Healthy together. Care and coverage that fits your life

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1 This is an advertisement Healthy together Care and coverage that fits your life The right plan for families. $0 primary care visits for children with improved Standard Option. kp.org/feds Federal employees and annuitants 2018 rates and benefits Colorado

2 Kaiser Permanente Welcome to care that fits your life Convenient cost estimates Get an idea of what you ll pay before you come in for care. For a personalized estimate based on your plan details, visit kp.org/costestimates. Your doctor, your choice Choose your doctor based on what s important to you. Go to kp.org/searchdoctors for details about education, specialties, languages spoken, and more. You can also change doctors at any time. More care options We ve got you covered in-person and online. You can come see us in person, exchange s, schedule phone consultations, connect with video visits, or chat in real time with Kaiser Permanente doctors. 1 To learn more, visit kp.org/getcare. Right care, right time Get the care you need when you need it with routine, specialty, urgent, and emergency care. If you re ever unsure where to go, call us for 24/7 care advice by phone. Many services under one roof Do more in less time. In most of our medical offices, you can see your doctor, get a lab test or X-rays, and pick up prescriptions all in a single trip. 2

3 Care and coverage that fits your life Experience the Kaiser Permanente difference To be healthy, you need quality care that s simple, personalized, and hassle-free. At Kaiser Permanente, care and coverage come together so you get everything you need to stay on top of your health in one easy-to-use package. Let s get started Quality care with you at the center 2 Great care, great results 3 Get more from your health plan 4 Your care, your way 5 Care when and where you need it 6 What you need to know for 2018 Your 2018 benefits summary 8 Which option is right for you? 9 Senior Advantage for Federal Members 11 Ready to enroll with Kaiser Permanente? 12 1

4 Kaiser Permanente Quality care with you at the center Our physician-led care teams work together to keep you healthy by delivering high-quality, personalized care. Great care from great doctors Our doctors come from top medical schools, and many of them teach at world-renowned universities. No matter which personal doctor you choose, you ll be in highly skilled, experienced hands and your health is their chief concern. Choosing a doctor your partner in health We make it easy to find the doctor who s right for you and you re free to change doctors at any time, for any reason. Having a good relationship is important because your personal doctor is your biggest health advocate. Your physician will coordinate your care journey, and you ll work closely together to make decisions about your health. If you live in Mountain, Northern, or Southern Colorado, you can also choose an affiliated doctor within your service area. To learn more about our doctors, visit kp.org/searchdoctors. Better care with a connected team Your Kaiser Permanente doctor, nurses, and other specialists all work together to keep you healthy. They re connected to each other, and to you, through your electronic health record. So they know important things about you and your health like when you re due for a screening and what medications you re taking. That way, you get personalized care that s right for you. Personalized care for all members Care at Kaiser Permanente isn t one-size-fitsall. We believe your story, background, and values are as important as your health history. To deliver care that s sensitive to all cultures, ethnicities, and lifestyles, we: Strive to hire doctors and staff who speak more than one language Offer telephone interpretation services in more than 150 languages Train our care teams on how to connect with and care for people of all backgrounds Through our culturally responsive care programs, we ve improved health outcomes among diverse populations for conditions like high blood pressure, diabetes, and colon cancer. 2 2

5 Great care, great results Care and coverage that fits your life From preventive screenings that keep you healthy to world-class care if you get sick, we ve got you covered. Preventive care to keep you healthy Preventive care is key to how we practice medicine at Kaiser Permanente. It can help you avoid some health issues and catch others before they become serious. Your electronic health record plays a vital role your preventive care services are tracked in the system, which triggers automatic reminders when you re due for your next screening. We ll let you know when to come in so you re free to focus on living your life. Support for ongoing conditions If you have a condition like diabetes or heart disease, you re automatically enrolled in a disease management program for personal coaching and support. With a well-rounded approach backed by proven best practices and advanced technology, we ll help you get the care you need to continue living life to the fullest. Specialty care when you need it Preventive care can help keep you healthy, but we re also here for you if you get sick or need specialty care. We re the largest multispecialty medical group in Colorado, so we can connect you with the right specialist faster. And you don t need referrals for certain specialties, like obstetrics-gynecology, psychiatry, and drug dependency services. From high-quality maternity care to treatment for cancer, heart problems, and more, you get great doctors, the latest technology, and evidence-based care all combined to help you recover quickly. A leader in clinical quality In 2016, Kaiser Permanente led the nation in 21 effectiveness-of-care measures, including prevention and screening, cardiovascular care, and comprehensive diabetes care. 3 Hear care stories from real Kaiser Permanente members at kp.org/carestories. 3

