ASK US ABOUT HEALTH. HMO Plans. This brochure provides a general overview of Kaiser Permanente. For specific information about benefits,

Transcription

1 HMO Plans ASK US ABOUT HEALTH This brochure provides a general overview of Kaiser Permanente. For specific information about benefits, copayments, limitations, and services, please refer to your Benefit Summary and Evidence of Coverage. Still have questions? Please give us a call at (404) or visit us online at kaiserpermanente.org. Member and Marketing Communications r12 Kaiser Foundation Health Plan of Georgia, Inc. HMO/BR Rights-managed

2 Health. It s much more than trying not to get sick and getting care when you do. It s an attitude. A philosophy. A way of life. You might be surprised to hear that from a health care company. After all, most of them offer just that health care when you re sick. At Kaiser Permanente, we see things differently. We understand the need to care for the whole you your mind, your body, and your spirit. We want to help you take an active role in your own health so that you can live your life to the fullest. So you can thrive. Ask us: We say health today is all about feeling good,

3 Live healthy We make it easier for you to live a healthy life. With our health classes and programs many of which are free you can learn how to make healthier choices. You ll find help on how to lower your cholesterol, quit smoking, manage diabetes or heart disease, prepare for pregnancy and childbirth, and more. We also offer weight and stress management classes, yoga classes, and even cosmetic dermatology on a fee-for-service basis*, to help you look better, feel better, and add balance to your life. We even make it more affordable to live healthy. Through our SelfWise program, you can take advantage of a variety of health-related discounts*. Join Weight Watchers.Treat yourself to chiropractic, acupressure, or massage therapy services. Get a new pair of glasses or contact lenses. Even receive LASIK procedures. *Please see Note on page 5 for important information. in every way. Taking care of ourselves, staying balanced, Stay healthy We want to help keep you healthy and enjoying life. That s why we offer preventive care for every stage of your life, including routine physicals, well-child care, and immunizations for children, adolescents, and adults. You also get cholesterol screenings, mammograms, Pap tests, and other screenings to help detect health problems before they become serious. And don t worry it s all covered. If you do need help getting better, we ve got you covered there, too. Whether you need primary care, specialty care, or programs to treat chronic conditions, the personal doctor you choose will be your health advocate. You ll have a doctor who knows you and your health needs, so you can get the kind of personalized care you deserve. affiliated doctors in their own offices all over town. So you can get care where it s convenient for you. You can also see doctors in select specialties like Ob/Gyn, dermatology, and behavioral health without a referral. And you can count on the security of emergency coverage anywhere in the world. You can have peace of mind knowing you ll be in good hands with Kaiser Permanente. Whether it s quality of care, customer service, or member satisfaction, Kaiser Permanente is ranked among the top health care organizations in the country.** **Kaiser Permanente Georgia is ranked among the top five health plans in the South Atlantic Region in effectiveness of care. (The State of Health Care Quality 2003 report by the National Committee You ll also have access to more than 200 doctors at our medical centers and more than 1,000 for Quality Assurance [NCQA].) Kaiser Permanente Georgia also holds NCQA Excellent 2 Accreditation, the highest status possible, for its HMO health plan (NCQA, September 2001). 3

4 Be informed Online at kaiserpermanente.org, you ll find great tools to help you achieve good health. Find out if you re at a healthy weight with our body mass index calculator, look up illnesses and medications in our health and drug encyclopedias, and learn about options to treat and manage medical conditions in our featured health topics. And there s so much more you can do, like request routine appointments, order prescription refills, nonurgent questions to an advice nurse or pharmacist, and find doctors, locations, and health classes near you. As a member, you ll also get the Kaiser Permanente Healthwise Handbook, a useful self-care guide to more than 200 common health problems, including ways to prevent them. And our Partners in Health newsletter and Kaiser Permanente Healthphone system empower you with information and keep you up-to-date on the latest wellness tips and medical news. So when you re looking for health resources, you ll know where to turn. It s all right at your fingertips, 24 hours a day. physically, mentally, emotionally. Knowing how to do it. Take charge of your health. Get SelfWise! Through our exclusive SelfWise program, you can enjoy many special discounts:* Health club discounts: Special rates at designated health clubs. off chiropractic, and 20 percent off acupressure services. Vision care: 25 percent off eyeglasses, 15 percent off regular contact lenses, and Swim Atlanta: 10 percent off lessons, lap swimming, and hydro-aerobics. American Medical Alert Corporation: Sign up for the system and receive free installation ($50 value). *Note: The discounts and services listed do not replace any existing benefit and are not covered benefits. Neither are they offered nor guaranteed under the contract with the FEHB program. They are made available to all enrollees and family members who are members of Kaiser Permanente and are created solely to provide discounted services on a fee-for-service basis. All listed discounts 5 percent off disposable contact lenses at are based on the regular price unless Weight Watchers membership: 50 percent off the Crystal Springs water: Sign up for delivery service, buy participating vision locations. otherwise noted. Kaiser Permanente assumes regular joining fee, and 10 weeks for only $95. one five-gallon bottle and get three five-gallon bottles no responsibility for the nature, quality, or LASIK services: 15 percent off usual charges or plus a 24-pack for free. outcome of the services. The arrangement Massage therapy, chiropractic, and acupressure 5 percent off the advertised fee, whichever is of service/care is the sole responsibility of services: 20 percent off massage therapy the consumer, and is between the practitioner lowest, from designated providers of LASIK services. services from designated providers, 25 percent and consumer only, not Kaiser Permanente. For more information, call Member Services 4 at (404)

