Member Guide. Yo u r I n t r o d u c t i o n to K a i s e r Pe r m a n e n te

Transcription

1 Member Guide Yo u r I n t r o d u c t i o n to K a i s e r Pe r m a n e n te

2 MEMBER GUIDE :063*/530%6$5*0/50,"*4&31&3."/&/5& This guide provides general information, not medical advice or benefit coverage. For complete details on your benefit coverage, including exclusions, limitations, and plan terms, please call the Customer Service Center at (Oahu) or (neighbor islands). If you are a member of one of the plans below, please refer to the guide that applies to your plan. If you have questions about which guide applies to you, and to get a copy, please contact our Customer Service Center. t 'FEFSBM&NQMPZFFT)FBMUI#FOFmUT1SPHSBNNFNCFST t,btfs1fsnbofouf"eefe$ipdf Plan members t,btfs1fsnbofoufgps*oewevbmtboe'bnmft1mbonfncfst t,btfs1fsnbofouf26&45boe26&45/funfncfst t,btfs1fsnbofouf4fops"ewboubhfnfncfst t,btfs1fsnbofouf.fedbsf$ptunfncfst *OGPSNBUPOOUITHVEFTDVSSFOUBTPG"VHVTUBOENBZCF subject to change without notice. 2 Kaiser Permanente Member Guide

3 ALOHA 8&-$0.&50,"*4&31&3."/&/5& Thank you for choosing to be a Kaiser Permanente member. We look forward to helping you live a longer, healthier life. This guide 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 following: Get care at our facilities and contracted providers Helpful tips: unexpected medical treatment or emergencies. separate location. Immediately call our Customer stolen, or needs to be replaced. CONTACT US Customer Service Center (Oahu) (neighbor islands) TTY hearing/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 PO0BIV.BVBOE)BXB BOEBGmMBUFEQSPWEFSTPO,BVB-BOBBOE.PMPLB7TU kp.org/locationsupmoeuif facility nearest you. Choose your doctor Good health care begins with building a relationship with your personal physician. Your doctor is your health care BEWPDBUFZPVSESFDUMOLUP all Kaiser Permanente services, and your source for referrals to specialists. -FBSOBCPVUPVSEPDUPSTO our Physicians and Locations Directory, biography cards at our reception counters, and on kp.org/chooseyourdoctor. You can also call our Customer Service Center for a copy of PVSNPTUDVSSFOUESFDUPSZ"OE remember, you can change your personal physician at any time and for any reason. Make an appointment $BMMZPVSEPDUPSTPGmDF or visit kp.org/locations.* Tip: 5PDBODFMBOBQQPOUNFOU DBMMUIFIPVSBQQPOUNFOU cancellation line of your Kaiser Permanente facility. * Scheduling appointments on kp.org is not applicable to specialty care departments. kp.org/thrive 5

6 YOUR FIRST APPOINTMENT 1 2 $IFDLOXUIZPVS,BTFS1FSNBOFOUFNFNCFS *%DBSEBOEBWBMEQIPUP*% #FSFBEZUPQSPWEFOGPSNBUPOBCPVUPUIFS health coverage you have, including showing UIFTF*%DBSET Tip: If you re bringing in a child who is not your own, please get an authorization form from the Customer Service Center or have a OPUBS[FE)FBMUI$BSF1PXFSPG"UUPSOFZGPSN 3 #SOHUIFOBNFTPGBOZNFEDOFZPVBSFUBLOH TPXFDBONBLFTVSFUIBUZPVSQSFTDSQUPOTBSF uninterrupted. 4 5FMMUIFEPDUPSBCPVUBOZUSFBUNFOUTZPV BSFDVSSFOUMZSFDFWOHBOEGFFMGSFFUPBTL 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 charges for labs, X-rays, procedures, or prescription medications are due on the day you receive services. Payment is easy with cash, debit card, QFSTPOBMDIFDLPS credit card. You may receive a bill for services performed after you ve paid and left our facility. 'PSFYBNQMFZPVSEPDUPSNBZ need to send tissue samples for further testing. 8FXMMMFUZPVLOPXCFGPSF scheduled procedures if payment is required for related IHIDPTUTFSWDFTPSUFNT CONTACT US Patient Financial Services Department (Oahu) (neighbor islands) kp.org/thrive 7

