On the GO Services for our Medicare health plan members who are visiting other Kaiser Permanente regions or Group Health Cooperative service areas Y0043_N011615 accepted
Travel WELL and get the care YOU NEED. Life is full of motion. Maybe you re hitting the road to visit our nation s capital, or you re on your way to visit a new grandchild. Whatever your destination, it s always more fun when you re at your healthiest. If you do need care while you re away from home, know that you ll have access to Kaiser Permanente care when visiting other Kaiser Permanente regions or Group Health Cooperative (Group Health) service areas.
What kind of health care services can I get in other Kaiser Permanente service areas? If you need care while you re traveling within a Kaiser Permanente region other than the region in which you are enrolled (your home region), you can have access to certain medically necessary health care services, including routine and specialty care, as described in this brochure. It is also possible for you to get ongoing care for a chronic condition while traveling in those regions. Kaiser Permanente region means a Kaiser Foundation Health Plan organization that has a direct-service health care program in the District of Columbia and parts of California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, and Washington. Outside of Kaiser Permanente regions, you can also access medically necessary health care and ongoing care for a chronic condition in parts of Washington and Northern Idaho through our collaboration with Group Health. For more information about Group Health, including locations, visit ghc.org/about_gh/index.jhtml. This brochure describes the care you can receive from providers in other Kaiser Permanente regions and the Group Health service area. It does not describe your coverage for emergency or urgent care received from non-plan providers. Please refer to your Evidence of Coverage (EOC) for details about out-of-plan coverage. Who is eligible for this care? For how long? While you are traveling, you can get certain health care services and items from plan providers in other Kaiser Permanente regions or providers in Group Health s service area (in parts of Washington and Northern Idaho) for up to 90 days. The 90-day limit does not apply if you are attending accredited colleges or accredited vocational schools, but you might need to show proof of student enrollment status.
Note: You will not be able to continue membership in your home region if you are absent from your home region s service area for more than: Six months if you are a Kaiser Permanente Senior Advantage (HMO), Kaiser Permanente Senior Advantage Plus Choice (HMO-POS), or Kaiser Permanente Senior Advantage Medicare Medicaid (HMO SNP) member; 90 days if you are a Kaiser Permanente Medicare Cost or Kaiser Permanente Medicare Plus (Cost) member without Medicare Part D; or 90 days if you are a Medicare Plus member with Medicare Part D. If you have permanently moved to another Kaiser Permanente region s service area, you may be able to enroll as a member in that region. For more information, please refer to your EOC or contact Member Services in your home region. Which services can I receive? You can receive the services and items on the following list when provided or referred by a plan provider in the Kaiser Permanente region or Group Health service area you are visiting. The services and items must be medically necessary and are subject to the exclusions, limitations, and preauthorization requirements described in your EOC and in this brochure. Inpatient services Hospitalization, including inpatient surgery and other services you receive while admitted Outpatient services Office visits Outpatient surgery Allergy tests and allergy injections Physical, occupational, and speech therapy (up to two months per condition) Prenatal and postnatal care Dialysis care Chemotherapy X-ray and laboratory services In or out of the hospital
Prescription drugs Available if the drug would be covered for you in your home region Mental health and chemical dependency services Available under the same terms and conditions as in your home region Skilled nursing facility services Up to 100 days per benefit period in a Medicare-certified skilled nursing facility (Except for certain students, members can get services only during temporary visits of 90 days or fewer.) Home health care services Part-time or intermittent home health care services within a Kaiser Permanente region or Group Health service area Is preauthorization required? For certain services and items, including inpatient physical rehabilitation, you must obtain preauthorization from your home region before you receive care from the region or service area you re visiting. Also, some services require preauthorization from the region or service area you re visiting. For more information, please contact Member Services in the Kaiser Permanente region you ll be visiting (or Group Health Customer Service, if you ll be visiting a Group Health service area). Are