Kaiser Permanente See how our care and coverage can help you … · 2019. 3. 30. · Kaiser Permanente will be hosting a special event at one of our Fort Collins medical offices in

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Kaiser Permanente See how our care and coverage can help you thrive

© Kaiser Permanente. All Rights Reserved.

2017 Open EnrollmentPresentation for

State of Colorado

live. work. play. healthier. together.


Today’s agenda

Here’s what we’ll cover in today’s presentation:

• Your health plan options

• Locations near you

• Your care experience

• Resources


Deductible HMO (DHMO)Pay little or no cost for preventive care.

Most of your preventive care services are covered at little or no

out-of-pocket cost to you, whether or not you’ve reached your deductible.

• Routine physical exam / well-woman / well-child exam• Preventive mammogram• Preventive colonoscopy• Cholesterol screening


Deductible HMO (DHMO)

• Copayment is a set dollar amount you’ll pay for certain services covered by your plan.

What is a copayment?

What is a deductible?

• A Deductible is the amount you pay for covered services each plan year before Kaiser Permanente starts paying. Depending on your plan, you may pay copays for some services without having to reach your deductible first.



What is coinsurance?

• Coinsurance is a percentage you pay for certain services after you meet your deductible.

• You will pay copayments and coinsurance for any applicable services until you meet your annual out-of-pocket maximum.


Enjoy a limit on your expenses (OPM).

• There’s a limit on how much you’ll pay for covered medical services each year. This is called your out-of-pocket maximum (OPM).

• Covered services subject to your deductible and coinsurance, and most services subject to copayments, accumulate toward your OPM.

• Once you reach your out-of-pocket maximum, we’ll pay the full cost of covered services for the rest of the contract year. For the DHMO plan, each covered family member has their own individual OPM.



Annual deductible – per plan year $750 individual / $1,500 family

Annual out-of-pocket maximum (OPM) – per plan year $2,000 individual / $4,000 family

Each person in the family has an individual Deductible and OPM. The Deductible is included in OPM.

Covered service You pay

Preventive care No cost for most services

Doctor’s office visit $30 copay PCP/$50 copay Specialist/10% coinsurance after deductible for covered services received during a visit

Diagnostic lab test No cost

Imaging (x-ray, MRI, CT/PET scan) 10% coinsurance after the deductible is met

Outpatient surgery 10% coinsurance after the deductible is met

Hospitalization 10% coinsurance after the deductible is met

Emergency care $500 copay /10% coinsurance after deductible for MRI, CT/PET scans

Retail prescriptions (30-day supply)Mail order (up to a 90 day supply) for 2 copays

$10 copay generic/$30 copay preferred brand/20% coinsurance up to $100 per drug per fill specialty drugs

State of Colorado 2017/18 DHMOThis table highlights some of the benefits of your group:

This is only a summary of some benefits. Please see your Evidence of Coverage (EOC) for more information about coverage, limitations and exclusions for all benefits, including those not listed in this summary.


Overview of how your High Deductible (HDHP) works

July 1st June 30th

PREMIUM

DEDUCTIBLE (full charges)

ANNUALOPM

COPAYMENTS ANDCOINSURANCE


Annual deductible – per plan year $1,500 subscriber only / $3,000 family

Annual out-of-pocket maximum (OPM) – per plan year $3,000 subscriber only / $6,000 family

You must meet the family Deductible before plan moves to coinsurance. Deductible is included in the OPM.

Covered service You payPreventive care No cost for most services

Doctor’s office visit 20% coinsurance after the deductible is met

Diagnostic lab tests 20% coinsurance after the deductible is met

Imaging (x-ray, MRI, CT/PET scan) 20% coinsurance after the deductible is met

Outpatient surgery 20% coinsurance after the deductible is met

Hospitalization 20% coinsurance after the deductible is met

Emergency care 20% coinsurance after the deductible is met

Retail prescriptions (30-day supply)Mail order (up to a 90 day supply) for 2 copays after deductible

$10 copay generic/$30 preferred brand/20% coinsurance up to $100 per drug per fill specialty drugs after the deductible is met

State of Colorado 2017/18 HDHPThis table highlights some of the benefits of your group:

This is only a summary of some benefits. Please see your Evidence of Coverage (EOC) for more information about coverage, limitations and exclusions for all benefits, including those not listed in this summary.


State of Colorado 2017/18 HDHPYou have an option to open a Health Savings Account (HSA).

• An HSA is a savings account that works with an HSA-Qualified High Deductible HMO (HDHP) plan.

• If you enroll in our HDHP and sign up for a Health Savings Account (HSA) with Optum Bank at www.optumbank.com, the State will deposit $60 to your account each month.

• You can also contribute money to your HSA each year and use those funds to pay for qualified medical expenses, now or in the future.