8 YOUR PRESCRIPTION Coverage of prescription drugs varies depending upon your benefit plan. Locations Pharmacies are located in most of our facilities and are open during regular business hours. :PVDBOHFUQSFTDSQUPOTmMMFE BOECVZPWFSUIFDPVOUFS medications and supplies at our pharmacies. In certain instances, you can use select OPO,BTFS1FSNBOFOUF pharmacies. Transfer your prescriptions 'PSIFMQUSBOTGFSSOHZPVS prescriptions, call our Care 5SBOTUPO5FBNBU POEBZUP'SEBZBNUPQN Provide the name and phone number of your current pharmacy BOEPVSQIBSNBDZUFBNXMMUBLF care of the rest. Refills 4BWFUNFCZPSEFSOHSFmMMT VTOH.Z)FBMUI.BOBHFS at kp.org.ptusfmmmtdbo be mailed to you at no extra DIBSHF"OEGZPVIBWF prescription drug coverage, ZPVDBOHFUBEBZTVQQMZPG SFmMMTGPSUIFDPTUPGEBZT Covered drugs We use an approved list PGESVHTUPNBLFTVSFUIBU the most appropriate, safe, and effective prescription medications are available to ZPV5ITMTUTSFWFXFEPO a regular basis and includes both generic, brand name, and specialty drugs covered under UIFQSFTDSQUPOESVHCFOFmU Drugs not covered /POQSFTDSQUPOPS PWFSUIFDPVOUFSNFEDOFT %SVHTGPSDPTNFUDVTFT %FOUBMQSFTDSQUPOT (unless prescribed for a medical condition) %SVHTVTFEGPSSFBTPOTOPU BQQSPWFECZUIF'%" 1MBOFYDMVEFE prescription drugs 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 calling. CONTACT US After-Hours Advice Line (Oahu) (neighbor islands) TTY for hearing/speech impaired Regular 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 -emergency, 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 garage and use the main entrance to the hospital to go 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, seven days a week. kp.org/thrive 9

10 AFTER-HOURS CARE CONTACT US Maui Hana Health Clinic 4590 Hana Highway Mon., 7:30 a.m. 8 p.m. Tues. Thurs., 7:30 a.m. 5 p.m. Fri., 8 a.m. 5 p.m. Sat., 8 a.m. noon Big Island Hilo Urgent Care Center, LLC thilo 45 Mohouli Street Mon. Fri., 8:30 a.m. 9 p.m. Sat. Sun., 9:30 a.m. 4 p.m tkeaau Old Volcano Highway Mon. Fri., 9 a.m. 5:30 p.m. Sat., 9:30 a.m. 4 p.m. Closed Sun Keauhou Urgent Care Center Keauhou Shopping Center (across from theater) Alii Drive Open every day 9 a.m. 7 p.m URGENT CARE IN LAS VEGAS 8FDPOUSBDUXUI$PODFOUSB6SHFOU$BSFBOE8BMHSFFOT)FBMUIDBSF$MODUPQSPWEFVSHFOUDBSF TFSWDFTUPNFNCFSTFYQFSFODOHOPOMGFUISFBUFOOHIFBMUIQSPCMFNTXIMFWTUOH-BT7FHBT 8IFOQPTTCMFDBMMZPVSEPDUPSPSBGUFSIPVSTBEWDFOVSTFmSTUUPETDVTTZPVSIFBMUITUVBUPO8IFO WTUOHPOFPGUIFTFVSHFOUDBSFDMODTQSFTFOUQIPUPEFOUmDBUPOBMPOHXUIZPVSNFNCFS*%DBSE 8BMHSFFOT$PODFOUSBXMMCMMZPVMBUFSBDDPSEOHUPZPVSIFBMUIQMBO'PSNPSFOGPSNBUPOPOVSHFOU DBSFO-BT7FHBTDPOUBDUPVS$VTUPNFS4FSWDF$FOUFS 10 Kaiser Permanente Member Guide