some services excluded? In addition to the exclusions and limitations described in your EOC, the following services and items are not covered in another Kaiser Permanente region or Group Health service area. (Note: You may have coverage for some of these services or items in your home region as described in your EOC. If one or more of these services or items are covered according to your EOC, you will need to get the services or items from plan providers in your home region.) Complementary and alternative medicine services Dental services and dental X-rays Eyeglasses Hearing aids Infertility services Organ transplants and related services Services related to conception by artificial means, such as in vitro fertilization Services related to sexual reassignment
Are there any other limitations? You may receive the services listed below from plan providers in another Kaiser Permanente region or providers in the Group Health service area, but the services will be covered in accordance with the coverage rules stated in your EOC. Also, you may be required to pay for the services in full and file a request for reimbursement with your home region. Durable medical equipment Emergency services (including emergency ambulance) and urgent care* Orthotic and external prosthetic devices What costs are involved? You may pay out-of-pocket costs for the services and items you receive in other Kaiser Permanente regions or Group Health service areas. These payments may be different from the copayments and coinsurance that you would usually pay in your home region. Also, for some services and items, you may be required to pay for the services in full and file a request for reimbursement with your home region. Please contact Member Services in your home region for more information. * If you need emergency or out-of-area urgent care, you can obtain care from any provider. (Refer to your EOC for details and coverage rules.) How do I get care? To get care, call Member Services in the Kaiser Permanente region you are visiting, and tell the representative that you are a member in another Kaiser Permanente region and would like to obtain care from plan providers. Member Services will give you all the information you need to make an appointment, including the plan facility or provider name, phone number, and location. If you are visiting a Group Health service area, call Group Health Customer Service to schedule an appointment or get location information.
Whom should I call for more information? Contact Member Services in your home region. For information about Group Health service areas, call Group Health Customer Service. CALIFORNIA Northern and Southern California Regions 1-800-443-0815 (TTY 711) Note: If you are seeking services from a contracted, non Kaiser Permanente provider in Coachella Valley (Palm Desert, Palm Springs, Desert Hot Springs, or Indio) in California, you may be required to contact your primary care physician in your home region to obtain prior authorization and a referral. COLORADO Denver/Boulder, Northern Colorado and Southern Colorado service area 1-800-476-2167 (TTY 711) Note: Network providers in Northern Colorado are available only to Northern Colorado members. Network providers in Southern Colorado are available only to Southern Colorado members. Please call Member Services for more information. DISTRICT OF COLUMBIA Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. 2101 E. Jefferson St. Rockville, MD 20852 1-888-777-5536 (TTY 711) GEORGIA Kaiser Foundation Health Plan of Georgia, Inc. Nine Piedmont Center 3495 Piedmont Rd. NE Atlanta, GA 30305 Atlanta Metro area 1-800-232-4404 (TTY 711) HAWAII The islands of Oahu and Maui and most of Hawaii (the Big Island) 1-800-805-2739 (TTY 711) MARYLAND Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. 2101 E. Jefferson St. Rockville, MD 20852 Baltimore and suburban D.C. area 1-888-777-5536 (TTY 711)
OREGON Northwest Region 1-877-221-8221 (TTY 711) VIRGINIA Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. 2101 E. Jefferson St. Rockville, MD 20852 Northern area 1-888-777-5536 (TTY 711) WASHINGTON STATE Northwest Region (Southwest area) 1-877-221-8221 (TTY 711) GROUP HEALTH COOPERATIVE Customer Service for all areas: 1-888-901-4600 (TTY 711) Note: Phone numbers beginning with 1-800, 1-866, 1-877, or 1-888 are toll free. TTY numbers are for the deaf, hard of hearing, or speech impaired. Kaiser Permanente is an HMO plan with a Medicare contract. Kaiser Permanente is a Cost plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year, and for group members, at other times in accord with your group 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. Note: Most members have worldwide emergency and urgent care coverage, and some members have additional coverage when they travel. Please refer to your EOC for coverage rules related to covered emergency and urgent care from non-plan providers. For a copy of your EOC, please log on to My Health Manager on kp.org or call Member Services.
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