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For more information, visit kp.org/feds or call 1-855-315-1004 (TTY 711), Monday through Friday, 8 a.m.to 5 p.m. During open enrollment season, 8 a.m. to 10 p.m.
Not a member yet?
• Rewards benefit:up to $75 in Visa reward cards
Federal Employees and Annuitants 2016 Rates and Benefits
Mid-Atlantic States Region
together in good health
see how easy healthy can be
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This is a summary of the features of the Kaiser Permanente health plan. Before making a final decision, please read the plan’s Federal brochure (RI 73-047). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.
The benefits listed on page 6 (except “Health classes”) and on page 9 under “Discounts and savings for additional health care services” are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees and family members who become members of Kaiser Permanente.
Kaiser Permanente Medicare Plus for Federal Members Kaiser Permanente is a Cost plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. To join a Kaiser Permanente Medicare health plan, you must reside in the Kaiser Permanente Medicare Plus service area in which you enroll. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year and at other times in accord with your group’s contract with us. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. You must pay the Medicare Part B premium to join a Kaiser Permanente Medicare health plan. Enrolling in Medicare Plus for Federal Members will not affect the benefits you receive through the Federal Employees Health Benefits (FEHB) Program, although the network and other rules of Medicare may apply.
Notice of Summary of Benefits and Coverage (SBC): Availability of Summary Health InformationThe Federal Employees Health Benefits (FEHB) Program offers numerous health benefits plans and coverage options. Choosing a health plan and coverage option is an important decision. To help you make an informed choice, each FEHB plan makes available a Summary of Benefits and Coverage (SBC) about each of its health coverage 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.org/feds. A paper copy is also available, free of charge, by calling 1-877-KP4-FEDS (1-877-574-3337). For TTY for the deaf, hard of hearing, or speech impaired, call 711. To find out more information about plans available under the FEHB Program, including SBCs for other FEHB plans, please visit opm.gov.
The right choice for your healthGet the great care and resources you need to live healthy — all together in one convenient package. Check out everything that comes with your health plan, and you’ll see why over 10 million people nationwide have chosen Kaiser Permanente.
Kaiser Permanente Together in good health
Visit kp.org/newmember for all you need to get started. It’s easy to choose your doctor, register for kp.org, and transition your prescriptions. If you have questions or need help making your first appointment, just give us a call.
Once you join …
Make sure you get the most out of your membership. If you haven’t already, register on kp.org, where you can schedule appointments, read about coverage and costs, email your doctor’s office, get most lab results, and more — all online.
Already a member?
A healthy partnership . . . . . . . . . . . . . . . . . . . . . . . . . 2
Great care, great results . . . . . . . . . . . . . . . . . . . . 3
Care the way you want it . . . . . . . . . . . . . . . . . . . 4
Extras for your well-being . . . . . . . . . . . . . . . . . 5
Healthy resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Our locations and hospital partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Benefit highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Which option is right for you? . . . . . . . . . . . . . . . . . 9
Your 2016 benefits summary . . . . . . . . . . . . . . . . . 10
Ready to enroll with Kaiser Permanente? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
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A healthy partnershipGetting you connected with a doctor who suits your individual needs is our top priority. When you have a doctor you connect with, it’s easier to stay healthy.
Choose your doctor — and change anytime
Browse our online doctor profiles at kp.org/searchdoctors to see your options. You’ll find information on a wide range of highly skilled doctors, including their education, credentials, and interests. Then choose the one who’s right for you.
You can choose your doctor from:• Adult medicine/internal medicine • Family medicine• Pediatrics/family medicine
(for children up to 18)
Choose 1 doctor for your whole family or a different doctor for each family member. You can also change your doctor anytime.
See specialists — often without a referralYou don’t need a referral for optometry, psychiatry, chemical dependency, or addiction medicine. If you’re a woman age 18 or older, you can also choose your personal obstetrician/gynecologist — no referral needed. For other specialties, your doctor can easily refer you.
What type of care do you need?
If you’re not sure what kind of care you need, you can call our advice nurses anytime. They’ll help you figure out what type of care is best for your symptom or condition, tell you where to go for care, and even schedule a routine appointment for you, if appropriate.
Great doctors working together as a team
With Kaiser Permanente, you get the support of a team of doctors, nurses, and specialists focused on your health.
Your entire care team works together — often under one roof — sharing information to give you the care you need. And with access to your electronic health record, they know your medical history, test results, medications, and allergies. This helps them tailor care for you.