11 EMERGENCY SERVICES t 8FDPWFSOUBMVSHFOUBOEFNFSHFODZDBSFBOZXIFSFOUIFXPSME t t *GZPVUIOLZPVSFFYQFSFODOHBOFNFSHFODZHPNNFEBUFMZ to an emergency department. *GZPVOFFEBOBNCVMBODFDBMM%POUDBMM,BTFS1FSNBOFOUF and waste precious time. Emergency conditions &NFSHFODZNFEDBMDPOEUPOT need immediate medical attention to avoid serious threats to your body or health. 5IFTFDPOEUPOTNHIUODMVEF Severe pain 4VTQFDUFEIFBSUBUUBDLPSTUSPLF &YUSFNFEGmDVMUZOCSFBUIOH #MFFEOHUIBUXMMOPUTUPQ.BKPSCVSOT Seizures Sudden onset of severe headache Suspected poisoning :PVS,BTFS1FSNBOFOUFQMBOEFGOFTBOi&NFSHFODZ.FEDBM Condition as an illness or injury that manifests itself by acute symptoms of sufficient severity (including severe pain) such that BQSVEFOUMBZQFSTPOXIPQPTTFTTFTBOBWFSBHFLOPXMFEHFPG health and medicine, could reasonably expect the absence of NNFEBUFNFEDBMBUUFOUPOUPSFTVMUOBOZPGUIFGPMMPXOH Placing the person s health (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy Serious impairment to bodily functions; or Serious dysfunction of any bodily organ or part. Copayment Copayment for an emergency department visit varies depending on your plan benefits. Refer to your Benefits Summary for a description of coverage. Coverage 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 begins (or as soon as reasonably possible) by calling the phone number on the back of your Kaiser Permanente member ID card or your claim for payment may be denied. kp.org/thrive 11

12 HOSPITAL SERVICES Hospital services 5IF.PBOBMVB.FEDBM$FOUFSTBGVMMTFSWDFIFBMOHIPTQUBM1BUFOUTBOEGBNMZBSFBUUIFDFOUFS PGFWFSZUIOHXFEP4QFDBMMZUSBOFEDMODBOTBOEDBSFHWFSTQBSUOFSUPQSPWEFDPNQBTTPOBUF BOERVBMUZDBSFBOETFSWDFT0VSTUBUFPGUIFBSUIFBMOHFOWSPONFOUTEFTHOFEUPDBSFGPSBDVUF MMOFTTBOEOKVSZ"ENTTPOTCBTFEPOBQIZTDBOSFWFXPGZPVSNFEDBMDPOEUPO4FSWDFT include medical, surgical, perinatal, labor and delivery, neonatal, pediatric, and intensive care GPSBDVUFMMOFTTBOEOKVSZ0VSIPTQUBMBMTPODMVEFTBOBNCVMBUPSZTVSHFSZBOESFDPWFSZ "43 EFQBSUNFOUBNCVMBUPSZUSFBUNFOUDFOUFS "5$BDMODBMEFDTPOVOUGPSPCTFSWBUPOTUBZT $%6 operating rooms, and emergency services. Neighbor island members 0VSQIZTDBOTXMMESFDUZPVUPB,BTFS1FSNBOFOUFEFTHOBUFEIPTQUBMPOZPVSTMBOE 5ITNBZODMVEF.BV.FNPSBM.FEDBM$FOUFS,POB$PNNVOUZ)PTQUBM )MP.FEDBM$FOUFS /PSUI)BXB$PNNVOUZ)PTQUBM 8MDPY.FNPSBM)PTQUBM 8FTU,BVB.FEDBM$FOUFS 4BNVFM.BIFMPOB.FNPSBM)PTQUBM.PMPLB(FOFSBM)PTQUBM -BOB$PNNVOUZ)PTQUBM 5IFOFFEUPBENUPSUSBOTGFSZPVUPUIF.PBOBMVB.FEDBM$FOUFSXMMCFEFUFSNOFECZZPVSQIZTDBO 12 Kaiser Permanente Member Guide

