Visiting Member Brochure
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- Octavia Flynn
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1 Visiting Member Brochure We look forward to meeting your health care needs. If you get a migraine while visiting Baltimore, or come down with the flu in Denver, we ll be there for you.
2 Please keep this brochure handy for future reference. It s a guide to the services available to you when you are temporarily visiting another Kaiser Permanente region or a Group Health Cooperative (GHC) service area. Who can get visiting member services? You can get visiting member services when you are temporarily visiting a Kaiser Permanente region other than your home region (the region in which you are enrolled) or visiting a GHC service area (in parts of Washington and northern Idaho), unless your hip is through one of the following plans or programs. Medicaid programs. (Including Medi-Cal and similar programs, but not including Medicare.) You might not be eligible for visiting member services or the services may differ from what is described here. Please call Member Services in your home region for more information. Deductible plans with HSAs or Federal Employees Health Benefits (FEHB) high deductible health plan. You are not eligible for visiting member services if you are enrolled in a deductible plan for use with a health savings account (HSA). However, if you re enrolled in one of these plans in either the Northern California or Southern California regions, you may receive visiting member services in the other California region. Self-funded plans. If you re enrolled in a group s self-funded plan, including a group s self-funded deductible plan for use with a health savings account, your access to care in other regions or a GHC service area may differ from the visiting member services described in this brochure. You may receive care in other regions or a GHC service area according to the terms and conditions described in your Summary Plan Description. For more information, call the Customer Services number on your Kaiser Permanente ID card. Kaiser Permanente Insurance Company (KPIC) plans. This brochure is for Kaiser Foundation Health Plan, and does not apply to KPIC coverage. If you have KPIC coverage, see your KPIC Certificate of Insurance for more information. How long can I receive visiting member services? Visiting member services are limited to 90 days. This 90-day limit does not apply to dependent children attending accredited colleges or accredited vocational schools, but you might need to show proof of student enrollment status. If you are not an FEHB member, and you permanently move to another Kaiser Permanente region or GHC service area, or visit one for more than 90 days in a row (180 days for Kaiser Permanente Senior Advantage (HMO) and Kaiser Permanente Senior Advantage (HMOPOS) ), you might not be able to continue your 2 3
3 home region hip. If you have permanently moved, you may be able to enroll as a member of a Kaiser Permanente plan or GHC plan offered in the region or service area of your new residence. For more information, please refer to your Evidence of Coverage or Member Handbook or contact Member Services in your home region. Phone numbers are listed in the back of this brochure for your convenience. Where can I receive visiting member services? You can receive visiting member services in a GHC service area or in any Kaiser Permanente region other than your home region (the region in which you are enrolled). If your home region has more than one service area, you cannot get visiting member services in other service areas in your home region. For information about a region, a service area, facility locations, or Plan physicians, please call Member Services in your home region or in the region or service area you will be visiting. Phone numbers are listed in the back of this brochure for your convenience. or deductibles that you pay in your home region. Please call Member Services in your home region for more information. You can receive the following visiting member services when the service is provided or arranged by a Plan physician in the Kaiser Permanente region or GHC service area you are visiting: Hospital inpatient services Physician services Prescription drugs Outpatient services Subject to all other limits for the services listed in this section. Office visits Outpatient surgery Physical, occupational, and speech therapy (up to two months per condition) Allergy tests and allergy injections Prenatal and postnatal care Dialysis care What services can I receive as a visiting member? The services available to you as a visiting member may differ from the services available in your home region and are subject to the exclusions listed in this brochure. You may have to make out-of-pocket payments for visiting member services, which may be different from the copayments, coinsurance, 4 5
4 X-ray and laboratory services In or out of the hospital. Outpatient prescription drugs Available if the drug is covered in your home region. Mental health and Chemical dependency services Available under the same terms and conditions as the service would be if covered in your home region. Skilled nursing facility services Up to 100 days per calendar year. Home health care services Part-time or intermittent home health care services inside a Kaiser Permanente region or GHC service area. Hospice services Home-based hospice services inside a Kaiser Permanente region or GHC service area. For and Medicare Plus enrolled in Medicare Parts A and B, hospice services are covered by Original Medicare and are not available as visiting member services. Services requiring preauthorization Inpatient physical rehabilitation services covered in your home region may also be available to you as a visiting member. Preauthorization from your home region is required. Services that require preauthorization in your home region may also be available to you when visiting another Kaiser Permanente region or GHC service area, once you have obtained preauthorization from your home region or GHC service area. Also, some services require preauthorization from the visited region or service area. Please contact Member Services in the region or GHC service area you ll be visiting for more information. Visiting member services exclusions The following services are not available as visiting member services. (Services include equipment and supplies.) Services that are not covered in your home region as described in your Evidence of Coverage or Member Handbook Services that are not medically necessary Physical examinations and related services for insurance, employment, or licensing drugs for the treatment of sexual dysfunction disorders dental services and dental X-rays infertility services Services related to conception by artificial means, such as in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT) 6 7