6 Kaiser Permanente Get more from your health plan Good health goes beyond the doctor s office. That s why we offer so many convenient resources to our members. Explore them all, and choose the ones that fit your life. Tools and resources for good health Online wellness tools Healthy rewards Health classes Personal wellness coaching Special rates for members Help to quit smoking Visit kp.org/healthyliving for wellness information, health calculators, fitness videos, podcasts, and recipes from world-class chefs. Take simple steps to improve your well-being and earn up to $150 per household to pay for qualified medical expenses.* FEHB subscribers and their enrolled spouses (18 and over) are eligible for the following rewards: $50 for taking the Total Health Assessment, an online questionnaire that gives you a wellness action plan $25 for completing a healthy lifestyle program, an online class to help you reach your health goals Go to kp.org/feds to learn more and get started. Get inspired to improve your health. Support groups and health education classes are offered at many Kaiser Permanente medical offices or with our community partners. Find classes at kp.org/classes. Some classes may require a fee. Get help reaching your health goals. Work one-on-one with a wellness coach by phone at no cost. Find out more at kp.org/wellnesscoach. Enjoy reduced rates on products and services that can help you stay healthy like acupuncture, massage therapy, and more. Explore your options at kp.org/choosehealthy. Basic Option members are eligible for Active&Fit fitness center membership (see page 9). Let us help you succeed in quitting. You pay nothing for classes, telephone coaching, online programs, and prescriptions, including over-the-counter tobacco-cessation drugs we prescribe to you. Ask your doctor about your treatment options. * As a Kaiser Permanente member, you and your enrolled spouse (age 18 and over) are eligible to earn up to $75 each in rewards. We will send you a Kaiser Permanente health payment card 4 to 6 weeks after you complete your first activity, then load additional rewards when you complete your second activity. You must keep your card for use throughout the year and use rewards to pay qualified medical expenses by March 31 of the next calendar year. Go to kp.org/feds to learn more and get started. 24

7 Care and coverage that fits your life Your care, your way Get care where, when, and how you want it. With more options to choose from, it s easier to stay on top of your health. Choose how you connect to care your doctor s office anytime with nonurgent questions. You ll usually get a response within 2 business days if not sooner. Video For some conditions, you can meet face-to-face online with your doctor on your computer, smartphone, or tablet. Online chat For nonurgent questions, chat online 7 days a week with Kaiser Permanente doctors, at no additional cost. Phone You may be able to save a trip to the doctor s office by having a phone appointment instead. We also offer care guidance and advice by phone 24/7. In person Most of our locations have many services under one roof, so you can see your doctor, get lab services or X-rays, and pick up a prescription all in the same trip. Manage your health your way Online Stay on top of your care at kp.org. Once you re registered, you can view your medical record, refill most prescriptions, schedule routine appointments, and more. In app Manage your care anytime, anywhere. Access many of the features on kp.org with the Kaiser Permanente mobile app. 4 Learn more at kp.org/mobile. 5

