Member Guide. Your Introduction to Kaiser Permanente

Transcription

1 Member Guide Your Introduction to Kaiser Permanente

2 MEMBER GUIDE YOUR INTRODUCTION TO KAISER PERMANENTE This uide provides eneral information, not medical advice or benefit coverae. For complete details on your benefit coverae, includin exclusions, limitations, and plan terms, please call the Customer Service Center at (Oahu) or (neihbor islands). If you are a member of one of the plans below, please refer to the uide that applies to your plan. If you have questions about which uide applies to you, or to et a copy, please contact our Customer Service Center. Federal Employees Health Benefits Proram members Kaiser Permanente Added Choice Plan members Kaiser Permanente for Individuals and Families Plan members Kaiser Permanente QUEST and QUEST-Net members Kaiser Permanente Senior Advantae members Kaiser Permanente Medicare Cost members Information in this uide is current as of July 2014 and may be subject to chane without notice. 2 Kaiser Permanente Member Guide

3 ALOHA WELCOME TO KAISER PERMANENTE Thank you for choosin to be a Kaiser Permanente member. We look forward to helpin you live a loner, healthier life. This uide will help you to learn more about Kaiser Permanente and how to access care as an active participant in your health care. Your Introduction to Kaiser Permanente 3

4 YOUR MEMBER ID CARD Your Kaiser Permanente member ID card will be mailed to you separately. You need your member ID card to do the followin: Get care at our facilities and contracted providers Fill prescriptions Helpful tips: Always keep your member ID card with you in case of unexpected medical treatment or emerencies. Write down your member ID number and keep it safe in a separate location. Immediately call our Customer Service Center if your ID is lost, stolen, or needs to be replaced. CONTACT US Customer Service Center (Oahu) (neihbor islands) TTY hearin/speech impaired Monday - Friday, 8 a.m. - 5 p.m. Saturday, 8 a.m. - noon 4 Kaiser Permanente Member Guide

5 GETTING STARTED Choose your facility Choose from medical facilities on Oahu, Maui, and the Bi Island and affiliated providers on Kauai, Lanai, and Molokai. Visit kp.or/locations to find the facility nearest you. Choose your doctor Good health care beins with buildin a relationship with your personal physician. Your doctor is your health care advocate, your direct link to all Kaiser Permanente services, and your source for referrals to specialists. Learn about our doctors in our Physicians and Locations Directory, bioraphy cards at our reception counters, and on kp.or/chooseyourdoctor. You can also call our Customer Service Center for a copy of our most current directory. And remember, you can chane your personal physician at any time and for any reason. To choose and chane your personal physician, simply call your facility or o online at kp.or/chooseyourdoctor. Make an appointment Call your doctor s office or visit kp.or/locations.* Tip: To cancel an appointment, call the 24-hour appointment cancellation line of your Kaiser Permanente facility. * Schedulin appointments on kp.or is not applicable to specialty care departments. kp.or/thrive 5

6 YOUR FIRST APPOINTMENT 1 2 Check in with your Kaiser Permanente member ID card and a valid photo ID. Be ready to provide information about other health coverae you have, includin showin these ID cards. Tip: If you re brinin in a child who is not your own, please et an authorization form from the Customer Service Center or have a notarized Health Care Power of Attorney form. 3 4 Brin the names of any medicine you are takin so we can make sure that your prescriptions are uninterrupted. Tell the doctor about any treatments you are currently receivin, and feel free to ask questions. We re here to help! 6 Kaiser Permanente Member Guide

7 PAYING FOR SERVICES When it s time for your appointment, be prepared to pay for your services. Your portion may be a copayment, coinsurance, or deductible. Supplemental chares for labs, X-rays, procedures, or prescription medications are due on the day you receive services. Payment is easy with cash, debit card, personal check, or credit card. You may receive a bill for services performed after you ve paid and left our facility. For example, your doctor may need to send tissue samples for further testin. We will let you know before scheduled procedures if payment is required for related hih-cost services or items. CONTACT US Patient Financial Services Department (Oahu) (neihbor islands) kp.or/thrive 7

