WASHINGTON MEDICAL PLANS 2018 FOR SMALL EMPLOYERS...*May be subject to cost share for members on...

229800614_SBG_04-18

All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest. 500 NE Multnomah St., Suite 100, Portland, OR 97232.

For Washington (Clark and Cowlitz counties) groups with 1 to 50 employeesCoverage effective on or after January 1, 2018

WASHINGTON

2018Kaiser PermanenteMEDICAL PLANSFOR SMALL EMPLOYERS

2

At Kaiser Permanente, we’re a little different from other carriers. We offer a fully integrated health care delivery system with providers, hospitals, pharmacies, and labs working together to provide better health care for our members. With access to value-added wellness services, care management programs, a 24-hour advice nurse line, and convenient online tools at kp.org, we help make it easier for members to play an active role in their health care.

A healthy workforce can mean higher productivity, less absenteeism, and fewer accidents in the workplace. And that translates into savings, no matter which plan you choose.

When you partner with Kaiser Permanente, you’re not only teaming up with an industry leader — you’re investing in top-quality care for your employees without losing sight of your bottom line. Our integrated model produces results you can measure. And industry analysts, third-party quality organizations, and the media consistently recognize us for it.

VARIETY OF PLAN OPTIONS

We offer a broad range of health care products to meet the needs of your small business:

• Traditional copay plans

• Deductible plans

• Point-of-service plans, including a preferred provider organization (PPO)

• Plans qualified for health savings accounts (HSAs)

• Bundled plans — you choose the plan options; your employees select the plan best suited to their needs

• Dental plans — if you’d like information about our dental plans, contact your Small Business Group representative or visit kp.org/dental/nw

A WELL-BALANCED TOTAL SOLUTION FOR SMALL EMPLOYERS WITH 1 TO 50 EMPLOYEES

3

Value-added services . . . . . . . . . . . . . . . . . . . . . . . . . 4

Convenient care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Where to find care . . . . . . . . . . . . . . . . . . . . . . . . . . 6–7

Plan overviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

The right plan for your business . . . . . . . . . . . . . . . . . 9

Plan highlights for bundled plan options . . . . . . . . . 10

Plan highlights for traditional copay plans . . . . . . . . 11

Plan highlights for deductible plans . . . . . . . . . . . . . 13

Plan highlights for HSA-qualified high

deductible health plans . . . . . . . . . . . . . . . . . . . . . . . 16

Kaiser Permanente consumer-directed plans . . . .18–19

IMPORTANT INFORMATIONThis brochure provides summaries for various plans and is not a contract. These plans are subject to exclusions and limitations. Plan details, including all benefits, exclusions, and limitations, are provided in the Evidence of Coverage (EOC).

To obtain an EOC for a particular plan, call Member Services at 1-800-813-2000. For TTY, call 711. For language interpretation services, call 1-800-324-8010.

Contact your sales executive or account manager for written coverage information including:

• Factors that affect rate setting and rate adjustments

• Provisions related to renewing coverage

• Premiums available to small groups

• Geographic areas covered

• Underwriting guidelines

Plan highlights for Added Choice®

point-of-service plans . . . . . . . . . . . . . . . . . . . . . 20–22

Plan highlights for Senior Advantage plan . . . . . . . . 26

Plan highlights for prescription drugs,

alternative care, vision, and dental . . . . . . . . . . . . . . 28

TABLE OF CONTENTS

4

FOR EMPLOYERS:From convenient online tools to occupational health and safety support, Kaiser Permanente offers the resources to effectively help manage your group’s health.

ACCOUNT.KP.ORG — YOUR ONE-STOP, SELF-SERVICE RESOURCEVisit account.kp.org to access account services and find:

• The latest information on health coverage

• Downloadable forms

• Tools for total health

• Medical directories

• Answers to employee questions

OCCUPATIONAL HEALTH AND SAFETYHelp improve the health and productivity of your workforce and bottom line with the Kaiser Permanente occupational health program. With Kaiser On-the-Job® you and your employees have access to specialized occupational health and safety services, including:

• Specialized care for treatment of work-related injuries

• Assistance with workers’ compensation paperwork

• Easy referrals to physical therapy, radiology, and specialty care

• OSHA-mandated medical exams

• Department of Transportation physicals

• Drug and alcohol testing

• Immunizations

• On-site lab testing and pharmacy

• Telehealth services

Kaiser On-the-Job is available to your entire workforce, even those without coverage under our health plans, so all your employees can benefit from the quality of our care. Because there are 7 Kaiser On-the-Job locations in Oregon and Southwest Washington, employees can conveniently access the services they need. Visit kp.org/occupationalhealth/nw for more information.

VALUE-ADDED SERVICES

FOR MEMBERS:At Kaiser Permanente, your employees can enjoy our online tools and discounts that will help keep them happy and healthy.

CHP ACTIVE AND HEALTHYchpactiveandhealthy.com

Your employees have access to a complementary and alternative medicine benefit. CHP Active and Healthy gives members discounts on:

• Alternative care (chiropractic, acupuncture, massage, and naturopath services)

• Health club memberships

• Sporting events

• Ski and snowboard tickets

• Theme park tickets

• Movie tickets

• And more

ONLINE ACCESS ANYTIME, ANYWHEREThrough kp.org, members have access to information and tools to better manage their health. Members can use it 24 hours a day, 7 days a week, to:

• View their Personal Action Plan

• Email their doctor’s office with nonurgent questions

• Schedule, cancel, or review routine appointments

• View most lab test results

• Refill prescriptions

• View recent immunizations, allergies, and more

To start using these features, go to kp.org/register. Always on the go? Download the Kaiser Permanente mobile app to stay connected anytime, anywhere.

TOTAL HEALTH ASSESSMENTkp.org/tha

The Total Health Assessment is an online tool to help members learn more about how their lifestyle behavior interacts with their health. Members take a simple online survey about their stress levels, physical activity, and eating habits to get a customized action plan based on their answers. It connects members to online programs tailored to their lifestyles.

5

MEETING MEMBERS WHEN AND WHERE THEY NEED CARE

Kaiser Permanente offers members options for how they connect with our exceptional providers. Both on-demand and scheduled care is available, allowing your workforce to thrive with better outcomes, all while saving them — and your business — time and money.

Online and mobileMembers can manage their care on kp.org or use the Kaiser Permanente mobile app to schedule routine appointments, refill most prescriptions, and more — even on the go.

Skip the trip with virtual careEmail, phone, and video visits allow members to save time and get the care they need, from wherever they want it.*

Care around the clock — wherever you areNurses are available 24/7 for consultation and appointment scheduling, with direct access to physician consultation when needed. Plus, with Kaiser Permanente’s Away from Home Travel Line, members can receive around-the-clock support even when traveling.

Convenient locationsWith 34 medical offices, 20 dental clinics, and access to all The Portland Clinic locations, we’re close by. Plus, with new locations in the Pearl District and Beaverton, we’re expanding access to meet member demand. At many clinics, members can access their doctor and lab, X-ray, pharmacy, and even dental services — often all in one convenient location.

Urgent and emergency careUrgent care is available with in-person and online appointments for treatment of minor injuries and illnesses. Emergency care is available for life-threatening medical or psychiatric conditions.

Cost estimatorMembers can access a cost estimator to see how much treatments, procedures, tests, or other medical services could cost.

New member onboardingNew members receive dedicated support to transfer their health records and prescriptions, make appointments, and register on kp.org.

Want to learn more? Visit kp.org/choosebetter.

CONVENIENT CARE

*May be subject to cost share for members on HSA-qualified high deductible health plans (HDHP).

