This is an advertisement Hawaii Reion Federal Employees and Annuitants 2013 Rates and Benefits I can choose my doctor Not a member yet? Chat live with a representative at kp.or/feds or call 1-855-366-9009, Monday Friday, 8 a.m. 5 p.m., for more information. Statements above related to Kaiser Permanente physicians and services only. kp.or/feds
A reat choice for ood health Kaiser Permanente is uniquely desined to ive you the information and support you need to live well, with everythin workin conveniently toether. your choice of top doctors With Kaiser Permanente, you et a wide choice of doctors from many of the top medical schools in the country. personalized care Your care team works with you, supported by your secure electronic health record, which connects them to your up-to-date health info like lab test results, medications, and preventive screenins that are due. 1 everythin under one roof Many of our locations include pharmacy, lab, and X-ray services, so you can do more and drive less. lots of healthy extras Stay at your best with healthy resources like farmers markets and wellness classes, some of which are free. kp.or/feds easy online access, anytime Use your computer, smartphone, or mobile device to email your doctor s office, schedule routine appointments, view lab test results, refill prescriptions, and more. 1 a reat experience Our Moanalua Medical Center received an A ratin for patient safety in a national report card issued in June 2012 by The Leapfro Group, a national nonprofit oranization focused on health care quality. 2 1 Available when you receive care at Kaiser Permanente facilities. 2 The Leapfro Hospital Safety Score SM rades hospitals on data related to how safe they are for patients. For more information, visit hospitalsafetyscore.or.
Better Informed. Better Toether. Makin smart decisions whether you re choosin a health plan for your family or dealin with a health condition can be easier than you think. All you need is a partner to ive you the riht information and support. Take a look at everythin you et with your membership, and you ll aree that Kaiser Permanente is the best choice for your health. A better way to et and stay healthy...2 Coordinated care...3 Online access anytime, anywhere...4 Convenient classes, resources, and more...5 Federal Employees Health Benefits (FEHB) Prorams...6 Kaiser Permanente Senior Advantae (HMO) for Federal Members...7 Your dental, chiropractic, and acupuncture benefits...8 Travel and student out-of-area benefits...9 Your benefits summary for 2013...10 How to enroll...12 Our locations...13 Prefer to see this information online? Go to kp.or/feds. Already a member? If you re currently a member and have questions, please call our Customer Service Center at 808-432-5955 (Oahu) or 1-800-966-5955 (Neihbor Islands), Monday throuh Friday from 8 a.m. to 5 p.m. and Saturday from 8 a.m. to noon. For TTY for the hearin/speech impaired, call 1-877-447-5990. 1
A better way to et and stay healthy Be better informed and take an active role in your health. You and your family et what you need to live well, and we work toether with you to help you make better choices every step of the way. What you need, when you need it We make it simple for you to et care: easy-to-schedule appointments email access to your doctor s office 1 same-day and Saturday services at many locations 24-hour telephone health advice from reistered nurses recent medical information and most test results online 1 convenient locations urent and emerency care coverae anywhere in the world 2 Personalized care Your doctors, nurses, and specialists take the time to know you and your health needs. Supported by your secure electronic health record, your Kaiser Permanente care team stays up to speed and ready to take care of you. Havin a team that s informed and focused on you can lead to quicker, better dianoses and treatments. Everythin under one roof Most of our locations conveniently offer multiple services under one roof. You can see your doctor, et lab services and X-rays, and fill prescriptions all at the same place. That can help you save time and avoid drivin all over town. For prescription refills, you can even order online and have most mailed to your home with free shippin. 1 Available when you receive care at Kaiser Permanente facilities. 2 This is a summary of the features of the Kaiser Permanente health plan. Before makin a final decision, please read the Plan s Federal brochure (RI 73-005). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure. See how Kaiser Permanente has helped members at kp.or/carestories. Your electronic health record brins it all toether Our innovative electronic health record system is securely linked to every Kaiser Permanente facility in Hawaii, so you et coordinated care wherever you o. 2 Your doctor s office Your electronic health record is updated with each visit, whether you see your personal physician or another Kaiser Permanente doctor. From department to department and facility to facility, your record oes where you o. Pharmacy, lab, and X-ray If your Kaiser Permanente doctor prescribes you medications or orders lab tests, there s no paperwork to take with you. Just visit any of our pharmacies, and the pharmacist or technician will pull up your doctor s orders.