Care for diverse and cultural needs
Great care isn’t one-size-fits-all. That’s why we have programs that focus on tailoring care for our diverse membership. We’re one of the only care providers with an institute dedicated to culturally competent care, where we do research to help improve health outcomes for all our members. We’ve already reduced health disparities among different ethnicities for conditions like high blood pressure, diabetes, and colon cancer.
Kaiser Permanente Together in good health
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Great care, great resultsGet the care you need to stay your healthiest. From preventive screenings to care for serious conditions, we’ve got you covered. And it’s all backed by the latest medical technology and research.
Preventive care that keeps you healthy
We help you protect your health, even when you’re healthy. To catch problems early, before they get serious, we offer preventive screenings, routine appointments, and more.
Through your electronic health record, your care team knows what you’re due for and can keep you up-to-date. With this focus on prevention, our members can rely on impressive results.
Leading the way in prevention*Kaiser Permanente of the Mid-Atlantic States:• Ranks first in the nation for breast cancer
screening• Is in the top 10 in the nation for many
childhood immunizations, many aspects of diabetes care, and care and management of cardiovascular conditions
Comprehensive care when you need it
Along with our commitment to prevention, we’re here for you if you get sick. You get great doctors, state-of-the-art facilities, and the latest technology — all combined to help you get healthy quickly.
Manage ongoing conditionsIf you have a condition like diabetes or heart disease, you’re automatically enrolled in a disease management program to help you get it under control. And we start managing your condition right away with care supported by proven best practices and advanced technology.
Cutting-edge research and care
Kaiser Permanente research centers make up one of the largest nonacademic research programs in the country. We have about 2,000 studies happening at any given time. And our clinical trials program drives cutting-edge cancer research, which leads to better care for members.
Through our innovative electronic health record system, your care team stays up-to-date — not only about each patient’s needs but also about the latest medical research and the safest, most effective treatments.
* 2015 Healthcare Effectiveness Data and Information Set (HEDIS®) published by the National Committee for Quality Assurance. For more information, visit ncqa.org.
Choose how you get and manage your care
In person
You can always make an appointment to see your doctor in person. And because most of our locations offer many services under one roof, you can see your doctor, get lab services and X-rays, and pick up your prescriptions — all in one trip.
By phoneSave a trip to the doctor’s office. Where telephone appointments are available, you can schedule one to talk to your doctor by phone. And medical advice is always available by phone, 24/7.
By emailConnect with your doctor anytime. You can email your doctor’s office with nonurgent questions and get a reply within 48 hours, often sooner.
By video
When you call for medical advice anytime, 24/7, you can also video chat with a doctor who is connected to your personal care team. In 2016, you’ll also be able to make a video appointment with your primary care doctor, to take place during regular office hours. Both are available at no extra cost.*
Online
Stay on top of your care 24/7. Once you’ve registered on kp.org, you can use our website to choose your doctor, schedule routine appointments, view most lab test results, refill most prescriptions, print vaccination records, manage a family member’s health, and much more.
On the goAfter registering on kp.org, you can go to your smartphone, download the Kaiser Permanente app, and start using our secure online features — anytime, anywhere. Learn more at kp.org/mobile.
Care the way you want itYou’re in control. How, when, and where do you want to receive care? How do you want to manage your health? Enjoy the ultimate in convenience, choosing what you need for the day and hour you need it. It’s care that fits your life.
Kaiser Permanente Together in good health
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* Video advice with a doctor is for certain medical conditions and for members 18 years and older. Both are available only when the member is physically present in Maryland, Virginia, or Washington, DC. Video appointments with pirmary care physicians are available only with Kaiser Permanente physicians.
Get coverage, no matter where life takes you
As a Kaiser Permanente FEHB member, your benefits go further than your home service area.
• You’re covered for emergency care anywhere in the world. We’ll cover urgent care at non–Kaiser Permanente facilities as long as it can’t wait until you get back home.
• You can receive care from Kaiser Permanente where our facilities are located in other areas of the country. Just call Member Services to check on what services are covered because plans in other areas vary.
• Students at school out of the service area can call Kaiser Permanente 24/7 for telephone medical advice. They are also covered for emergency care. If a follow-up appointment is needed after an emergency room visit, it’s easy to get a referral for that appointment and any additional lab or imaging services.
Help to quit smoking
Let us help you succeed in quitting. You pay nothing for classes, telephone coaching, online programs, and prescriptions, including prescribed over-the-counter tobacco-cessation drugs. Ask your doctor about your treatment options.