MEDICAL FACILITIESPortland-area medical centers1 Kaiser Permanente Sunnyside

Medical Center 10180 SE Sunnyside Road Clackamas, OR 97015

2 Kaiser Permanente Westside Medical Center 2875 NE Stucki Ave. Hillsboro, OR 97124

3 OHSU Doernbecher Children’s Hospital 3181 SW Sam Jackson Park Road Portland, OR 97239 (For children 17 and younger)

Portland-area medical offices4 Beaverton Medical Office

4855 SW Western Ave. Beaverton, OR 97005

5 Brookside Center 10180 SE Sunnyside Road Clackamas, OR 97015

6 Care Essentials by Kaiser Permanente 1035 NW Northrup St. Portland, OR 97209

7 Cedar Hills Medical Office 12450 SW Walker Rd. Beaverton, OR 97005

8 Center for Health Research 3800 N. Interstate Ave. Portland, OR 97227

9 Clackamas Eye Care 12100 SE Stevens Court, Suite 106 Portland, OR 97086

10 Gateway Medical Office 1700 NE 102nd Ave. Portland, OR 97220

11 Hillsboro Medical Office 5373 E. Main St. Hillsboro, OR 97123

12 Interstate Medical Office Central 3600 N. Interstate Ave. Portland, OR 97227

13 Interstate Medical Office East 3550 N. Interstate Ave. Portland, OR 97227

14 Interstate Medical Office South 3500 N. Interstate Ave. Portland, OR 97227

15 Interstate Medical Office West 3325 N. Interstate Ave. Portland, OR 97227

16 Interstate Radiation Oncology Center 3620 N. Interstate Ave. Portland, OR 97227

17 Lake Road Nephrology Center 6902 SE Lake Road, Suite 100 Milwaukie, OR 97267

18 Mt. Scott Medical Office 9800 SE Sunnyside Road Clackamas, OR 97015

Polk

Washington

Columbia

Yamhill

Clark

Cowlitz

5

30

5

20526

Salem

Vancouver

Longview

Portland

N

84

Multnomah

Clackamas

217

5

5

205

205

84

26

Hillsboro

Tigard

Portland

Milwaukie

Tualatin

Beaverton

Oregon City

66

65

64

63

62

61

60

59

58

57

55

54

53

5251

49

48

45

43

42

4139

38

37

36

35

34

33

32

3130

29

2827

26

25

2423

22

2120

191817

16

15141312

11

10

9

8

5

4

32

1

40

6746

47

6

50

44

7

56

Vancouver

Please note: Facility locations are approximate. Facility location numbers on this map correspond with our larger location map for Kaiser Permanente Northwest.

Lane

Facility information is current as of July 2017. For up-to-date information, please visit kp.org/facilities.

WHERE TO FIND CARE

Facility information is current as of August 2017. For up-to-date information, please visit kp.org/facilities.

MEDICAL FACILITIESPortland-area medical centers1 Kaiser Permanente Sunnyside

Medical Center 10180 SE Sunnyside Road Clackamas, OR 97015

2 Kaiser Permanente Westside Medical Center 2875 NE Stucki Ave. Hillsboro, OR 97124

3 OHSU Doernbecher Children’s Hospital 3181 SW Sam Jackson Park Road Portland, OR 97239 (For children 17 and younger)

Portland-area medical offices4 Beaverton Medical Office

4855 SW Western Ave. Beaverton, OR 97005

5 Brookside Center 10180 SE Sunnyside Road Clackamas, OR 97015

6 Care Essentials by Kaiser Permanente 1035 NW Northrup St. Portland, OR 97209

7 Cedar Hills Medical Office 12450 SW Walker Rd. Beaverton, OR 97005

8 Center for Health Research 3800 N. Interstate Ave. Portland, OR 97227

9 Clackamas Eye Care 12100 SE Stevens Court, Suite 106 Portland, OR 97086

10 Gateway Medical Office 1700 NE 102nd Ave. Portland, OR 97220

11 Hillsboro Medical Office 5373 E. Main St. Hillsboro, OR 97123

12 Interstate Medical Office Central 3600 N. Interstate Ave. Portland, OR 97227

13 Interstate Medical Office East 3550 N. Interstate Ave. Portland, OR 97227

14 Interstate Medical Office South 3500 N. Interstate Ave. Portland, OR 97227

15 Interstate Medical Office West 3325 N. Interstate Ave. Portland, OR 97227

16 Interstate Radiation Oncology Center 3620 N. Interstate Ave. Portland, OR 97227

17 Lake Road Nephrology Center 6902 SE Lake Road, Suite 100 Milwaukie, OR 97267

18 Mt. Scott Medical Office 9800 SE Sunnyside Road Clackamas, OR 97015

Polk

Washington

Columbia

Yamhill

Clark

Cowlitz

5

30

5

20526

Salem

Vancouver

Longview

Portland

N

84

Multnomah

Clackamas

217

5

5

205

205

84

26

Hillsboro

Tigard

Portland

Milwaukie

Tualatin

Beaverton

Oregon City

66

65

64

63

62

61

60

59

58

57

55

54

53

5251

49

48

45

43

42

4139

38

37

36

35

34

33

32

3130

29

2827

26

25

2423

22

2120

191817

16

15141312

11

10

9

8

5

4

32

1

40

6746

47

6

50

44

7

56

Vancouver

Please note: Facility locations are approximate. Facility location numbers on this map correspond with our larger location map for Kaiser Permanente Northwest.

Lane

Facility information is current as of July 2017. For up-to-date information, please visit kp.org/facilities.

THE PORTLAND CLINIC — AVAILABLE THROUGH KAISER PERMANENTEKaiser Permanente health plans include access to primary care and specialty care at The Portland Clinic. Members who access The Portland Clinic will find the same high-quality care they have come to expect from Kaiser Permanente and will have access to an additional 6 locations. Visit kp.org/theportlandclinic for more information.

19 Mt. Talbert Medical Office 10100 SE Sunnyside Road Clackamas, OR 97015

20 Murrayhill Medical Office 11200 SW Murray Scholls Place, Suite 100 Beaverton, OR 97007

21 One Town Center 10163 SE Sunnyside Road, Suite 490 Clackamas, OR 97015

22 Rockwood Medical Office 19500 SE Stark St. Portland, OR 97233

23 Sunnybrook Medical Office 9900 SE Sunnyside Road Clackamas, OR 97015

24 Sunnyside Medical Office 10180 SE Sunnyside Road Clackamas, OR 97015

25 Sunset Medical Office 19400 NW Evergreen Parkway Hillsboro, OR 97124

26 Tualatin Medical Office 19185 SW 90th Ave. Tualatin, OR 97062

27 Westside Medical Office 2875 NE Stucki Ave. Hillsboro, OR 97124 (located inside Kaiser Permanente Westside Medical Center)

