Healthy together. See how our care and coverage can help you thrive. kp.org/eutf. Earn up to $100 and improve your health Learn how on page 2

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1 Hawaii Employer-Union Health Benefits Trust Fund 2017 Benefits Earn up to $100 and improve your health Learn how on pae 2 NEW! Earn free ym membership Learn how on pae 3 Healthy toether See how our care and coverae can help you thrive kp.or/eutf Not a member yet? For more information, visit kp.or/eutf or call (Oahu) or (toll free from the neihbor islands). Monday throuh Friday, 7 a.m. to 7 p.m., except holidays. Saturday, 9 a.m. to 1 p.m.

2 Kaiser Permanente Experience the Kaiser Permanente difference With Kaiser Permanente Choosin your doctor Learn about our doctors by readin their profiles and bioraphies on kp.or/searchdoctors, then choose the one who s riht for you. Choosin how you et care For minor concerns, you have the option to request a phone appointment or your doctor s office with routine questions. Makin a routine appointment You ve ot options: You can use your phone, computer, or mobile device anytime, anywhere. Callin for medical advice Our specially trained nurses can offer medical advice by phone 24/7. They can also help you make an appointment at the facility nearest you, if needed. Gettin the convenient care you need In most of our facilities, you can see your doctor, et a lab test, and pick up prescriptions all under one roof. Viewin your medical records online Access your electronic health record which includes your medical history and most test results online 24/7, keepin you connected with your doctors. Gettin care in your lanuae Interpreter services are available durin business hours at no cost to you. You can request an interpreter for your next visit when you call to make your appointment. These features are available when you et care at Kaiser Permanente facilities.

3 See how our care and coverae can help you thrive With medical offices and hospitals close to where you work and live, you have options when it comes to ettin care. To find a location near you, visit kp.or/doctorsandlocations or download our free Kaiser Permanente app for your smartphone or mobile device. Then just use our location finder to search by ZIP code or keyword. Kahuku Kauai Oahu Samuel Mahelona Memorial Hospital Wilcox Memorial Hospital West Kauai Lihue Medical Center Nanaikeola Kapolei Waipio Koolau Pearlride Kailua Moanalua Mapunapuna Honolulu Behavioral Health Hawaii Kai Molokai Molokai General Hospital Lahaina Wailuku Maui Lani Maui Lani Elua Maui Memorial Medical Center Maui Lanai Kihei Kula Hospital Lanai Community Hospital Waimea North Hawaii Community Hospital Hawaii Kona Hilo Hilo Medical Center Kona Community Hospital Medical Centers / Plan Hospitals Medical Offices Neihborhood Clinics Other Specialty Services N Map not to scale 1

4 Kaiser Permanente Support for better health Assess your health and et rewarded This proram ives EUTF members 4 chances to et up to $100 in Visa reward cards per contract year for takin steps to improve your health: $25 per year for completin a Total Health Assessment This online questionnaire ives you a picture of your overall health, plus an action plan that s based on your answers. $25 for each online healthy lifestyle proram, up to 3 prorams per year Get help to reduce stress, quit smokin, lose weiht, and more. You can take a proram when it s convenient for you, at your own pace. You are responsible for any taxes that may be due on the amounts received. Please talk to your personal tax adviser for specific tax information about this reward. The rewards proram runs from July 1, 2017 to June 30, 2018 and is open to all EUTF subscribers and your enrolled spouses, except for those enrolled in the HSTA VB Plan. Total health assessments and healthy lifestyle prorams completed before July 1, 2017 may be eliible for Kaiser Permanente rewards under the rewards proram for the plan year endin June 30, You can take the total health assessment as often as you like and as many healthy lifestyle prorams as you like, but you can only earn up to $100 per contract period. You must complete the activities durin the contract year. Rewards will be issued 4 to 6 weeks after you complete your activity. Reward cards expire 12 months after activation. 2

5 See how our care and coverae can help you thrive NEW! Earn a free ym membership The Kaiser Permanente Fit Rewards Proram Join or renew at a participatin ym and pay your $200 annual membership fee. Work out at your ym at least 45 times for a minimum of 30 minutes per session in 2017 and you'll et your $200 back. Choose a participatin ym from our full list at kp.or/fitrewards. You can switch fitness facilities within the network as often as monthly. The Active&Fit Home Fitness Proram If workin out at a ym isn't for you, we also offer a home fitness proram as an option. Choose any 2 kits from a variety of dynamic workout kits, includin strenth exercise kit, yoa kit, pilates kit, and more, for just $10 per year. Kits are equipped with a motivational DVD, instructional booklet, and quick start uide. Please consult with your own tax advisor about the taxability of the reimbursement. Kaiser Permanente Fit Rewards is available to all Kaiser Permanente Hawaii members, 16 years and older, excludin Medicare and Medicaid (QUEST Interation) members. Meet the 45-day, 30-minute a session activity requirement by December 31, 2017 to qualify for reimbursement. Reimbursement is limited to your Active&Fit annual proram fee each benefit year. Taxes and additional fees you pay your ym for classes, services, or amenities are not included in the Active&Fit proram and are not eliible for reimbursement. Except for earnin your annual proram fee back by exercisin 45 days a year for at least 30 minutes a session, your Active&Fit annual proram fee is not reimbursable and will not be prorated. The Active&Fit Home Fitness Proram annual fee is non-refundable and not eliible for reimbursement. Kaiser Permanente Fit Rewards is a value-added service and not part of your medical benefits. Your annual fee does not count toward your annual out-of-pocket maximum. Please see your Evidence of Coverae or kp.or/fitrewards for details, includin conditions, limitations, and exclusions. Kaiser Permanente Fit Rewards is part of the Active&Fit proram administered by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH) throuh its Active&Fit proram. Active&Fit and the Active&Fit loo are federally reistered trademarks of ASH and used with permission herein. 3