13 TRANSPORTATION SERVICES Shuttle service on Oahu 8FQSPWEFGSFFTIVUUMFTFSWDFPO0BIVCFUXFFOPVS.PBOBMVB.FEDBM$FOUFSBOEUIF GPMMPXOHGBDMUFT )POPMVMV.FEDBM0GGDF,BIVLV$MOD Kapolei Clinic,PPMBV.FEDBM0GGDF.BQVOBQVOB.FEDBM0GGDF /BOBLFPMB$MOD 8BQP.FEDBM0GGDF )POPMVMV*OUFSOBUPOBM"SQPSU*OUFSTMBOE5FSNOBM 4IVUUMFPQFSBUFT.POEBZUP'SEBZFYDFQUIPMEBZT4DIFEVMFTBOETHOVQTBSFQPTUFEBUFBDI location. You can also find the shuttle schedule at kp.org/locations. Neighbor island concierge Your doctor will refer you to a specialist when it s medically necessary. In some cases, that may mean recommending our neighbor island members get 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 go to Oahu for medically necessary care, we can assist you with coordinating your medical appointments. Our concierge can also offer shuttle and ground transportation information, hotel and IPVTOHSFDPNNFOEBUPOTBMPOHXUIUQTPONBLOHUIFNPTUPGZPVSTUBZ CONTACT US UFLY.PO'SBNQN *GZPVMWFPO.BV,BVB.PMPLB-BOBPSUIF#H*TMBOE and need transportation assistance to Oahu for medically OFDFTTBSZDBSFDBMMPVS5SBWFM%FQBSUNFOU BV ,BVB.PMPLB-BOBBOEUIF#H*TMBOE.POEBZ'SEBZBNQN4BUVSEBZ BNOPPO FNFSHFODFTPOMZ Closed Sunday and most holidays kp.org/thrive 13

14 ONLINE SERVICES A variety of convenient services are offered online at kp.org. You can access medical information and data, improve your lifestyle with customized online programs, receive discounts on health services and products, and participate in programs designed to increase your physical activity level. Your electronic health record: My Health Manager -OLFEESFDUMZUPZPVSNFEDBMSFDPSE.Z)FBMUI.BOBHFSHWFT you the power to manage your health online at kp.org. You DBOWFXNPTUMBCUFTUSFTVMUTFNBMZPVSEPDUPSTPGmDFPSEFS QSFTDSQUPOSFmMMTSFRVFTUSPVUOFBQQPOUNFOUTDIFDLQBTUPGmDF WTUOGPSNBUPOMPPLVQGVUVSFBQQPOUNFOUTBOENPSF5IFTF UNFTBWOHGFBUVSFTIFMQZPVTQFOEMFTTUNFNBOBHOHZPVS health and more time enjoying life. Go to kp.org/register to get started. Once you register, you DBOTHOPOXUIZPVSVTFS*% BOEQBTTXPSE3FHTUSBUPOT RVDLBOEFBTZ Free, customized online programs We offer you many ways to improve your lifestyle with free customized online programs designed to help you succeed in creating a healthier you. 5IFTFQSPHSBNTBSFCSPVHIU to you in collaboration with )FBMUI.FEB, and we offer them to you at no cost. 5PTFMFDUUIFQSPHSBNZPVXBOUDIPPTFGSPNUIFMTUCFMPX then sign on to kp.org/healthylifestyles.'mmpvuuifpomof questionnaire and you ll receive a customized guide to the program you specify. We ll even follow up with personalized s UPIFMQLFFQZPVPOUSBDL:PVDBOTUBSUNFBTVSOHZPVSTVDDFTT XUIOXFFLTPGDPNQMFUOHZPVSQSPHSBN "TTFTTZPVSIFBMUI (total health assessment).bobhfpohpohifbmui conditions.bobhfdispodqbo -PTFXFHIU &BUSHIU 3FEVDFTUSFTT 2VUTNPLOH Keep diabetes under control 6OEFSTUBOEEFQSFTTPO.BOBHFOTPNOB.BOBHFCBDLQBO 14 Kaiser Permanente Member Guide