8 YOUR PRESCRIPTION Coverae of prescription drus varies dependin upon your benefit plan. Locations Pharmacies are located in most of our facilities and are open durin reular business hours. You can et prescriptions filled and buy over-the-counter medications and supplies at our pharmacies. In certain instances, you can use select non-kaiser Permanente pharmacies. Transfer your prescriptions For help transferrin your prescriptions, call our Care Transition Team at Monday - Friday, 9 a.m. - 5 p.m. Provide the name and phone number of your current pharmacy and our pharmacy team will take care of the rest. Refills Save time by orderin refills usin My Health Manaer at kp.or/rxrefill. Most refills can be mailed to you at no extra chare. And, if you have prescription dru coverae, you can et a 90-day supply of refills for the cost of 60 days. Covered drus We use an approved list of drus to make sure that the most appropriate, safe, and effective prescription medications are available to you. This list is reviewed on a reular basis and includes both eneric, brand name, and specialty drus covered under the prescription dru benefit. Drus not covered Nonprescription or over-the-counter medicines Drus for cosmetic uses Dental prescriptions (unless prescribed for a medical condition) Drus used for reasons not approved by the FDA Plan-excluded prescription drus CONTACT US Automated Prescription Refill Service RxRx ( ) 8 Kaiser Permanente Member Guide

9 AFTER-HOURS CARE If you have medical concerns after our facilities have closed, call our After-Hours Advice Line for medical advice. You will need to provide the medical record number of the person for whom you are callin. CONTACT US After-Hours Advice Line (Oahu) (neihbor islands) TTY for hearin/speech impaired Reular hours: Holidays: Monday - Friday, 5 p.m. - 8 a.m. Saturday, noon - Monday, 8 a.m. 8 a.m. 8 a.m. the next day After-Hours Care We provide extended, non-emerency, non-routine care after our facilities are closed Moanalua Medical Center, Oahu Monday - Friday, 5-10 p.m. Saturday, 1-10 p.m. Sunday and holidays, 8 a.m p.m. Maui Lani Medical Office, Maui Monday - Friday, 5-8 p.m. Saturday, noon - 5 p.m. Sunday and holidays, 8 a.m. - 5 p.m. Closed Christmas and New Year s Day Please call for an appointment before your visit. Park in the Moanalua Medical Center arae and use the main entrance to the hospital to o to the third floor, module 3A. Cost of an after-hours visit is the same as a routine doctor s appointment. Please call for an appointment before your visit. Cost of an after-hours visit is the same as a routine doctor s appointment. Hawaii Poison Center For medical problems related to poison or chemicals, call the Hawaii Poison Center at Open 24 hours a day, 7 days a week. kp.or/thrive 9

10 AFTER-HOURS CARE CONTACT US Maui Hana Health 4590 Hana Hwy. Mon., Tues., Wed., Fri., 8 a.m. - 5 p.m. Thurs., 8 a.m. - 8 p.m. Sat., 8 a.m. noon Bi Island Hilo Urent Care Center, LLC Hilo 45 Mohouli St. Mon. Fri., 8:30 a.m. 8:30 p.m. Sat. Sun., 8:30 a.m. 4:30 p.m Keaau Old Volcano Hwy. Mon. Fri., 8:30 a.m. 6:30 p.m. Sat., 8:30 a.m. 4:30 p.m. Closed Sun Keauhou Urent Care Center Keauhou Shoppin Center (across from theater) Alii Dr. Open every day, 9 a.m. 7 p.m URGENT CARE IN LAS VEGAS We contract with Concentra Urent Care and Walreens Healthcare Clinic to provide urent care services to members experiencin non-life threatenin health problems while visitin Las Veas. When possible, call your doctor or after-hours advice nurse first to discuss your health situation. When visitin one of these urent care clinics, present photo identification alon with your member ID card. Walreens/Concentra will bill you later accordin to your health plan. For more information on urent care in Las Veas, contact our Customer Service Center. 10 Kaiser Permanente Member Guide