The Portland Clinic facilities*

28 The Portland Clinic — Beaverton 15950 SW Millikan Way Beaverton, OR 97003

29 The Portland Clinic — Columbia 5847 NE 122nd Ave. Portland, OR 97230

30 The Portland Clinic — Downtown 800 SW 13th Ave. Portland, OR 97205

31 The Portland Clinic — East 541 NE 20th Ave., Suite 210 Portland, OR 97232

32 The Portland Clinic — South 6640 SW Redwood Lane Portland, OR 97224

33 The Portland Clinic — Tigard 9250 SW Hall Blvd. Tigard, OR 97223

Vancouver-area medical center and offices34 Legacy Salmon Creek Medical Center

2211 NE 139th St. Vancouver, WA 98686 (24-hour, emergency, low-risk childbirth, and selected services only)

35 Cascade Park Medical Office 12607 SE Mill Plain Blvd. Vancouver, WA 98684

36 Mill Plain One Medical Office 203 SE Park Plaza Drive, Suite 140 Vancouver, WA 98684

37 Orchards Medical Office 7101 NE 137th Ave. Vancouver, WA 98682

38 Salmon Creek Medical Office 14406 NE 20th Ave. Vancouver, WA 98686

Salem-area medical center and offices39 Salem Hospital

890 Oak St. SE Salem, OR 97301

40 Keizer Station Medical Office 5940 Ulali Drive Keizer, OR 97303

41 North Lancaster Medical Office 2400 Lancaster Drive NE Salem, OR 97305

42 Skyline Medical Office 5125 Skyline Road S. Salem, OR 97306

43 West Salem Medical Office 1160 Wallace Road NW Salem, OR 97304

Longview-area medical center and office44 PeaceHealth St. John Medical Center

1614 E. Kessler Blvd. Longview, WA 98632

45 Longview-Kelso Medical Office 1230 Seventh Ave. Longview, WA 98632

Eugene-Springfield-area medical office

46 Downtown Eugene Medical Office 100 W. 13th Ave. Eugene, OR 97401

Battle Ground-area medical office

47 Battle Ground Medical Office 720 W. Main St., Suite 15 Battle Ground, WA 98604

DENTAL FACILITIESPortland-area dental offices48 Aloha Dental Office

17675 SW Tualatin Valley Hwy. Beaverton, OR 97003

49 Beaverton Dental Office 4855 SW Western Ave. Beaverton, OR 97005

50 Cedar Hills Dental Office 12450 SW Walker Rd. Beaverton, OR 97005

51 Clackamas Dental Office 10209 SE Sunnyside Road Clackamas, OR 97015

52 Eastmoreland Dental Office 5025 SE 28th Ave. Portland, OR 97202

53 Glisan Dental Office 10102 NE Glisan St. Portland, OR 97220

54 Grand Avenue Dental Office 1314 NE Grand Ave. Portland, OR 97232

55 Gresham Dental Office 360 NW Burnside St. Gresham, OR 97030

56 Kaiser Permanente Dental at Johnson Creek 9300 SE 91st Ave., Ste. 310 Happy Valley, OR 97086

57 North Interstate Dental Office 7201 N. Interstate Ave. Portland, OR 97217

58 Oregon City Dental Office 1900 McLoughlin Blvd., Suite 68 Oregon City, OR 97045

59 Rockwood Dental Office 822 NE 181st Ave. Portland, OR 97230

60 Tannasbourne Medical and Dental Office 19075 NW Tanasbourne Drive Hillsboro, OR 97124

61 Tigard Dental Office 7105 SW Hampton St. Tigard, OR 97223

Vancouver-area dental offices62 Cascade Park Dental Office

12711 SE Mill Plain Blvd. Vancouver, WA 98684

63 Salmon Creek Dental Office 14406 NE 20th Ave. Vancouver, WA 98686

Salem-area dental offices64 North Lancaster Dental Office

2300 Lancaster Drive NE Salem, OR 97305

65 Skyline Dental Office 5135 Skyline Road S. Salem, OR 97306

Longview-area dental office66 Longview-Kelso Dental Office

1230 Seventh Ave. Longview, WA 98632

Eugene-Springfield-area dental office67 Valley River Dental Office

1011 Valley River Way Eugene, OR 97401

*Available to all Kaiser Permanente members except those on Medicaid, receiving full financial assistance, or visiting from another Kaiser Permanente region.

*Available to all Kaiser Permanente members except those on Medicaid, receiving full financial assistance, or visiting from another Kaiser Permanente region.

8

TRADITIONAL COPAY PLAN

Predictable copays and out-of-pocket maximums make it easier for employees to manage their health care spending and give them financial peace of mind. You’ll appreciate the variety of copay options.

DEDUCTIBLE PLANS

You’ll get more options at an affordable cost. With the addition of an employee deductible and out-of-pocket cost, monthly payments are lower than for traditional copay plans. You’ll be able to reduce premiums while still maintaining quality care and access to our doctors for your employees.

HSA-QUALIFIED HIGH DEDUCTIBLE PLANS

Offer lower premiums than other plan types, plus tax savings.1 With our HSA-qualified high deductible plans and deductible plans with health reimbursement arrangement (HRA), your employees will have more control over their health care dollars, helpful online decision-support tools, and the same high-value access to services as members of our traditional plans.

ADDED CHOICE® POS PLANS

An Added Choice plan gives your employees the opportunity to keep their current doctor or have the flexibility to choose providers and services from an external provider network. With an Added Choice plan, members benefit from being able to access care from any licensed provider for covered services.

KAISER PERMANENTE SENIOR ADVANTAGE PLAN

Provides your retirees over 65 with the benefits of Medicare Advantage and Kaiser Permanente’s award-winning care.2

DENTAL PLANSChoose from our cost-effective Traditional HMO dental plans or flexible Dental Choice PPO plans. We have a range of options with comprehensive coverage to meet the unique needs of your employees.

Please contact your Kaiser Permanente representative for help building your health care strategy.

1 The tax references relate to federal income tax only. Consult with your financial or tax advisor for information about state income tax laws. 2 Kaiser Foundation Health Plan of the Northwest’s Medicare and commercial health plans are the highest rated plans among health plans in Oregon and Washington, according to NCQA’s Medicare Health Insurance Plan Ratings for 2015–2016 and NCQA’s Private Health Insurance Plan Ratings for 2015–2016.

PLAN OVERVIEWS

All our plans give your employees what they need to help them be healthier and more productive every day — prevention, health promotion, and care for ongoing health conditions. You have lots of choices, from traditional copay plans to consumer-directed options, from out-of-area coverage to dental coverage. Here’s a quick overview of what we offer. For plan specifics, contact your Kaiser Permanente representative.

9

THE RIGHT PLAN FOR YOUR BUSINESS

You have the ability to customize a medical plan with vision and/or alternative care benefit options, based on your company’s needs and budget. Follow the 3 easy steps to choose a health plan that’s right for your business.

STEP 1:

CHOOSE YOUR MEDICAL PLAN OR PLANS

Traditional plans• KP WA Platinum 0/20 (2018)

• KP WA Gold 0/30 (2018)

Deductible plans• KP WA Platinum 250/20 (2018)

• KP WA Gold 500/20 (2018)

• KP WA Gold 1000/20 (2018)

• KP WA Gold 1500/35 (2018)

• KP WA Silver 2000/40 (2018)

• KP WA Silver 3500/40 (2018)

• KP WA Bronze 5000/50 (2018)

• KP WA Bronze 6600/40 (2018)

HSA-qualified high deductible health plans• KP WA Silver 2700/25% HSA (2018)

• KP WA Bronze 5200/20 HSA (2018)

Added Choice deductible plans• KP WA Platinum 250/10 3T POS (2018)

• KP WA Gold 600/35 3T POS (2018)

• KP WA Gold 1000/35 3T POS (2018)

• KP WA Silver 2500/40 3T POS (2018)

STEP 2:

CHOOSE YOUR OPTIONAL BUY-UP COVERAGE

All our medical plans can be paired with the following buy-up option:

Adult vision hardware and exam: $200 benefit allowance every 2-year period and primary care office visit cost share applies for exam.

