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Copyright ©2018 Kaiser Foundation Health Plan, Inc.1Copyright ©2018 Kaiser Foundation Health Plan, Inc.
2018 Open Enrollment
Presentation for2019 Open Enrollment presentation for
VMwareSam Yee, Regional Account Manager November 2018
Copyright ©2018 Kaiser Foundation Health Plan, Inc.2
2019 Open Enrollment
▪ What’s new for 2019
▪ Overview of the Deductible HMO plan
▪ Tools and Resources
Agenda
Copyright ©2018 Kaiser Foundation Health Plan, Inc.3
How is the Kaiser Permanente
Deductible HMO Plan different
Copyright ©2018 Kaiser Foundation Health Plan, Inc.4
Same care and convenience
WHY CHOOSE KAISER PERMANENTE?
▪ Same great doctors
▪ Same personalized attention
▪ Same convenient locations
▪ Same online tools
▪ Same healthy resources
▪ Same Medical Record Number
(MRN)
A different way to pay for your care
Copyright ©2018 Kaiser Foundation Health Plan, Inc.5
Preventive care at no cost
WHY CHOOSE KAISER PERMANENTE?
Because finding and treating problems before they get serious is an
important part of staying healthy, you get most preventive care at no
cost— even before you reach your deductible.
Preventive care includes:
▪ Cancer screenings
▪ Cholesterol and high blood
pressure screenings
▪ Diabetes screenings
▪ Immunizations
▪ Routine prenatal care
▪ Well-child visits
Copyright ©2018 Kaiser Foundation Health Plan, Inc.6
Convenient care management
WHY CHOOSE KAISER PERMANENTE?
*Available when you receive care at Kaiser Permanente facilities.
On kp.org or with the KP app, you can stay on top of
your care 24/7 with these convenient features:*
▪ Schedule and cancel routine appointments.
▪ View most lab results as soon as they are available.
▪ Refill most prescriptions with no charge for shipping.
▪ Email your doctor’s office with nonurgent questions.
▪ Print vaccination records for school, sports, or camp.
▪ Manage a family member’s health.
Copyright ©2018 Kaiser Foundation Health Plan, Inc.8
Key terms
KEY TERMS
▪ Deductible: The amount you pay for covered services
each year before Kaiser Permanente starts paying. You
may pay copays for some services without having to
reach your deductible.
▪ Out-of-pocket maximum: The most you’ll pay for
covered services each year. For a small number of
services, you may need to keep paying copays or
coinsurance after reaching your out-of-pocket maximum.
Note: Your deductible and out-of-pocket maximum will reset
on January 1st.
Copyright ©2018 Kaiser Foundation Health Plan, Inc.9
Key terms (continued)
▪ Copay: The set amount you pay for covered services
— for example, a $20 copay for an office visit.
▪ Coinsurance: A percentage of the charges that you
pay for covered services — for example, a 10%
coinsurance for a $200 procedure means you pay
just $20.
KEY TERMS
Copyright ©2018 Kaiser Foundation Health Plan, Inc.11
How your deductible plan works
PREVENTIVE CARE SERVICES AND DOCTOR’S OFFICE VISITS DEDUCTIBLE HMO PLAN
You’ll pay full charges for covered services, including
emergency, hospital care, X-rays, therapy visits, and lab tests
before meeting your plan deductible.
After meeting your plan deductible, you’ll start paying less for
these services — a copay or coinsurance — until you reach
your out-of-pocket maximum.
January 1st December 31st
Copyright ©2018 Kaiser Foundation Health Plan, Inc.12
Family deductibles and out-of-pocket maximums
YOUR PLAN BENEFITS
If your family is covered under your plan:
▪ Each family member has an individual
deductible, and the family as a whole has
a deductible.
▪ Each family member has an individual
out-of-pocket maximum, and the family
as a whole has an out-of-pocket maximum.
▪ Your individual deductible is $250
Your family deductible is $500.
▪ Your individual out-of-pocket maximum is
$1,500.
Your family out-of-pocket maximum is
$3,000.
Copyright ©2018 Kaiser Foundation Health Plan, Inc.14
Covered service You pay
Routine physical exams No charge
Primary care office visits $20 Copay (Plan Deductible doesn’t apply)
Specialty care office visits $30 Copay (Plan Deductible doesn’t apply)
Lab tests 10% Coinsurance after Plan Deductible
X-ray 10% Coinsurance after Plan Deductible
Outpatient surgery 10% Coinsurance after Plan Deductible
Hospitalization 10% Coinsurance after Plan Deductible
Urgent care visits $20 Copay (Plan Deductible doesn’t apply)
Emergency Department visits 10% Coinsurance after Plan Deductible
Generic prescription drugs
Generic refills through mail order service
$10 Copay for a 30-day supply (Plan Deductible doesn’t apply) $20 Copay for up to a 100-day supply (Plan Deductible doesn’t apply)
Brand-name prescription drugs
Brand-name refills through mail order service
$20 Copay for a 30-day supply (Plan Deductible doesn’t apply) $40 Copay for up to a 100-day supply (Plan Deductible doesn’t apply)
Specialty prescription drugs $20 Copay for a 30-day supply (Plan Deductible doesn’t apply)
Highlights of this plan’s benefits*
YOUR PLAN BENEFITS
*This is just a summary of some examples of covered services and their corresponding copay and coinsurance amounts. Please see your
Evidence of Coverage for information about coverage, limitations, and exclusions for all benefits, including those not listed in this summary.
Deductible: $250 individual / $250 family member / $500 family
Out-of-pocket maximum: $1,500 individual / $1,500 family member / $3,000 family
Copyright ©2018 Kaiser Foundation Health Plan, Inc.16
Visit kp.org/deductibleplans
GETTING CARE
▪ View claims summaries.