5 experimental services and all clinical trials Cosmetic surgery and other services performed primarily to change appearance Custodial care and care provided in an intermediate care facility Services related to sexual reassignment transplants and related services Complementary and alternative medicine services, such as chiropractic services Services you receive as a result of a written referral from a Plan physician in your home region* emergency services, including emergency ambulance services, and urgent care services* durable medical equipment, orthotics and external prosthetics, eyeglasses, and hearing aids For Mid-Atlantic States : If your Kaiser Permanente hip is through a Maryland-based contract, care for physical, occupational, and speech therapy is different from the care described here. Please call Mid-Atlantic States Member Services for more information. *Emergency services, urgent care, and referral services may be covered under your home region coverage even when you receive the services outside your home region. Please call Member Services in your home region for more information. How do I get visiting member services? Please make your appointment as far ahead of time as possible if you know you re going to need routine or follow-up care, such as blood tests or a prenatal checkup. To arrange for services, call Member Services in the Kaiser Permanente region or GHC service area you are visiting and tell the representative that you are a visiting member. He or she will give you the information you need to make an appointment, including the Plan facility or physician name, phone number, and location. 8 9
6 Please don t forget to take your Kaiser Permanente identification card with you when you leave home. For other than Kaiser Permanente Senior Advantage and Medicare Plus : Kaiser Permanente may change this visiting member program at any time, including the Kaiser Permanente regions and GHC service areas where you may obtain visiting member services. If you have any questions, please call Member Services in your home region. Kaiser Permanente Member Services If you would like more information about visiting member services, please call Member Services in your home region. If you would like to make an appointment for care in the Kaiser Permanente region or GHC service areas you will be visiting, please call Member Services in that area. You will receive services directly from Group Health when visiting a GHC service area. Regions and service areas California (Northern and Southern California Regions) (TTY) Mon. Fri., 7 a.m. 7 p.m. Sat. Sun., 7 a.m. 3 p.m. and Kaiser Permanente Medicare Cost (TTY) Colorado Region Denver/Boulder area (303) (from the Denver metro area) (from other areas) (303) (TTY, Denver metro area) (TTY, other areas) Mon. Fri., 8 a.m. 5 p.m. Denver Metro area (TTY) Southern Colorado area (TTY) 10 11
7 Note: You need a Southern Colorado ID number and primary care physician assignment to receive routine, follow-up, or nonemergency care in the Southern Colorado service area. Please call Southern Colorado Member Services for more information. District of Columbia (Mid Atlantic States Region) (301) (from the D.C. metro area) (from other areas) (301) (TTY) Mon. Fri., 7:30 a.m. 5:30 p.m. Kaiser Permanente Medicare Plus (TTY) Georgia Region Metro-Atlanta area (404) (from the metro-atlanta area) (from other areas) (TTY) Mon. Fri., 8 a.m. 9 p.m. Sat. Sun., 8 a.m. 2 p.m. (404) (from the metro-atlanta area) (from other areas) (TTY) Hawaii Region Oahu, Maui, Hawaii, Kauai, Lanai, and Molokai areas (808) (from the Oahu area) (from other areas) (TTY) Mon. Fri., 8 a.m. 5 p.m. Sat., 8 a.m. noon and Kaiser Permanente Medicare Cost Oahu, Maui, and Hawaii areas (TTY) Note: The Hawaii Region excludes ZIP codes 96718, 96772, and Maryland (Mid-Atlantic States Region) Baltimore and suburban D.C. area (301) (TTY) Mon. Fri., 7:30 a.m. 5:30 p.m. Kaiser Permanente Medicare Plus (TTY) 12 13
8 Ohio Region Northeast area (TTY) Mon. Thu., 8:15 a.m. 5 p.m. Fri., 9 a.m. 5 p.m. Kaiser Permanente Medicare Plus (TTY) Washington (Northwest Region) Kaiser Permanente (southwest area) (TTY) Mon. Fri., 8 a.m. 6 p.m (TTY) Oregon (Northwest Region) (TTY) (language interpretation) Mon. Fri., 8 a.m. 6 p.m (TTY) Virginia (Mid-Atlantic States Region) Northern area (301) (TTY) Mon. Fri., 7:30 a.m. 5:30 p.m. Kaiser Permanente Medicare Plus (TTY) Note: Phone numbers beginning with 1-800,1-866, 1-877, or are toll free. TTY numbers are for the deaf, hard of hearing, or speech impaired. Kaiser Permanente is a health plan with a Medicare contract. Note: If you are a Kaiser Permanente Medicare Cost or Kaiser Permanente Medicare Plus (Cost) member, you must use plan providers for in-network care. You may use your Original Medicare coverage separate from your Health Plan benefits and obtain care from non-plan providers. If you do so, ask the non-plan provider to file a claim directly with Medicare. You are responsible for Medicare coinsurance, any unmet portion of deductibles, and, for charges from providers who do not participate in Medicare, amounts up to the Medicare limiting charge
9 Please recycle. This material was produced from eco-responsible resources. kp.org H0524_H6050_H6052_H1230_ H1200_H9003_H9103_H0630_ H1170_H6360_H2150_N (12/09/2009) SKU Member and Marketing Communications r99 January 2010
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