A better choice for good health

Transcription

1 CalPERS Enrollment Guide 2015 This is an advertisement A better choice for ood health a wide rane of specialists test results online convenient facilities near you I can choose and chane my doctor anytime better care for healthier tomorrows I can my doctor I m part of the decision free to focus on you kp.or/calpers

2 Discover the Kaiser Permanente difference With care and coverae workin seamlessly toether, Kaiser Permanente is uniquely desined to be your partner in health so you can feel your best in mind, body, and spirit. your choice of top doctors You can choose and chane your doctor anytime, for any reason. Our doctors are amon the best. They love carin for people and aren t weihed down by a lot of paperwork, so they can focus on you. personalized care and attention You re at the center of your care. Your doctors, nurses, and specialists, all connected by your electronic health record, work toether to help you manae your health. everythin under one roof You can do more and drive less because most of our locations include pharmacy, lab, X-ray services, and more. lots of healthy extras Stay at your best with healthy resources like farmers markets and wellness classes, many of which are offered at no cost. online access anytime, anywhere It s easy to stay involved in your care. Use your computer or mobile device to your doctor s office, schedule routine appointments, view most lab test results, refill most prescriptions, and more. healthier tomorrows Every decision starts with what s best for you. That s why our hihquality care for conditions like cancer, heart disease, and diabetes leads to better outcomes and healthier tomorrows. kp.or/calpers Note: Many features discussed in this book are available only to members receivin care at Kaiser Permanente medical facilities.

3 Kaiser Permanente A better choice for ood health Your partner in ood health Nationwide, over 9 million people turn to us as their trusted partner in total health. Take a look, and you ll see why Kaiser Permanente is a better choice. The power to choose With many reat doctors and convenient facilities, it s easier to et the care you need when and where you want it. Plus, you can choose and chane your doctor anytime, for any reason. Excellent care You et care that fits your needs from a team of doctors, specialists, and nurses. We pioneer new ways to prevent and treat illness. It s no wonder Kaiser Permanente rated hihest in overall member satisfaction amon CalPERS Basic and Medicare plans.* Your health. Your way. We re always here when you need us, however you need us in person, by phone, or online. With convenient online and mobile tools, you can manae your family s health care anytime, anywhere. Healthy extras We re not your typical health care provider. We partner with you so you have the knowlede and resources to manae your health inside and outside the doctor s office. We also partner with communities, throuh farmers markets, fitness events, and other prorams. * CalPERS 2013 Health Plan Member Survey To learn more about Kaiser Permanente, visit kp.or/calpers. 1

4 The power to choose Stay in chare of your health. It s simple to make smart choices when you have reat doctors and convenient facilities. Your choice of top doctors You have a wide selection of skilled doctors that you can choose from and chane anytime, for any reason. Our doctors: Come from many of the top medical schools in the country Work hand in hand with your entire care team, who are all connected by your electronic health record Don t have excessive paperwork, so they can focus on deliverin the care you need Care about their patients and love what they do Under-one-roof access Save time and avoid drivin all over town for care. You ll have many locations to choose from, and most of them offer multiple services under one roof. You can see your doctor, et a lab test or an X-ray, and pick up your medications all without leavin the buildin. And when you et care with fewer delays, you can et better faster too. Extra conveniences your doctor s office with routine questions. Get same-day, after-hours, and weekend services at most locations. Doctors and staff who speak more than one lanuae, providin personalized care. Refill most prescriptions online with free shippin. Make routine appointments with a call or click. View recent office visits and most test results online. Call an advice nurse with access to your health information, 24/7. Travel freely; you re covered for emerency care worldwide. Hear examples of how Kaiser Permanente has helped different members at kp.or/carestories. Your electronic health record brins it all toether Your doctor s office Your record ets updated with each visit to a Kaiser Permanente facility, so it s current. Pharmacy, lab, X-ray No need for paperwork when you et services at our facilities your doctor s orders are already there. 2