STEP 3:

APPLY OR RENEW YOUR COVERAGE

New groups: Complete the Washington Small Business employer application and submit it to a Kaiser Permanente sales executive by the 20th of the month prior to the effective date.

Renewing groups: We will provide you with coverage options that best match the plan or plans your business offers today, but you can choose from any of our other plans available to small employers if you prefer. Please complete and submit the Renewal Decision Form to your Kaiser Permanente account manager no later than the 15th of the month prior to the anniversary date.

10

SOLUTIONS FOR EMPLOYERS AND CHOICE FOR EMPLOYEES

You’re looking for more plan options, more services, and more doctor choices for your employees, but without the added complexity that usually comes with more plans. With us, you can get all of this — and choose your contribution level.

Select 2 or 3 medical plans to offer your employees. There is a limit of one traditional plan per bundle and one point-of-service plan per bundle. As an employer, your contribution for each plan will be the same. It must be at least 50% — but not more than 100% — of the lowest-cost plan.

Then each of your employees can choose the plan in the bundle that best meets his or her needs. If employees select a higher-cost plan, they will pay the difference. To help your employees choose the right plan, we will provide you with enrollment packages customized for the bundle you’ve chosen. The package will explain the differences among all the plans so your employees can choose the features that are most important to them.

Buy-up option Any of the above medical plans can be paired with the adult vision hardware and exam buy-up option. This includes a $200 benefit allowance every 2-year period (primary care office visit cost share applies for exam).

PLAN OPTIONS

METAL TIER Deductible Traditional HDHP POS

PLATINUM KP WA PLATINUM 250/20 (2018)

KP WA PLATINUM 0/20 (2018)

KP WA PLATINUM 250/10 3T POS (2018)

GOLD KP WA GOLD 500/20 (2018)

KP WA GOLD 1000/20 (2018)

KP WA GOLD 1500/35 (2018)

KP WA GOLD 0/30 (2018) KP WA GOLD 600/35 3T POS (2018)

KP WA GOLD 1000/35 3T POS (2018)

SILVER KP WA SILVER 2000/40 (2018)

KP WA SILVER 3500/40 (2018)

KP WA SILVER 2700/25% HSA (2018)

KP WA SILVER 2500/40 3T POS (2018)

BRONZE KP WA BRONZE 5000/50 (2018)

KP WA BRONZE 6600/40 (2018)

KP WA BRONZE 5200/20 HSA (2018)

PLAN HIGHLIGHTS FOR BUNDLED PLAN OPTIONS

11

ENJOY WIDE ACCESS TO OUR UNIQUE INTEGRATED HEALTH CARE SYSTEM

As a small employer, you know that when employees miss work, it can mean lost profits and business opportunities. What would it mean to you if employees could get most of their care during one appointment without running all over town for specialty appointments, labs, and X-ray services?

Your employees can choose a medical office close to home or work where they will find a full range of health care services in one convenient location. And because almost everything is under one roof, care can be efficiently coordinated among physicians, specialists, lab personnel, pharmacists, and other medical staff.

PLAN HIGHLIGHTS FOR TRADITIONAL COPAY PLANS

12

PLAN NAME KP WA PLATINUM 0/20 (2018) KP WA GOLD 0/30 (2018)

ANNUAL OUT-OF-POCKET MAXIMUM $3,000 per individual; $6,000 per family

$5,250 per individual; $10,500 per family

BENEFITS MEMBER PAYSOFFICE VISITS Preventive care $0 $0

Primary care $20 $30

Urgent care $40 $50

Specialty care $30 $40

Prenatal care $0 $0

Allergy shots and other injections $10 $10

Routine immunizations for children $0 $0 OUTPATIENT THERAPIES1 Physical, occupational, and speech $30 $40

Outpatient surgery $100 35%

Lab $20 $30

X-ray/diagnostic test $20 $30

CT, MRI, AND PET SCANS $75 $300

INPATIENT HOSPITAL CARE $300/day, $1,500 per admit $500/day, $2,500 per admit

EMERGENCY DEPARTMENT VISIT $150 $300

AMBULANCE SERVICES $150 $200

MENTAL HEALTH SERVICES Inpatient psychiatric care

$300 $500

Residential treatment $300 $500

Outpatient/day treatment $20 $30

CHEMICAL DEPENDENCY SERVICES Inpatient care $300 $500

Residential treatment $300 $500

Outpatient/day treatment $20 $30

DURABLE MEDICAL EQUIPMENT 20% 35%

INFERTILITY SERVICES (diagnosis) 50% 50%

DEPENDENT OUT-OF-AREA 20% coinsurance for up to 5 office visits, 5 X-rays, and 5 prescription fills

20% coinsurance for up to 5 office visits, 5 X-rays, and 5 prescription fills

PHYSICIAN-REFERRED ALTERNATIVE CARE2 $30 $40

OUTPATIENT PRESCRIPTION DRUGS$5 generic; $15 preferred brand;

$50 non-preferred brand; 50% specialty$15 generic; $30 preferred brand;

$60 non-preferred brand; 50% specialty

VISION HARDWARE PEDIATRICNo charge for 1 pair standard frames w/lenses

or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or

for medically necessary contact lenses

No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year;

no charge for low vision aid from selected list or for medically necessary contact lenses

OUTPATIENT ADMINISTERED MEDICATIONS 20% 20%

MATERNITY CARE Inpatient $300/day, $1,500 per admit $500/day, $2,500 per admit

1Rehabilitative, habilitative services, and neurodevelopmental therapy have separate limits of 25 visits each per calendar year.2Referred chiropractic/naturopathic/acupuncture based upon medical criteria.

TRADITIONAL COPAY PLANS

13

WHEN THE DEDUCTIBLE APPLIES

The member will be charged the full costs of these services, until they reach their deductible.

• Ambulance services

• Chemical dependency care (inpatient/residential)

• Durable medical equipment (outpatient)

• Emergency services

• Home health services

• Inpatient hospitalization

• Mental health services (inpatient/residential)

• Outpatient or same-day surgery

• Skilled nursing facility services

WHEN THE DEDUCTIBLE DOES NOT APPLY

The member will be charged the copay or coinsurance for these services, regardless of whether they have met their deductible.

• Office visits for primary, preventive, and prenatal and postpartum care and for routine eye exams

• Hospice*

• Immunizations

• Prescription drugs*

OUT-OF-POCKET MAXIMUM ON DEDUCTIBLE PLANS• Amounts paid toward the deductible count toward the out-of-pocket maximum.

• All copays and coinsurance apply to the out-of- pocket maximum.

• After meeting the out-of-pocket maximum, no further costs apply for the remainder of the calendar year.

*Some plans are different. Please check your benefit summary for details.

Visit kp .org/deductibleplans for more details.

Our deductible plans offer various copays, coinsurance levels, deductibles, and out-of-pocket maximums to help you reduce your premiums. Just like our traditional copay plans, our deductible plans give your employees access to our broad range of primary care, specialty care, and hospital services. Many preventive services are covered in full without the need to satisfy a deductible. Because all the plans have an out-of-pocket maximum, employees know both their health and financial security are being protected.

