Training Partnership and Health Benefits Trust 2012-2013 Benefits Book

2012-2013 BENEFITS BOOK 1

YOUR BENEFITS

2012-2013 GUIDE TO TRAINING AND HEALTH BENEFITS

2012-2013

SECOND EDITION

2 MYSEIUBENEFITS.ORG

WELCOMEWelcome to the second “Your Benefits” book from the SEIU Healthcare NW

Training Partnership and Health Benefits Trust. This book is designed to serve

as a complete guide to your training and health benefits. It features resources

and information to make it easier to get the support you need.

As a Home Care Aide, your training and health benefits are a critical part of

the compensation you receive. Quality training and affordable health benefits

provide the skills foundation and personal stability needed to help you deliver

excellent care to your consumers and create future career pathways.

You are the key to quality care in Washington’s long-term care system. Thank

you for all you do to promote excellence in home care.

Charissa RaynorExecutive Director, Training Partnership and Health Benefits Trust

David RolfBoard Chair, Training Partnership and Health Benefits Trust

President, SEIU Healthcare 775NW

USERNAME

PASSWORD

MANAGE TRAINING / BENEFITS ONLINE www.myseiubenefits.orgEnter your Username and Password below for easy reference

PRIMARY CARE DOCTOR NAME PHONE

URGENT CARE CENTER NAME AND ADDRESS

PRIMARY CARE PROVIDER (DOCTOR) / URGENT CARE CENTERWrite your Doctor and nearest Urgent Care Center here for reference

PLAN NAME

YOUR HEALTH PLAN Write your Health Benefits Plan name here


TRAIN

ING

BA

SICSTRA

ININ

G STA

ND

ARD

SPO

LICIESH

EALTH

BEN

EFITSW

ELLNESS

POLICIESCO

NTE

NTS

Quick Start GuideYour Benefits Book 4

If You Need Assistance 5

Multi-language Assistance 6

Quick Start: Training and Health 7

How to Access www.myseiubenefits.org 8

Update Online Preferences 10

2012-2013 Benefit Highlights 11

MySEIUBenefits.org Overview 12

Online Continuing Education Overview 13

Online Continuing Education Classes 14

Home Care Aide Magazine Preview 15

Training BasicsTraining Overview 17

How to Get the Most from Your Training 21

Interpretation 22

How to Help Improve Future Classes 23

Training StandardsTraining Standards Overview 25

Training Standards Chart 26

Home Care Aide Categories 27

Support Contacts 28

Safety and Orientation 29

Training PoliciesFrequently Asked Questions 30

Classroom Policies 32

Reasonable Accommodation Policy 34

Health BenefitsHealth Benefits Overview 37

Participating Employers 38

Benefits Basics 39

2012-2013 Medical Plan Highlights 40

Prescription/RX Co-pay Grid 41

Plan and Network Grid 42

Medical Plan Highlights Grid 43

Group Health Urgent Care Centers 45

Dental and Vision Benefits 47

WellnessYour Wellness 49

Health Benefits Quick Start 55

Health Benefits PoliciesFrequently Asked Questions 56

Benefit Summaries 63

Willamette Dental 64

Delta Dental 66

Kaiser Permanente Health 71

Group Health 74

Questions and Appeals 81

Notices 83

Glossary 84

Home Care Aide Categories 86

Training Standards Chart 87

One-Stop Resource for Training, Health BenefitsTo make it easier to understand your training and health ben-efits, the Training Partnership and Health Benefits Trust put together this “Your Benefits” book to help guide you. These benefits are effective Aug. 1, 2012 through July 31, 2013. This Benefits Book will be in effect until July 31, 2013.

Inside, you will find important benefits information, including:

Training Benefits• Training standards • Classroom policies• Glossary• Student resources

Health Benefits(For eligible Individual Providers or Home Care Aides covered through their employers)• Eligibility• Benefit summaries• Wellness guide

Where to Find UpdatesIf there are changes to training standards or other information after the book is re-leased, we will update this “Your Benefits” book the following ways:

ONLINE - Updates will be available online at www.myseiubenefits.org/benefits

YOUR MAGAzINE- Updates will also be in Home Care InSight, the magazine for Home Care Aides. See Page 15 for more information.

COLOR CODED - Throughout the book, you will see information for both Individual Providers (IPs) and Agency Providers (APs). To help keep them straight, look for these colors:

n Individual Providers n Agency Providers

QU

ICK

REFE

REN

CE G

UID

E


YOUR BENEFITS

2012-2013 GUIDE TO TRAINING AND HEALTH BENEFITS

2012-2013

SECOND EDITION

QUICK REFERENCE GUIDEYOUR BENEFITS BOOK


DID YOU kNOw? Did you know there is an online version of the Benefits Book? The online ver-sion of the Benefits Book is a useful tool if you misplace your book or want to view your benefits information from anywhere. You can view the online Benefits Book at www.myseiubenefits.org/benefits


General Training and Health Benefits SupportFill out a Contact Form at www.myseiubenefits.org/contact

Member Resource Center1-866-371-3200Mon.-Fri., 7 a.m.-7 p.m. The MRC is closed the following holidays:New Year’s DayMartin Luther King, Jr. DayPresidents’ DayMemorial Day Independence DayLabor DayThanksgiving

Day after ThanksgivingChristmas Eve DayChristmas Day Check www.myseiubenefits.org/MRC for office closures and the most updated hours

QU

ICK REFERENCE G

UID

E

Medical Plan SupportGroup Healthwww.ghc.org1-888-901-4636Mon.-Fri., 8 a.m.-5 p.m.

kaiser Permanente1-800-813-2000www.kp.org

Dental Plan SupportDelta Dental (Dental)1-800-554-1907www.deltadentalwa.com

willamette Dental1-800-359-6019www.willamettedental.com

For answers to medical or dental plan questions, contact:

QUICK REFERENCE GUIDEIF YOU NEED ASSISTANCE

Specific Health Benefits Support

Specific Training SupportSee chart on Page 28 for who to contact for specific training-related questions.

n Individual Providers: If you need information about your training or benefits eligibility, log in to www.myseiubenefits.org first. If you cannot find the answer to your question, contact help.

n Agency Providers: Contact your employer for support.

QUICK REFERENCE GUIDEQ

UIC

K RE

FERE

NCE

GU

IDE

IF YOU NEED ASSISTANCEQ

UIC

K RE

FERE

NCE

GU

IDE

For AssistanceComuníquese con el Centro de Recursos para Miembros al 1-866-371-3200 si necesita asistencia para registrarse en su entrenameinto o para saber cuál es su elegibilidad para los beneficios de salud.

Hãy gọi Trung Tâm Nguồn Lực Thành Viên theo số 1-866-371-3200 nếu quý vị cần được trợ giúp trong việc lên lịch đào tạo hoặc tìm hiểu về điều kiện để nhận phúc lợi y tế.

훈련일정을 잡거나 건강혜택 자격 확인을 위해 도움이 필요하시면

회원지원센터 1-866-371-3200로 전화주세요.

如需在安排培训日程或了解您是否有资格获取保健福利方面获取协

助，请致电 1-866-371-3200 联系会员资源中心。

Если у Вас есть вопросы, связанные с определением расписания занятий, или относительно получения Вами пособия по нетрудоспособности, обращайтесь в Учебно-методический центр по телефону 1-866-371-3200.




UICK REFEREN

CE GU

IDE

Training Quick Start1. Find Your Training Standards

n Individual Providers: • There are different training standards depending on what type of care you provide.• Use the online Training Wizard – a tool to help you know which category

applies to you – to find your individual training standards. Go to: www.myseiubenefits.org/wizard to complete the Wizard.

n Agency Providers: • Your employer can help you understand your training standards. Contact your

employer to get your training standard information.

2. Watch the Safety and Orientation DVDs - If Required• Look at the training grid on Page 26 to see your requirement.

3. Schedule Training Early Schedule within first two weeks of hire to ensure the best choices.

n Individual Providers:• Create your Username and Password to login to the training portal at

www.myseiubenefits.org.• Go online to www.myseiubenefits.org to log in to register for training

or call the Member Resource Center at 1-866-371-3200.

n Agency Providers: • Check with your employer on the best way to register. Your employer has

policies on scheduling for training.

Health Benefits Quick Start1. Check your eligibility for health insurance benefits and enroll

n Individual Providers: Go online to www.myseiubenefits.org to log in to see your eligibility and enroll online, or call the Member Resource Center at 1-866-371-3200. Your eligibility for health insurance depends on the number of hours you work.

n Agency Providers: Contact your employer to see if you are eligible for health benefits through your employer.