• You own the money in this account, which you can grow and take with you even if you change jobs or retire.

http://www.optumbank.com/


You receive triple tax advantages with your HSA funds.

• The funds in your HSA are not considered part of your wages, so they’re not

subject to federal income taxes.

• HSA funds used to pay for qualified medical expenses are not subject to taxes.

• Any investment earnings in an HSA are tax-free so long as they’re used for

qualified medical expenses, which may include deductible, copay and

coinsurance.

State of Colorado 2017/18 HDHP


Pick a plan that’s right for you


Pick a plan that’s right for you


Denver/Boulder: convenient locations and access

• 22 medical offices in

Denver/Boulder area.

• Pharmacies in all locations.

• State of Colorado members can

access care and services at any

Kaiser Permanente medical

office in our other Colorado

service areas: Northern

Colorado, Southern Colorado

and Mountain Colorado.


• 3 medical offices in Southern

Colorado: two in Colorado

Springs and one in Pueblo.

• Community providers in addition

to our medical offices.

• We partner with local hospitals

for inpatient care.

• After the 1st fill of a maintenance

medication, Southern Colorado

members need to fill Rx either at

a Kaiser Permanente medical

office or through our mail order

service.

Southern CO: convenient locations and access


• .

• 4 medical offices: Loveland,

Fort Collins (2) and

Greeley.

• 80+ primary care physicians

at 20 network offices.

• 400+ specialists and

ancillary providers at 130+

network offices.

• 3 Banner Health hospitals.

• Pharmacies in all 4 of our

medical offices, but also

contract with network

pharmacies.

Expanded Network Specialty CareBanner Hospitals

KPCO Medical OfficeExpanded Network Primary Care

Northern CO: convenient locations and access

NEW


• Watch your mailbox for an invitation.

• We hope you’ll stop by for a few minutes and get to know us a little better….firsthand.

• Grab some food, have some fun and learn ways to live, work and play, a little healthier.

Kaiser Permanente will be hosting a special event at one of our Fort Collins medical offices in April for State of Colorado employees and their families.

Northern CO: convenient locations and access


• State of Colorado employees who live in the MTCO service area will see the Kaiser Permanente plans as enrollment options when completing their enrollment through Benefitsolver.

• Eligibility is based on home address being in one of the following zip codes: 80423, 80424, 80426, 80435, 80443, 80463, 80497, 80498, 81620, 81631, 81632, 81637, 81645, 81649, 81655, 81657, 81658.

Kaiser Permanente offers coverage to State of Colorado employees and their family members who live in Eagle and Summit counties.

Coverage available in the mountains


Frisco Medical Office226 Lusher Court., Suite 104Frisco, CO 80443

• Two primary care physicians

• Network providers in pediatrics, urology, psychiatry, optometry/ophthalmology, obstetrics/gynecology

• Full support services: radiology, laboratory, contracts with network pharmacies, contracts for DME, home health, behavioral health, PT/OT/SP, hospice, infusion, and SNF

Mountain CO: convenient locations and access


Edwards Medical Office56 Edwards Village Blvd., Suite 208Edwards, CO 81632

• Three primary care physicians

• Network providers locally with Colorado Mountain Medical and Valley View Hospital

• Full support services: radiology, laboratory, contracts with network pharmacies, contracts for DME, home health, behavioral health, PT/OT/SP, hospice, infusion, and SNF



In-network pharmacy locations:

Eagle County

• Eagle Pharmacy, Eagle• City Market Pharmacy, Avon• Walmart Pharmacy, Avon• Eagle Vail Pharmacy, Vail• City Market Pharmacy, Eagle• City Market Pharmacy, Vail• Edwards Medical Center, Edwards• Costco Pharmacy, Gypsum• Vail Valley Pharmacy, Edwards• Walgreens, Avon

Summit County

• Walmart Pharmacy, Frisco• City Market Pharmacy, Dillon• City Market Pharmacy, Breckenridge• Target Pharmacy, Silverthorne • Safeway Pharmacy, Frisco• Walgreens, Dillon


your care experience


Colorado Permanente Medical Group

Pediatricians Internists

Specialists

Family Practice

OB/GYN

195 86 140

60 500+

Specialists

700+

Family Practice

205

OB/GYN

67

Pediatricians

83

Internists

149


Specialty Care1

Services from doctors trained in specific areas of care.

Urgent CareIllnesses or injuries that require attention soon, but aren’t emergencies.

Emergency Care2

When your health is in danger and you need immediate care.

Routine CareRegular visits to your doctor to

catch health problems early, when they’re easier to treat.

1 Medicaid members need a referral from a primary care physician for specialty care.2 If you have a medical emergency, call 911 or go to the nearest hospital.

Get the right care: when you need it, how you want it


Video VisitOnline alternative to an

in-person appointment.1, 2

Chat OnlineConnect in real time with a Kaiser Permanente physician.

