Deductible HMO Open Enrollment Presentation (English) · country. Long-distance charges may apply,...

Copyright ©2018 Kaiser Foundation Health Plan, Inc.1Copyright ©2018 Kaiser Foundation Health Plan, Inc.

2018 Open Enrollment

Presentation for2019 Open Enrollment presentation for

VMwareSam Yee, Regional Account Manager November 2018

Copyright ©2018 Kaiser Foundation Health Plan, Inc.2

2019 Open Enrollment

▪ What’s new for 2019

▪ Overview of the Deductible HMO plan

▪ Tools and Resources

Agenda


How is the Kaiser Permanente

Deductible HMO Plan different


Same care and convenience

WHY CHOOSE KAISER PERMANENTE?

▪ Same great doctors

▪ Same personalized attention

▪ Same convenient locations

▪ Same online tools

▪ Same healthy resources

▪ Same Medical Record Number

(MRN)

A different way to pay for your care


Preventive care at no cost


Because finding and treating problems before they get serious is an

important part of staying healthy, you get most preventive care at no

cost— even before you reach your deductible.

Preventive care includes:

▪ Cancer screenings

▪ Cholesterol and high blood

pressure screenings

▪ Diabetes screenings

▪ Immunizations

▪ Routine prenatal care

▪ Well-child visits


Convenient care management


*Available when you receive care at Kaiser Permanente facilities.

On kp.org or with the KP app, you can stay on top of

your care 24/7 with these convenient features:*

▪ Schedule and cancel routine appointments.

▪ View most lab results as soon as they are available.

▪ Refill most prescriptions with no charge for shipping.

▪ Email your doctor’s office with nonurgent questions.

▪ Print vaccination records for school, sports, or camp.

▪ Manage a family member’s health.


Key terms


Key terms

KEY TERMS

▪ Deductible: The amount you pay for covered services

each year before Kaiser Permanente starts paying. You

may pay copays for some services without having to

reach your deductible.

▪ Out-of-pocket maximum: The most you’ll pay for

covered services each year. For a small number of

services, you may need to keep paying copays or

coinsurance after reaching your out-of-pocket maximum.

Note: Your deductible and out-of-pocket maximum will reset

on January 1st.


Key terms (continued)

▪ Copay: The set amount you pay for covered services

— for example, a $20 copay for an office visit.

▪ Coinsurance: A percentage of the charges that you

pay for covered services — for example, a 10%

coinsurance for a $200 procedure means you pay

just $20.

KEY TERMS


How your plan works


How your deductible plan works

PREVENTIVE CARE SERVICES AND DOCTOR’S OFFICE VISITS DEDUCTIBLE HMO PLAN

You’ll pay full charges for covered services, including

emergency, hospital care, X-rays, therapy visits, and lab tests

before meeting your plan deductible.

After meeting your plan deductible, you’ll start paying less for

these services — a copay or coinsurance — until you reach

your out-of-pocket maximum.

January 1st December 31st


Family deductibles and out-of-pocket maximums

YOUR PLAN BENEFITS

If your family is covered under your plan:

▪ Each family member has an individual

deductible, and the family as a whole has

a deductible.

▪ Each family member has an individual

out-of-pocket maximum, and the family

as a whole has an out-of-pocket maximum.

▪ Your individual deductible is $250

Your family deductible is $500.

▪ Your individual out-of-pocket maximum is

$1,500.

Your family out-of-pocket maximum is

$3,000.


Your plan benefits


Covered service You pay

Routine physical exams No charge

Primary care office visits $20 Copay (Plan Deductible doesn’t apply)

Specialty care office visits $30 Copay (Plan Deductible doesn’t apply)

Lab tests 10% Coinsurance after Plan Deductible

X-ray 10% Coinsurance after Plan Deductible

Outpatient surgery 10% Coinsurance after Plan Deductible

Hospitalization 10% Coinsurance after Plan Deductible

Urgent care visits $20 Copay (Plan Deductible doesn’t apply)

Emergency Department visits 10% Coinsurance after Plan Deductible

Generic prescription drugs

Generic refills through mail order service

$10 Copay for a 30-day supply (Plan Deductible doesn’t apply) $20 Copay for up to a 100-day supply (Plan Deductible doesn’t apply)

Brand-name prescription drugs

Brand-name refills through mail order service

$20 Copay for a 30-day supply (Plan Deductible doesn’t apply) $40 Copay for up to a 100-day supply (Plan Deductible doesn’t apply)

Specialty prescription drugs $20 Copay for a 30-day supply (Plan Deductible doesn’t apply)

Highlights of this plan’s benefits*

YOUR PLAN BENEFITS

*This is just a summary of some examples of covered services and their corresponding copay and coinsurance amounts. Please see your

Evidence of Coverage for information about coverage, limitations, and exclusions for all benefits, including those not listed in this summary.