PLAN HIGHLIGHTS FOR DEDUCTIBLE PLANS

14

PLAN NAMEKP WA PLATINUM

250/20 (2018)KP WA GOLD 500/20

(2018)KP WA GOLD 1000/20

(2018)KP WA GOLD 1500/35

(2018)ANNUAL DEDUCTIBLE Accumulates to annual out-of-pocket maximum

$250 per individual; $500 per family

$500 per individual; $1,000 per family



Drug deductible $0 $0 $0 $0

ANNUAL OUT-OF-POCKET MAXIMUM$2,000 per individual;

$4,000 per family$5,850 per individual;



$12,000 per family

BENEFITS MEMBER PAYS

OFFICE VISITS Preventive care $0 $0 $0 $0

Primary care $20 $20 $20 $35

Urgent care $40 $40 $40 $55

Specialty care $30 $30 $30 $45

Prenatal care $0 $0 $0 $0

Allergy shots and other injections $10 $10 $10 $10

Routine immunizations for children $0 $0 $0 $0 OUTPATIENT THERAPIES1 Physical, occupational, and speech $30 $30 $30 $45

Outpatient surgery 10%t 20%t 20%t 20%t

Lab $10 $20 $20 $40

X-ray/diagnostic test $10 $20 $20 $40

CT, MRI, AND PET SCANS $75 $300 $300 $300

INPATIENT HOSPITAL CARE 10%t 20%t 20%t 20%t

EMERGENCY DEPARTMENT VISIT 10%t 20%t 20%t 20%t

AMBULANCE SERVICES 10%t 20%t 20%t 20%t

MENTAL HEALTH SERVICES Inpatient psychiatric care 10%t 20%t 20%t 20%t

Residential treatment 10%t 20%t 20%t 20%t

Outpatient/day treatment $20 $20 $20 $35 CHEMICAL DEPENDENCY SERVICES Inpatient care 10%t 20%t 20%t 20%t


Outpatient/day treatment $20 $20 $20 $35 DURABLE MEDICAL EQUIPMENT 10%t 20%t 20%t 20%t

INFERTILITY SERVICES (diagnosis) 50% 50% 50% 50%

DEPENDENT OUT-OF-AREA20% coinsurance for up to 5 office visits, 5 X-rays, and 5

prescription fills

20% coinsurance for up to 5 office visits, 5 X-rays, and 5

prescription fills


prescription fills


prescription fills

PHYSICIAN-REFERRED ALTERNATIVE CARE2 $30 $30 $30 $45

OUTPATIENT PRESCRIPTION DRUGS $5 generic; $15 preferred brand; $50 non-preferred

brand; 50% specialty

$15 generic; $30 preferred brand; $60 non-preferred






VISION HARDWARE PEDIATRIC No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per

calendar year; no charge for low vision aid from selected

list or for medically necessary contact lenses

No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per









OUTPATIENT ADMINISTERED MEDICATIONS 10%t 20%t 20%t 20%t

MATERNITY CARE Inpatient 10%t 20%t 20%t 20%t

tSubject to deductible.1Rehabilitative, habilitative services, and neurodevelopmental therapy have separate limits of 25 visits each per calendar year.2Referred chiropractic/naturopathic/acupuncture based upon medical criteria.

DEDUCTIBLE PLANS

PLAN NAMEKP WA SILVER 2000/40

(2018)KP WA SILVER 3500/40

(2018)KP WA BRONZE 5000/50 (2018)

KP WA BRONZE 6600/40 (2018)

ANNUAL DEDUCTIBLE Accumulates to annual out-of-pocket maximum





Drug deductible $0 $0 $700 $400

ANNUAL OUT-OF-POCKET MAXIMUM$7,350 per individual;




$14,300 per family


OFFICE VISITS Preventive care $0 $0 $0 $0

Primary care $40 $40 $50

First 3 visits per year at $40 not subject to the

deductible, remaining visits at 50% coinsurance

after deductible

Urgent care $50 $70 30%t $100t

Specialty care $50 $50 $60t 50%t

Prenatal care $0 $0 $0 $0

Allergy shots and other injections $10 $10 $10 $10

Routine immunizations for children $0 $0 $0 $0 OUTPATIENT THERAPIES1 Physical, occupational, and speech $50 $50 $60t 50%t

Outpatient surgery 30%t 30%t 30%t 50%t

Lab $40 $40 30%t 50%t

X-ray/diagnostic test $40 $40 30%t 50%t

CT, MRI, AND PET SCANS 30%t 30%t 30%t 50%t

INPATIENT HOSPITAL CARE 30%t 30%t 30%t 50%t

EMERGENCY DEPARTMENT VISIT 30%t 30%t 30%t 50%t

AMBULANCE SERVICES 30%t 30%t 30%t 50%t

MENTAL HEALTH SERVICES Inpatient psychiatric care 30%t 30%t 30%t 50%t


Outpatient/day treatment $40 $40 $50 50%t

CHEMICAL DEPENDENCY SERVICES Inpatient care 30%t 30%t 30%t 50%t


Outpatient/day treatment $40 $40 $50 50%t

DURABLE MEDICAL EQUIPMENT 30%t 30%t 30%t 50%t

INFERTILITY SERVICES (diagnosis) 50% 50% 50% 50%

DEPENDENT OUT-OF-AREA20% coinsurance for up to 5 office visits, 5 X-rays, and 5

prescription fills


prescription fills


prescription fills


prescription fills

PHYSICIAN-REFERRED ALTERNATIVE CARE2 $50 $50 $60 50%

OUTPATIENT PRESCRIPTION DRUGS$30 generic; $50 preferred brand; 30% non-preferred


$30 generic; $50 preferred brand; 30% non-preferred


$25 generic; $60 preferred brand; 50% non-preferred

brand; 50% after RX deductible

$30 generic; 30% preferred brand; 50% non-preferred

brand; 50% after RX deductible

VISION HARDWARE PEDIATRIC No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per












OUTPATIENT ADMINISTERED MEDICATIONS 30%t 30%t 30%t 50%t

MATERNITY CARE Inpatient 30%t 30%t 30%t 50%t


DEDUCTIBLE PLANS

16

Health savings account (HSA)–qualified plans encourage employees to become more involved with their own health care spending — and their own health. If you’re struggling with the high cost of health care, this could be a good option for you. An HSA is an easy-to-administer, tax-exempt account that is paired with an HSA-qualified high deductible plan. It allows your employees to pay for current health expenses and save for future qualified expenses on a tax-free basis.*

Individual members own these accounts and keep their HSA if they change jobs or become unemployed. Unlike a flexible spending account, there is no “use it or lose it” provision. Instead, unused contributions roll over each year and can be used for future medical expenses, including long-term care and insurance.

Employers and/or individuals can contribute to these accounts. Annual contributions from all sources are limited to the amount of the HSA-qualified plan deductible. More detailed information can be found in IRS publication 502.

Unlike financial savings vehicles like IRAs, HSAs have the potential to offer triple tax savings with:

• Tax-free contributions

• Tax-free investment earnings

• Tax-free withdrawals for qualified medical expenses

*The tax references in this brochure relate to federal income tax only. Consult with your financial or tax adviser for more information about state income tax laws.