8 Kaiser Permanente Care when and where you need it It s easy for you and your family to get the care you need when you need it. There are many Kaiser Permanente medical offices in your area, offering convenient hours and a wide range of care and services. Convenient care near you With multiple locations to choose from, it s easy to find one near home or work. We offer same-day, next-day, after-hours, and weekend services at many of our locations, along with ob-gyn, pediatrics, and other specialty departments. You can also see different doctors at different locations whatever works best for you. Finding the right location Choosing a convenient place to get care is simple just hop online or grab your smartphone. Visit kp.org/facilities to search by ZIP code, keyword, or the type of service you need. Search on your smartphone with the location finder on the Kaiser Permanente mobile app. 4 Getting care anytime, anywhere Emergency care If you ever need emergency care, you re covered. You can always get care at any Kaiser Permanente or non Kaiser Permanente hospital emergency department. 5 Travel care As a Kaiser Permanente FEHB member, your benefits go farther than your home service area. Wherever you go, you re covered for: Emergency room and urgent care visits anywhere in the world Care at any Kaiser Permanente location in another region Coverage for certain ongoing outpatient care and follow-up care outside of Kaiser Permanente service areas through the FEHB travel benefit To learn more, call our 24/7 Away from Home Travel Line at or visit kp.org/travel. Expanded dependent care Kaiser Permanente covers routine, continuing, and follow-up care received outside of any Kaiser Permanente service area by any spouse or legal dependent up to age 26 who is enrolled in the plan. Out-of-area services are limited to covered, nonurgent medical needs. Medically necessary urgent and emergency care are always covered for dependents while out of the service area. See Plan brochure RI for details. 26

9 Care and coverage that fits your life Benefit highlights 2018 benefit changes what s new? High Option Decreased the copay for specialty care office visits from $40 to $30 per visit. Decreased the urgent care office visit copay from $75 to $30. Removed coinsurance for ambulance: You'll now pay $150 per trip. Standard Option Decreased deductible from $350 per person (up to $700 per family enrollment) to $150 per person (up to $300 per family enrollment). $0 copay for primary care for children through age 17 (decreased from $20); increased the primary care office visit copay from $20 to $30, and increased the specialty care office visit copay from $35 to $40 per visit. Removed coinsurance for outpatient surgery: You ll now pay $250 after the deductible per procedure. Removed coinsurance for specialty scans: You ll now pay $150 after the deductible. Removed coinsurance for ambulance: You'll now pay $200 per trip. Decreased urgent care office visit copay from $75 to $40. Increased emergency care office visit copay from $200 to $250. Increased out-of-pocket maximum from $4,350 per person up to $8,700 per family to $5,000 per person up to $10,000 per family. High, Standard, and Basic Options Removed coinsurance for specialty drugs and office-administered medication replaced with a predictable copay. Cost-sharing for services received in another Kaiser Permanente region now applies. For a full list of 2018 benefit changes, please refer to the FEHB Plan brochure, RI Save on prescription drugs Save time and money by ordering prescription refills online or by phone. We can mail most prescription drugs to you within 10 days. You don t pay any extra cost for standard U.S. postage. You get a 90-day supply for only twice the 30-day supply copay when we mail your prescriptions. Chiropractic services You can receive up to 20 chiropractic visits per year and you don t need a referral. You can visit our Centers for Complementary Medicine for chiropractic services. For a list of participating providers, call Member Services at for Denver/Boulder, for Northern Colorado, for Mountain Colorado, or for Southern Colorado. 7

10 Kaiser Permanente Your 2018 benefits summary Benefits and Services High Option Standard Option Basic Option Deductible (2x per family maximum) None $150 per person $600 per person Outpatient services (per visit or procedure) Preventive care $0 $0 $0 Primary care $20 $30; $0 through age 17 Specialty care $30 $40 $50 Procedures received during an office visit $0 10%* 20%* Most lab tests $0 $0 $0 Most X-rays $0 $0 20%* Chiropractic services (up to 20 visits per year) $25 $25 $25 Hospital and facility Outpatient surgery $200 $250* 20%* Inpatient hospital care (per admission) $500 per day up to $1,000 10%* 20%* Maternity Routine prenatal care visit, first postpartum visit $0 $0 $0 Delivery (per admission) $500 per day up to $1,000 10%* 20%* Emergency and urgent care (per visit or trip) Emergency care $200 $250 20%* Urgent care $30 $40 $75 Ambulance $150 $200 20% up to $500 Prescription drugs (up to a 30-day supply at plan pharmacies, or up to a 90-day supply for 2 copays through mail order) Preferred generic $15 $15 $15 Preferred brand $40 $50 $60 Non-preferred generic and brand $60 $70 $80 Specialty $100 $150 $200 Out-of-pocket maximum (2x per family maximum) $4,000 per person 5,000 per person $6,000 per person $20 *You pay the deductible, then cost-sharing. Plan providers determine the drug that is medically necessary. If you request another drug, you pay prices charged to members for non-covered drugs. 28