Care when you need it
• Urgent care services are located in 10 of our medical centers and 6 are open 24/7 along with lab, X-ray, and pharmacy. You have the convenience of care you need under one roof.
• New! Urgent care is coming to the Manassas Medical Center in fall 2015.
• Expanded! Urgent care with an observation unit is now 24/7 at the Woodbridge Medical Center, along with lab, pharmacy, and radiology.
• Convenient locations.• Turn to page 7 to see which Kaiser Permanente
medical center is closest to where you live or work.
• New! In Baltimore, the City Plaza Medical Center is relocating to Little Italy at 815 E. Pratt Street. The new Kaiser Permanente Baltimore Harbor Medical Center will include more space, more doctors, new services (including mammography), and plenty of free parking. It opens November 9, 2015.
Earn up to $150 in Visa reward cards for taking healthy steps*
You and your enrolled spouse can each get up to $75 in Visa reward cards per year for taking the Total Health Assessment and doing a healthy lifestyle program. Learn more at kp.org/feds.
Extras for your well-beingWe care for the whole you. From emergencies to personal wellness goals, you get the support you need to thrive. And to sweeten the deal, we’ll even throw in Visa reward cards just for taking healthy steps.
* The rewards program runs from January 1 through December 31, 2016, and is open to all Kaiser Permanente FEHB subscribers and their enrolled spouses 18 and older. You can take the Total Health Assessment as often as you would like and as many healthy lifestyle programs as you want, but you can only earn rewards for them once during the reward period. Visa reward cards expire 12 months from date issued.
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Healthy resourcesGood health goes beyond the doctor’s office. Take a look at all the healthy tools and resources available online, by phone, and at our facilities — and choose the ones that are right for you.
Get the most out of your health plan
Online wellness tools
Visit kp.org/healthyliving for helpful articles, wellness information, health calculators, fitness videos, music channels, podcasts, and recipes from world-class chefs.
Health classes
There’s always something new to learn about how to be your healthiest. With the many health classes we offer, there’s something for everyone. Try classes for eating well, baby care, ongoing health conditions, and much more. Classes vary by location and some require a fee.
Personal wellness coaching
Work one-on-one by phone with a personal wellness coach — at no extra cost. You can get help and inspiration for reaching a variety of health goals. Find out more at kp.org/wellnesscoach.
Special rates for members
Our members get reduced rates on a variety of products and services — like gym memberships, massage therapy, and more. See your options at kp.org/choosehealthy.
Kaiser Permanente Together in good health
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MD
DC
VA
40
83
95
695
9795
495
95
295
50
70
50
267
95
66
Carroll
Baltimore
Harford
Frederick
HowardBalt City
Montgomery
Loudoun
Anne Arundel
Fairfax
Prince William
Charles
Calvert
Spotsylvania
Stafford
King GeorgeCity ofFredericksburg
Westm
oreland
Caroline
Culpeper
Fauquier
HanoverLouisa
Orange
Prince George’s
Towson Medical Center
White Marsh Medical Center
WoodlawnMedical Center
Kaiser Permanente Baltimore Harbor Medical Center (opening fall 2015)
City Plaza Medical Center*
Columbia GatewayMedical Center
Ashburn Medical Center
RestonMedical Center
Fair Oaks Medical Center Falls Church
Medical Center
Manassas Medical Center
Burke Medical Center
Springfield Medical Center
Woodbridge Medical Center
Fredericksburg Medical Center†
South Baltimore County Medical Center
Severna Park Medical Center
Annapolis Medical Center
Largo Medical Center
Camp SpringsMedical Center
Kaiser PermanenteFrederick Medical Center
Gaithersburg Medical Center
270
Shady GroveMedical Center
Kensington Medical Center
Silver Spring Medical Center
Kaiser Permanente Capitol Hill Medical Center
495
Prince George’s Medical Center
Northwest DC Medical Office Building
Marlow Heights Medical Center
Tysons CornerMedical Center
These centers offer 24/7: • urgent care • lab • pharmacy • radiology
* All City Plaza services and providers will be relocating to the Baltimore Harbor Medical Center in fall 2015. Please check kp.org/facilities for the most up-to-date listing of the services located at Kaiser Permanente medical centers, or call Member Services.† Not available for Medicare Plus enrollees.