6 Kaiser Permanente See how our care and coverae can help you thrive Your 2017 benefit summary (July 1, June 30, 2018) Your 2017 benefit summary (July 1, June 30, 2018) Services Standard Plan Comprehensive Plan HSTA VB Plan NEW! Gym membership or home fitness kits Join or renew at a participatin ym and pay your $200 annual membership fee. Work out at your ym at least 45 times in 2017 and you'll et your $200 back. Or, choose any 2 home fitness kits for $10 instead. $10 per year for 2 home fitness kits or reimbursable $200 per year for ym membership $10 per year for 2 home fitness kits or reimbursable $200 per year for ym membership $10 per year for 2 home fitness kits or reimbursable $200 per year for ym membership Up to $100 in Visa reward cards per year Receive $25 for completin a health assessment and an additional $25 per healthy lifestyle proram, up to 3 prorams per contract year Receive $25 for completin a health assessment and an additional $25 per healthy lifestyle proram, up to 3 prorams per contract year Not covered Preventive care, adults Routine physical exams, well-child preventive care, and immunizations No chare No chare No chare Outpatient office visits Primary, specialty, and mental health office visits $20 copay $15 copay $15 copay Tier 1 enerics $5 copay up to a 30-day supply $5 copay up to a 30-day supply Prescription drus Tier 2 enerics $15 copay up to a 30-day supply $10 copay up to a 30-day supply Tier 3 brand name $50 copay up to a 30-day supply $35 copay up to a 30-day supply Tier 4 specialty $75 copay up to a 30-day supply $75 copay up to a 30-day supply $10 copay up to a 30-day supply Delivered by our mail-order service Two copays for a 90-day supply Two copays for a 90-day supply Two copays for a 90-day supply Outpatient basic labs and X-rays $10 copay per department per day $15 copay per department per day $15 copay per department per day Outpatient specialty labs, X-rays, and imain 20% coinsurance $15 copay per department per day $15 copay per department per day Outpatient surery 15% coinsurance $15 copay $15 copay Prenatal and postpartum care Delivery and inpatient care for the newborn Routine prenatal visits and first scheduled postpartum visit No chare after confirmation of prenancy No chare after confirmation of prenancy No chare after confirmation of prenancy 15% coinsurance No chare No chare Hospitalization Inpatient services includin mental health inpatient services 15% coinsurance No chare No chare Emerency care Covered services are provided in and out of the service area $100 copay $50 copay $50 copay Ambulance Medically necessary transport in a licensed ambulance 20% coinsurance 20% coinsurance 20% coinsurance Annual out-of-pocket maximum The most you'll pay for covered medical and prescription dru costs per calendar year* * Covered medical and prescription dru costs are for medically necessary "Basic Health Services" $2,500/$7,500 $2,000/$6,000 $2,000/$6,000 This is a summary of some benefits and their copayments and/or coinsurance. Please see your Evidence of Coverae for information about coverae, limitations, and exclusions for all benefits, includin those not listed in this summary. 4 5

7 Kaiser Foundation Health Plan, Inc. 711 Kapiolani Blvd., Suite 400 Honolulu, HI Enjoy healthy perks Earn free ym membership You now have 2 prorams to improve your health. Choose the one that works best for you: Get your $200 annual membership fee reimbursed when you join a participatin fitness facility. Work out at that ym at least 45 times durin the calendar year and et your money back! Choose any 2 home exercise kits available for just $10 per calendar year. See pae 3 for more information. Get rewards Take steps to improve your well-bein and earn up to $100 in Visa reward cards. EUTF subscribers and your enrolled spouses are eliible for the followin rewards: $25 for takin the Total Health Assessment, an online questionnaire that ives you a wellness action plan $25 per online healthy lifestyle proram, up to 3 prorams to help you reach your health oals Go to kp.or/eutf to learn more and et started. Help to quit smokin If you re ready to quit, we ll make it easier. You pay nothin for tobacco cessation prorams and tobacco cessation prescription and over-the-counter drus approved by the FDA. Talk to your physician about your treatment options. For more information about your coverae, refer to your 2017 EUTF and HSTA VB Reference Guide. Please recycle. KAH ST-17 February 2017