11 Care and coverage that fits your life Which option is right for you? High Option Standard Option Basic Option Higher premiums, with lower copays for most services and prescription drugs. No deductible. If you want low out-ofpocket costs, this may be the right choice. Lower premiums compared to the High Option. You pay nothing for primary care visits for children. You pay copays for most services. No deductible for office visits, prescription drugs, labs, X-rays, emergency care, and many other services. Low $150 deductible for other services. If you want predictable copays for most services and office visits and prescriptions at a lower premium, this may be the right choice. Lowest premiums, but highest share of the cost. You pay copays for office visits and most prescriptions. No deductible for office visits, prescription drugs, labs, urgent care, and some other services. $600 deductible for certain services. Eligible for Active&Fit fitness center membership. (see below). If you rarely go to the doctor, but you use a gym and want the lowest premium with some predictability, this may be the right choice. Additional dental coverage available for all Option members All Kaiser Permanente FEHB members can buy a dental plan. For more information, go to deltadentalco.com or call Delta Dental at Active&Fit for Basic Option members Stay on top of your game with a fitness center membership. Basic Option members age 16 and older pay only $100 per calendar year for access to participating Colorado fitness centers. To learn more and enroll, visit kp.org/activeandfit or call , Monday through Friday, from 6 a.m. to 7 p.m. Mountain time. Note: Members of Kaiser Permanente Senior Advantage for Federal Members get a similar benefit, which is called SilverSneakers. See page 11 for more information. 9

12 Kaiser Permanente Kaiser Permanente Senior Advantage (HMO) for Federal Members Are you considering Medicare health plan options? If you decide to enroll in Senior Advantage for Federal Members, you ll get better benefits than with your FEHB coverage alone. You ll get all of your FEHB benefits plus: No annual deductible Lower copays for office visits (High and Standard Options) and for most other services, such as inpatient hospital admissions, emergency care, urgent care (Basic Option only), and most prescription drugs Up to a 60-day supply of prescription drugs at Plan pharmacies for 1 copay $200 credit toward lenses, frames, and contact lenses every 2 years (High Option only) $500 credit per ear toward hearing aids every 3 years (High Option only) Lower out-of-pocket maximums Membership in SilverSneakers Fitness Program at no extra cost To enroll in Senior Advantage for Federal Members, you must first enroll in Kaiser Permanente s FEHB plan (either the High, Standard, or Basic Option), plus Medicare Parts A and B. After that, you can apply for Senior Advantage for Federal Members. We ll enroll you in the plan option that matches the Kaiser Permanente FEHB option you have now. For example, if you re a Kaiser Permanente High Option member, you ll be enrolled in Senior Advantage for Federal Members High Option. Be sure to choose the right enrollment code on page 12. When you become eligible for Medicare, you may be able to change your current plan or option. To learn more about making enrollment changes outside of Open Season: Go to opm.gov, or Contact your employing agency or retirement office. We can help you make an easy transition. For more information, download our brochure, Your Guide to Choosing a Kaiser Permanente Medicare Health Plan, at kp.org/feds. For questions or help with the enrollment process or to have information sent to you, please call Member Services at for Denver/Boulder or Northern Colorado, for Mountain Colorado, or for Southern Colorado (TTY 711), Monday through Friday, 8 a.m. to 5 p.m. Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. To join a Kaiser Permanente Medicare Health Plan, you must reside in the Kaiser Permanente Senior Advantage service area in which you enroll. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year and at other times in accord with your group s contract with us. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. You must pay the Medicare Part B premium to join a Kaiser Permanente Medicare health plan. Enrolling in Senior Advantage for Federal Members will not affect the benefits you receive through the Federal Employees Health Benefits (FEHB) Program, although the network and other rules of Medicare may apply. 210