5 Excellent care Kaiser Permanente has one of the larest multispecialty medical roups in the country, which includes cardioloists, cardiac sureons, and others. Personalized care and attention Top specialty care for healthier tomorrows Leaders in prevention A care team that s informed and focused on you can lead to better health. Your doctor and careivers are all connected to your electronic health record, so they re up-to-date and ready to ive you personalized care. Our doctors, nurses, and other careivers use an advanced care delivery system that Kaiser Permanente pioneered. It s had a measurable impact on the prevention, detection, and treatment of conditions like cancer, heart disease, stroke, and diabetes. We were also rated in the top 10 percent amon cholesterol-manaement prorams for patients with cardiovascular conditions. * With Kaiser Permanente, you have a partner committed to keepin you healthy. We re #1 in screenins for breast cancer in all our reions, and were rated in the top 10 percent for cervical and colon cancer screenins. Plus, 86 percent of our members who were dianosed with hih blood pressure now have their blood pressure under control, compared to 50 percent nationally. *, * Ratins based on Breast Cancer Screenin, Cervical Cancer Screenin, Colorectal Cancer Screenin, and Controllin Hih Blood Pressure 2012 ratins for commercial and Medicare plans from the Healthcare Effectiveness Data and Information Set (HEDIS ) published by the National Committee for Quality Assurance. For more information, visit ncqa.or. Kaiser Permanente proram averae is the weihted averae of each reional health plan s screenin rate and its eliible population. Learn more about the doctors available in your area at kp.or/doctorsandlocations. Specialty care Your specialists are up to speed and ready to take care of you. At home or on the o Get your health information on your computer or mobile device to stay informed and in chare. 3

6 Your health. Your way. We re always here when you need us, however you need us. You et many services under one roof at most of our locations and can call an advice nurse, 24/7. Online or throuh mobile, you can manae your family s health needs anytime, anywhere. It s easy to stay connected Members reistered on kp.or have secure access to My Health Manaer, the online tool that helps you manae your family s health care anytime, anywhere. With My Health Manaer, you can: your doctor s office with routine questions. Refill most prescriptions. View most lab test results. Schedule or cancel routine appointments. A website full of healthy ideas Get informed and inspired on our award-winnin website, kp.or. Take chare of your health with articles, wellness topics, and health calculators. Our music channels, podcasts, fitness videos, and recipes from world-class chefs can help you find new and interestin ways to live well and thrive. Good health on the o Manae your care at home, work, or play with our mobile app, which puts all the convenient features of My Health Manaer riht in the palm of your hand. You can download the free Kaiser Permanente app from the App StoreSM or Goole Play. App Store is a service mark of Apple, Inc., and Goole Play is a trademark of Goole, Inc. For a uided tour of My Health Manaer, visit kp.or/experience. Top reasons to join Kaiser Permanente You can choose and chane your doctor anytime, for any reason. Excellent care for conditions like cancer, heart disease, and diabetes leads to healthier tomorrows. 4

7 Healthy extras Good health starts with helpful information and resources. That s why you et lots of healthy extras that can help you stay educated on ways to live healthier in body, mind, and spirit. Classes and coachin We offer classes on yoa, eatin well, baby care, onoin health conditions, and much more, riht in our facilities. And many health education counselin and roup prorams are now offered at no chare. For one-on-one help, you can speak to a wellness coach. Our specially trained coaches can ive you support by phone when it s convenient. The service is offered at no chare to members, in Enlish or Spanish. Fresh food in the parkin lot Eatin well is easier when you brin home fresh food from our farmers markets. They re conveniently located at many of our facilities, so you can pick up some healthy fruits and veies after your visit. Maximize your health Our personalized, online wellness prorams can help you lose weiht, stay active, reduce stress, sleep better, stop smokin, and much more. You can also download the free Every Body Walk! app for your smartphone or mobile device from the App Store or Goole Play. It s a fun, interactive tool to help you create and maintain a daily walkin routine. Find tools, tips, and information for livin well at kp.or/livehealthy. Under-one-roof convenience and care online or by phone means you can manae your health needs anytime, anywhere. Healthy extras like on-site classes* and farmers markets help you stay well. * Some classes may require a fee. 5