PLAN HIGHLIGHTS FOR HSA-QUALIFIED HIGH DEDUCTIBLE HEALTH PLANS

17

PLAN NAME KP WA SILVER 2700/25% HSA (2018) KP WA BRONZE 5200/20 HSA (2018)




Drug deductible $0 $0

ANNUAL OUT-OF-POCKET MAXIMUM $5,400 per individual; $10,800 per family



OFFICE VISITS Preventive care $0 $0

Primary care 25%t $20t

Urgent care 25%t 50%t

Specialty care 25%t $30t

Prenatal care $0 $0

Allergy shots and other injections 25%t 50%t

Routine immunizations for children $0 $0

OUTPATIENT THERAPIES1 Physical, occupational, and speech 25%t $30t

Outpatient surgery 25%t 50%t

Lab 25%t 50%t

X-ray/diagnostic test 25%t 50%t

CT, MRI, AND PET SCANS 25%t 50%t

INPATIENT HOSPITAL CARE 25%t 50%t

EMERGENCY DEPARTMENT VISIT 25%t 50%t

AMBULANCE SERVICES 25%t 50%t

MENTAL HEALTH SERVICES Inpatient psychiatric care 25%t 50%t

Residential treatment 25%t 50%t

Outpatient/day treatment 25%t $20t

CHEMICAL DEPENDENCY SERVICES Inpatient care 25%t 50%t

Residential treatment 25%t 50%t

Outpatient/day treatment 25%t $20t

DURABLE MEDICAL EQUIPMENT 25%t 50%t

INFERTILITY SERVICES (diagnosis) 50%t 50%t

DEPENDENT OUT-OF-AREA 20%t coinsurance for up to 5 office visits, 5 X-rays, and 5 prescription fills

20%t coinsurance for up to 5 office visits, 5 X-rays, and 5 prescription fills

PHYSICIAN-REFERRED ALTERNATIVE CARE2 25%t $30t

OUTPATIENT PRESCRIPTION DRUGS$20 generic; $40 preferred brand;

30% non-preferred brand; 50%t specialty$20 generic; 50% preferred brand;

50% non-preferred brand; 50%t specialty

VISION HARDWARE PEDIATRIC No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year;


No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year;


OUTPATIENT ADMINISTERED MEDICATIONS 25%t 50%t

MATERNITY CARE Inpatient 25%t 50%t


HSA-QUALIFIED HIGH DEDUCTIBLE HEALTH PLANS

18

An easier approach to consumer-directed care When it comes to health care, you expect plans that are simple and easy to use — not just for you, but for your employees. You need financial account options that give you flexibility and control over your health care dollars. And you want it all from a trusted partner who can guide you every step of the way. That’s the solution you get with health payment accounts administered through Kaiser Permanente.

You can choose from 3 categories of health payment accounts — health reimbursement arrangement (HRA), health savings account (HSA), and flexible spending account (FSA) — to create an approach that works for your business. And with our enhanced administrative capabilities, you can combine a variety of plans with these accounts to get a solution that lets you spend less time managing your employees’ health care expenses and more time moving your business forward. A dedicated team of support specialists makes sure you and your employees get the help you need to make the most of your health care solution with Kaiser Permanente.

You get:• Administrative support from setup to day-to-day management

• Flexible account options

• Integrated enrollment and eligibility management

• A convenient portal for administration

• Automated reports and notifications on balances, reimbursements, and more

Your employees get: • A convenient method of payment or reimbursement, no matter which type of account you offer

• The ability to access and manage their personal health information and health payment account just by signing on to kp.org• Live phone support

iPhone is a trademark of Apple, Inc., registered in the U.S. and other countries. Android is a trademark of Google, Inc.

MOBILE ACCESS KEEPS EMPLOYEES CONNECTEDEmployees with iPhone® and Android™ devices can download our Balance Tracker app and check balances and account activity on the go. For extra convenience, employees with HRA and FSA plans can avoid paperwork by submitting financial account claims and other information using their smartphone cameras.1

For more information on consumer-directed health plans, please contact your sales executive or account manager.

KAISER PERMANENTE CONSUMER-DIRECTED PLANS

19

KAISER PERMANENTE’S HEALTH PAYMENT ACCOUNTS

HRA $3.75 per account per month

HSA $3.25 per account per month

FSA $3.75 per account per month

Account fees are per employee account per month. They’ll be billed monthly to the employer, separate from the premium.3 There are no additional setup fees for standard account types and no transaction or annual debit card fees.4

Product pairingsTake advantage of Kaiser Permanente’s paired consumer-directed health care offerings by choosing the plan and health payment account that work for you.

HRA Employees can use funds contributed by you to pay for qualified medical expenses on a tax-free basis. There are several HRA types available, from broad to more limited coverage, with options for point-of-service payment using our health payment card or conve-nient automatic reimbursement.

HSA These employee-owned accounts can be used to pay for qualified medical expenses, including services not covered under the Kaiser Permanente health plan. The money your employees contribute to their HSAs through payroll withholding isn’t considered part of their wages, so they won’t be taxed on it. They can also contribute after-tax funds. Mutual fund investment options are available with HSAs as well.

FSA With a medical FSA, your employees make pretax contributions to an account they can use to pay for a wide range of qualified expenses such as doctor visits, prescription drugs, and lab tests, including services not covered under the Kaiser Permanente health plan. A dependent care FSA can be used for expenses such as child care.2

The integrated differenceYou can choose from a variety of deductibles, copays, and coinsurance for your employees and their families. In addition to the flexibility of these health payment account options, you get the unmatched quality of our integrated care delivery system. So your employees receive better care that’s more efficient — which means healthier outcomes for them, less time away from work, and lower costs for you. And you get a partner committed to protecting your employees and building a stronger future for your business.

1Applies only to HRA and FSA.2Refer to IRS Publication 502 for a list of qualified medical and dental expenses. Refer to IRS Publication 503 for a list of qualified child and dependent care expenses. 3Except for self-funded groups.4For HSAs, employers may choose to have their employees billed for the administrative fees.The tax references in this flier relate to federal income tax only. Consult with your financial or tax advisor for information about state income tax laws.Information may have changed since publication.

HELPFUL TOOLS AND RESOURCES

HSA calculators — Visit kp.org/deductibleplans and click “Resources” to see how much you can save by using our tax savings and future value calculators.

Online access, 24/7 — Check your account balances, view transactions, make contributions, request reimbursements, and more through kp.org.

Mobile access — Download our secure HRA/HSA/FSA Balance Tracker app to your smartphone or tablet to view and manage your account on the go.

Customer support — Call our Health Payment Services team at 1-877-761-3399, Monday through Friday (except holidays), 5 a.m. to 7 p.m. Pacific time.

KAISER PERMANENTE CONSUMER-DIRECTED PLANS

20

CHOICE AND FLEXIBILITY

Would you like to give your employees the opportunity to keep their current doctor or have the option of seeing any licensed provider for covered services — at any time? Do you have employees who travel for extended periods and need access to routine care?

We offer the option to see any licensed provider in the nation for covered services — along with exclusive access to select providers.* With our solution, your employees can:

• Go to a select provider and receive quality care at an affordable price (Tier 1 benefits).

• Go to a preferred (PPO) provider anywhere in the nation and receive care with higher copays and coinsurance.

• Go to non-participating providers nationwide and receive care with higher member cost-sharing and limits on coverage. Members may need to make their own financial arrangements. See the detailed plan information and Evidence of Coverage for more information.

Visit kp .org/medicalstaff to locate Tier 1 providers.Visit kp .org/addedchoice to locate Tier 2 providers.

* See the 2018 Evidence of Coverage for a complete description of services and providers covered under a plan, including a definition of select provider.

Tier 2 services in a 3-tier plan are provided by PPO providers and facilities. Refer to the Evidence of Coverage for a complete definition of PPO providers and facilities.Tier 3 services in a 3-tier plan are provided by non-participating providers and facilities. Refer to the Evidence of Coverage for a complete definition of non-participating providers and facilities.Deductible and out-of-pocket maximum amounts cross accumulate between tiers 1 and 2. There is a separate deductible and out-of-pocket maximum amount in Tier 3, which does not accumulate across any other tiers.

PLAN HIGHLIGHTS FOR ADDED CHOICE® POINT-OF-SERVICE PLANS

http://kp.org/medicalstaff

http://kp.org/addedchoice

21

If you’re looking for choice and convenience, we’ve got a solution — our Added Choice® point-of-service (POS) plan. Added Choice members have access to all that Kaiser Permanente offers, plus the option to seek covered services from licensed providers across the country.

