Kaiser Permanente: Questions and Answersinfo.kaiserpermanente.org/info_assets/deductibleplans/pdfs/HRA... · Managing your health reimbursement arrangement (HRA) administered through

kp.org/healthpayment 1

Questions and answersThese questions and answers will help you get started with your HRA, plus give you

information to help you use and manage your account.

Getting startedHow do I start using my HRA?

1. Once your employer has set up your HRA, sign on to the Health Payment Online Portal at kp.org/healthpayment1 using your kp.org user ID and password. Once you create your security questions and answers, you can download an HRA Online User Guide for instructions on managing your account. Youll find this guide under Tools & Support.

2. Update your profile on kp.org/healthpayment1 to add your email address or mobile phone number. Next, set your notification preferences to get important alerts about your HRA by text or email.

3. Download the KP HRA/HSA/FSA Balance Tracker app to your mobile device so you can manage your account from wherever you are. The first time you log in to the app, your temporary username and password will both be: the first initial of your first name, plus your first name, plus the last 4 digits of your Social Security number.

Understanding your HRA

What is a health reimbursement arrangement (HRA)?An HRA is an account that gives you money to pay for care.2 Your employer sets up the account and puts money into it. Because the money isnt part of your wages, you wont pay taxes on it.3 You can use this money to help pay your health care costs.

When can I start accessing the money in my HRA?The availability of your HRA money will depend on your plan details. Please contact your employers benefits administrator to find out when youll have access to the money.

Have questions?

Kaiser Permanente Health Payment Services1-877-761-3399Monday through Friday, 5 a.m. to 7 p.m. Pacific time (except holidays)

[email protected]

Managing your health reimbursement arrangement (HRA) administered through Kaiser Permanente

https://kp.org/healthpaymenthttps://kp.org/healthpaymenthttps://kp.org/healthpaymentmailto: [email protected]



Who puts money into my HRA, and how much is in the account?Your HRA is owned and funded by your employer. You cant put money into the account. Each year, your employer will determine the amount available in your HRA. See your companys benefit plan documents for more information.

What can I pay for with my HRA?You can use the money in your HRA to pay for care for you and your covered dependents. Specifically, you can use it to pay for types of care that your employer has defined as qualified medical expenses.2 Ask your employers plan administrator for details.

How can I get account information on my HRA, such as my balance?You can access your account information online, 24 hours a day, 7 days a week, at kp.org/healthpayment.1 Youll be able to view your balance, file claims, view transaction history, and more.

You can also use the KP HRA/HSA/FSA Balance Tracker app or call Health Payment Services to check your balance and file a claim. Another way to view your balance is to request a cost estimate for services at kp.org/costestimate. Please note that your HRA balance wont appear on your Explanation of Benefits (EOB) or bills.

What if I leave my current employer or retire with money still in my HRA?You can be reimbursed for any care you get before you leave the company or retire, but any remaining balance will be lost. This may work differently if you choose to continue your medical benefits through COBRA. Please contact your employers benefits administrator for more information.

What if theres money left in my HRA at the end of the year?As long as its permitted by your employer and youre still enrolled in the HRA, the unused money may roll over to the next year. Your employer will determine how much leftover money, if any, will roll over.4

https://kp.org/healthpaymenthttps://kp.org/healthpaymenthttps://kp.org/costestimate



Paying for careWhen should I submit claims for reimbursement?You can submit claims for out-of-pocket expenses anytime within the same coverage period that you received the qualified services. You may also have an extra window of time after your coverage period ends, known as a run-out period.5 Contact your employers benefits administrator for details.

How do I file a claim for reimbursement?You can file a claim 3 ways:

1. Online at kp.org/healthpayment

2. Through the KP HRA/HSA/FSA Balance Tracker app

3. By calling Health Payment Services and requesting a claim form that you can fill out and mail

For all claims that you file, youll need to provide supporting documents to show that your expenses are qualified medical expenses as defined by your employer.2

What kind of paperwork will I need in order to submit or to validate a claim?Your Explanation of Benefits (EOBs), bills, and itemized receipts have the necessary details to validate that your expenses are qualified medical expenses as defined by your employer. These documents should be provided with any claim you file, as well as anytime you receive a letter or email from Health Payment Services requesting supporting documentation.