2. Make an appointment with your primary care doctorGo to your health insurance provider’s website or contact them by phone (see contact info on Page 5) to find available doctors and other providers. See the Health Benefits section for more details.

QUICK START


UIC

K RE

FERE

NCE

GU

IDE

ACCESS MYSEIUBENEFITS.ORGQ

UIC

K RE

FERE

NCE

GU

IDE

Manage Training and Benefits Easily OnlineThe best way to manage your training and find your eligibility for benefits is through the www.myseiubenefits.org website. We have improved the Username and Password process to make it easier for you to access the site.

How to Log In to the Website 1. Sign up for a First Time Username and Password

2. Verify Your Information

You can enter EITHER your Student ID (the card sent to you by the Training Partner-ship) OR the last four of your Social Security Number and your birthdate. Note: If you work for DSHS, you should use the Student ID option.




UICK REFEREN

CE GU

IDE

ACCESS MYSEIUBENEFITS.ORG

3. Create Your Username and Password

4. Confirm Your Username and Password

Note: You can choose any username or password you like

5. You’re Done!

Now You’re Ready to Log in to the Website!

Please write your Username and

Password on Page 2 of this book

to remember.



UIC

K RE

FERE

NCE

GU

IDE


UPDATE PREFERENCES

1. Log in.

Update Your Preferences for a Better Student ExperienceKeeping your language and contact preferences updated is an important way

to help the Training Partnership provide you with the best possible training

experience. Make sure to update your preferences as soon as possible so we

can reach you effectively.

2. Click “Manage … Profile” link on the left side of the screen:

3. Modify the settings you wish to, and click the “Save Preferences” button.



UICK REFEREN

CE GU

IDE

2012-2013 BENEFIT HIGHLIGHTSWhat’s New and Improved?TRAINING

More Online Continuing Education ClassesThe Training Partnership now has 26 English Online Continuing Education classes for students to take at their convenience. In addition, there are 10 Online CE courses available for students in Russian and Spanish. For more on Online CE, visit www.myseiubenefits.org/online-continuing-education

Home Care InSight MagazineThe Training Partnership will be offering the second issue of Home Care InSight Magazine in Fall 2012. This magazine will be a resource for Training Partner-ship students and Health Benefits Trust members to learn about best practices in training and wellness as well as get important updates on their benefits.

Print Your Own CertificatesNow, students who have completed their training can print their own certifi-cates, quickly and easily through the online learning portal.

HEALTH BENEFITS

Group Health Offers Free Mail Prescriptions for Value-Based DrugsIn an exciting new benefit for Health Benefits Trust members, Group Health is now offering some mail-order Value-Based drugs at no cost to members. This is in addition to lower costs on other prescriptions as well.

Cash Incentives for Using Health Benefits The Health Benefits Trust will continue to offer incentives to members who use important parts of their health benefits:

Initial Primary Care Appointment = $10 Members who make an initial primary care appointment within the first three months of coverage will receive a $10 check.

Complete a Health Profile = $25 Members who complete a Health Profile either online or on paper will receive a $25 check from the Health Benefits Trust.

Same Low Cost for Members Health Benefits Trust members still pay $25 a month for health, dental and vision benefits.


UIC

K RE

FERE

NCE

GU

IDE

GET ONLINE


MYSEIUBENEFITS.ORGYour easy online source for online CE, training standards, class registration

Once you get your online login and

password, you’re ready to go online to

manage and take training!

Over the past year, the Training Partner-

ship has worked to increase the quantity

and depth of the resources available on

the website www.myseiubenefits.org.

In addition to the ability to register

online, find training standards and

other resources, students can now take

a robust number of Online Continuing

Education courses – right from their

computer.

Why go online?

Online Training WizardThe online Training Wizard will give you a customized understanding of the

training you need. The easy online Training Wizard is found at

www.myseiubenefits.org/wizard.

Register for Training If you are an Individual Provider, you can register for training yourself online.

You can view available courses and pick times that work for you.

Online Continuing Education Students can now take their Continuing Education conveniently online –

anytime, anywhere! See the following page for details on Online Continuing

Education.

www.myseiubenefits.org



UICK REFEREN

CE GU

IDE

ONLINE CONTINUING EDUCATIONAs of July 2012, there

are 26 English Con-

tinuing Education (CE)

classes you can take

online by going to

www.myseiubenefits.

org. In addition, there

are 10 online CE

courses in Russian

and Spanish available

as well.

With online classes you pick the time and

topics that work for you. You can see the

available courses, register and access

courses, receive credit, and navigate help in-

formation – all online and all 24 hours a day!

Each online course takes about one hour

to complete, which may vary depending on

learning style, material covered and Internet

connection speed.

‘‘ I loved being able to

take the Multiple

Sclerosis module

online. I learned a

lot and I could do it

at home!

– Abdul, Training

Partnership Student



UIC

K RE

FERE

NCE

GU

IDE

ENGLISHHearing and Vision Conditions

Cultural Competency: Pain Management and Health Literacy

Arthritis & Acute Mental Status Changes

Cultural Competency: Pain Management and Assumptions

Gaining Consumer Cooperation for Oral Health

Oral Health Basics

Denture Care and Cleaning

Using Household Cleaning Chemicals Safely

Green Cleaning

Cultural Competency - Nutrition

Best Practices for the Professional HCA

Multiple Sclerosis

Traumatic Brain Injury

Body Mechanics

Infection Control and Workplace Safety

Better Health through Nutritious Cooking

An Introduction to Developmental Dis-abilities

An Introduction to Physical Disabilities

An Introduction to Mental Illness

An Introduction to Dementia

Best Practices for the Professional HCA

Multiple Sclerosis


Body Mechanics

Important Note: The following courses were available in early 2011 for a short time so if you took them at that time, you cannot take them again. If you did not take them then, they are available to take online.

Relationships Between Consumers

Home Care Aides Make a Difference

Supporting Consumer Independence

The Faces of Down Syndrome

Dispelling Disability Myths

Promoting Creativity

Online Continuing Education Classes as of July 2012

SPANISH & RUSSIANBest Practices for the Professional HCA

Multiple Sclerosis


Body Mechanics

Infection Control and Workplace Safety

Better Health through Nutritious Cooking

An Introduction to Developmental Dis-abilities

An Intro to Physical Disabilities

An Introduction to Mental Illness

An Introduction to Dementia

Important Note: The following courses were available in early 2011 for a short time so if you took them at that time, you cannot take them again. If you did not take them then, they are available to take online.

Relationships Between Consumers

Home Care Aides Make a Difference

Supporting Consumer Independence

The Faces of Down Syndrome

Dispelling Disability Myths

Promoting Creativity



UICK REFEREN

CE GU

IDE

MAGAZINE

Fall 2012 - Next Issue of Home Care InSight Magazine

As a community of Home Care Aides, you do

important work and you have an important

story to tell. You can help raise understanding

of common challenges and experiences

for Home Care Aides to help improve the

profession.

To help share knowledge and skills with

the Home Care Aide community, a new

magazine will be published to focus on

you and your work. Look for the next issue in

the Fall of 2012.

Magazine HighlightsTraining and Health

• Training standards updates

• Best practices for Home Care Aides

• Knowledge and skills builders

• Student participation policies and news

• Health benefits policies and news

• Your safety at work

Important Updates to the “Your Benefits” book• Updates to the “Your Benefits” book will be printed in the magazine

as well as posted online; be sure to check your magazine for updates

SEND US YOUR STORY IDEAS!Do you have an interesting story to share of your successes or challenges as a Home Care Aide? Do you have a story about personal health and wellness? Do you have suggestions for stories or profiles you would like to see in the magazine? Send them to us! Go to www.myseiubenefits.org/stories to submit your story idea.

16 MYSEIUBENEFITS.ORGTRAI

NING

BAS

ICS


TRAIN

ING

BA

SICS

VisionOur vision is that every long-term care worker is a professional who has been trained rigorously, whose work is well respected and well compensated, who has meaningful opportunities for professional development and career growth, and who provides high quality care.

‘‘ The classes were very helpful and they gave me new, healthier ways to

deal with challenges at work.

– Jasmine, Training Partnership Student

QUALITY TRAINING, QUALITY CAREThe Training Partnership under-

stands that adult learners bring a

broad set of life experiences, educa-

tion levels, and English language

proficiency to the classroom. To

meet that diversity, learning experi-

ences are designed for you, adult

students who bring previous knowl-

edge and a passion for their work to

class. The focus is on practical skill

development that will help you to do your job.