BENEFIT TIERS

Added Choice offers 3 levels of coverage, called tiers. Members can move from 1 tier to another to get care. The choices members make determine which doctors they see, which medical facilities they use, and how much they pay.


TIER 1

SELECT PROVIDERS*

Members choose a provider from Kaiser Permanente or The Portland Clinic, conveniently located throughout our service area. With a referral, members can also choose other contracted community providers and facilities. This tier has the lowest out-of-pocket costs.

TIER 3

NON-PARTICIPATING PROVIDERS*

Members choose a non-participating provider nationwide. Non-participating providers include any licensed providers who are not select providers or PPO providers. This tier has the highest out-of-pocket costs.

TIER 2

PPO PROVIDERS*

Members choose a preferred provider (PPO) from the First Choice Health Network or the First Health Network. This is a good choice for those who want to keep their current PPO provider or who live outside our service area.

$$$

$$$

*See your Evidence of Coverage (EOC) or visit kp.org/addedchoice for definitions of select provider, PPO provider, and non-participating provider. This brochure is not a contract. Plan details are provided in the EOC. To obtain an EOC for a particular plan, contact Member Services. In the event of any conflict between this brochure and the EOC, the EOC prevails.

22

PPO NETWORK: MORE CHOICE, GREATER FLEXIBILITY

With the Kaiser Permanente Added Choice plan, members have access to a wide choice of providers, facilities, and hospitals n the First Choice Health Network and First Health Network.

Washington• 92 hospitals

• 1,175 facilities

• 39,100 practitioners

Oregon• 63 hospitals

• 491 facilities

• 18,445 practitioners

For a full list of PPO providers and facilities, visit kp.org/addedchoice.


23

ADDED CHOICE® POINT-OF-SERVICE PLANS

PLAN NAME KP WA PLATINUM 250/10 3T POS (2018) KP WA GOLD 600/35 3T POS (2018)

Tier 1 Tier 2 Tier 3 Tier 1 Tier 2 Tier 3


$250 per individual; $500 per family




$1,800 per indi-vidual; $3,600 per

family


family

Drug deductible $0 $0 $0 $0 $0 $0

ANNUAL OUT-OF-POCKET MAXIMUM


family


family

$6,000 per individ-ual; $12,000 per

family


family


family


familyBENEFITS MEMBER PAYS

OFFICE VISITS Preventive care $0 $0 35%t $0 $0 50%t

Primary care $10 $25 35%t $35 $60 50%t

Urgent care $40 $55 35%t $60 $80 50%t

Specialty care $20 $35 35%t $45 $70 50%t

Prenatal care $0 $0 35%t $0 $0 50%t

Allergy shots and other injections $10 $20 35%t $10 $30 50%t

Routine immunizations for children $0 $0 35%t $0 $0 50%t

OUTPATIENT THERAPIES1 Physical, occupational, and speech $20 $35 35%t $45 $70 50%t

Outpatient surgery 10%t 25%t 35%t 30%t 50%t 50%t

Lab 10%t 25%t 35%t $35 40%t 50%t

X-ray/diagnostic test $10 $25 35%t 30% 40%t 50%t

CT, MRI, AND PET SCANS $100 25%t 35%t $200t 50%t 50%t

INPATIENT HOSPITAL CARE 10%t 25%t 35%t 30%t 50%t 50%t

EMERGENCY DEPARTMENT VISIT $100t 30%t

AMBULANCE SERVICES 10% Not covered 10%t 30%t Not covered 50%t

MENTAL HEALTH SERVICES Inpatient psychiatric care 10%t 25%t 35%t 30%t 50%t 50%t

Residential treatment 10%t 25%t 35%t 30%t 50%t 50%t

Outpatient/day treatment $10 $25 35%t $35 $60 50%t

CHEMICAL DEPENDENCY SERVICES Inpatient care 10%t 25%t 35%t 30%t 50%t 50%t

Residential treatment 10%t 25%t 35%t 30%t 50%t 50%t

Outpatient/day treatment $10 $25 35%t $35 $60 50%t

DURABLE MEDICAL EQUIPMENT 20%t 35%t 45%t 30%t 50%t 50%t

INFERTILITY SERVICES (diagnosis) 50% 50% 50% 50% 50% 50%

DEPENDENT OUT-OF-AREA Not covered Not covered Not covered Not covered Not covered Not covered

PHYSICIAN-REFERRED ALTERNATIVE CARE2 $20 Not covered Not covered $45 Not covered Not covered

OUTPATIENT PRESCRIPTION DRUGS $10 generic; $20 preferred brand;

$50 non-preferred brand;

50% specialty

Not covered

$15 generic; $30 preferred brand;

50% non-preferred brand;

50% specialty


$60 non-preferred brand;

50% specialty

Not covered


50% non-preferred brand;

50% specialty

VISION HARDWARE PEDIATRIC No charge for 1 pair standard frames w/lenses

or 6-month supply contact lenses per calendar year; no

charge for low vision aid from

selected list or for medically necessary

contact lenses

No charge for 1 pair standard frames w/lenses




contact lenses

50%t for 1 pair standard frames w/ lenses or 6-month

supply contact lenses per calendar year;

50%t for low vision aid from selected

list or for medically necessary contact

lenses





contact lenses





contact lenses

50%t for 1 pair standard frames w/ lenses or 6-month

supply contact lenses per calendar year;

50%t for low vision aid from selected

list or for medically necessary contact

lensesOUTPATIENT ADMINISTERED MEDICATIONS 10%t 25%t 35%t 30%t 50%t 50%t

MATERNITY CARE Inpatient 10%t 25%t 35%t 30%t 50%t 50%t


24

PLAN NAME KP WA GOLD 1000/35 3T POS (2018)

Tier 1 Tier 2 Tier 3





Drug deductible $0 $0 $0






OFFICE VISITS Preventive care $0 $0 50%t

Primary care $35 $60 50%t

Urgent care $75 $100 50%t

Specialty care $45 $70 50%t

Prenatal care $0 $0 50%t

Allergy shots and other injections $10 $30 50%t

Routine immunizations for children $0 $0 50%t

OUTPATIENT THERAPIES1 Physical, occupational, and speech $45 $70 50%t

Outpatient surgery 25%t 40%t 50%t

Lab $35 40%t 50%t

X-ray/diagnostic test $35 40%t 50%t

CT, MRI, AND PET SCANS $200 40%t 50%t

INPATIENT HOSPITAL CARE 25%t 40%t 50%t

EMERGENCY DEPARTMENT VISIT 25%t

AMBULANCE SERVICES 20% Not covered 20%t

MENTAL HEALTH SERVICES Inpatient psychiatric care 25%t 40%t 50%t

Residential treatment 25%t 40%t 50%t

Outpatient/day treatment $35 $60 50%t

CHEMICAL DEPENDENCY SERVICES Inpatient care 25%t 40%t 50%t



DURABLE MEDICAL EQUIPMENT 25%t 40%t 50%t

INFERTILITY SERVICES (diagnosis) 50% 50% 50%t

DEPENDENT OUT-OF-AREA Not covered Not covered Not covered

PHYSICIAN-REFERRED ALTERNATIVE CARE2 $45 Not covered Not covered

OUTPATIENT PRESCRIPTION DRUGS

$10 generic; $20 preferred brand; $60 non-preferred brand; 50% specialty Not covered $25 generic; $75 preferred brand; 50%

non-preferred brand; 50% specialty

VISION HARDWARE PEDIATRIC

No charge for 1 pair standard frames w/lenses or 6-month supply contact

lenses per calendar year; no charge for low vision aid from selected list or for

medically necessary contact lenses




50%t for 1 pair standard frames w/ lenses or 6-month supply contact

lenses per calendar year; 50%t for low vision aid from selected list or for medically necessary contact lenses