How do I use my HRA to pay for care?

There are a couple of ways to pay for care with your HRA:

Health payment card

Some HRAs come with the Kaiser Permanente health payment card, a debit card you can use either:

When you get care, or To pay a bill by mail by writing your card number on the bill and sending it in.

Be sure to keep copies of your Explanation of Benefits (EOBs), bills, and itemized receipts, in case you need to provide them later.

Reimbursement Other HRAs require you to pay out of pocket (using your own money) and get reimbursed later. In most cases, youll be automatically reimbursed for qualified medical expenses. However, there are some cases where you may need to file a claim for reimbursement.

For more details about filing a claim, see the questions and answers above and on the next page.

https://kp.org/healthpaymenthttps://kp.org/healthpayment



How long will it take for my HRA claim to be approved? HRA reimbursement claims are typically processed within 1 business day. If the supporting documents you provided cant be used to validate your claim, your claim approval will be delayed and youll be asked to provide new documents. Once Health Payment Services receives supporting documents confirming your expense is a qualified medical expense, your claim will be processed and approved.

What if I receive a request for supporting documents for a submitted claim or expense paid with a health payment card? For certain claims, you may receive a letter or email from Health Payment Services requesting supporting paperwork. This will typically happen if the documents you submitted cant be used to validate your claim or if additional details are needed. Please be sure to respond promptly to these requests by providing an Explanation of Benefits (EOB), bill, or itemized receipt for the expense. You can get additional details about such requests online at kp.org/healthpayment, or by calling Health Payment Services.

If a payment I make with my health payment card or a claim I submit is denied, can I appeal the denial? If a filed claim for reimbursement or an expense paid with a health payment card is denied, it is typically because the supporting documentation provided could not be used to validate that the expense was a qualified medical expense as defined by your employer. Before your claim is denied, youll receive a request for supporting documentation at 30, 60, and 90 days from the transaction date. To appeal your claim denial, simply send supporting documentation to Health Payment Services using the contact information below.

Fax: 1-877-535-0821 Mailing address: Kaiser Permanente P.O. Box 1540 Fargo, ND 58107-1540

Your health payment card will be suspended 180 days from the date of the disputed transaction if we dont receive the proper supporting documents, or if you dont reimburse your HRA or your employer. Contact Health Payment Services for more information.




Kaiser Permanente health payment cardsIf your HRA comes with the Kaiser Permanente health payment card, you can use it to pay for care.2

Where can I use my health payment card?You can use your health payment card at Kaiser Permanente facilities and pharmacies. You can also use it at any other provider or facility that accepts Visa debit cards. Keep in mind that HRA money can only be used for the types of care your employer has defined as qualified medical expenses.2

What if my health payment card isnt accepted by a health care provider or facility?If you have trouble using your card, it may be because it hasnt been activated, or because the provider or facility doesnt accept Visa debit cards.

If your health payment card isnt accepted, youll need to pay the entire amount out of pocket using another payment method.

You can then request reimbursement by following the instructions under How do I file a claim for reimbursement on page 3.

Can I use my health payment card to pay Kaiser Permanente bills that I get in the mail?If you receive a Kaiser Permanente bill for care thats defined as a qualified medical expense and want to pay it using your HRA, write your health payment card number in the payment section of the bill. Then mail it in to the address provided on the bill. Be sure to keep copies of your Explanation of Benefits (EOBs), bills, and itemized receipts, in case you need them to validate your claim.

How do I order additional health payment cards?If you need additional health payment cards, you can order them online or by phone. You should receive 2 cards by the start date of your HRA, and you can order an additional 2 cards at no charge. After this, youll be charged $10 for each additional 2-card order. Sign on to kp.org/healthpayment1 or contact Health Payment Services.