What Can You Expect from Basic Training Courses?• As a student, you can expect to meet an instructor with direct care

experience who is passionate about supporting Home Care Aides in their

professional growth.

• You can expect opportunities to learn using different methods like watch-

ing video clips, completing written activities, and presenting to others.

• You can expect to learn specific skills, see them demonstrated and then

have a chance to demonstrate the skill yourself.

• You can expect to use a student guide during class which you can keep

as a future resource.



TRAIN

ING

BA

SICS

What Characterizes the Work of the Training Partnership?There are several themes that infuse the courses, actions, and work of the Training Partnership. They are:

• Dignity of the work and the Home Care Aides who do the work;

• Dignity of the consumer whose preferences, individuality, and needs must be respected;

• Empowerment of the Home Care Aide to improve their lives and the lives of consumers;

• Professionalism of the workforce; and

• Cultural competency and inclusiveness to honor differences.

• You can expect to be asked

what you think, to share what

you know, to contribute to

discussion, and to answer

questions.

What Can You Expect from Continuing Education Courses?• You can expect options in course formats, including in-person and online

learning choices.

• You can expect choice in the style courses are taught, from expert lec-

tures to interactive videos.

• You can expect variety in subjects, from broad overviews to in-depth

explorations on specific topics.

• You can expect to have online courses in multiple languages available to

take 24-hours-a-day, seven days a week.

• You can expect online learning courses that present information and ask

you to apply what you have learned through interactive activities.

MissionOur mission is to train and develop professional long-term care workers to deliver high quality care.



TRAIN

ING

BA

SICS

HOW TO GET THE MOST FROM YOUR TRAININGUse the Training WizardStart with the easy online Training Wizard to find the training you need.

Go to: www.myseiubenefits.org/wizard to complete the Wizard.

Register Early for TrainingIf you need Basic Training, we encourage you to register for your classes within

the first two weeks of hire to get the best choice of class options. If you want

Instructor Led Continuing Education (CE) classes, register as early as possible to

get the best choice of class options before your deadline.

Take Online Learning for Continuing Education CreditsOnline Continuing Education courses are an easy and convenient way to get the

CE hours you need as a Home Care Aide. You can view available courses, take

classes and view your credits all from your computer – 24/7.

Go Online for Convenient Service and SupportThe www.myseiubenefits.org web portal is your comprehensive resource for

available classes, your current training status, benefits eligibility and much

more. Log in to the portal first to get the answers you need. Instructions for get-

ting a username and password are on Page 8.

Update Your Contact InfoEnsure you are receiving the most current information about your training by

updating your contact information with your employer. If are you an Individual

Provider, update your information with your primary DSHS contact. If you are an

Agency Provider, update your information with your employer.

Sign Up for News and AlertsHelp make sure you get all the latest

news and information you need on

training standards, deadlines and new

online learning courses. Sign up to

receive news and alerts through email.


INTERPRETATIONn Individual Providers: The Community Interpretation option is available to you. You need to tell the Training

Partnership you are using a community interpreter at time of registration.

n Agency Providers: Indicate to the person who registers you for class that you will be bringing

a Community Interpreter.

Community InterpretationThe Training Partnership values the diversity of Home Care Aides. Basic Training courses

are offered in English, Cantonese, Spanish, Russian, Korean, and Vietnamese. For those

students who speak another primary language and are unable to take courses in English,

we offer a Community Interpretation option.

Steps to Register for Community Interpretation

1. Notify the Training Partnership: At the time of course registration, tell us either using the

online portal or the Member Resource Center if you will be bringing someone with you to

serve as your interpreter. If you are bringing someone to interpret, you are responsible for

telling them when and where the class will be held and for reserving space for them in

the class.

2. Orientation:

Online Orientation Video: You and your Community Interpreter should watch a helpful

online Orientation before their first community interpretation session. This Orientation will

help prepare your Community Interpreter and you for the class. It is very important that

your interpreter watches this orientation before your first class, especially if they do not

have training in interpreting.

Tip Sheet: If you have a friend or family member interpret for you, we offer a tip sheet and

other information that will help prepare your interpreter to assist you in class.

View orientation info and tip sheet here: www.myseiubenefits.org/training/interpretation


HELP IMPROVE FUTURE CLASSESParticipate in strengthening future classes – a call to action

Course ReviewsAll Home Care Aides are encouraged to

complete a course review online at

www.myseiubenefits.org after each course

they take. Course reviews allow the Training

Partnership to make adjustments in course

content and instructors. Your feedback is

taken seriously.

How do you submit a course review? Course

reviews are available on your student

profile.

1. When a course has been completed, login to the online learning portal,

look at the “Completed Training” box, and click the “Review Now” link for the

course you wish to review.

2. Complete the form, and click the “Submit Answers” button below the form.

TRAIN

ING

BA

SICS

Course ReviewsHow do you submit a course review? Course reviews are available on your student profile. Log in with your username and password, select “manage my training,” and under the completed training box, click “review now.”

24 MYSEIUBENEFITS.ORGTRAI

NING

STA

NDAR

DS


TRAIN

ING

STAN

DA

RDS

TRAINING STANDARDSUPDATED JUNE 2012

The passage of Initiative 1163 in November 2011 reinstated the comprehen-

sive training and certification standards for most new Home Care Aides (ex-

empting those caring for a parent or child). These higher standards had been

suspended in July 2011.

Home Care Aides who have already

taken Basic Training will not need

to take the more in-depth training.

Training standards vary for differ-

ent types of workers. Be sure to

check your own training standards

through the online wizard and see

the training standards chart on

Page 26.

Basic Training CurriculumDifferent types of workers have different Basic Training standards. Basic Train-

ing is the introductory training you take to understand the fundamentals of

Home Care Aide work.

Continuing EducationDifferent types of workers have different Continuing Education standards.

The Training Partnership provides quality instructor-led and online Continuing

Education (CE) classes across the state. Continuing Education is ongoing or

refresher training covering a broad range of subjects. You choose the ones that

are most suited to your interests and the consumers you serve.

Training WizardAs training standards change, you may wonder: “How do I know what my training standards are?” The Training Partnership has a conve-nient and easy online Training Wizard to help. The Wizard – in addition to the Training Standards Chart on Page 26 - will help you understand the training you need.

Go to www.myseiubenefits.org/wizard to get started!

www.yes1163.com


TRAI

NING

STA

NDAR

DS

UPD

ATED

JUNE

201

2

ORI

ENTA

TIO

N A

ND

SA

FETY

BA

SIC

TRA

ININ

GCO

NTI

NU

ING

ED

UCA

TIO

N

Orie

ntat

ion

2 H

ours

Safe

ty Tr

aini

ng

3 Ho

urs

Acce

lera

ted

Basi

c Tr

aini

ng

30 H

ours

Basi

c Tr

aini

ng 7

0 Ho

urs

Pare

nt P

rovi

der

(DDD

Onl

y)

Clas

s 7

Hour

s

Cont

inui

ng E

duca

tion

12 H

ours

HCA

Ce

rtifi

catio

nRe

quire

d?

Agen

cy

Prov

ider

(AP)

Com

plet

ed p

rior t

o pr

ovid

ing

care

Com

plet

ed p

rior

to p

rovi

ding

car

eNo

t req

uire

dW

ithin

120

day

s of

em

ploy

men

tNo

t req

uire

d12

hou

rs/y

ear f

or th

e re

newa

l of

certi

ficat

ion

Yes

Indi

vidu

al

Prov

ider

(IP)

Com

plet

ed p

rior t

o pr

ovid

ing

care

Com

plet

ed p

rior

to p

rovi

ding

car

eNo

t req

uire

dW

ithin

120

day

s of

em

ploy

men

tNo

t req

uire

d12

hou

rs/y

ear f

or th

e re

newa

l of

certi

ficat

ion

Yes

Indi

vidu

al P

rovi

ders

or

Agen

cy P

rovi

ders

hire

d be

fore

1/7

/201

2No

t req

uire

dNo

t req

uire

dNo

t req

uire

dNo

t req

uire

dNo

t req

uire

d

As o

f 7/1

/201

2, 1

2 cr

edits

/yea

r by

your

birt

hday

. Use

trai

ning

wiza

rd a

t ww

w.m

ysei

uben

efits

.org

/wiza

rd o

r ca

ll th

e M

RC to

see

your

requ

irem

ent.