Coordinated care Get coordinated care from doctors, nurses, and specialists who focus on you and your health. Your Kaiser Permanente care team works toether, sharin best practices and arranin any specialty care you may need. This combination of teamwork and expertise helps make our doctors better informed, so they can provide the best care for your needs. A wide choice of doctors Our physicians come from many of the top medical schools in the country, and they all o throuh an extensive hirin process before becomin Kaiser Permanente doctors. Only 1 in 17 who apply make the cut. This makes it easier for you to find a doctor who s riht for you. Just o online to view our doctor profiles or ive us a call. Specialists ready to care for you You also have access to hihly trained specialists. They re ready to help dianose and treat most conditions that miht come up. Our doctors and specialists work toether, makin referrals easier. And you don t even need a referral for certain specialty departments and services, includin Ob-Gyn, Psychiatry, and Chemical Dependency Services. A focus on you and your family Our care model reduces the burden of administrative hassles, insurance claim forms, and other paperwork for our doctors, nurses, and specialists. This keeps them free to focus on what they do best deliver care that s riht for you. Learn more about the doctors available in your area at kp.or/doctorsandlocations. Specialty care If your doctor refers you to a specialty department, you ll receive a call. When you come in, your specialist will have your health information riht at his or her finertips. At home or on the o My Health Manaer on kp.or is your personal link to your electronic health record. This set of online tools helps you stay connected and informed about your health. 3
Online access anytime, anywhere Plu into your health with a variety of online and mobile tools that help you et the information you want, when you want it. Whether you re on the o or just takin advantae of a quiet moment at home, we ve ot you covered. It s easy to stay connected As a member reistered on kp.or, you have secure, 24-hour access to My Health Manaer. This online resource offers convenient tools for manain your care at our facilities.* Email your doctor s office. View most lab test results as soon as they re available. Refill prescriptions. Schedule or cancel routine appointments. Help take care of a family member, like a child or parent, usin these features and more. * Available when you receive care at Kaiser Permanente facilities. A website full of healthy ideas Get informed and inspired on our award-winnin website, kp.or. Take chare of your health anytime, anywhere, with online articles, wellness topics, and health calculators. And find new ways to live well with recipes from world-class chefs, music channels, podcasts, videos, and more. Good health on the o Our mobile apps make it easy to manae your health no matter where you are at home, at work, and when you re on the o. Just download our free apps for the iphone, ipad, or ipod touch from the App Store SM, or for Android devices from Goole Play. Apple, iphone, ipad, and ipod touch are trademarks of Apple, Inc., reistered in the U.S. and other countries. App Store is a service mark of Apple, Inc. Android is a trademark of Goole, Inc. For a uided tour of My Health Manaer, visit kp.or/experience. Top reasons to join Kaiser Permanente Great care You et care backed by innovative technoloy. Your Kaiser Permanente care team can securely access your up-todate health information to help you et care that s riht for you. Great doctors You et hihly trained Kaiser Permanente doctors who aren t overburdened with insurance paperwork. Their focus is workin toether with you to deliver the care you need. 4
Convenient classes, resources, and more Fit wellness into your schedule, no matter how busy you are. We ive you lots of healthy extras that can help you stay informed about ways to live healthier mind, body, and spirit. And we ll work toether with you to provide the extra motivation you need to et started, stick with it, and maybe even cross a finish line. Learn somethin new Fresh food, better health Maximize your well-bein With the many health classes offered at our facilities, there s somethin for everyone. Try classes on yoa, eatin well, baby care, specific health conditions, and much more. Classes vary by location and some may require a fee. Visit kp.or/classes to find a class near you. 1 Eatin well is easier when you brin home fresh food from our farmers markets. They re conveniently located at some of our facilities, so you can pick up some healthy fruits and veies after your visit. Go to kp.or/farmersmarket to learn more. 1 These benefits are neither offered nor uaranteed under contract with the FEHB Proram, but are made available to all enrollees and family members who become members of Kaiser Permanente. 2 This is a summary of the features of the Kaiser Permanente health plan. Before makin a final decision, please read the Plan s Federal brochure (RI 73-005). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure. Our personalized online wellness prorams can help you lose weiht, stay active, reduce stress, sleep better, and more. Tobacco-cessation prorams and certain drus are also available to you, without a copay. 2 Plus, you can download the free Every Body Walk! mobile app for your smartphone or mobile device. 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. Better access You et information and tools that make it easy for you to et and stay healthy includin easyto-schedule appointments, email access to your Kaiser Permanente doctor, telephone health advice, and helpful online tools. Better visits You et the convenience of bein able to take care of multiple services in one trip, with virtually no paperwork. At most locations, your doctor, lab services, X-rays, and pharmacy are all toether in one place. Watch members share why they chose Kaiser Permanente 5
Federal Employees Health Benefits (FEHB) Prorams As a Federal employee, you can choose between two Kaiser Permanente traditional HMO plan options. Both offer a wide rane of care and support to help you stay healthy and et the most out of life. They re desined to make it easy for you to know what to expect and et the riht care for your needs. Kaiser Permanente FEHB Hih Option If you expect to receive care often, this option may be riht for you. You ll pay hiher premiums but lower copays for most health care services and prescription drus. Kaiser Permanente FEHB Standard Option If you and your family are in ood overall health, this miht be the riht option for you. You ll pay lower premiums but hiher copays for most services and prescriptions. The easier, the better simple copays for most covered services, includin office visits and prescriptions no paperwork to fill out or bills for the services you receive from Kaiser Permanente providers no deductibles to keep track of no referrals for certain specialties, like optometry and ob-yn For help decidin which health plan option best fits your needs, visit kp.or/feds and click on Choose a Health Plan. 6
Kaiser Permanente Senior Advantae (HMO) for Federal Members If you re enrolled in Medicare Parts A and B (or Part B only), Kaiser Permanente Senior Advantae for Federal Members may be riht for you. Your FEHB premiums stay the same when you enroll in this plan, but you ll have lower copays and better Maximize your health plan With Senior Advantae for Federal Members, you ll enjoy all the benefits of Oriinal Medicare, plus all the benefits of your FEHB proram, without any increase in your FEHB premiums. Review the benefits chart in this brochure for details about the lower copays and the extra benefits you receive with this option. Better benefits reduced copays for office visits, lab and X-rays, hospitalization, urent care, and many other benefits with both the Hih Option and the Standard Option additional credit toward hearin aids and eyewear membership in the Silver&Fit fitness and healthy ain prorams Give us a call For details about benefits, copays, limitations, and services, please call 1-800-805-2739, 8 a.m. to 8 p.m., seven days a week. For TTY for the hearin/ speech impaired, call 711. One of our representatives will be happy to help. Senior Advantae for Federal Members benefits are subject to Medicare rules and you may have to receive care from different plan providers than with your FEHB coverae. 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. Benefits, formulary, pharmacy network, premiums, and copayments/coinsurance may chane on January 1 of each year and at other times in accord with your roup s contract with us. To join a Kaiser Permanente Medicare health plan, you must reside in the Kaiser Permanente Senior Advantae service area in which you enroll. You must pay the Medicare Part B premium to join a Kaiser Permanente Medicare health plan. Kaiser Permanente is a health plan with a Medicare contract. 7
Your dental, chiropractic, and acupuncture benefits Whichever option you choose, your Kaiser Permanente health plan comes with dental, chiropractic, and acupuncture benefits. You re covered for annual dental exams and cleanins, and your plan includes up to 20 combined chiropractic and acupuncture visits each year. Dental benefits Healthy teeth and ums are an important part of your total health. That s why your Kaiser Permanente health plan comes with dental benefits.* Whether you choose the Hih Option or the Standard Option, you ll have coverae for annual exams and cleanins throuh Hawaii Dental Service. For more information about your choices for dental coverae, visit kp.or/feds or return the reply card at the back of this brochure. Details about your dental benefits are included in the FEHB brochure (RI 73-005). About Hawaii Dental Service Hawaii Dental Service (HDS) is the larest nonprofit dental service in Hawaii. More than 90 percent of Hawaii s licensed, practicin dentists participate in the HDS network. That means you ll have the larest choice of dentists in the state. To find a participatin dentist near you, visit deltadentalhi.or. By ettin care from a participatin dentist, you can save money. You also have coverae outside of Hawaii. HDS is part of Delta Dental, the larest dental network in the country. So if you re visitin the mainland for work, school, or vacation, you can find a participatin dentist and et the care you need. Chiropractic and acupuncture benefits You have access to many resources that can help you feel your best mind, body, and spirit. Your plan comes with additional health benefits that include up to 20 combined chiropractic and acupuncture visits each calendar year throuh American Specialty Health, Inc. (ASH).