What should I do if my health payment card is lost or stolen?Contact Health Payment Services to report any loss or theft of your health payment card as soon as possible. Once you report it, your card will be suspended and you wont be responsible for transactions after this date.

If you wish to dispute a transaction that has taken place within the last 60 days, contact Health Payment Services to obtain a Debit Card Dispute Form. Youll have 21 days to return the form and have the transaction investigated. During the investigation period, youll be given a provisional credit. If the charge is determined to be fraudulent, the credit will remain in your HRA. If the transaction is determined to be valid, the amount will be debited from your HRA.



6

1 You must be registered on kp.org to access this website. If youre not registered yet, visit kp.org/register today. It may take up to 9 days from when you register on kp.org before you can access your account through kp.org/healthpayment.

2 You can use your HRA to pay for types of care that are defined as qualified medical expenses. These are described in IRS Publication 502, Medical and Dental Expenses, available at irs.gov/publications. Consult with your employers plan administrator to find out what type of HRA you have and which categories of qualified medical expenses are eligible for payment or reimbursement under your HRA.

3 The tax references in this document relate to federal income tax only. Federal and state tax laws and regulations are subject to change. Consult with a qualified professional for tax or legal advice.

4 If your employer has chosen to roll over unused money, that money will be available to you when your next HRA coverage period begins. Contact your employers benefits administrator for more information.

5 Your run-out period is determined by your employer. Contact your employers benefits administrator for more information.

Colorado state law requires that an Access Plan be available that describes Kaiser Foundation Health Plan of Colorados network of provider Services. To obtain a copy, please call Member Services or visit kp.org.

Kaiser Permanente health plans around the country, including: Kaiser Foundation Health Plan, Inc., in Northern and Southern California Kaiser Foundation Health Plan of Colorado Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, 404-364-7000 Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232

Please recycle. 60656408 September 2017

Language Assistance

Services

English: Language assistance

is available at no cost to you,

24 hours a day, 7 days a week.

You can request interpreter

services, materials translated

into your language, or in

alternative formats. Just call us

at 1-800-464-4000, 24 hours a

day, 7 days a week (closed

holidays). TTY users call 711.

Arabic :

.

4000-464-800-1 .

) (.

(.711 )

Armenian:

` 24 ,

7 :

,

:

` 1-800-464-4000 `

24 ` 7 ( ): TTY-

711:

Chinese: 7 24

7

24 1-800-757-7585

(TTY)

711

Farsi: 7 24

.

7 24.

4000-464-800-1) (

. 711 TTY .

Hindi: , 24 ,

,

,

1-800-464-4000 , 24

, ( )

TTY 711

Hmong: Muajkwc pab txhais lus pub dawb rau koj,

24 teev ib hnub twg, 7 hnub ib lim tiam twg..Koj thov

tau cov kev pab txhais lus, muab cov ntaub ntawv

txhais ua koj hom lus, los yog ua lwm hom.Tsuas hu

rau 1-800-464-4000, 24 teev ib hnub twg, 7 hnub ib

lim tiam twg (cov hnub caiv kaw). Cov neeg siv

TTY hu 711.

Japanese:

1-800-464-4000

TTY

711

Khmer: 24 7 1-800-464-4000 24 7 ( ) TTY 711

Korean:

.

,

.

1-800-464-4000

( ). TTY 711.

Navajo: Saad bee 1k1aayeed n1h0l= t11 jiik4,

naadiin doo bib22 d99 ah44iikeed tsostsid yisk32j9

damoo n1'1dleehj9. Atah halne4 1k1adoolwo[7g77 j0k7,

t1adoo le4 t11 h0hazaadj9 hadily22go, 47 doodaii

n11n1 l1 a[22 1daateh7g77 bee h1dadilyaago. Koj9

hodiilnih 1-800-464-4000, naadiin doo bib22 d99

ah44iikeed tsostsid yisk32j9 damoo n11dleehj9

(Dahodiyin biniiy4 eeaahgo 47 dadeelkaal). TTY

chodeeyool7n7g77 koj9 hodiilnih 711

Punjabi: , 24 , 7 ,

,

,

1-800-464-4000 , 24 ,

7 ( ) TTY

711

Russian:

24 , 7 .