No

Cred

entia

led

AP

( per

RCW

18.

88B.

041)

Not r

equi

red

Not r

equi

red

Not r

equi

red

Not r

equi

red

Not r

equi

red

12 h

ours

/yea

r by

thei

r birt

hday

No

Cred

entia

led

IP

( per

RCW

18.

88B.

041)

Not r

equi

red

Not r

equi

red

Not r

equi

red

Not r

equi

red

Not r

equi

red

12 h

ours

/yea

r by

thei

r birt

hday

No

Pare

nt In

divi

dual

Pr

ovid

er (H

CS/A

AA)

Com

plet

ed p

rior t

o pr

ovid

ing

care

Com

plet

ed p

rior

to p

rovi

ding

car

eW

ithin

120

day

s of

em

ploy

men

tNo

t req

uire

dNo

t req

uire

dNo

t req

uire

d, u

nles

s vo

lunt

arily

ce

rtific

ed a

s a

HCA.

No

Pare

nt D

D IP

(DDD

)Co

mpl

eted

prio

r to

prov

idin

g ca

reCo

mpl

eted

prio

r to

pro

vidi

ng c

are

Not r

equi

red

Not r

equi

red

With

in 1

20 d

ays

of e

mpl

oym

ent

Not r

equi

red,

unl

ess

volu

ntar

ily

certi

ficed

as

a HC

A.

No

Lim

ited

Serv

ice

Prov

ider

Com

plet

ed p

rior t

o pr

ovid

ing

care

Com

plet

ed p

rior

to p

rovi

ding

car

eW

ithin

120

day

s of

em

ploy

men

tNo

t req

uire

dNo

t req

uire

dNo

t req

uire

d, u

nles

s vo

lunt

arily

ce

rtific

ed a

s a

HCA.

No

Adul

t Chi

ld In

divi

dual

Pr

ovid

er (H

CS/A

AA/D

DD)

Com

plet

ed p

rior t

o pr

ovid

ing

care

Com

plet

ed p

rior

to p

rovi

ding

car

eW

ithin

120

day

s of

em

ploy

men

tNo

t req

uire

dNo

t req

uire

d12

hou

rs/y

ear b

y birt

hday

No


Home Care Aide (HCA)Provides care to a consumer living in his or her home. Employed by a private homecare agency or DSHS.

Agency Provider (AP)Provides care to a consumer living in his or her home. Employed by a private homecare agency.

Certified Home Care Aide

Provides care to a consumer living in his or her home having successfully passed the DOH certification exam. Employed by a private homecare agency or DSHS.

Individual Provider (IP)Provides care to a consumer living in his or her home. Employer of record is DSHS.

Credentialed Agency Provider

This is an AP with a current healthcare credential as a Registered Nurse (RN), Licensed Practical Nurse (LPN), Nursing Assistant Certified (NAC), Physical Therapist, Occupational Therapist or Medicare-Certified Home Health Aide.

Credentialed Individual Provider

This is an IP with a current healthcare credential as a Registered Nurse (RN), Licensed Practical Nurse (LPN), Nursing Assistant Certified (NAC), Physical Therapist, Occupational Therapist or Medicare-Certified Home Health Aide.

Parent Individual Provider (HCS/AAA)

This is an IP who provides care to his/her own adult child and is contracted through Home and Community Services (HCS) and/or an Area Agency on Aging (AAA).

Parent DD Individual Provider (DDD)

This is an IP who provides care to his/her own adult child with a developmental disability and is contracted through the Department of Developmental Disabilities (DDD).

Limited Service Provider (HCS/AAA/DDD)

This is any IP who provides care 20 hours a month or less for one consumer.

Adult Child Individual Provider

An adult child providing care for his/her biological, step or adoptive parent.

Effective Jan. 7, 2012 HOME CARE AIDE CATEGORIES

TRAIN

ING

STAN

DA

RDS

The Training Partnership provides training to a variety of Home Care Aides (HCA). The chart below describes the different categories of HCAs.

Provide care to a consumer living in his or her home. Employed by a private homecare agency or DSHS.


WHO TO CONTACT FOR TRAINING SUPPORT

INDIvIDUAL PROvIDERS

AGENCY PROvIDERS(visiting Nurse

Homecare, Senior Life Resources,

Oly CAP, CoastalCAP, Concerned

Citizens, Full Life)

AGENCY PROvIDERS

(Addus, Chesterfield, KWA, ResCare, SeaMar,

Amicable)

AGENCY PROvIDERS

(Catholic Community Services -

Agency Provider, CDM)

Class registration and rescheduling Website or MRC Website or MRC Your Employer Your Employer

How to complete your training Website or MRC Website or MRC Your Employer Your Employer

Username and Password assistance Website or MRC Website or MRC Website, MRC

or Employer Your Employer

Confirmation Code Website or MRC Website or MRC MRC Your Employer

Requesting a student ID Website or MRC Website or MRC MRC Your Employer

Requesting a certificate See Next Page See Next Page See Next Page See Next Page

Confirming class schedule Website or MRC Website or MRC Website, MRC


Training requirement and deadlines Primary DSHS Contact Your Employer Your Employer Your Employer

Questions about payment Primary DSHS Contact Your Employer Your Employer Your Employer

Change of address Primary DSHS Contact Your Employer Your Employer Your Employer

Change in training standards due to change in employment status

Primary DSHS Contact Your Employer Your Employer Your Employer


If you are in a category that requires

either the Training Partnership’s Safety or

Orientation training (or both) you should

have received a kit at the time of hiring

or contracting.

The kit contains the following:

1. Instructions on “How to Com-

plete and Receive Credit for

Safety and/or Orientation.”

2. Three DVDs: Orientation,

Safety Training Part 1, and

Safety Training Part 2.

3. Supplemental information titled, “Orientation & Safety – A Reference

Tool for Individual Providers.”

Agencies may supplement this training with an agency specific orientation program.

If you did not receive the Safety and Orientation Kit, please contact your employer.

Safety and Orientation Verification Line: 1-866-483-1397

SAFETY AND ORIENTATION

TRAIN

ING

STAN

DA

RDS

SAFETY &ORIENTATION

SEIU HEALTHCARE NW TRAINING PARTNERSHIPThe Training Partnership trains and develops professional long-term

care workers to deliver high quality care and support to older adults

and people with disabilities.

S E I U H E A L T H C A R E N WT R A I N I N G PA RT N E R S H I P

WWW.MYSEIUBENEFITS.ORG 635 ANDOVER PARK WEST SUITE 200, TUKWILA, WA 98188

NEED HELP? CONTACT THE MEMBER RESOURCE CENTER1-866-371-3200

INDIvIDUAL PROvIDERS

AGENCY PROvIDERS(visiting Nurse

Homecare, Senior Life Resources,

Oly CAP, CoastalCAP, Concerned

Citizens, Full Life)

AGENCY PROvIDERS

(Addus, Chesterfield, KWA, ResCare, SeaMar,

Amicable)

AGENCY PROvIDERS

(Catholic Community Services -

Agency Provider, CDM)

Class registration and rescheduling Website or MRC Website or MRC Your Employer Your Employer

How to complete your training Website or MRC Website or MRC Your Employer Your Employer

Username and Password assistance Website or MRC Website or MRC Website, MRC


Confirmation Code Website or MRC Website or MRC MRC Your Employer

Requesting a student ID Website or MRC Website or MRC MRC Your Employer

Requesting a certificate See Next Page See Next Page See Next Page See Next Page

Confirming class schedule Website or MRC Website or MRC Website, MRC


Training requirement and deadlines Primary DSHS Contact Your Employer Your Employer Your Employer

Questions about payment Primary DSHS Contact Your Employer Your Employer Your Employer

Change of address Primary DSHS Contact Your Employer Your Employer Your Employer

Change in training standards due to change in employment status

Primary DSHS Contact Your Employer Your Employer Your Employer

1. 2.

That’s it, you’re done! It’s fast and easy and you can do it from home.

CERTIFICATESStudents (and Agency employers and DSHS staff) can now print their own certifi-

cates. Once you have completed your training, log in to your account and go to:


1. what is www.myseiubenefits.org?

The website www.myseiuben-efits.org is where you can read important announcements from the Training Partner-ship, learn about our different programs and ask questions. On the website, you can register for classes, see your training history and track your progress.

You can also take online Continuing Education classes by going to this website.

2. How do I log in to www.myseiubenefits.org?

Logging into your account is an easy process from the website.

Follow the instructions on Page 8 to log in.