13 Care and coverage that fits your life Senior Advantage for Federal Members Benefits and Services High Option Standard Option Basic Option Outpatient services Preventive care $0 $0 $0 Primary care $10 $20 $20 Specialty care $20 $35 $50 Most lab tests $0 $0 $0 Most X-rays $0 $0 $0 Spinal manipulation services (up to 20 visits per year) $15* $20* $20* Hospital and facility Outpatient surgery $100 $250 20% Inpatient hospital care (per admission) $100 $250 per day up to $750 $275 per day up to $1,100 Emergency and urgent care (per visit or trip) Emergency care $50 $65 $75 Urgent care $30 $40 $50 Ambulance (per trip) $150 $195 $235 Prescription drugs (up to a 60-day supply at plan pharmacies or through mail order) Generic $5 $10 $15 Preferred brand $20 $40 $50 Non-preferred brand $20 $40 $50 Specialty $40 $60 $75 Additional Senior Advantage benefits Eyeglasses and contact lenses (every 24 months) $200 allowance Not covered Not covered Hearing aids (per ear every 3 years) $500 allowance Not covered Not covered SilverSneakers Fitness Program $0 $0 $0 Out-of-pocket maximum (2x per family maximum) $2,500 per person $2,950 per person $3,400 per person *For spinal manipulation services, you self-refer to a participating provider. To find a participating provider, call Member Services at for Denver/Boulder or Northern Colorado, for Mountain Colorado, or for Southern Colorado. These chiropractic services are separate from the chiropractic services that we cover in accordance with Medicare guidelines. Plan providers determine the drug that is medically necessary. If you request another drug, you pay prices charged to members for non-covered drugs. If you request a brand-name drug in place of a generic drug prescribed by your doctor, you may be required to pay full charges. For certain drugs, you can get prescription refills mailed to you through our Kaiser Permanente mail-order pharmacy. You should receive them within 10 business days. If not, please call (TTY 711), Monday through Friday, 8 a.m. to 6 p.m. The pharmacy network may change at any time. You will receive notice when necessary. 11

14 Kaiser Permanente Ready to enroll with Kaiser Permanente? 7 1. Choose an option. High Option Standard Option Basic Option Find brief descriptions of these options on page Select the type of enrollment you want. Self Only covers you. Self Plus One covers you and 1 eligible family member. Self and Family covers you and all eligible family members. 3. Sign up online or call. Find your enrollment code in the chart below. Then, visit opm.gov to enroll online or contact your employing agency or retirement office for next steps and other information. Annuitants can contact the Retirement Information Center at or (TTY ), or retire@opm.gov. If you qualify for Medicare, or will soon, see page 10 for more information. Your Premium Share* High Option Standard Option Basic Option Biweekly Non-Postal $95.78 $58.97 $46.32 Self Only Biweekly Postal Category 1 $89.41 $53.66 $42.16 Biweekly Postal Category 2 $83.05 $48.95 $38.45 Monthly Non-Postal $ $ $ Biweekly Non-Postal $ $ $ Self Plus One Biweekly Postal Category 1 $ $ $95.27 Biweekly Postal Category 2 $ $ $86.90 Monthly Non-Postal $ $ $ Biweekly Non-Postal $ $ $ Self and Family Biweekly Postal Category 1 $ $ $95.27 Biweekly Postal Category 2 $ $ $86.90 Monthly Non-Postal $ $ $ Enrollees covering themselves and one other eligible family member may choose either the Self Plus One or Self and Family enrollment type. If you choose the High Option, you ll save money if you enroll in Self and Family. Current Self Plus One subscribers must make an active enrollment election to move to Self and Family and get a lower member contribution. Choose the right enrollment code Enrollment Code High Option Standard Option Basic Option Self Only N41 Self Plus One N43 Self and Family N42 *These rates do not apply to all enrollees. If you are in a special enrollment category, please contact the agency or Tribal Employer which maintains your health benefits enrollment. 212