E-VisitOnline consultations are

available for some medical conditions.

EmailMessage your doctor’s office with nonurgent questions, anytime.1

In PersonSame-day appointments are

often available.

PhoneSave yourself an office visit by scheduling a call with a doctor.1

1 These features are available when you receive care at Kaiser Permanente medical offices.

2 Check with your doctor’s office to find out if video visits are available to you.






Video: Kaiser Permanente video visits: not just for millennials!

https://www.youtube.com/watch?v=mBvT6ftEjMk


How the team supports you and your doctorAdult and Pediatric Surgeons

Health Educators

Clinical Pharmacists

Adult and Pediatric Medical Specialists

Nurse Care Coordinators

Mental Health Specialists

Adult and Pediatric Hospitals and

Emergency Room Doctors


Kaiser Permanente Colorado patient talks about the quality and service from her care team

Video: My Kaiser Permanente Care Team Was Wonderful

https://www.youtube.com/watch?v=bGgwK98WK-E

resources


• If you have an illness or injury, call our medical advice team (time permitting).

• They can assess your situation and direct you to the most appropriate care setting, if an in-person visit is needed.

• Or, they can help you handle the problem at home until your next appointment.

For medical advice anytime, day or night, call 303.338.4545 (TTY 711).

Call before you go…our advice team is here for you 24/7


3 easy options to order your prescriptions through our mail order pharmacy:

• Visit kp.org/pharmacy center and follow the prompts to order online.

• Call our Automated Refill Line at 1-866-938-0077, and leave the appropriate information.

• If you need to speak to a pharmacist, call us directly at 303-326-6777 or1-866-523-6059, weekdays, 8 a.m. – 6 p.m.

Skip the trip and get it quick

Look into the State of Colorado’s enhanced mail-order prescription benefit and sign up for convenience and savings.


Online at kp.org, or with our mobile app, you can stay on top of your care 24/7 with these convenient features:*

• Access your electronic ID card

• Schedule and cancel routine appointments

• View most lab results as soon as they are available

• Refill most prescriptions, with no charge for shipping when you order online

• Email your doctor’s office with nonurgent questions

• Print vaccination records for school, sports, or camp

• Use tools to help you manage your coverage and costs

• Manage a family member’s health

Manage your health, anytime, anywhere

*Available when you receive care at Kaiser Permanente facilities.


Manage your health, anytime, anywhere

To use your digital member ID card, tap the card icon at the bottom of the Kaiser Permanente app dashboard.


Get a cost estimate at www.kp.org/estimates

• Members need to be registered on kp.org to use this secure tool.

• Provides the average cost of a service in your area, applies your plan benefits and how much you’ve spent on care thus far for the year. It will provide a low, likely and high cost for the service, including your member portion of the cost.

• Available when you receive care at Kaiser Permanente medical offices.


• Greeley: chiropractic

• Loveland: chiropractic

• Briargate (Colorado Springs): chiropractic

• Baseline (Boulder): acupuncture (open now!)and massage therapy

Centers for Complementary MedicineWe will be expanding to additional medical offices at the end of April, 2017:

The Kaiser Permanente Centers for Complementary Medicine have earned a high degree of member satisfaction.


• Health classes: Get inspired and find support groups at our medical offices, and get help improving your health.*

• Healthy lifestyle programs: Our personalized online programs can help you lose weight, reduce stress, quit smoking, and more—at no cost to members.

• Wellness coaching: Our wellness coaches will work one-on-one with you to help you achieve your health goals—no cost to members, and no referrals needed.

• Special rates for members: Get reduced rates on variety of products and services, like gym memberships and massage therapy through ChooseHealthy.†

• Online wellness tools: You have access to health calculators, podcasts, recipes, fitness videos and more on our award-winning website kp.org.

* Classes vary at each location and some may require a fee. †ChooseHealthy is a product of American Specialty Health Administrators, Inc., a subsidiary of American Specialty Health Incorporated (ASH). ChooseHealthy and the ChooseHealthy logo are federally registered trademarks of ASH. Please note that this is a discount program; it is not insurance.


• Get answers to frequently asked questions about what makes Kaiser Permanente different.

• View high-level information about your plan options.

• Watch 2-minute videos highlighting how to choose a health plan and why to select Kaiser Permanente.

• Find Kaiser Permanente locations, physicians and community providers.

We stand for health. Yours.

my.kp.org/stateofcolorado 1-866-635-8743

Whether you’re a long-time member or considering Kaiser Permanente for the first time, you can get all of the information you need at my.kp.org/stateofcolorado.

[email protected]


questions State of Colorado

2017 Open EnrollmentPresentation for

Documents

Kaiser Permanente See how our care and coverage can help you … · 2019. 3. 30. · Kaiser Permanente will be hosting a special event at one of our Fort Collins medical offices in