▪ View and pay medical bills.
▪ Use the Estimates tool
▪ Sample fee list
Access information and tools to help you better understand
and manage your deductible plan coverage and costs.
For example, you can:
Copyright ©2018 Kaiser Foundation Health Plan, Inc.17
Before your visit — getting an estimate
GETTING CARE
Use our online Estimates tool to:
▪ Get an estimate of how much a
treatment, procedure, test, or
other medical service will cost.
▪ Track how close you are to
reaching your deductible and
out-of-pocket maximum.
▪ See how it works
kp.org/costestimates/video
Call 1-800-390-3507, weekdays
from 7 a.m. to 5 p.m.
Copyright ©2018 Kaiser Foundation Health Plan, Inc.18
During your visit — paying for care
GETTING CARE
When you check in for your visit, you’ll be asked to make a
payment. You can expect to get a bill later for any remaining
amount you owe.
Copyright ©2018 Kaiser Foundation Health Plan, Inc.19
After your visit — what to expect
GETTING CARE
You’ll also get a bill if your payment
at check-in didn’t cover the full cost
of the services you received.
You’ll get an Explanation of Benefits (EOB)
statement to help you track the care you’ve
received and how close you are to reaching
your deductible and out-of-pocket maximum.
Copyright ©2018 Kaiser Foundation Health Plan, Inc.20
Questions?
HEALTHY TOGETHER
Call our Member Service Contact Center, 24 hours a day,
7 days a week (closed holidays).
1-800-464-4000 English
711 TTY
Copyright ©2018 Kaiser Foundation Health Plan, Inc.22
Kaiser Permanente See how our care and coverage can help you thrive – Additional Resources
What’s integrated care? A simpler, seamless experience in which the
health plan and doctors work together for you.
You get:
• Hassle-free health care with less
paperwork
• A care team that’s connected to each
other and you
• Many services under one roof
Care and coverage built around you
Copyright ©2018 Kaiser Foundation Health Plan, Inc.23
Schedule
appointments
and get 24/7
medical advice
by phone.
Meet face-to-
face with a
doctor online.*
Email your
doctor’s office
with nonurgent
questions
anytime.
Visit your
doctor at your
local facility.
Save yourself a
trip to the
doctor’s office
with a telephone
appointment.*
*When appropriate and available.
Kaiser Permanente See how our care and coverage can help you thrive – Additional Resources
Your care, your way
Copyright ©2018 Kaiser Foundation Health Plan, Inc.24
Kaiser Permanente See how our care and coverage can help you thrive – Additional Resources
For more on specialty care, visit thrive.kp.org/healthier-outcomes.
Maternity care
For family planning
to first steps and
beyond, visit
kp.org/maternity
Mental health
Our members can access
mental health services
with no referral needed at
kp.org/mentalhealth
Cardiac care
Learn how we’re healing
hearts and saving lives with
advanced cardiac care at
kp.org/cardiaccare
No matter what life throws your way, you can count on us. Get access to excellent
care from top-notch doctors across a wide range of specialties, including:
World-class specialty care
Copyright ©2018 Kaiser Foundation Health Plan, Inc.25
*This number can be dialed inside and outside the United States. Before the phone number, dial “001” for landlines and “+1” for mobile lines if you’re outside the
country. Long-distance charges may apply, and we can’t accept collect calls. The phone line is closed on major holidays (New Year’s Day, Easter, Memorial Day,
July Fourth, Labor Day, Thanksgiving, and Christmas). It closes early the day before a holiday at 10 p.m. Pacific time (PT), and it reopens the day after a holiday
at 4 a.m. PT.
• If you get hurt or sick while traveling, we’ll help
you get care. Our plans include emergency and
urgent care coverage from qualified providers
anywhere in the world.
• We can also help you before you leave town by
checking to see if you need a vaccination,
refilling eligible prescriptions, and more. Just
call us or go online:
Kaiser Permanente See how our care and coverage can help you thrive – Additional Resources
24/7 Away from
Home Travel Line:
951-268-3900*
kp.org/travel
Care away from home
Copyright ©2018 Kaiser Foundation Health Plan, Inc.26
1Classes vary at each location and some may require a fee.2Not available in all areas.
• Wellness Coaching by Phone
kp.org/wellnesscoach
• Healthy Lifestyle programs
kp.org/healthylifestyles
• On-site Health Education Classes and support
groups1 kp.org/classes
• Online videos, podcasts, recipes, and more
kp.org/healthyliving
• Seasonal Farmers Markets2
kp.org/farmersmarkets
Kaiser Permanente See how our care and coverage can help you thrive – Additional Resources
Healthy resources
Copyright ©2018 Kaiser Foundation Health Plan, Inc.27
21 medical centers
59 medical offices
2 affiliated plan hospitals
11 affiliated medical offices
Map not to scale
Kaiser Permanente See how our care and coverage can help you thrive – Additional Resources
N
Northern California
Copyright ©2018 Kaiser Foundation Health Plan, Inc.28
Scotts Valley Medical Offices
Santa Cruz Medical Offices
Kaiser Permanente See how our care and coverage can help you thrive – Additional Resources
Open now
• Sacramento Downtown Commons Medical Offices
• San Jose Skyport Medical Offices
• Santa Cruz Medical Offices
• Santa Rosa Mercury Way Medical Offices
• Scotts Valley Medical Offices
• Watsonville Community Hospital
• Watsonville Medical Offices
Coming NEW in Spring 2019:
• Dublin Medical Office and Cancer Center
New locations in Northern California
Visit kp.org/locations
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