Deductible: $250 individual / $250 family member / $500 family

Out-of-pocket maximum: $1,500 individual / $1,500 family member / $3,000 family


Getting care


Visit kp.org/deductibleplans

GETTING CARE

▪ View claims summaries.

▪ View and pay medical bills.

▪ Use the Estimates tool

▪ Sample fee list

Access information and tools to help you better understand

and manage your deductible plan coverage and costs.

For example, you can:


Before your visit — getting an estimate

GETTING CARE

Use our online Estimates tool to:

▪ Get an estimate of how much a

treatment, procedure, test, or

other medical service will cost.

▪ Track how close you are to

reaching your deductible and

out-of-pocket maximum.

▪ See how it works

kp.org/costestimates/video

Call 1-800-390-3507, weekdays

from 7 a.m. to 5 p.m.


During your visit — paying for care

GETTING CARE

When you check in for your visit, you’ll be asked to make a

payment. You can expect to get a bill later for any remaining

amount you owe.


After your visit — what to expect

GETTING CARE

You’ll also get a bill if your payment

at check-in didn’t cover the full cost

of the services you received.

You’ll get an Explanation of Benefits (EOB)

statement to help you track the care you’ve

received and how close you are to reaching

your deductible and out-of-pocket maximum.


Questions?

HEALTHY TOGETHER

Call our Member Service Contact Center, 24 hours a day,

7 days a week (closed holidays).

1-800-464-4000 English

711 TTY


Additional Resources


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

What’s integrated care? A simpler, seamless experience in which the

health plan and doctors work together for you.

You get:

• Hassle-free health care with less

paperwork

• A care team that’s connected to each

other and you

• Many services under one roof

Care and coverage built around you


Schedule

appointments

and get 24/7

medical advice

by phone.

Meet face-to-

face with a

doctor online.*

Email your

doctor’s office

with nonurgent

questions

anytime.

Visit your

doctor at your

local facility.

Save yourself a

trip to the

doctor’s office

with a telephone

appointment.*

*When appropriate and available.


Your care, your way



For more on specialty care, visit thrive.kp.org/healthier-outcomes.

Maternity care

For family planning

to first steps and

beyond, visit

kp.org/maternity

Mental health

Our members can access

mental health services

with no referral needed at

kp.org/mentalhealth

Cardiac care

Learn how we’re healing

hearts and saving lives with

advanced cardiac care at

kp.org/cardiaccare

No matter what life throws your way, you can count on us. Get access to excellent

care from top-notch doctors across a wide range of specialties, including:

World-class specialty care


*This number can be dialed inside and outside the United States. Before the phone number, dial “001” for landlines and “+1” for mobile lines if you’re outside the

country. Long-distance charges may apply, and we can’t accept collect calls. The phone line is closed on major holidays (New Year’s Day, Easter, Memorial Day,

July Fourth, Labor Day, Thanksgiving, and Christmas). It closes early the day before a holiday at 10 p.m. Pacific time (PT), and it reopens the day after a holiday

at 4 a.m. PT.

• If you get hurt or sick while traveling, we’ll help

you get care. Our plans include emergency and

urgent care coverage from qualified providers

anywhere in the world.

• We can also help you before you leave town by

checking to see if you need a vaccination,

refilling eligible prescriptions, and more. Just

call us or go online:


24/7 Away from

Home Travel Line:

951-268-3900*

kp.org/travel

Care away from home


1Classes vary at each location and some may require a fee.2Not available in all areas.

• Wellness Coaching by Phone

kp.org/wellnesscoach

• Healthy Lifestyle programs

kp.org/healthylifestyles

• On-site Health Education Classes and support

groups1 kp.org/classes

• Online videos, podcasts, recipes, and more

kp.org/healthyliving

• Seasonal Farmers Markets2

kp.org/farmersmarkets


Healthy resources


21 medical centers

59 medical offices

2 affiliated plan hospitals

11 affiliated medical offices

Map not to scale


N

Northern California


Scotts Valley Medical Offices

Santa Cruz Medical Offices


Open now

• Sacramento Downtown Commons Medical Offices

• San Jose Skyport Medical Offices

• Santa Cruz Medical Offices

• Santa Rosa Mercury Way Medical Offices

• Scotts Valley Medical Offices

• Watsonville Community Hospital

• Watsonville Medical Offices

Coming NEW in Spring 2019:

• Dublin Medical Office and Cancer Center

New locations in Northern California

Visit kp.org/locations

Deductible HMO Open Enrollment Presentation (English) · country. Long-distance charges may apply,...

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Transcript of Deductible HMO Open Enrollment Presentation (English) · country. Long-distance charges may apply,...