3. How do I get a Student ID?

As a new student you will receive an ID card in the Welcome Packet that is sent to you.

If you do not receive your ID card, please check with your employer to make sure your address is correct. Replacement cards can take up to six weeks to receive. For fastest class check in, bring your student ID card. If you don’t have a student ID card, bring driver’s license, passport, or other legal identification to class.

Refer to the Support chart on Page 28 if you need assistance.

4. How do I change my address with the Training Partnership?

Ensure you are receiving the most current information about your train-ing by updating your contact information with your employer. If you are an Individual Provider, update your information with your primary DSHS contact. If you are an Agency Provider, update your information with your employer.

I have a question about wages for training? Contact your employer or your DSHS case manager. The Training Partnership cannot answer questions regarding wages.

FREQUENTLY ASKED QUESTIONS


5. I arrived to class and I am not on the roster, what do I do?

Only registered students and interpreters can attend Training Partner-ship classes. If you are not on the roster, you will need to reschedule your class.

6. How do I provide feedback about a class?

Your feedback is very important to us and we want to know about your class experience with the Training Partnership. You can complete a course review after attending a class by going to www.myseiubenefits.org.

For more information on submitting feedback, see Page 23.

7. How do I get my training certificate?

You now have access to printing your own certificate at any time. Once you’ve completed all your training requirements, you can log on your record on the Website www.myseiubenefits.org and get your certificate of completion at your convenience.

Refer to the Certificate section on Page 29 if you need assistance.

8. I have a question about wages for training.

Contact your employer or your DSHS contact. The Training Partnership cannot answer questions regarding wages.

POLICIES


‘‘ The class on mental health really helped me understand the issue better

and gave me tools. I feel more prepared to help my client with mental

health issues now.

– Marcos, Training Partnership Student


At the Training Partner-

ship we know you have

taken your valuable time

to come to class. To sup-

port each other and en-

sure everyone can get the

most out of each class,

we have created the

following polices in order

to create a successful

learning environment.

Class Registration• Students need to be registered for class and on the class roster in

order to take a class.

• If you have not previously registered for a class, you will not be able to take the class.

• If you are not on the class roster, you will not get credit for the class.

Only Registered Students and Interpreters are Allowed in Class• The only people allowed in class are registered students and

registered interpreters.

• Students may not bring consumers, children, or any other visitors to class.

Classes Start On Time• If you arrive to class after the start time, you will be considered late,

you will need to reschedule your class.

• You should arrive to class 15 minutes before the start time to

avoid being late.

Bring Picture ID• Students are expected to show valid picture ID to sign in for class.

• You should bring your Training Partnership ID if you have one.

CLASSROOM POLICIES


Student Participation• Students are expected to fully participate in the learning experience.

• Personal phone calls or other personal matters should be taken care of during breaks.

Class Cancellation• A student will need to cancel class registration at least 72 hours in

advance of the class time.

• If the Training Partnership has to cancel a class, a notification of the class cancellation will be sent to you based on the communication preference in your online profile. The Training Partnership will work with you to reschedule the class.

No Shows• Cancelling late or not attending class results in a no show. After two

no shows, you will have to pay a $25 no-show fee to access training.

Appeals Process• If you wish to appeal the $25 “no show” fee because you believe

you had a good reason for not attending the class you must file an appeal.

• The appeal must be filed on an appeal form that is available at www.myseiubenefits.org.

Inclement Weather• If the Training Partnership has to cancel a class due to inclement

weather, a notification of the class cancellation will be sent based on the communication preference in your profile. The Training Partner-ship will work with you to reschedule the class.

POLICIES

CLASSROOM POLICIES


Policy on Reasonable Accommodation of Students with DisabilitiesThe SEIU Healthcare NW Training

Partnership (“Training Partnership”)

admits students regardless of race,

color, national origin, ethnic origin,

gender, age, disability and sexual ori-

entation to all the rights, privileges,

programs, and activities gener-

ally accorded or made available to

students by the Training Partnership.

It does not discriminate on the basis

of race, color, national origin, ethnic

origin, gender, age, disability and

sexual orientation in administration

of its training and educational poli-

cies, admissions policies, scholar-

ship and loan programs, and other

Training Partnership administered

programs.

Students with disabilities have the

right to request and receive reason-

able accommodation so that students may have the opportunity to take full

advantage of the Training Partnership’s programs and activities.

When is a person regarded as having a disability?For purposes of accommodation, a person is regarded as having a disability if

he or she has a sensory, mental, or physical impairment that is medically cog-

nizable or diagnosable or exists as a record or history or is perceived to exist.

What is Reasonable Accommodation?Reasonable accommodation means modifying or adjusting practices, proce-

dures, policies, educational services and delivery, or the training environment

so that a student with a disability can enjoy equal educational opportunity, so

long as (1) there is sufficient medical evidence establishing a relationship be-

tween the disability and the need addressed by the specific accommodation;

and (2) it does not impose an undue hardship on the Training Partnership.

REASONABLE ACCOMMODATION POLICY

What is Reasonable Accommodation?Reasonable accommodation means modifying or adjust-ing practices, procedures, policies, educational services and delivery, or the training environment so that a student with a disability can enjoy equal educational opportu-nity, so long as (1) there is sufficient medical evidence establishing a relationship between the disability and the need addressed by the specific accommodation; and (2) it does not impose an un-due hardship on the Training Partnership.


What is Undue Hardship?Undue hardship means, among other things, an excessively costly, extensive,

substantial or disruptive modification or one that would fundamentally alter the

nature or operations of the Training Partnership or its programs.

Overview of Accommodation ProcessTo request reasonable accommodation, a student with a disability should re-

quest accommodation from the Training Partnership by completing the “ADA

Request Form” found at www.myseiubenefits.org/ADA_policy or by calling

the Member Resource Center. Once the request is received by the Training

Partnership, the Accommodation process will start, during which the student

will be asked to provide current documentation of his or her disability, the

functional limitations resulting from the disability and recommendations for

specific accommodations.

As part of the Accommodation process, the Training Partnership will confer

with the student to identify appropriate and reasonable accommodations that

may be warranted under the particular circumstances.

The Training Partnership has the right to establish qualifications and other

essential standards and requirements for its courses, programs, activities and

services. All students are expected to meet these essential qualifications, stan-

dards, and requirements with or without reasonable accommodations.

More detailed information on the Accommodation process can be found at

www.myseiubenefits.org/ADA_policy.

REASONABLE ACCOMMODATION POLICYPO

LICIES

36 MYSEIUBENEFITS.ORGHEAL

TH B

ENEF

ITS


AFFORDABLE HEALTH BENEFITS FOR YOUFor eligible Individual Providers and Agency Providers, the

Health Benefits Trust is a nonprofit organization providing affordable health

coverage focused on keeping you healthy. The health care benefits offered by

the Health Benefits Trust are part of a community of care that starts with the

wellness of you, the Home Care Aide.

2012-2013 Benefits PlanThe Health Benefits Trust designed the 2012-2013 benefits, which took effect

on Aug. 1, 2012, to fulfill the following goals:

• Lower out-of-pocket costs for Home Care Aides

• Emphasis on preventive care to encourage wellness

• Increased participation in health risk assessments

• Higher use of urgent care facilities in urgent situations that don’t

require emergency-room care

• Encouraging convenient, lower-cost prescriptions through mail order

• Making mail prescriptions for some chronic conditions free

• Encouraging use of in-network providers

The 2012-2013 benefits plan accomplishes those goals and allows for the continuation of affordable, quality benefits for all eligible Home Care Aides. You may be eligible if you worked 86 hours in each of the previous three months. Your coverage will begin the first of the second month after you be-come eligible and enroll. For example, if you begin work in January and work more than 86 hours in January, February and March, you will be come eligible to enroll in April and your coverage will start on May 1. Once enrolled in health coverage, your coverage will continue as long as you work at least 86 hours every month and pay your monthly co-premium.

How to Enrolln Individual Providers: You can enroll by logging in to

www.myseiubenefits.org and by filling out the enrollment form.

Call the Member Resource Center toll-free at 1-866-371-3200 to get answers

to your questions about eligibility for benefits.

n Agency Providers: Contact your employer for assistance and enrollment

information.

HEALTH BENEFITS BASICS


PARTICIPATING EMPLOYERSWashington employers whose employees are eligible for benefits through the Health Ben-

efits Trust. NOTE: This list may change, check with your employer to verify participation.