8 Your CalPERS Basic Plan With your Kaiser Permanente health plan, your benefits include a wide rane of prorams and support to help you stay healthy. And you et a streamlined approach to care that helps you make choices simply and et thins done quickly so you can et well and et on with your life. Hihlihts of your plan Convenient access Call us to learn more Simple copays for most covered services, includin office visits and most prescriptions Virtually no paperwork to fill out or bills for the services you receive No deductibles to keep track of or percentaes to fiure out No referrals for certain specialties, like optometry and obstetrics-ynecoloy When you need care, it s easy to find a Kaiser Permanente location near your home or work. Just visit kp.or/ doctorsandlocations or download our free Kaiser Permanente app for your smartphone or mobile device. Then use our convenient location finder to search by ZIP code or keyword. For an overview of our locations, see the maps in this brochure. For more information about your Basic Plan, visit kp.or/ calpers or call our Member Service Contact Center at , 24 hours a day, 7 days a week (closed holidays). For TTY service for the hearin/speech impaired, call

9 Kaiser Permanente Senior Advantae (HMO) If you qualify for Medicare, the Kaiser Permanente Senior Advantae plan miht be riht for you. Our Medicare-eliible members enjoy health plans that celebrate independence and well-bein. Our plan ives you more benefits and services than Oriinal Medicare alone, and at a reat value. Lower copays help protect your pocketbook Call us to learn more Here are just some of the benefits and services you can expect with our plan: Low copays for routine preventive care A $175 eyewear allowance every 24 months Low copays for appointments with your personal physician Part D dru coverae includin drus throuh the coverae ap with low copays No chare for hospital services, X-rays, and lab tests A cap on medical expenses for the year, so your finances are always protected Doctor s office, lab, and pharmacy services, often under one roof Convenient online services, includin refillin most prescriptions and checkin most lab test results For more information about Kaiser Permanente Senior Advantae, call our Member Service Contact Center at or 711 (TTY for the hearin/speech impaired), 8 a.m. to 8 p.m., 7 days a week. Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may chane on January 1 of each year and at other times in accord with your roup s contract with us. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. You must continue to pay your Medicare Part B premium and any other applicable Medicare premium(s), if not otherwise paid by Medicaid or another third party. 7

10 CalPERS summary of benefits for 2015 These benefits reflect the 2015 contract year. For a complete explanation of benefits, exclusions, and limitations, refer to the 2015 Combined Evidence of Coverae and Disclosure Form (Evidence of Coverae). For details about chanes to your prescription dru benefits, please see your Evidence of Coverae, and check with your aency for information about your monthly premiums. Basic Plan Physician services Hospital services Emerency care X-ray and lab tests Online service features (Available throuh My Health Manaer at kp.or/calpers) Prescription drus $15 per visit No chare $50 per Emerency Department visit (does not apply if you are held for observation in a hospital unit outside the Emerency Department or if you are admitted directly to the hospital as an inpatient) No chare your doctor s office: No chare Take a Total Health Assessment: No chare View most lab test results: No chare Schedule routine appointments: No chare View portions of your medical record: No chare Order prescription refills: No extra chare for delivery $5 eneric/$20 brand, up to a 30-day supply from a Plan pharmacy $10 eneric/$40 brand, up to a 100-day supply by mail-order service (delivery at no extra chare), Drus prescribed for treatment of sexual dysfunction now covered at 50% coinsurance for up to a 100-day supply from a Plan pharmacy or by mail-order service (delivery at no extra chare),** Routine preventive care Mental health Hearin services Allery services Chiropractic/acupuncture (Up to a combined total of 20 chiropractic and acupuncture visits per calendar year from network providers) Periodic health exam: No chare Scheduled prenatal care and first postpartum visit: No chare Well-child visits (0 23 months): No chare Vaccines (immunizations): No chare Eye refraction exam: No chare (no chare for eyelasses or contact lenses followin cataract surery) Outpatient visits: $15 per individual visit; $7 per roup visit Inpatient psychiatric hospitalization: No chare Routine preventive hearin tests: No chare Hearin aid(s): $1,000 allowance every 36 months Allery injection visits: No chare Allery testin visits: $15 per visit $15 per visit 8