15 Care and coverage that fits your life This is a summary of the features of the Kaiser Permanente health plan. Before making a final decision, please read the plan s Federal brochure, RI All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure. The services listed on page 4 ( Get more from your health plan, except Health classes ) and on page 9 (Additional dental coverage for FEHB members.) are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees and family members who become members of Kaiser Permanente. 1 These features are available when you get care at Kaiser Permanente facilities. 2Kaiser Permanente improved blood pressure control in our Black/African American members, raised colon cancer screening rates in our Hispanic/Latino members, and improved blood sugar control in our members with diabetes. Self-reported race and ethnicity data are captured in KP HealthConnect, and HEDIS measures are updated quarterly in the interregional CORE Datamart. 3Kaiser Permanente 2016 HEDIS scores. Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compass and represent all lines of business. Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality. The source for data contained in this publication is Quality Compass 2016 and is used with the permission of NCQA. Quality Compass 2016 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass and HEDIS are registered trademarks of NCQA. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality. 4 To use the Kaiser Permanente app, you must be a Kaiser Permanente member registered on kp.org. 5 If you reasonably believe you have an emergency medical condition, which is a medical or psychiatric condition that requires immediate medical attention to prevent serious jeopardy to your health, call 911 or go to the nearest emergency department. For the complete definition of an emergency medical condition, please refer to the Plan brochure, RI This number can be dialed from inside and outside the United States. Outside, you must dial the U.S. country code 001 for landlines and +1 for mobile before the phone number. Long-distance charges may apply and we cannot accept collect calls. This phone line is closed on major holidays. 7 These are highlights of the FEHB enrollment process. Please refer directly to opm.gov and your employing agency or retirement office for FEHB coverage effective dates, enrollment procedures and deadlines, and other information. To add an eligible family member to your Kaiser Permanente Self and Family enrollment, complete and return an Enrollment Change Form to us. These forms can be obtained at kp.org/feds or by calling Member Services. Need help? Call us at for Denver/Boulder or Northern Colorado, for Mountain Colorado, or for Southern Colorado (TTY 711), Monday through Friday, 8 a.m. to 5 p.m. 13

16 Kaiser Foundation Health Plan of Colorado P.O. Box Denver, CO The right choice for a healthier you Having a good health plan is important. So is getting quality care. With Kaiser Permanente, you get both. Not a member yet? For more information, visit kp.org/feds or call , Monday through Friday, 8 a.m. to 6 p.m. Open Season hours: Monday through Friday, 7 a.m. to 8 p.m. Saturday and Sunday, 7 a.m. to 4 p.m. Notice of Summary of Benefits and Coverage (SBC): Availability of Summary Health Information The Federal Employees Health Benefits (FEHB) Program offers numerous health benefits plans and coverage options. Choosing a health plan and coverage option is an important decision. To help you make an informed choice, each FEHB plan makes available a Summary of Benefits and Coverage (SBC) about each of its health coverage options, online and in paper. The SBC summarizes important information in a standard format to help you compare plans and options. This plan s SBC is available on the internet at kp.org/feds. A paper copy is also available, at no charge, by calling for Denver/Boulder or Northern Colorado, for Mountain Colorado, or for Southern Colorado, Monday through Friday, 8 a.m. to 6 p.m. For TTY, call 711. To find out more information about plans available under the FEHB Program, including SBCs for other FEHB plans, please visit opm.gov/insure. Please recycle October Kaiser Foundation Health Plan, Inc.