11 EMERGENCY SERVICES We cover initial urent and emerency care anywhere in the world. If you think you re experiencin an emerency, o immediately to an emerency department. If you need an ambulance, call 911. Don t call Kaiser Permanente and waste precious time. Emerency conditions Emerency medical conditions need immediate medical attention to avoid serious threats to your body or health. These conditions miht include: Suspected heart attack Suspected stroke Extreme difficulty in breathin Severe pain Bleedin that will not stop Major burns Seizures Sudden onset of severe headache Suspected poisonin Your Kaiser Permanente plan defines an Emerency Medical Condition as an illness or injury that manifests itself by acute symptoms of sufficient severity (includin severe pain) such that a prudent layperson, who possesses an averae knowlede of health and medicine, could reasonably expect the absence of immediate medical attention to result in any of the followin: Placin the person s health (or, with respect to a prenant woman, the health of the woman or her unborn child) in serious jeopardy Serious impairment to bodily functions Serious dysfunction of any bodily oran or part Copayment Copayment for an emerency department visit varies dependin on your plan benefits. Refer to your Benefits Summary for a description of coverae. Coverae Non-Kaiser Permanente Facilities If admitted to a non-kaiser Permanente facility, you or a family member must notify us within 48 hours after care beins (or as soon as reasonably possible) by callin the phone number on the back of your Kaiser Permanente member ID card or your claim for payment may be denied. kp.or/thrive 11

12 HOSPITAL SERVICES Hospital services The Moanalua Medical Center is a full-service healin hospital. Patients and family are at the center of everythin we do. Specially-trained clinicians and careivers partner to provide compassionate and quality care and services. Our state-of-the-art healin environment is desined to care for acute illness and injury. Admission is based on a physician review of your medical condition. Services include medical, surical, perinatal, labor and delivery, neonatal, pediatric, and intensive care for acute illness and injury. Our hospital also includes an ambulatory surery and recovery (ASR) department, ambulatory treatment center (ATC), a clinical decision unit for observation stays (CDU), operatin rooms, and emerency services. Neihbor island members Our physicians will direct you to a Kaiser Permanente-desinated hospital on your island. This may include: Maui Memorial Medical Center Kona Community Hospital Hilo Medical Center North Hawaii Community Hospital Wilcox Memorial Hospital West Kauai Medical Center Samuel Mahelona Memorial Hospital Molokai General Hospital Lanai Community Hospital The need to admit or transfer you to the Moanalua Medical Center will be determined by your physician. 12 Kaiser Permanente Member Guide

13 TRANSPORTATION SERVICES Shuttle service on Oahu We provide free shuttle service on Oahu between our Moanalua Medical Center and the followin facilities: Honolulu Medical Office Kahuku Clinic Kapolei Clinic Koolau Medical Office Mapunapuna Medical Office Nanaikeola Clinic Waipio Medical Office Honolulu International Airport Interisland Terminal Shuttle operates Monday - Friday except holidays. Schedules and sin-ups are posted at each location. You can also find the shuttle schedule at kp.or/locations. Neihbor island conciere Your doctor will refer you to a specialist when it s medically necessary. In some cases, that may mean recommendin our neihbor island members et treated on Oahu where you ll be cared for by a team of physicians who have access to facilities and equipment which may not be available on your island. If you have to o to Oahu for medically necessary care, we can assist you with coordinatin your medical appointments. Our conciere can also offer shuttle and round transportation information, hotel and housin recommendations, alon with tips on makin the most of your stay. CONTACT US UFLY ( ) Mon. - Fri., 7:30 a.m. - 4 p.m. If you live on Maui, Kauai, Molokai, Lanai, or the Bi Island and need transportation assistance to Oahu for medically necessary care, call our Travel Department: (Maui) (Kauai, Molokai, Lanai, and the Bi Island) Monday - Friday, 8 a.m. - 5 p.m., Saturday, 8 a.m. - noon (emerencies only) Closed Sunday and most holidays kp.or/thrive 13