,

.

1-800-464-4000,

24 , 7

( ). TTY

711.

Spanish: Contamos con asistencia de idiomas sin costo

alguno para usted 24 horas al da, 7 das a la semana.

Puede solicitar los servicios de un intrprete, que los materiales se traduzcan a su idioma o en formatos

alternativos. Solo llame al 1-800-788-0616, 24 horas al

da, 7 das a la semana (cerrado los das festivos). Los

usuarios de TTY, deben llamar al 711.

Tagalog: May magagamit na tulong sa wika nang wala

kang babayaran, 24 na oras bawat araw, 7 araw bawat

linggo. Maaari kang humingi ng mga serbisyo ng

tagasalin sa wika, mga babasahin na isinalin sa iyong

wika o sa mga alternatibong format. Tawagan lamang

kami sa 1-800-464-4000, 24 na oras bawat araw, 7 araw

bawat linggo (sarado sa mga pista opisyal). Ang mga

gumagamit ng TTY ay maaaring tumawag sa 711.

Thai: 24

1-800-464-4000 24

() TTY

711

Vietnamese: Dch v thng dch c cung cp min

ph cho qu v 24 gi mi ngy, 7 ngy trong tun. Qu

v c th yu cu dch v thng dch, ti liu phin dch

ra ngn ng ca qu v hoc ti liu bng nhiu hnh

thc khc. Qu v ch cn gi cho chng ti ti s

1-800-464-4000, 24 gi mi ngy, 7 ngy trong tun

(tr cc ngy l). Ngi dng TTY xin gi 711.

tel:1-800-788-0616

Kaiser Permanente does not discriminate on the basis of age, race, ethnicity, color, national origin, cultural background, ancestry, religion, sex, gender identity, gender expression, sexual orientation, marital status, physical or mental disability, source of payment, genetic information, citizenship, primary language, or immigration status.

Language assistance services are available from our Member Services Contact Center 24 hours a day, seven days a week (except closed holidays). Interpreter services, including sign language, are available at no cost to you during all hours of operation. We can also provide you, your family, and friends with any special assistance needed to access our facilities and services. In addition, you may request health plan materials translated in your language, and may also request these materials in large text or in other formats to accommodate your needs. For more information, call 1-800-464-4000 (TTY users call 711).

A grievance is any expression of dissatisfaction expressed by you or your authorized representative through the grievance process. A grievance includes a complaint or an appeal. For example, if you believe that we have discriminated against you, you can file a grievance. Please refer to your Evidence of Coverage or Certificate of Insurance, or speak with a Member Services representative for the disputeresolution options that apply to you. This is especially important if you are a Medicare, MediCal, MRMIP, MediCal Access, FEHBP, or CalPERS member because you have different disputeresolution options available.

You may submit a grievance in the following ways: By completing a Complaint or Benefit Claim/Request form at a Member Services office located at a Plan

Facility (please refer to Your Guidebook for addresses) By mailing your written grievance to a Member Services office at a Plan Facility (please refer to Your

Guidebook for addresses)

By calling our Member Service Contact Center toll free at 1-800-464-4000 (TTY users call 711)

By completing the grievance form on our website at kp.org

Please call our Member Service Contact Center if you need help submitting a grievance.

The Kaiser Permanente Civil Rights Coordinator will be notified of all grievances related to discrimination on the basis of race, color, national origin, sex, age, or disability. You may also contact the Kaiser Permanente Civil Rights Coordinator directly at One Kaiser Plaza, 12th Floor, Suite 1223, Oakland, CA 94612.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, D.C. 20201, 1-800-368-1019, 1-800-537-7697 (TDD). Complaint forms are available at www.hhs.gov/ocr/office/file/index.html.

http://www.hhs.gov/ocr/office/file/index.htmlhttp://ocrportal.hhs.gov/ocr/portal/lobby.jsf

Kaiser Permanente no discrimina a ninguna persona por su edad, raza, etnia, color, pas de origen, antecedentes culturales, ascendencia, religin, sexo, identidad de gnero, expresin de gnero, orientacin sexual, estado civil, discapacidad fsica o mental, fuente de pago, informacin gentica, ciudadana, lengua materna o estado migratorio.