5 Making good choices. Ask us. We choose Kaiser Permanente. Convenient and simple Thrive At most of our medical centers, you can see a doctor, have an X-ray, get lab work done, and pick up a prescription all in the same building. You won t have to worry about filing claims when you visit any of our medical centers or any of our affiliated doctors and hospitals. And there s just one phone number to use for appointments or 24-hour nurse advice. If you can t come in during regular business hours, many locations have doctors available on evenings and weekends, too. And we even offer same-day appointments at many facilities. So you can feel better faster and get back to living life to the fullest. Because we offer so many paths to better health, you get more than just health care. It s life care, really care for the whole you. So you can thrive. 6 7

6 Our locations Alpharetta Medical Center 3550 Preston Ridge Road, Alpharetta, GA Directions (24 hours): (770) Location: In the Preston Ridge Business Park, off of Old Milton Parkway near Georgia 400 Services: Adult medicine, Ob/Gyn, pediatrics/adolescent medicine, pharmacy, lab, X-ray, and health education Brookwood at Peachtree Medical Office 1745 Peachtree St., Suite U, Atlanta, GA Directions (24 hours): (404) Hours: Mon. Fri., 7 a.m. 4:30 p.m. Location: In Brookwood Place just south of Piedmont Hospital Services: Adult medicine and pharmacy Cascade Medical Center 1175 Cascade Parkway, Atlanta, GA Directions (24 hours): (404) Location: Off the Cascade Road exit of I-285 Services: Adult medicine, family medicine, nutrition, Ob/Gyn, pediatrics/adolescent medicine, pharmacy, lab, X-ray, and health education Crescent Medical Center 200 Crescent Centre Parkway, Tucker, GA Directions (24 hours): (770) Location: LaVista Road exit of I-285 Services: Adult medicine, dermatology, podiatry, endocrinology, behavioral health, nutrition, Ob/Gyn, pediatrics/adolescent medicine, psychiatry, radiology, rheumatology, pharmacy, lab, X-ray, and health education Legend: Kaiser Permanente Medical Centers (13 locations; more than 200 doctors) Affiliated Community Physicians medical offices (more than 1,000 doctors) H Affiliated hospitals (11 locations) New Stonecrest location coming early 2005 Map not to scale Cumberland Medical Center 2525 Cumberland Parkway, Atlanta, GA Directions (24 hours): (770) Location: Near I-285 and the Paces Ferry Road exit Services: Adult medicine, dermatology, infectious diseases, behavioral health, nutrition, Ob/Gyn, oncology, pediatrics/adolescent medicine, psychiatry, rheumatology, pharmacy, lab, X-ray, and health education The hospital that you will be admitted to will be determined by the primary care physician you select. 8 9