* To search for an ASH provider, o to kp.or/choosehealthy. See your benefits summary on pae 10 of this brochure for applicable copayments or refer to the FEHB brochure (RI 73-005) for additional details. * This is a summary of the features of the Kaiser Permanente health plan. Before makin a final decision, please read the Plan s Federal brochure (RI 73-005). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure. 8
Travel and student out-of-area benefits You don t need to worry when you hit the road. And full-time students can rest easy when they re studyin away from home. Travel benefits that ive you peace of mind Student out-of-area benefit Your travel benefits are in addition to the emerency benefits available to you within or outside your service area.* When you re temporarily outside your home service area by more than 100 miles and outside any other Kaiser Permanente service area, you re covered for the followin: outpatient follow-up care to complete a course of treatment after a covered emerency (for example, to remove stitches or a cast) outpatient continuin care for covered services related to conditions dianosed and treated within the previous 12 months by a Kaiser Permanente provider or affiliated provider (like dialysis or prescription dru monitorin) The travel benefit is limited to $1,200 each calendar year and members pay $25 for each follow-up or continuin care office visit. In addition to urent and emerency care, students are now covered for routine primary, continuin, and followup care when studyin away from home. Students must be reistered full time at an accredited institution outside Kaiser Permanente s service areas and within the United States to take advantae of this benefit. The student out-of-area benefit is limited to $1,200 each calendar year and members pay 20 percent of billed chares.* For more information please contact Customer Service at 808-432-5955 (Oahu) or 1-800- 966-5955 (Neihbor Islands). 9
Your benefits summary for 2013 Your benefits summary for 2013 Kaiser Permanente Kaiser Permanente Senior Advantae (HMO) for Federal Members Services Hih Option Standard Option Hih Option Standard Option Preventive care, adults Routine physical exams, routine mammorams, and preventive screenins that include colorectal cancer screenins and routine Pap tests $0 $0 $0 $0 Preventive care, children Well-child preventive care and immunizations $0 $0 $0 $0 Outpatient office visits Primary and specialty office visits $20 $30 $10 $20 Lab and X-ray Outpatient 10% 50% $0 20% Prenatal care Prenatal care and first scheduled postpartum visit $0 $0 N/A N/A In-area urent care Office visits within the Hawaii service area at Kaiser Permanente urent care centers $20 $30 $10 $20 Emerency care Covered services are provided in and out of the service area $75 $100 $50 3 $65 3 Ambulance Medically necessary transport in a licensed ambulance 20% 20% 20% 20% Hospitalization Inpatient services $100 per admission Prescription drus 1 Generic drus Brand-name drus 10% room and board/$0 for other hospital services Picked up from a Plan pharmacy $15 (up to 30-day supply) $20 (up to 30-day supply) Delivered by our mail-order service $30 (up to 90-day supply) $40 (up to 90-day supply) $0 $75 per day No more than $10 (up to 30-day supply) No more than $20 (up to 90-day supply) No more than $10 (up to 30-day supply) No more than $20 (up to 90-day supply) Picked up from a Plan pharmacy $15 (up to 30-day supply) $20 (up to 30-day supply) $15 (up to 30-day supply) $20 (up to 30-day supply) Delivered by our mail-order service $30 (up to 90-day supply) $40 (up to 90-day supply) $30 (up to 90-day supply) $40 (up to 90-day supply) Eyewear Not covered Not covered $100 allowance every 12 months toward eyelasses and contact lenses 2 $100 allowance every 12 months toward eyelasses and contact lenses 2 Chiropractic/Acupuncture Up to 20 combined visits per calendar year $20 per visit $30 per visit $20 per visit $30 per visit Dental services Coverae throuh Hawaii Dental Service (one oral exam and cleanin per year) Oral exam $0 Cleanin 20% Oral exam $0 Cleanin 20% Oral exam $0 Cleanin 20% Oral exam $0 Cleanin 20% This is a summary of the features of the Kaiser Permanente health plan, includin Kaiser Permanente Senior Advantae for Federal Members. Before makin a final decision, please read the Plan s Federal brochure (RI 73-005) and the Kaiser Permanente Senior Advantae for Federal Members Evidence of Coverae (EOC). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure and the Kaiser Permanente Senior Advantae for Federal Members EOC. 10 1 If you request a brand-name dru in place of a eneric dru prescribed by your doctor, you may be required to pay full chares. 2 These benefits are neither offered nor uaranteed under contract with the FEHB Proram, but are made available to all enrollees and family members who become members of Kaiser Permanente. 3 The emerency copay is waived if you re admitted to the hospital and the hospitalization copay will apply. 11