11 Find additional health resources to meet your needs. Get reduced rates on acupuncture, chiropractic care, and massae therapy, plus preferred rates on selected health club memberships at kp.or/choosehealthy. *, These convenient resources can help you stay on track for ood health. Kaiser Permanente Senior Advantae (HMO) $10 per visit No chare $50 per Emerency Department visit (does not apply if you are held for observation in a hospital unit outside the Emerency Department or if admitted to the hospital as an inpatient within 24 hours for the same condition) No chare your doctor s office: No chare Take a Total Health Assessment: No chare View most lab test results: No chare Schedule routine appointments: No chare View portions of your medical record: No chare Order prescription refills: No extra chare for delivery $5 eneric/$20 brand, up to a 30-day supply from a Plan pharmacy $10 eneric/$40 brand, up to a 100-day supply by mail-order service (delivery at no extra chare), Drus prescribed for treatment of sexual dysfunction now covered at 50% coinsurance for up to a 100-day supply from a Plan pharmacy or by mail-order service (delivery at no extra chare), ** Periodic health exam: $10 per visit Scheduled prenatal care and first postpartum visit: $10 per visit Eye refraction exam and laucoma screenin: $10 per visit ($175 allowance for eyelasses and contact lenses every 24 months; no chare for eyelasses or contact lenses followin cataract surery, in accord with Medicare uidelines) Outpatient visits: $10 per individual visit; $5 per roup visit Inpatient psychiatric hospitalization: No chare Routine preventive hearin tests: $10 per visit Hearin aid(s): $1,000 allowance every 36 months Allery injection visits: $3 per visit Allery testin visits: $10 per visit $10 per visit * The products and services described here are neither offered nor uaranteed under our contract with the Medicare proram. In addition, they are not subject to the Medicare appeals process. Any disputes reardin these products and services may be subject to the Kaiser Permanente Senior Advantae rievance process. These products and services are provided by entities other than Kaiser Permanente. Some Kaiser Permanente benefit plans include coverae for certain of these services. Plan benefits must be used before those services are available. Check your Evidence of Coverae for details. Kaiser Permanente disclaims any liability for these products and services. Should a problem arise, you may take advantae of the Kaiser Permanente rievance process by callin the Member Service Contact Center at or (TTY for the hearin/speech impaired), 24 hours a day, 7 days a week (closed holidays). Includes covered outpatient items in accord with our dru formulary uidelines. ** Episodic drus prescribed for the treatment of sexual dysfunction are covered up to a maximum of 8 doses in any 30-day period or 27 doses in any 100-day period. For certain drus, you can et prescription refills mailed to you throuh our Kaiser Permanente mail-order pharmacy. You should receive them within 10 business days. If not, please call (TTY 711), Monday throuh Friday, 8 a.m. to 6 p.m. (Northern California); (TTY 711), Monday throuh Friday, 7 a.m. to 7 p.m. (Southern California). 9

12 What s new in Northern California Oakland Medical Center: Our expanded facility features a new, 12-story hospital with a comprehensive pediatric center and 14 inpatient operatin rooms. San Leandro Medical Center: The new hospital includes a 24-hour pharmacy and a 24-hour Emerency Department with 40 private treatment rooms. Redwood City Hospital (scheduled to open late 2014): The new hospital will include our world-class neuroscience center, which treats members for brain and spine conditions. San Mateo Fresno County n Kaiser Permanente medical centers (hospital and medical offices) Kaiser Permanente medical offices Affiliated plan hospitals Affiliated medical offices Maps not to scale 10

13 What s new in Southern California Sierra Nevada Mountains Carmel Valley and Oceanside Medical Offices: Our new medical offices China make Lake it more convenient Naval Weapons Center for members to et care in North County. Cerritos Medical Offices: You can et a broad rane of services at our new 50,000-square-foot facility, includin primary care, pediatrics, obstetrics-ynecoloy, lab, radioloy, and pharmacy. North Hollywood Medical Offices: Located near the Red and Orane Metro lines, the offices feature Mountains Tehachapi primary care, obstetrics-ynecoloy, pediatrics, dianostic imain, lab services, and pharmacy. Kern County area Edwards Air Force Base San Bernardino National Forest San Bernardino Mountains Cleveland National Forest San Jacinto Mountains San Bernardino National Forest Santa Rosa Mountains Anza-Borreo Desert State Park Cleveland National Forest n Kaiser Permanente medical centers (hospital and medical offices) Kaiser Permanente medical offices Affiliated plan hospitals Affiliated medical offices Maps not to scale 11