AAA Residential ServicesAddus HealthcareAmicable HealthcareCatholic Community Services (Agency Provider)CDMChesterfield HealthcareConcerned CitizensFull LifeHome Care Services of Montana

KWALower Columbia CACOlympic CAPCoastal CAPResCareSenior Life Resources NorthwestState of Washington (employer of record)

Visiting Nurse Home Care

ELIGIBILITY AND ENROLLMENTHow many hours do I have to work for continuing coverage?

After your coverage begins, you must work at least 86 hours each month to have continuous coverage.

How do I enroll?

Individual Provider: Log on to www.myseiubenefits.org to complete enrollment or call the Member Resource Center at 1-866-371-3200.

Agency Provider: Contact your employer to coordinate your enrollment.


BENEFITS BASICSHome Care Aides get the following comprehensive benefits through

the Health Benefits Trust:

MedicalNobody ever plans to get sick, but the Health Benefits Trust has you covered.

Depending on where you live, your medical, vision and prescription drug

coverage will be provided by Group Health or Kaiser Permanente. You pay very

little out-of-pocket for the following services:

• Doctor office visits

• In-patient hospitalization

• X-rays and diagnostic imaging

• Laboratory services

• Mental health

• Hearing exams

• Chiropractor visits

• Acupuncture

• Mammograms

• Allergy shots and other injections

• Routine immunizations

• Rehabilitative therapies

• Maternity services

Vision• Routine exams

• Hardware, such as glasses and contacts Prescription Drugs• Generic drugs

• Brand-name drugs DentalThe Health Benefits Trust helps with routine dental care as well as dental

emergencies. Dental benefits are provided by Delta Dental and Willamette

Dental.

Preventive care: There is no annual

deductible for preventive proce-

dures. Covered procedures include

check-ups, cleanings and X-rays.

Basic procedures: Covered proce-

dures include fillings, oral surgery,

periodontics (gum disease) and

endodontics (root canals).

Major procedures: Covered procedures

include crowns, dentures and bridges.

HOW MUCH DOES IT COST? The Health Benefits Trust works hard to keep your out-of-pocket costs low. You pay $25 per month toward the premium for medical/prescription/vision and dental coverage. You cannot enroll for only medical or only dental coverage.



2012-2013 Medical Plan Highlights • Prescriptions for some value-based drugs will be free using

mail order services• Office visit co-pay will change from $10 to $15• Prescription/Rx co-pays will be cheaper (except for non-

formulary brand name drugs)• Self-Insured Dental network will change to Delta Dental

(Washington Dental Service) • All changes are effective 8/1/2012• Your $25 monthly payroll deduction will stay at $25

Your Current Insurance Plan

If you are currently enrolled in the Trust, you are enrolled in one of the follow-ing plans depending on your ZIP code:

Group Health POS – you live within 30 miles of a Group Health Medical Center or contracted facility

Group Health PPO – you live more than 30 miles from Group Health Medical Center or contracted facility

kaiser Permanente HMO – you live within the Kaiser Permanente service area (southwest Washington/ Portland, OR only)

If You Enroll for Coverage Effective 8/1/12 or Later

If you enroll for coverage effective 8/1/12 or later and you live within 30 miles of a Group Health Medical Center of contracted facility, you will be covered under Group Health Options Select - HMO Plan. This plan only has coverage in-network. There are no out-of-network benefits.

Monthly Cost Share Unchanged The monthly cost share for Home Care Aides will remain the same at $25 per month.

Understanding Health Insurance TermsCo-payThe amount you will pay at the time of your visit.

DeductibleThe amount that you pay for covered services before the plan begins paying in a given year. You need only to satisfy your deduct-ible once in a calendar year.

In-networkYou don’t have to pay as much when you use this group of providers. HMO: You only have coverage in-network.

Out-of-networkA bigger group of providers where you may access care but your out of pocket expenses will be higher than with in-network providers.


A Little More About These Changes

The Office Visit Co-pay will increase from $10 to $15. However, preventive care visits will continue with a $0 co-pay.

Insurance Carrier for Dental

The Trust’s self-insured dental plan will be adminis-tered by Delta Dental (Washington Dental Service) instead of Premera Blue Cross. To receive the highest level of benefits, you should choose a Delta Dental PPO Provider. You also have a choice of dental insurance plans: Delta Dental (Washington Dental Service) or Willamette Dental. There are no changes to the dental benefits for either dental programs.

Group Health: No Cost for Value Based Prescriptions by Mail

The Rx co-pay will be lowered for value based drugs that treat diabetes, high blood pressure, high cholesterol and heart failure. The co-pay will also be lowered for other generic drugs, and formulary brand name drugs. However, if you choose to use brand name drugs that are not a part of Group Health or Kaiser’s formulary, your co-pay will increase to $50.

Use Mail Order for your Prescriptions: You will have the lowest co-pay, or no co-pay, by using mail order prescription drugs.

Health Profile = $25 for youFill out your Health Profile, offered by Group Health Options or the Total Health Assessment, offered by Kaiser Permanente and the Health Benefits Trust will send you a check for $25! Good for your health, good for your wallet.


Rx Co-pay (In-network) for

30 day supply

Current Effective 8/1/12 Effective 8/1/12Mail order

Value Based Drugs*

Group Health $15 $4 $0

Kaiser $15 $5 $10 for 90 day supply

Generic drugs



Formulary brand name drugs



Non-formulary brand name drugs


Kaiser (requires approval)

$30 $50 $100 for 90 day supply

Value Based Drugs are for Diabetes: metformin, glipizide, glyburide, insulin NPH High Cholesterol: simvastatin, lovastatin, pravastatin Heart Failure: carvedilol, metoprolol XL, spironolactone High Blood Pressure: hydrochlorothiazide, chlorthalidone, lisinopril, enalapril, captopril, ramipril, lisinopril/HCTZ, amlodipine, verapamil, diltiazem, metoprololIR, atenolol

PRESCRIPTION/Rx CO-PAY GRID


WHICH PLAN AND NETWORK APPLIES TO ME?

New Plan Group Health Options Select – HMO Plan for members who enroll 8/1/2012

or later

Group Health “Options Select”– POS Planif you have been previously enrolled prior to 8/1/2012 and are re-enrolling:

Group Health “Options”– PPO Plan

Your network is called: “Group Health Options Select”

If you are enrolling effective 8/1/2012 or later, you will be automatically enrolled in this plan if you live within 30 miles of a Group Health Facility or Contracted Provider.

Your network is called: “Group Health Options Select” If you are enrolling effective 8/1/2012 or later, you will be automatically enrolled in this plan if you live within 30 miles of a Group Health Facility or Contracted Provider.

Your in-network is called: “Options Select”

Your in-network is called: “Options”

You will be automatically enrolled in this plan if you live farther than 30 miles from a Group Health Facility or Contracted Provider or live in Montana.

All care is provided at Group Health Medical Centers and from other Group Health contracted providers

No out-of-network coverage is available.

In-Network care is provided at Group Health Medical Centers and from other Group Health contracted providers

Out-of-Network care is provided by First Choice Health Network Providers

The First Choice Health Network has an extensive panel of preferred providers in WA, OR, ID, AK and MT.

In-Network care is provided by Group Health Medical Centers; other Group Health contracted providers; First Choice Health Network Providers and Beech Street Providers

The First Choice Health Network has an extensive panel of preferred providers in WA, OR, ID, AK and MT.

Out-of-Network care is any other licensed provider

Link to look up Group Health Providers http://myseiu.be/imSCSp

Group Health PHARMACY

HMO Plan POS Plan PPO PlanAny Group Health Medical Center or contracted community pharmacy.

In-Network: Any Group Health Medical Center or contracted Community Pharmacy

Out-of-Network: Med Impact Pharmacies

In-Network: Group Health Medical Centers and Med Impact Pharmacies

Out-of-Network: All other pharmacies

KAISER PERMANENTEIf you live in the Kaiser Permanente Service Area (please see FAQ #30) you will be automatically enrolled in this plan. You must access a Kaiser Permanente provider/facility for your care. There is no out-of-network coverage under this plan.

Link to look up Kaiser Permanente Providers http://myseiu.be/mTdBBa

DENTAL PLANSYou have a choice of dental plans, however you would only choose Willamette Dental if you lived near a Willamette Dental Clinic.