How to enroll Becomin a member is easy. Just follow the three simple steps below. The information in this brochure can help you pick the riht plan, and you may be able to enroll online or by phone. 1. Choose the option that meets your needs Brief descriptions of your plan options (Hih and Standard) are on pae 6. If you re eliible for Medicare, or will be soon, take a look at additional details on pae 7. 2. Select the type of coverae you want If you need coverae only for yourself, choose Self Only. If you want coverae for yourself and a spouse, child, or other dependents, choose Self and Family. Then note the enrollment code for your choice. 3. Enroll in Kaiser Permanente Employees and annuitants of participatin aencies may be able to enroll online. Visit opm. ov/insure/health/enrollment or contact your personnel office for information. Annuitants may call the Retirement Information Center at 1-888-767-6738 or 855-887-4957 (TTY for the hearin/speech impaired). 1 Your rates for 2013 2 Non-Postal Premium Postal Premium Biweekly Share Monthly Share Biweekly Share Hih Option Standard Option Enrollment Code Gov t You Gov t You Cateory 1 Your Share Cateory 2 Your Share Self Only 631 $187.63 $62.54 $406.53 $135.51 $41.28 $46.91 Self + Family 632 $418.43 $139.48 $906.61 $302.20 $92.06 $104.61 Self Only 634 $96.38 $32.12 $208.82 $69.60 $21.20 $24.09 Self + Family 635 $214.92 $71.64 $465.66 $155.22 $47.28 $53.73 1 To sin up, fill out a Health Benefits Reistration Form (Standard Form 2809) from your personnel office indicatin the enrollment you want. The enrollment codes for Kaiser Permanente Health Plan are: Hih Option Self Only: 631, Hih Option Self and Family: 632, Standard Option Self Only: 634, and Standard Option Self and Family: 635. The form must then be returned to your personnel office before the December 10, 2012, deadline. Your Kaiser Permanente coverae will bein the first pay period in January 2013. If you are a retired Federal employee and need forms, contact the Office of Personnel Manaement at P.O. Box 45, Boyers, PA 16017. You can also email retire@opm.ov or visit the website at opm.ov/retire. 2 These rates do not apply to all enrollees. If you are in a special enrollment cateory, please refer to your special FEHB Guide or contact the aency that maintains your health benefits enrollment. 12
Our locations With medical offices and hospitals close to where you live, we re makin Hawaii a healthier place to be. To find a location near you, visit kp.or/doctorsandlocations or download our free KP app for your smartphone or mobile device. Then just use our location finder to search by ZIP code or keyword. Maps not to scale Medical centers (hospital and medical offices) Medical offices Other facilities 13
Kaiser Foundation Health Plan, Inc. 711 Kapiolani Blvd., Suite 400 Honolulu, HI 96813 A website just for you At kp.or/feds you ll find your Kaiser Permanente 2013 enrollment materials, includin the Federal Employees Health Benefits brochure (RI 73-005). You can also connect to our facility and physician directories and learn more about our services. Notice of Summary of Benefits and Coverae (SBC): Availability of Summary Health Information The Federal Employees Health Benefits (FEHB) Proram offers numerous health benefits plans and coverae options. Choosin a health plan and coverae option is an important decision. To help you make an informed choice, each FEHB plan makes available a Summary of Benefits and Coverae (SBC) about each of its health coverae options, online and in paper. The SBC summarizes important information in a standard format to help you compare plans and options. This plan s SBC is available on the Internet at kp.or/feds. A paper copy is also available, free of chare, by callin 808-432-5955 (Oahu) or 1-800-966-5955 (Neihbor Islands, a toll-free number). For more information about plans available under the FEHB Proram, includin SBCs for other FEHB plans, please visit opm.ov/insure. kp.or/feds Please recycle. This material was produced from eco-responsible resources. Member and Marketin Communications 83298 October 2012 KAH1251
About me... I am a current Kaiser Permanente member. I have been a Kaiser Permanente member in the past. I have never been a Kaiser Permanente member. Name Address City State ZIP Code Fold here and seal Please send me... I d like to receive the followin materials by mail: FEHB brochure (RI 73-005) Kaiser Permanente Senior Advantae for Federal Members Evidence of Coverae Medical facility directory Summary of Benefits and Coverae (SBC)
Want to know more? Use this reply card to et more information about the Kaiser Permanente health coverae available throuh the Federal Employees Health Benefits Proram. Fill out your information and choose the materials you d like to receive. Tear off the card and fold it with your information inside. Seal the card and drop it in the mail. Postae is free.