7 Our locations Eastside Medical Office 1608 Tree Lane, Building C, Suite 300-C, Snellville, GA Directions (24 hours): (770) Hours: Mon. Fri., 9 a.m. 5 p.m. Location: Near Medical Way off Ronald Reagan Parkway on Tree Lane Services: Ob/Gyn Forsyth Medical Office 1400 Northside Forsyth Drive, Suite 350, Cumming, GA Directions (24 hours): (770) Hours: Mon. Fri., 8:30 a.m. 12:30 p.m. and 1:30 5:30 p.m. Location: Off GA 400 exit 14 (Highway 20) Services: Adult medicine and pediatrics/adolescent medicine Glenlake Medical Center 20 Glenlake Parkway, Atlanta, GA Directions (24 hours): (770) Hours: Mon. Fri., 8 a.m. 6 p.m. Location: In the Glenlake office development at Georgia 400 and Abernathy Road Services: Adult medicine, audiology, gastroenterology, general surgery, behavioral health, neurology, nutrition, Ob/Gyn, ear/nose/throat (ENT), pediatrics/adolescent medicine, perinatology, podiatry, pulmonology, radiology, urology, pharmacy, lab, X-ray, and health education Gwinnett Medical Center 3650 Steve Reynolds Blvd., Duluth, GA Directions (24 hours): (770) Location: At Steve Reynolds Boulevard and Shackleford Road Services: Adult medicine, family medicine, dermatology, behavioral health, nutrition, Ob/Gyn, pediatrics/adolescent medicine, psychiatry, pharmacy, lab, X-ray, and health education Panola Medical Center 5440 Hillandale Drive, Lithonia, GA Directions (24 hours): (770) Location: At Panola Road and Hillandale Drive Services: Adult medicine, nutrition, Ob/Gyn, pediatrics/adolescent medicine, pharmacy, lab, X-ray, and health education Southwood Medical Center 2400 Mt. Zion Parkway, Jonesboro, GA Directions (24 hours): (770) Hours: Mon. Sun., 8:30 a.m. 6 p.m. Location: In the Southwood development near I-75 and the Mt. Zion Boulevard exit Services: Adult medicine, dermatology, gastroenterology, infectious diseases, behavioral health, nutrition, Ob/Gyn, oncology, ENT, pediatrics/adolescent medicine, psychiatry, pulmonology, radiology, surgery, pharmacy, lab, X-ray, and health education TownPark Medical Center 750 TownPark Lane, Kennesaw, GA Directions (24 hours): (770) Hours: Mon. Thurs., 8:30 a.m. 6 p.m.; Fri., 8:30 a.m. 5:30 p.m. Location: In the TownPark office development off of Chastain Road between I-75 and I-575 Services: Adult medicine, behavioral health, Ob/Gyn, pediatrics/adolescent medicine, pharmacy, lab, X-ray, and health education Coming early 2005 New Stonecrest location serving south DeKalb and Rockdale counties. Henry Towne Centre Medical Center 1125 Towne Centre Village Drive, McDonough, GA Directions (24 hours): (678) Hours: Mon. Thurs., 8:30 a.m. 6 p.m.; Fri., 8:30 a.m. 5:30 p.m. Location: On Towne Centre Village Drive near I-75 and the Jonesboro Road exit Services: Family medicine (pediatrics/adolescent/adult), pharmacy, lab, and X-ray Legend: Kaiser Permanente medical centers (13 locations; more than 200 doctors) New Stonecrest location coming early 2005 Medical centers designated for after-hours urgent care. Hours: Monday through Friday, 6 to 10 p.m.; Saturday, 9 a.m. to 9 p.m.; and Sunday, 10 a.m. to 6 p.m. International travel immunization services available

8 Getting started Who to call After you join Kaiser Permanente, we ll send you additional information about how to use your plan. If you have questions about what to expect, the following Q&A may help. How do I choose a doctor? It s simple; all you need to do is choose a personal physician from the physician directory when you enroll. You can choose from our medical center or affiliated doctors in family medicine, general practice, internal medicine, or pediatrics/adolescent medicine. If you don t select a physician when you enroll, we ll assist you by identifying a doctor in a medical center near your home and listing that doctor as your personal physician. You may change your personal physician for any reason and as often as you wish, simply by calling our Member Services Department at (404) How do I make my first appointment if I haven t received my Kaiser Permanente ID card yet? ID cards are mailed approximately two weeks after we receive your enrollment information. However, you can make an appointment as soon as your membership is effective. You simply need your health medical record number. To get it, call our Member Services Department at (404) What if I m traveling and need care? You re covered for emergency or urgent care anywhere in the world. Receiving emergency or urgent care outside of our metro-atlanta Service Area is one of the few times you may need to file a claim. If you re visiting another Kaiser Permanente service area, you have benefit coverage as a visiting member. Visiting member benefits can provide you with coverage similar to your home service area. Care provided under visiting member benefits must be arranged or provided by a Plan physician in the service area you are visiting. For information about visiting member benefits and facilities in other areas, or to file a claim, call us at (404) or , Monday through Friday, 8:30 a.m. to 5 p.m. I have children away at school are they covered? Yes, members who are temporarily outside of our service area, such as students, are covered. If your children are attending school in another Kaiser Permanente service area, they can receive visiting member benefits. If your children are not in a Kaiser Permanente service area, they re only covered for emergency and urgent care. They can go to any provider, but if they are admitted to the hospital, we should be notified within 24 hours of their admission, or as soon as reasonably possible. And of course, your personal physician can provide routine or elective services, such as flu shots or annual physical exams, in your home service area. Please refer to your Evidence of Coverage and the Kaiser Permanente Visiting Member Program brochure for more information. Can I still see my current doctors if I join Kaiser Permanente? If your current primary care doctor is one of our affiliated community physicians, you can continue to see him or her. If your current specialist is part of our network, you may be able to see him or her as well. You will need a referral from your personal Kaiser Permanente physician for specialty care. This allows your personal physician to talk to you about treatment plans and specialty care, and help determine the care that s appropriate for you. For questions about our health plan or benefits: Member Services (404) When outside Atlanta, call toll free (Disponible en español) Mon. Fri., 8:30 a.m. 9 p.m. Sat. Sun., 8 a.m. 2 p.m. kaiserpermanente.org For appointments and nurse advice: Health Line (404) or (Disponible en español) Mon. Fri., 7 a.m. 7 p.m.: Appointment scheduling and cancellation 24 hours a day, seven days a week: Nurse advice and information For the hearing and speech impaired (TTY) 12