15 AWARDS AND RECOGNITIONS 8)"505)&344":"#065,"*4&31&3."/&/5& /BNFEUIFIHIFTUSBUFEDPNNFSDBMIFBMUIOTVSBODFQMBOO )BXBCBTFEPOFYDFMMFODFOQSFWFOUPOUSFBUNFOUBOENFNCFS TBUTGBDUPOBDDPSEOHUPUIF/BUPOBM$PNNUUFFGPS2VBMUZ "TTVSBODF /$2" 0VS.PBOBMVB.FEDBM$FOUFSSFDFWFEOBUPOBMSFDPHOUPO in The oint Commission s 2012 annual report on quality and safety, Improving America s Hospitals. We were one of only two IPTQUBMTO)BXBUPCFSFDPHO[FEBTBiTop PerformerOLFZ RVBMUZNFBTVSFTwODMVEOHIFBSUBUUBDLIFBSUGBMVSFQOFVNPOB and surgical care. 'STUNVMUTUFIFBMUIDBSFPSHBO[BUPOO)BXBUPCFSFDPHO[FE CZ/$2"GPS1BUFOU$FOUFSFE.FEDBM)PNF 1$.).PEFM "MM QSNBSZDBSFGBDMUFTBOEQSPWEFSTSFDFWFEMFWFMSFDPHOUPO the highest level possible. 0VS.PBOBMVB.FEDBM$FOUFSSFDFWFEUIF"NFSDBO)FBSU "TTPDBUPOT"NFSDBO4USPLF"TTPDBUPOT(FU8UI5IF Guidelines 4USPLF(PME1MVT2VBMUZ"DIFWFNFOU"XBSEGPS FYDFMMFODFOUIFUSFBUNFOUPGTUSPLFQBUFOUT 0VS.PBOBMVB.FEDBM$FOUFSTUIFmSTUBOEPOMZ#BCZ'SFOEMZ )PTQUBMO)BXBBDDPSEOHUPUIF8PSME)FBMUI0SHBO[BUPO BOE6/*$&'OSFDPHOUPOPGPVSBEWPDBDZPGCSFBTUGFFEOH /$2"T)FBMUI*OTVSBODF1MBO3BOLOHT/BUPOBM$PNNUUFFGPS2VBMUZ"TTVSBODF/$2"TBQSWBUFOPUGPSQSPmU PSHBO[BUPOEFEDBUFEUPNQSPWOHIFBMUIDBSFRVBMUZ7TU/$2"PSH.PBOBMVB.FEDBM$FOUFSTSFDPHO[FEBTB5PQ1FSGPSNFSO5IF+POU$PNNTTPOT5PQ1FSGPSNFSTPO,FZ2VBMUZ.FBTVSFT QSPHSBN5IF+POU$PNNTTPOSFDPHO[FT.PBOBMVB.FEDBM$FOUFSGPSBDIFWOHFYDFMMFODFOQFSGPSNBODFPOUT BDDPVOUBCMUZNFBTVSFTEVSOHGPSUIFGPMMPXOHNFBTVSFTFUTIFBSUBUUBDLIFBSUGBMVSFQOFVNPOBBOETVSHDBMDBSF /$2"T1IZTDBO1SBDUDF$POOFDUPOT o1bufou$foufsfe.fedbm)pnf 5. IBTSFDPHO[FEBMM,BTFS1FSNBOFOUFQSNBSZ DBSFGBDMUFTO)BXBBU-FWFMUIFIHIFTUMFWFM/$2"TBQSWBUFOPOQSPmUPSHBO[BUPOEFEDBUFEUPNQSPWOHIFBMUIDBSF RVBMUZ7TU/$2"PSH kp.org/thrive 15

16 IMPORTANT NUMBERS Customer Service Center (Oahu) (neighbor islands) :IFBSOH speech impaired.poebz'sebzbnqn 4BUVSEBZBNOPPO After-Hours Advice Line (Oahu) (neighbor islands) :IFBSOH speech impaired.poebz'sebzqnbnuifofyuebz 4BUVSEBZOPPO.POEBZBN )PMEBZTBNBNUIFOFYUEBZ Prescription refills 3FmMMQSFTDSQUPOTPOMOFBUkp.org/rxrefill 0SEFSSFmMMTCZQIPOF IPVSTBEBZTFWFOEBZTBXFFL 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: 7TUkp.org and download our free Kaiser Permanente BQQGSPNUIF"QQ4UPSF 4. or Google Play. "QQ4UPSFTBTFSWDFNBSLPG"QQMF*OD(PPHMF1MBZ TBUSBEFNBSLPG(PPHMF*OD KAH NM -13 Rev August 2013