La Central de Llamadas de Servicio a los Miembros (Member Service Contact Center) brinda servicios de asistencia con el idioma las 24 horas del da, los siete das de la semana (excepto los das festivos). Se ofrecen servicios de interpretacin sin costo alguno para usted durante el horario de atencin, incluido el lenguaje de seas. Tambin podemos ofrecerle a usted, a sus familiares y amigos cualquier ayuda especial que necesiten para acceder a nuestros centros de atencin y servicios. Adems, puede solicitar los materiales del plan de salud traducidos a su idioma, y tambin los puede solicitar con letra grande o en otros formatos que se adapten a sus necesidades. Para obtener ms informacin, llame al 1-800-788-0616 (los usuarios de la lnea TTY deben llamar al 711).

Una queja es una expresin de inconformidad que manifiesta usted o su representante autorizado a travs del proceso de quejas. Una queja incluye una queja formal o una apelacin. Por ejemplo, si usted cree que ha sufrido discriminacin de nuestra parte, puede presentar una queja. Consulte su Evidencia de Cobertura (Evidence of Coverage) o Certificado de Seguro (Certificate of Insurance), o comunquese con un representante de Servicio a los Miembros (Member Services) para conocer las opciones de resolucin de disputas que le corresponden. Esto tiene especial importancia si es miembro de Medicare, MediCal, MRMIP (Major Risk Medical Insurance Program, Programa de Seguro Mdico para Riesgos Mayores), MediCal Access, FEHBP (Federal Employees Health Benefits Program, Programa de Beneficios Mdicos para los Empleados Federales) o CalPERS ya que dispone de otras opciones para resolver disputas.

Puede presentar una queja de las siguientes maneras: completando un formulario de queja o de reclamacin/solicitud de beneficios en una oficina de Servicio a los

Miembros ubicada en un centro del plan (consulte las direcciones en Su Gua) enviando por correo su queja por escrito a una oficina de Servicio a los Miembros en un centro del plan

(consulte las direcciones en Su Gua)

llamando a la lnea telefnica gratuita de la Central de Llamadas de Servicio a los Miembros al 1-800-788-0616 (los usuarios de la lnea TTY deben llamar al 711)

completando el formulario de queja en nuestro sitio web en kp.org

Llame a nuestra Central de Llamadas de Servicio a los Miembros si necesita ayuda para presentar una queja.

Se le informar al coordinador de derechos civiles (Civil Rights Coordinator) de Kaiser Permanente de todas las quejas relacionadas con la discriminacin por motivos de raza, color, pas de origen, gnero, edad o discapacidad. Tambin puede comunicarse directamente con el coordinador de derechos civiles de Kaiser Permanente en One Kaiser Plaza, 12th Floor, Suite 1223, Oakland, CA 94612.

Tambin puede presentar una queja formal de derechos civiles de forma electrnica ante la Oficina de Derechos Civiles (Office for Civil Rights) en el Departamento de Salud y Servicios Humanos de los Estados Unidos (U. S. Department of Health and Human Services) mediante el portal de quejas formales de la Oficina de Derechos Civiles (Office for Civil Rights), en ocrportal.hhs.gov/ocr/portal/lobby.jsf, o por correo postal o por telfono a: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, D.C. 20201, 1-800-368-1019, 1-800-537-7697(lnea TDD). Los formularios de queja formal estn disponibles en www.hhs.gov/ocr/office/file/index.html.