ANNE ARUNDEL MEDICAL CENTER
GREATER BALTIMORE MEDICAL CENTER
HOLY CROSS HOSPITAL
HOLY CROSS GERMANTOWN HOSPITAL
SIBLEY MEMORIAL HOSPITAL
ST. AGNES HOSPITAL
SUBURBAN HOSPITAL
RESTON HOSPITAL CENTER
H
STAFFORDHOSPITAL VIRGINIA HOSPITAL CENTER
CHILDREN’S NATIONAL MEDICAL CENTER
WASHINGTON HOSPITAL CENTER
H Hospitals are independently owned and operated and are not affiliated entities of Kaiser Permanente.
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Benefit highlights
Kaiser Permanente Together in good health
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Save on prescription drugs
Save time and money by ordering prescription refills online or by phone. We can mail most prescription drugs to you within 10 days. You don’t pay any extra cost for standard U.S. postage. When we mail you a prescription, you pay $2 less than you would pay for a 30-day supply at a plan pharmacy. Also, you get a 90-day supply of maintenance medication for only twice the 30-day mail-order copay when we mail your prescription (some medications are limited to a 30-day supply).
Take advantage of chiropractic acupuncture services
You can receive up to 20 chiropractic visits per year for the diagnosis and treatment of neuromusculoskeletal disorders and up to 20 acupuncture visits per year to diagnose and treat chronic pain and nausea when referred by your plan physician. You pay $20 per visit (High Option) and $30 per visit (Standard Option).
Preventive dental care included
With an emphasis on prevention and early detection of dental problems, your dental benefit can help you maintain good oral health and avoid costly procedures in the future. You pay just $30 per visit for diagnostic and preventive dental services, which include oral evaluation, cleaning, and certain X-rays. Other covered dental services are provided at a reduced fee. You must receive all your care from participating Dominion Dental Services dental providers. To learn more, call Dominion member services specialists at 703-518-5338 or 1-888-518-5338, Monday through Friday, 7:30 a.m. to 6 p.m. For TTY for hearing/speech impaired, call 711. Or visit dominiondental.com/kaiserdentists.
2016 benefit changes — what’s new?
Key benefit changes to High and Standard Options include:
• Added a specialty drug prescription drug tier. Specialty drugs are very high-cost drugs approved by the FDA that are on our formulary. You can use Kaiser Permanente’s FEHB drug formulary to find which tier your drug is in.
• Increased the cost share for up to a 90-day supply filled at a plan pharmacy or an affiliated network pharmacy from 2 copayments to 3. The mail service delivery program will continue to apply 2 copayments for up to a 90-day supply.
• Decreased copayment for interventional radiology to $100 per procedure (Standard Option only).
• Removed the 90-day limit for care when you get care at a Kaiser Permanente facility in another region through the Visiting Member Program.
To learn more, see the 2016 benefits summary on page 10; download our FEHB brochure, FEHB Drug Formulary, and other material at kp.org/feds; or call us at 1-855-315-1004 (TTY 711), Monday through Friday, 8 a.m. to 5 p.m. You can also fill out the reply card at the back of this brochure to get material.
Eyewear benefits
Whether you choose the High or Standard Option of care, you pay 75% of our allowance for eyeglass frames, lenses, and total contact lens package at Kaiser Permanente optical centers.
Which option is right for you?
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Medicare members get better benefits
If you have Medicare and decide to enroll in Kaiser Permanente Medicare Plus (Cost) for Federal Members, you’ll get richer benefits than with your FEHB coverage alone. Learn all about the different parts of Medicare and how they work together in Your Guide to Choosing a Kaiser Permanente Medicare Health Plan. Download our brochure at kp.org/feds/Medicare, or to have one sent to you, please call Member Services at 1-888-777-5536 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.
Discounts and savings for additional health care services
ChooseHealthy™ You’ll receive discounts off regular rates for services such as massage therapy and acupuncture, and get preferred rates on select fitness club memberships.† You’ll also get no-cost shipping on purchases of vitamins and herbal supplements. To learn more, go to the “Health & Wellness” section of kp.org.
* Video appointments with PCPs are available only with Kaiser Permanente physicians. Video advice with a doctor is for certain medical conditions and for members 18 years and older (12 and older starting winter 2015). Both are available only when the member is physically present in Maryland, Virginia, or Washington, DC. † This value-added service is an extra service provided by entities other than Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (KFHP-MAS), and is neither offered nor guaranteed under any KFHP-MAS contract. This entity may change or discontinue offering this service at any time. KFHP-MAS disclaims any liability for the service provided by this entity.
High Option Standard Option Included with Both Options
• Higher premiums, with lower copays for most services and prescription drugs
If you want low out-of-pocket costs, this may be the right choice.
• Lower premiums, but higher copays for most services and prescription drugs
If you want predictable copays at a lower premium, this may be the right choice.
