee Retirement Income Security Act of 1974, as amended (ERISA). Please keep this document with your copy of the Summary Plan Description.

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