Kaiser Permanente

24

1-800-757-7585TTY711

Evidence of CoverageCertificate of InsuranceMedicareMediCalMRMIPMediCal AccessFEHBPCalPERS

/

1-800-757-7585TTY711

kp.org

Kaiser PermanenteCivil Rights Coordinator Kaiser Permanente One Kaiser Plaza, 12th Floor, Suite 1223, Oakland, CA 94612

Office for Civil RightsCivil Rights Complaint PortalU.S. Department of Health and Human Services, Office for Civil Rightsocrportal.hhs.gov/ocr/portal/lobby.jsf U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, D.C. 20201, 1-800-368-1019, 1-800-537-7697TDD www.hhs.gov/ocr/office/file/index.html


60577108_ACA_1557_MarCom_CO_2017_Taglines

NONDISCRIMINATION NOTICE

Kaiser Foundation Health Plan of Colorado (Kaiser Health Plan) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Kaiser Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. We also: Provide no cost aids and services to people with disabilities to communicate

effectively with us, such as: Qualified sign language interpreters Written information in other formats, such as large print, audio, and

accessible electronic formats

Provide no cost language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages

If you need these services, call 1-800-632-9700 (TTY: 711) If you believe that Kaiser Health Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by mail at: Customer Experience Department, Attn: Kaiser Permanente Civil Rights Coordinator, 2500 South Havana, Aurora, CO 80014, or by phone at Member Services: 1-800-632-9700. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 1-800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

____________________________________________________________________

HELP IN YOUR LANGUAGE

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-800-632-9700 (TTY: 711).

(Amharic) : 1-800-632-9700 (TTY: 711).

. : (Arabic) (.TTY :711) 9700-632-800-1

as Wuu (Bassa) D n k dy gbo: j k m s-w-po-ny j n, n, wuu k k po-po n m gbo kpa. 1-800-632-9700 (TTY: 711)

(Chinese) 1-800-632-9700TTY711

https://ocrportal.hhs.gov/ocr/portal/lobby.jsfhttp://www.hhs.gov/ocr/office/file/index.html

60577108_ACA_1557_MarCom_CO_2017_Taglines

: (Farsi) .TTY) 1-800-632-9700: 711) .

Franais (French) ATTENTION: Si vous parlez franais, des services d'aide linguistique vous sont proposs gratuitement. Appelez le 1-800-632-9700 (TTY: 711).

Deutsch (German) ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfgung. Rufnummer: 1-800-632-9700 (TTY: 711).

Igbo (Igbo) NRBAMA: br na na as Igbo, r enyemaka ass, nefu, dr g. Kp 1-800-632-9700 (TTY: 711).

(Japanese) 1-800-632-9700TTY: 711

(Korean) : , . 1-800-632-9700 (TTY: 711) .

Naabeeh (Navajo) D baa ak nnzin: D saad bee yntigo Din Bizaad, saad bee kndawod, t jiikeh, n hl, koji hdlnih 1-800-632-9700 (TTY: 711).

(Nepali) : 1-800-632-9700 )TTY: 711( Afaan Oromoo (Oromo) XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-800-632-9700 (TTY: 711).

P (Russian) : e , . 1-800-632-9700 (TTY: 711).

Espaol (Spanish) ATENCIN: si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Llame al 1-800-632-9700 (TTY: 711).

Tagalog (Tagalog) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-800-632-9700 (TTY: 711).

Ting Vit (Vietnamese) CH : Nu bn ni Ting Vit, c cc dch v h tr ngn ng min ph dnh cho bn. Gi s 1-800-632-9700 (TTY: 711).

Yorb (Yoruba) AKIYESI: Ti o ba nso ede Yoruba ofe ni iranlowo lori ede wa fun yin o. E pe ero ibanisoro yi 1-800-632-9700 (TTY: 711).

60577109_ACA_1557_MarCom_GA_2017_Taglines


Kaiser Foundation Health Plan of Georgia, Inc. (Kaiser Health Plan) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Kaiser Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. We also: Provide no cost aids and services to people with disabilities to communicate

effectively with us, such as: Qualified sign language interpreters Written information in other formats, such as large print, audio, and


Provide no cost language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages

If you need these services, call 1-888-865-5813 (TTY: 711) If you believe that Kaiser Health Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by mail at: Member Relations Unit (MRU), Attn: Kaiser Civil Rights Coordinator, Nine Piedmont Center, 3495 Piedmont Road, NE Atlanta, GA 30305-1736. Telephone Number: 1-888-865-5813. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 1-800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

____________________________________________________________________



(Amharic) : 1-888-865-5813 (TTY: 711).