• No copays for Most preventive care
Emailing your doctor’s office
Video appointments with your personal care physician (PCP)*
Video medical advice with a doctor*
• No deductible• $30 preventive care dental
benefit• Eyewear coverage• No paperwork or bills
when you get care in Kaiser Permanente facilities
• Covered for emergency care worldwide
Your 2016 benefits summaryBenefits and Services High Option Standard OptionOutpatient services (per visit or procedure)Preventive care $0 $0Primary care $10 $20Specialty care $20 $30Lab tests and X-rays $0 $0Specialty scans $75 $100Chiropractic services (up to 20 visits per year) $20 $30Hospital and facilityOutpatient surgery $75 $150Inpatient hospital care (per admission) $100 $250 per day up to $750MaternityRoutine prenatal care visit, first postpartum visit $0 $0Delivery (per admission) $100 $250 per day up to $750Emergency and urgent care (per visit or trip)Emergency care $100 $125Urgent care $20 $30Ambulance $0 $100Prescription drugs (up to a 30-day supply at plan pharmacies. See page 8 for mail-order discounts.)*Generic $7 $12Preferred brand $30 $35Non-preferred brand $45 $50Specialty 20% up to $100 30% up to $150Out-of-pocket maximum (2x per family maximum) $2,250 per person $3,500 per personYour Premium Share† High Option Standard Option
Self OnlyBiweekly Non-Postal and Biweekly Postal Category 2 $72.11 $53.74Biweekly Postal Category 1 $60.25 $44.60Monthly Non-Postal $156.24 $116.44
NEW Self Plus One
Biweekly Non-Postal and Biweekly Postal Category 2 $184.15 $121.45Biweekly Postal Category 1 $158.54 $100.80Monthly Non-Postal $398.99 $263.14
Self and Family
Biweekly Non-Postal and Biweekly Postal Category 2 $179.51 $125.75Biweekly Postal Category 1 $152.37 $104.37Monthly Non-Postal $388.94 $272.46
* Plan providers determine the drug that is medically necessary. If you request another drug, you pay prices charged to members for non-covered drugs. † These rates do not apply to all enrollees. If you are in a special enrollment category, please contact the agency or Tribal Employer which maintains your health benefits enrollment.
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Kaiser Permanente Together in good health
These are highlights of the FEHB enrollment process. Please refer directly to opm.gov and your employing agency or retirement office for FEHB coverage effective dates, enrollment procedures and deadlines, and other information. To add an eligible family member to your Kaiser Permanente Self and Family or Self Plus One enrollment, complete and return an Enrollment Change Form to us. These forms can be obtained at kp.org/feds or by calling Member Services.
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Ready to enroll with Kaiser Permanente?
If you qualify for Medicare, or will soon, see page 9 for more information.
1. Choose an option. 2. Select the type of enrollment you want.
3. Sign up online or call.
• High Option• Standard OptionFind brief descriptions of these options on page 9. More details about benefits and rates are on page 10.
• Self Only covers you.• Self Plus One covers
you and 1 eligible family member.
• Self and Family covers you and all eligible family members.
Find your enrollment code in the chart below. Then, visit opm.gov to enroll online or contact your employing agency or retirement office for next steps and other information.Annuitants can contact the Retirement Information Center at 1-888-767-6738 or 1-855-887-4957 (TTY), or [email protected].
Choose the right enrollment code
Need help? Call us at 1-855-315-1004 (TTY 711), Monday through Friday, 8 a.m. to 5 p.m.
Enrollment Code High Option Standard OptionSelf Only E31 E34NEW Self Plus One E33 E36Self and Family E32 E35
New Self Plus One enrollment type
Self Plus One is a new enrollment type for 2016. Enrollees who cover themselves and 1 eligible dependent may choose to enroll in Self Plus One or Self and Family. You decide which enrollment type is best for you. If you choose the High Option, you will pay a lower premium if you enroll in Self and Family. If you choose the Standard Option, you will pay a lower premium if you enroll in Self Plus One.
All FEHB enrollees can make enrollment changes during Open Season, when you experience a qualifying event, or during a Special Enrollment. If you are a retiree, you have the additional option to decrease your enrollment type throughout the year.
To move from Self and Family to Self Plus One, you must change your enrollment by following Step 3 above.
Please recycle. 60342013 September 2015
Kaiser Foundation Health Plan, Inc.2101 East Jefferson StreetRockville, MD 2085260380008 MAS 10/1/15–9/30/16