Delta Dental (washington Dental Service) PPO Plan willamette Dental In-network: You will have the highest level of coverage by using a Delta Dental PPO dentist. You can find a Delta Dental PPO network dentist by visiting their Web site at www.DeltaDentalWA.com. Click on the Patients tab and then on the Find a Dentist tab at the top of the screen to begin your search. Choose the “Delta Dental PPO” option for participating dentists under the In a Certain Plan or Network. Be sure to check the Delta Dental PPO network.

For dentists outside of Washington state, click on the green “search the national Delta Dental directory” link. This will take you to the national directory.

Coverage for this plan is only offered at Willamette Dental Clinics. You can find the locations of Willamette Dental clinics by visiting www.willamettedental.com. Click on the Locations tab for your state.

PLAN

AND

NET

WOR

K GR

ID


2012-2013 BENEFIT IN-NETWORK OUT-OF-NETWORK POS PLAN ONLY NOTES

Preventive Care Covered In Full

Covered in full up to $300; 80% covered

Mammograms Covered In Full

$500 deduct, 80% Covered

Routine mammograms

Urgent Care

Group Health $15$15 co-pay, deductible and coinsurance apply

Kaiser $30 No out-of-network allowed

Emergency Room $200 co-pay $200 co-pay Waived if admitted

Out-of-Network Deductible

Group Health $0

$500 and services may not be cov-ered depending on your plan

Kaiser $0 Not allowed No out-of-network allowed

MEDICAL PLAN HIGHLIGHTS



Group Health Urgent Care CentersSeven Group Health medical centers have Urgent Care Centers, most with evening, weekend, and holiday hours. Use the Group Health Provider Directory at www.ghc.org to find urgent care providers in other areas. You can also find urgent care locations, hours and wait times from the Group Health iPhone and Android App. Call the Consulting Nurse Line at 1-800-297-6877 for the nearest location.

URGENT CARE SAVES MONEY

$200 vs. $15The out-of-pocket cost for a trip to the emergency room is $200 (waived if you are admitted to the hospital) vs. just $15 for a trip to Urgent Care with Group Health and $30 with Kaiser.


Bellevue Medical Center11511 N.E. 10th St.Bellevue, WA 98004425-502-4120Open 24 hours a day, 7 days a week

Everett Medical Center2930 Maple St.Everett, WA 98201425-261-1660Mon.-Fri. 4:30 pm-8 pm Sat. 9 am - 3:30 pm Sun. 9 am - 12:30 pm

Olympia Medical Center700 Lilly Road N.E. Olympia, WA 98506360-923-7740Mon.-Fri. 8 am-11 pm Weekends 9 am-7 pm

Seattle Capitol Hill201 16th Ave. E.Seattle, WA 98112206-326-3175Open 24 hours a day, 7 days a week

Silverdale Medical Center10452 Silverdale Way NW Silverdale, WA 98383360-307-7300

Mon.-Fri. 3-11 pm Weekends 11 am-7 pm

Spokane Riverfront322 North River DriveSpokane, WA 99201509-324-6464Mon.-Fri. 1-9 p.m. Weekends 9 a.m.-9 p.m.

Tacoma (coming in Fall 2012)209 MLK Jr. Way Tacoma, WA 98405253-596-3300Open 24 hours a day, 7 days a week

Bothell-Northshore11913 N.E. 195th St.Bothell, WA 98011425-489-3100

Burien140 S.W. 146th St.Burien, WA 98166206-901-2400

Federal way 301 S. 320th St.Federal Way, WA 98003253-874-7000

Lynnwood20200 54th Ave. W.Lynnwood, WA 98036425-672-6400

Renton275 Bronson Way N.E.Renton, WA 98056425-235-2800

Seattle-Northgate9800 4th Ave. N.E. Seattle, WA 98115206-302-1200

Saturday Clinics - 9 a.m.-12:30 p.m. In addition to the Centers above, these clinics are for mi-nor injuries or issues that require immedidate attention.



Dental BenefitsHealthy teeth and gums are a critical part of

your overall health. That’s why comprehensive

dental benefits are included in the coverage

you receive through the Health Benefits Trust.

To keep your teeth healthy, your dental

benefits include at no additional cost to you

for in-network services:

• Routine exams

• Regular cleanings

• X-rays

• Gum care

• Fillings

Depending on your plan, some of the cost of the following procedures may

also be covered:

• Crowns, inlays

• Dentures

• Implants

To take the best care of your teeth, gums and overall health, you should see

your dentist every six months for a complete exam and cleaning.

Vision BenefitsKeeping your eyes healthy and regularly updating optical prescriptions are

important to your overall health and well being. Vision benefits through the

Health Benefits Trust are an affordable way to ensure your sight is protected.

•For a $15 co-pay per visit, you receive routine

vision care.

•Every two years you receive $200 worth of optical

supplies, including contact lenses and frames.

Did You Know? The American Dental Association says healthy gums are linked to a healthy heart? Another reason to visit your dentist regularly.


Did You Know? As part of a complete wellness plan, everyone should have regular eye exams, even if you’re not having problems with your vision.

48 MYSEIUBENEFITS.ORGWEL

LNES

S


WELLN

ESS

YOUR WELLNESS Working Together To Keep You HealthyAs a Home Care Aide, you know how important it is to stay healthy. With the

benefits you receive from the Health Benefits Trust, you have excellent health

care, dental and vision benefits at a low cost.

There are three things we can all do to ensure that health care for Home Care

Aides continues for years to come:

• Keep ourselves healthy

• Keep out-of-pocket costs low

• Help control health care costs (for example through limiting use of the emergency room, using mail order, generic prescriptions) so we do not have to pay more next year

Four Steps to Better HealthThere are four key ways you can maximize your benefits for better health:

• Making your first appointment with a Primary Care Provider (and earning $10!)

• Using urgent care vs. the emergency room when appropriate

• Managing prescriptions

• Completing a Health Profile or Assessment (and earning $25!)

Follow the steps below and on the following pages to get started.

URGENT CARE

URGENT CARE

URGENT CARE URGENT CARE

HEALTHYHOmE CARE AIDE

See a Primary Care ProviderFind a doctor, set up your first visit

Earn $10! See P. 50

Health Profile or AssessmentFill out an easy online quiz

Earn $25! See P. 51

Find Urgent Care CentersLocate the centers near you

manage Your PrescriptionsTransfer prescriptions to your provider, use mail order


See a Primary Care Provider1One of the most important things for you to do is to select

a Primary Care Provider and set up your first visit. A strong

relationship with your Primary Care Provider is at the heart of

your care, and helping you stay healthy.

How to Select Your Primary Care Provider

Go Online: Use the provider directory at www.ghc.org or www.kp.org to find a

personal physician who’s a good match for you. or

Call: Group Health Customer Service at 1-888-901-4636

Kaiser Permanente Customer Service at 1-800-813-2000

Make an Initial Primary Care Appointment = Earn $10!

Establishing a relationship with your Primary Care Provider is important to your

health. If you complete a preventive care/wellness visit with your Primary Care

Provider within the first three months of

your coverage effective date, the Health

Benefits Trust will pay you $10. You can

only receive this benefit once.

What’s a Primary Care Provider?

A Primary Care Provider is a family prac-

tice, general practice, internal medicine,

or pediatrics physician who provides most

of a member’s primary care. A PCP helps

coordinate a member’s specialty care.

URGENT CARE

DID YOU KNOW?Your out-of-pocket expenses are much less when you use in-network providers. Assuming you have four office visits this year, your out-of-pocket expenses using a Group Health provider would be $60 vs. $500 or more with an out-of-network provider.


Complete a Health Profile

How Healthy are You?

Filling out an easy health quiz called a Health Profile or

Health Risk Assessment will help you find out!

• What are your daily eating habits?

• How often do you exercise?

• How often do you drink alcohol?

Find out how the answers to questions like these affect your health.

Your Health Profile (Group Health) or Total Health Assessment (Kaiser) are

online quizzes to help you and your doctor take better control of your health.

Filling out a Health Profile is a key step on the path to better health.

Fill out a Health Profile, Earn $25!

Home Care Aides who complete a Group Health Profile or kaiser Permanente Total

Health Assessment will receive a $25 check from the Health Benefits Trust. You

will receive a check within 6–8 weeks of submitting your health profile. You can

also fill out a paper version of the profile by contacting your provider.

2

URGENT CARE

Register for myGroupHealth for members at ghc.orgTo access the Health Profile, you need to upgrade your MyGroupHealth account so you have access to online services. To register, visit www.ghc.org or call Website Customer Service at 1-888-874-1620.