14 ONLINE SERVICES A variety of convenient services are offered online at kp.or. You can access medical information and data, improve your lifestyle with customized online prorams, receive discounts on health services and products, and participate in prorams desined to increase your physical activity level. Your electronic health record: My Health Manaer Linked directly to your medical record, My Health Manaer ives you the power to manae your health online at kp.or. You can view most lab test results, your doctor s office, order prescription refills, request routine appointments, check past office visit information, look up future appointments, and more. These time-savin features help you spend less time manain your health and more time enjoyin life. Go to kp.or/reister to et started. Once you reister, you can sin on with your user ID and password. Reistration is quick and easy. Free, customized online prorams We offer you many ways to improve your lifestyle with free customized online prorams desined to help you succeed in creatin a healthier you. These prorams are brouht to you in collaboration with HealthMedia, and we offer them to you at no cost. To select the proram you want, choose from the list below, then sin on to kp.or/healthylifestyles. Fill out the online questionnaire and you ll receive a customized uide to the proram you specify. We ll even follow up with personalized s to help keep you on track. You can start measurin your success within weeks of completin your proram. Assess your health (total health assessment) Manae onoin health conditions Manae chronic pain Lose weiht Eat healthy Reduce stress Quit smokin Keep diabetes under control Understand depression Manae insomnia Manae back pain 14 Kaiser Permanente Member Guide

15 AWARDS AND RECOGNITIONS WHAT OTHERS SAY ABOUT KAISER PERMANENTE Kaiser Permanente has the hihest-ranked commercial and Medicare health plans in Hawaii, and some of the hihest-rated plans in the nation, accordin to the National Committee for Quality Assurance. 1 These ratins are based on the excellence in prevention, treatment, and the satisfaction of our members. Our Moanalua Medical Center received national reconition in The Joint Commission s 2013 annual report on quality and safety, Improvin America s Hospitals. We were one of only two hospitals in Hawaii to be reconized as a Top Performer in key quality measures includin heart attack, heart failure, pneumonia, and surical care. 2 All 17 of our primary care clinics and our primary care providers have received the National Committee for Quality Assurance s Physician Practice Connections Patient-Centered Medical Home Reconition at Level 3 the hihest level possible. 4 This reconition celebrated our interated and coordinated care model, which supports quality, access, communications, and better patient involvement. Our Moanalua Medical Center is the first and only Baby-Friendly Hospital in Hawaii, accordin to the World Health Oranization and UNICEF, in reconition of our advocacy of breastfeedin. 1 NCQA s Health Insurance Plan Rankins , National Committee for Quality Assurance. NCQA is a private, not-for-profit oranization dedicated to improvin health care quality. Visit NCQA.or. 2 Moanalua Medical Center is reconized as a Top Performer in The Joint Commission s Top Performers on Key Quality Measures proram. The Joint Commission reconizes Moanalua Medical Center for achievin excellence in performance on its accountability measures durin 2012 for the followin measure sets: heart attack, heart failure, pneumonia, and surical care. 3 NCQA s Physician Practice Connections Patient-Centered Medical Home TM has reconized all 17 Kaiser Permanente primary care facilities in Hawaii at Level 3, the hihest level. NCQA is a private, non-profit oranization dedicated to improvin health care quality. Visit NCQA.or. kp.or/thrive 15

16 IMPORTANT NUMBERS Customer Service Center (Oahu) (neihbor islands) TTY hearin/ speech impaired Monday - Friday, 8 a.m. - 5 p.m. Saturday, 8 a.m. - noon After-Hours Advice Line (Oahu) (neihbor islands) TTY hearin/ speech impaired Monday - Friday, 5 p.m. - 8 a.m. the next day Saturday, noon - Monday 8 a.m. Holidays, 8 a.m. - 8 a.m. the next day Prescription refills Refill prescriptions online at kp.or/rxrefill Order refills by phone, 24 hours a day, 7 days a week RxRx (7979) Member s name: Member s ID number: Doctor s name: Doctor s phone number: Member s name: Member s ID number: Doctor s name: Doctor s phone number: Member s name: Member s ID number: Doctor s name: Doctor s phone number: Member s name: Member s ID number: Doctor s name: Doctor s phone number: Member s name: Member s ID number: Doctor s name: Doctor s phone number: Visit kp.or and download our free Kaiser Permanente app from the App Store SM or Goole Play. App Store is a service mark of Apple, Inc. Goole Play is a trademark of Goole, Inc. KAH NM-14 July 2014