. : (Arabic) (.TTY :711) 5813-865-888-1

(Chinese) 1-888-865-5813TTY711

: (Farsi) .TTY) 1-888-865-5813: 711) .


60577109_ACA_1557_MarCom_GA_2017_Taglines



(Gujarati) : , : . 1-888-865-5813 (TTY: 711). Kreyl Ayisyen (Haitian Creole) ATANSYON: Si w pale Kreyl Ayisyen, gen svis d pou lang ki disponib gratis pou ou. Rele 1-888-865-5813 (TTY: 711).

(Hindi) : 1-888-865-5813 (TTY: 711) (Japanese) 1-888-865-5813TTY: 711

(Korean) : , . 1-888-865-5813 (TTY: 711) .


Portugus (Portuguese) ATENO: Se fala portugus, encontram-se disponveis servios lingusticos, grtis. Ligue para 1-888-865-5813 (TTY: 711).

P (Russian) : e , . 1-888-865-5813 (TTY: 711).




60576526_ACA_1557_MarCom_NW_2017_Taglines


Kaiser Foundation Health Plan of the Northwest (Kaiser Health Plan) complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Kaiser Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. We also:

Provide no cost aids and services to people with disabilities to communicateeffectively with us, such as: Qualified sign language interpreters Written information in other formats, such as large print, audio, and


Provide no cost language services to people whose primary language is notEnglish, such as: Qualified interpreters Information written in other languages

If you need these services, call 1-800-813-2000 (TTY: 711)

If you believe that Kaiser Health Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by mail or phone at: Member Relations, Attention: Kaiser Civil Rights Coordinator, 500 NE Multnomah St. Ste 100, Portland, OR 97232, telephone number: 1-800-813-2000.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 1-800-537-7697 (TDD). Complaint forms are available athttp://www.hhs.gov/ocr/office/file/index.html.

____________________________________________________________________



(Amharic) : 1-800-813-2000 (TTY: 711).

. : (Arabic) (.TTY :711) 2000-813-800-1

(Chinese) 1-800-813-2000TTY711

: (Farsi) .TTY) 1-800-813-2000: 711) .


60576526_ACA_1557_MarCom_NW_2017_Taglines



(Japanese) 1-800-813-2000TTY: 711

(Khmer) , 1-800-813-2000 (TTY: 711)

(Korean) : , . 1-800-813-2000 (TTY: 711) .

(Laotian) : , , , . 1-800-813-2000 (TTY: 711).


Afaan Oromoo (Oromo) XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-800-813-2000 (TTY: 711).

(Punjabi) : , 1-800-813-2000 (TTY: 711) ' Romn (Romanian) ATENIE: Dac vorbii limba romn, v stau la dispoziie servicii de asisten lingvistic, gratuit. Sunai la 1-800-813-2000 (TTY: 711).

P (Russian) : , . 1-800-813-2000 (TTY: 711).



(Thai) : 1-800-813-2000 (TTY: 711).

(Ukrainian) ! , . 1-800-813-2000 (TTY: 711).


Questions and answers Getting started Understanding your HRA Paying for careKaiser Permanentehealth payment cards

Language Assistance Services Kaiser Permanente does not discriminate on the basis of age, race, ethnicity, color, national origin, cultural background, ancestry, religion, sex, gender identity, gender expression, sexual orientation, marital status, physical or mental disability, source of payment, genetic information, citizenship, primary language, or immigration status. NONDISCRIMINATION NOTICE HELP IN YOUR LANGUAGE NONDISCRIMINATION NOTICE HELP IN YOUR LANGUAGE NONDISCRIMINATION NOTICE HELP IN YOUR LANGUAGE

Documents

Kaiser Permanente: Questions and Answersinfo.kaiserpermanente.org/info_assets/deductibleplans/pdfs/HRA... · Managing your health reimbursement arrangement (HRA) administered through