OUTPATIENT ADMINISTERED MEDICATIONS 25% 40% 50%t

MATERNITY CARE Inpatient 25%t 40%t 50%t

PLAN NAME KP WA SILVER 2500/40 3T POS (2018)





















Lab $40 40%t 50%t


CT, MRI, AND PET SCANS 30%t 40%t 50%t
























50%t for 1 pair standard frames w/ lenses or 6-month supply contact lenses per

calendar year; 50%t for low vision aid from selected list or


OUTPATIENT ADMINISTERED MEDICATIONS 30%t 40%t 50%t




25

PLAN NAME KP WA GOLD 1000/35 3T POS (2018)





















Lab $35 40%t 50%t


CT, MRI, AND PET SCANS $200 40%t 50%t
























50%t for 1 pair standard frames w/ lenses or 6-month supply contact

lenses per calendar year; 50%t for low vision aid from selected list or for medically necessary contact lenses

OUTPATIENT ADMINISTERED MEDICATIONS 25% 40% 50%t


PLAN NAME KP WA SILVER 2500/40 3T POS (2018)





















Lab $40 40%t 50%t


CT, MRI, AND PET SCANS 30%t 40%t 50%t
























50%t for 1 pair standard frames w/ lenses or 6-month supply contact lenses per

calendar year; 50%t for low vision aid from selected list or


OUTPATIENT ADMINISTERED MEDICATIONS 30%t 40%t 50%t




26

Your commitment to high-quality health care for your employees doesn’t have to end when they become eligible for Medicare. You can offer your Medicare-eligible employees the same access to our physicians, services, and facilities that our other members enjoy.

Kaiser Permanente Senior Advantage (HMO) picks up where Medicare leaves off, combining original Medicare coverage and Kaiser Permanente traditional coverage — as well as features unique to Senior Advantage (such as an outside service area benefit and health club benefit) — into one comprehensive plan.

TO ENROLL IN KAISER PERMANENTE GROUP SENIOR ADVANTAGE

Plan members must obtain Medicare Parts A and B and must complete the Kaiser Permanente Senior Advantage enrollment form.

EMPLOYERS WITH 1–19 TOTAL EMPLOYEES

Medicare-eligible employees and/or their dependents who enroll in Senior Advantage will receive Senior Advantage rates and benefits. (In most cases, Medicare is primary for groups with fewer than 20 employees.)

EMPLOYERS WITH 20–50 TOTAL EMPLOYEES

Actively working Medicare-eligible employees and/or their dependents may remain on the active plan with active rates and benefits. They may enroll in the Senior Advantage plan and receive active rates and group Senior Advantage benefits. (Medicare is secondary for groups of 20 or more when the member is actively working.)

Different rules apply for those who are eligible for Medicare due to disability or end stage renal disease. Contact your Kaiser Foundation Health Plan of the Northwest representative for more information.

PLAN HIGHLIGHTS FOR SENIOR ADVANTAGE PLAN

27

PLAN NAME 2018 SENIOR ADVANTAGE

ANNUAL DEDUCTIBLE No deductible

ANNUAL OUT-OF-POCKET MAXIMUM $1,000


OFFICE VISITS Preventive care $0

Primary care $20

Urgent care $25

Specialty care $20

Prenatal care $0

Allergy shots and other injections $10

Routine immunizations $0 OUTPATIENT THERAPIES1 Physical, occupational, and speech $20

Outpatient surgery $50

Lab $0

X-ray/diagnostic test $0 CT, MRI, AND PET SCANS $0

INPATIENT HOSPITAL CARE $200 per admission

EMERGENCY DEPARTMENT VISIT $50

AMBULANCE SERVICES $100

MENTAL HEALTH SERVICES Inpatient psychiatric care $200

Residential treatment $100 Outpatient/day treatment $20 CHEMICAL DEPENDENCY SERVICES Inpatient care $200

Residential treatment $100 Outpatient/day treatment $20 DURABLE MEDICAL EQUIPMENT 20%; $0 for certain diabetic suppliesOUTSIDE SERVICE AREA ($1,000 maximum per year) 20%

PHYSICIAN-REFERRED ALTERNATIVE CARE2 $20

OUTPATIENT PRESCRIPTION DRUGS3 $20 generic; $40 brand

VISION HARDWARE $100 for lenses, frames, or contact lenses every 2 calendar years

OUTPATIENT ADMINISTERED MEDICATIONS 15%

FITNESS PROGRAM Access to Silver&Fit® fitness program, which includes no-cost membership at participating local health clubs

Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. Benefits, premiums and/or copays/coinsurance may change on January 1 of each year and at other times in accord with your group’s contract with us. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

1Rehabilitative, habilitative services, and neurodevelopmental therapy have separate limits of 25 visits each per calendar year.2CHP network only. Self-referred massage is limited to 12 visits per calendar year at a $25 copay per massage. There is a $1,000 limit per calendar year on all alternative care services.3The Part D prescription drug gap begins when total drug costs (Kaiser Permanente share plus your copay or coinsurance) for the year to date total $3,750.

SENIOR ADVANTAGE PLAN

28 28


The Kaiser Permanente formulary applies to all plans. Members get up to a 30-day supply for each copay (up to a 90-day supply of eligible drugs for 2 copays when using our mail-delivery pharmacy). All of these plans are Medicare Part D creditable. View our formulary at kp .org/formulary.

ADDITIONAL PRESCRIPTION OPTIONS FOR ADDED CHOICE® PLANS

Members on an Added Choice plan have the option of filling their prescriptions through MedImpact. When a member fills a prescription at a MedImpact pharmacy, the plan covers up to a 30-day supply of generic drugs. To locate a pharmacy, go to kp .org/addedchoice.

ALTERNATIVE CARE (SELF-REFERRED)

Self-referred chiropractic care is available from The CHP Group network providers in our service area with an annual 10-visit limit. Acupuncture is also covered for up to 12 visits per year. Visit chpgroup .com for a list of providers. The office visit copay will match the cost of the specialty office visit copay.

VISION HARDWARE AND ROUTINE EYE EXAM

Many of our plans can be purchased to include coverage for adult vision hardware and routine eye exams. All plans include coverage for children 18 and younger. Vision hardware must be prescribed and purchased at Kaiser Permanente.

If added to Added Choice plans, members may use their benefit at select facilities, PPO, and other non-participating providers and facilities. Visit kp2020 .org for more information

DENTAL COVERAGE

Investing in dental health helps keep your employees happy, healthy, and productive. Our Traditional HMO dental plans allow you to choose from a wide range of options and mix and match deductibles or office visit copays for any plan combination. If you would like more flexibility, the Dental Choice PPO plans are designed for choice — providing comprehensive coverage, while allowing members to see any dentist.

PLAN HIGHLIGHTS FOR PRESCRIPTION DRUGS, ALTERNATIVE CARE, VISION, AND DENTAL

WASHINGTON MEDICAL PLANS 2018 FOR SMALL EMPLOYERS...*May be subject to cost share for members on...

Documents

Transcript of WASHINGTON MEDICAL PLANS 2018 FOR SMALL EMPLOYERS...*May be subject to cost share for members on...