14 The care you need, when you need it With our many facilities located throuhout the state, you ll have access to a broad array of services desined to meet almost any medical situation. Below is an overview of the many types of care available to you and examples of which services miht be best, dependin on your situation. Of course, if you reasonably believe you have an emerency, call 911 or o to the nearest hospital. What is it for? What should you know? Routine Nonurent Care An expected care need, like a recommended preventive screenin or a visit for a health issue currently bein treated. Examples of routine nonurent care needs include: Physical exams Pretravel exams Pap tests Well-child checkups Medication checkups Follow-up visits Other Nonurent Care A new health concern or a chane in an existin health condition that is not an urent care need. Examples of other nonurent care needs include: Trouble sleepin General diestion problems Gradual skin chanes Joint stiffness Onoin anxiety issues Weiht loss or ain What do you do? Make an appointment: Online throuh My Health Manaer at kp.or By callin your local appointment line listed in Your Guidebook to Kaiser Permanente Services Make an appointment: Online throuh My Health Manaer at kp.or By callin your local appointment line listed in Your Guidebook to Kaiser Permanente Services This is important information from Kaiser Permanente. If you need help understandin this information, please call and ask for lanuae assistance. Esta es información importante de Kaiser Permanente. Si necesita ayuda para comprender esta información, llame al y solicite asistencia de idiomas. 這是來自 Kaiser Permanente 的重要資訊 如果您在理解此資訊方面需要協助, 請撥打電話到 並要求語言協助 12

15 We re always ready to help If you have an illness or injury and you re not sure what kind of care you need, our advice nurses can help. With access to your electronic health record, they can assess your situation, help determine what type of care is most appropriate for your condition or symptoms, and even help you handle the problem at home until your next appointment. To et advice or schedule an appointment, just call the appointment and advice line listed for your area in Your Guidebook to Kaiser Permanente Services. Urent Care An illness or injury that requires prompt medical attention, but is not an emerency medical condition. Examples of urent care needs include: Minor injuries Minor wounds Backaches Chronic or recurrin headaches Fever Emerency Care A medical or psychiatric condition that requires immediate medical attention to prevent serious jeopardy to your health.* Symptoms that may indicate an emerency medical condition include: Chest pain or pressure that may radiate to the arm, neck, back, shoulder, jaw, or wrist Sudden onset of severe abdominal pain Severe shortness of breath Sudden decrease in or loss of consciousness Sudden inability to talk or to move one side of the body, or sudden slurred speech Severe, persistent bleedin that cannot be stopped Major injuries like unshot or stab wounds or severe injuries from a vehicle accident Active labor when there isn t time for a safe transfer to a desinated hospital before delivery If you have an urent care need, call the advice line listed for your area in Your Guidebook to Kaiser Permanente Services, and we can assist you. We can even schedule a same-day or next-day appointment with your physician in most cases, if appropriate. If you reasonably believe you have an emerency medical condition, call 911 or o to the nearest hospital. * An emerency medical condition is a medical condition manifestin itself by acute symptoms of sufficient severity (includin severe pain) such that a reasonable person would have believed that the absence of immediate medical attention would result in any of the followin: (1) placin the person s health (or, with respect to a prenant woman, the health of the woman or her unborn child) in serious jeopardy; (2) serious impairment to bodily functions; or (3) serious dysfunction of any bodily oran or part. A mental health condition is an emerency medical condition when it meets the requirements of the pararaph above or, for members who are not enrolled in Kaiser Permanente Senior Advantae, when the condition manifests itself by acute symptoms of sufficient severity such that either of the followin is true: The person is an immediate daner to himself or herself or to others, or the person is immediately unable to provide for or use food, shelter, or clothin due to the mental disorder. 13

16 It s time to choose better Learn more about Kaiser Permanente at kp.or/calpers or call our Member Service Contact Center, 24 hours a day, 7 days a week (closed holidays) Enlish Spanish Chinese dialects TTY for the deaf, hard of hearin, or speech impaired For updates about health care reform, visit kp.or/reform. Kaiser Foundation Health Plan, Inc Franklin St. Oakland, CA kp.or /calpers Please recycle. This material was produced from eco-responsible resources. Member and Marketin Communications July 2014