Register for Kaiser Online AccessUsing Kaiser online access, you can fill out your Total Health Assessment. Register at www.kp.org

WELLN

ESS


Locate Closest Urgent Care Center

It is important to locate your Urgent Care Center in

advance because in the event you need urgent care, it is

often a difficult time to look for an Urgent Care Center.

3URGENT CARE

DID YOU KNOW?Urgent Care is a much more affordable option for Home Care Aides through the Health Benefits Trust. The out-of-pocket cost for a trip to the emergency room is $200 (waived if you are admitted to the hospital) vs. just $15 for a trip to Urgent Care with Group Health Options and $30 with kaiser.

Where to Find Urgent CareGROUP HEALTH: Many Group Health medical

clinics have Urgent Care Centers, most with

evening, weekend, and holiday hours. Use

the Provider Directory online to find urgent

care providers in other areas.

Find an Urgent Care Center at www.ghc.org

or call 1-888-901-4636.

kAISER: Find an Urgent Care Center at www.kp.org or call 1-800-813-2000.

URGENT CARE - $15 per visitAllergiesAsthma Attack (Minor)Cold, Flu, FeverCoughDizzinessFracturesNauseaMinor BurnsMinor Cuts/LacerationsSore ThroatSprainsStitches

EMERGENCY ROOM - $200 per visit (waived if admitted)Chest PainCompound Fractures (Bone Visible)High FeverIngestion of PoisonMajor Head InjurySeizuresSevere Asthma AttackSevere BurnsShockUncontrollable Bleeding

When to Use Urgent Care vs. Emergency RoomHere are some examples of when to use urgent care or the emergency room. This is not intended to be a complete list.


Manage Your Prescriptions 4Your prescriptions are a big part of your health benefits.

Make the most of them by managing them wisely.

Transfer PrescriptionsIf you have existing prescriptions, have them transferred to Group Health or Kai-

ser Permanente to receive the best benefit from your coverage.

Mail Order PrescriptionsGetting your prescriptions by mail does not cost any more than the co-pays.

Group Health members get a co-pay discount of up to $5 vs. filling your prescrip-

tion at the pharmacy. Kaiser members can obtain 3 months supply for only 2

co-pays vs. 3 co-pays at the pharmacy.

New Prescription Benefit: Value-Based Prescriptions Free for YouFor some Value-Based prescriptions through Group Health, there is no co-pay

when you have drugs mailed to you through convenient mail order services. See

Page 41 for a list of the prescriptions available for this benefit.

URGENT CARE

How to Transfer Your PrescriptionGroup Health: Go online to www.ghc.org to transfer your prescription or call Customer Service at 1-888-901-4636.

kaiser Permanente: Go online to www.kp.org or call Customer Ser-vice at 1-800-813-2000.

How to Set Up mail Order PrescriptionsGroup Health: After setting up an online account you can order refills online or by phone and have them mailed to you – free of charge.

kaiser Permanente: After setting up an online account you can order refills online and have them mailed to you – free of charge.

WELLN

ESS



Check Your Eligibility for Health Benefits• You must work at least 86 hours per month for three consecutive

months to be eligible for these benefits. You do not need to wait until you are eligible to enroll, you can complete the form after you’re hired.

Enrolln Individual Providers: You can enroll by logging in to www.myseiubenefits.org and filling out the enrollment form.

n Agency Providers: Talk with your employer about enrollment.

Look for Your ID CardAfter you are eligible and enroll you should receive an ID card in the mail. You will need the ID card number to access your benefits. If you do not receive the card by the 10th of the month that your coverage starts, call the MRC at 1-866-371-3200 if you are an Individual Provider or, if you are an Agency Provider, talk with your employer. Look for and write down your nearest Urgent Care Center and keep it with your card for reference.

Fill Out Your Health ProfileThe Health Profile is an online quiz and report to help you manage your health. To help encourage participation, you will receive a check for $25 for filling it out. If you do not have com-puter access, you can fill out the profile in paper format as well.

Make a Primary Care AppointmentUse the online provider directory at www.ghc.org or www.kp.org to find a primary care doctor who’s a good match for you. You will receive $10 for attending a primary care appointment within the first three months of your coverage.

Locate Your Nearest Urgent Care CenterAs soon as possible, you should identify the closest urgent care center to you in case of an emergency. You can find urgent care centers online at www.ghc.org or www.kp.org.

Manage Your PrescriptionsIf you have existing prescriptions, have them transferred to Group Health or Kaiser Permanente. Next, set up mail order prescription refills online to save money and save time.

HEALTH BENEFITS QUICK START

URGENT CARE

URGENT CARE

URGENT CARE

URGENT CARE

URGENT CARE

WELLN

ESS


COVERAGE BASICS1. when I am outside washington state or the United States am I covered by the plan?

Yes, but you must contact the health insurance provider for specific benefits and claim submission procedures at: Group Health 1-888-901-4636 Kaiser 1-800-813-2000 Delta Dental 1-800-554-1907 Willamette (contact the clinic where the services were provided)

2. Can I add dependents to my plan?

n Individual Provider: Dependents are not covered. The Individual Provider benefits do not allow coverage for dependents under this plan.

n Agency Provider: If you are covered by the Health Benefits Trust, you can cover dependents by paying the full premium for them through payroll deduc-tion. Dependents can only be added when they are initially eligible or during the annual open enrollment period. Check with your employer for information.

3. How do I cancel my coverage and the corresponding paycheck deductions?

The request must be made in writing and sent to the Health Benefits Trust via fax or U.S. Mail. Fax to 206-859-2637 or mail to SEIU Healthcare NW Health Benefits Trust PO Box 6, Mukilteo, WA 98275. Requests in writing received before the 15th of the month will stop further payroll deductions.

4. If I haven’t received an ID card, who do I call?

Allow up to 10 days after your coverage begins for processing and mailing your ID cards. After you enroll and are eligible you should receive an ID card in the mail. You will need the ID card number to access your benefits. If you do not re-ceive the card by the 10th of the month that your coverage starts, call the MRC at 1-866-371-3200 if you are an Individual Provider or if you are an Agency Provider, talk with your employer. Look for and write down your nearest Urgent Care Center and keep it with your card for reference.

5. Is dental or vision coverage included with this plan?

Yes. Vision coverage is part of your medical plan administered by your medi-cal health insurance provider – Group Health or Kaiser. You have the choice of dental coverage either through Delta Dental or Willamette.

6. Is there a pre-existing condition waiting period?

No.



ELIGIBILITY7. Can I use authorized, unclaimed hours from a previous month to satisfy my hour requirement in a subsequent month?

No. For the purpose of health care insur-ance eligibility, hours are only applicable to the month in which they are authorized, not when they are claimed or paid.

8. How do I enroll for coverage?

n Individual Provider: Log on to www.myseiubenefits.org to complete enroll-ment or call the Member Resource Center at 1-866-371-3200.

n Agency Provider: Contact your employer to coordinate your enrollment.

9. How many hours do I have to work for continuing coverage?

After your coverage begins, you must work at least 86 hours each month to have continuous coverage.

10. I don’t have enough hours some months resulting in a lapse in coverage, do I have to meet the initial eligibility requirements again?

If you are not covered by the plan for 12 months in a row, you will need to re-qualify for the initial eligibility requirements.

11. I work for a Home Care Agency and I’m also an Individual Provider. If I’m currently enrolled in my agency employer’s plan, can I terminate that coverage and enroll in the Health Benefits Trust as an Individual Provider instead of keeping my agency plan?

Yes, but please keep in mind the initial eligibility requirements when determining your cancellation date. You’ll need to keep your current plan until your coverage as an Individual Provider begins. NOTE: You cannot be covered under both the Health Benefits Trust as an Individual Provider and another employer’s plan.

12. what happens if I work less than 86 hours in a month after I am enrolled in the plan?

For all Grandfathered Agency Providers - (this means you were an Agency Provider and must have had health care coverage by the Trust in the month of September 2011).

Your coverage will terminate the first day of the following month.

FREQUENTLY ASKED QUESTIONSPO

LICIES

HOW DO I ENROLL FOR COVERAGE? n Individual Provider: Log on to www.myseiubenefits.org to complete enrollment or call the Member Resource Center at 1-866-371-3200.



Example: If you work less than 86 hours in May, your health care coverage will end that month and you will NOT have coverage starting June 1st.

For all Individual Providers and all Non-Grandfathered Agency Providers

Your coverage will continue for one month and end the first of day of the second month.

Example: If you work less than 86 hours in May, you WILL have health care coverage in June, but you will NOT have coverage starting July 1st.

If you lose coverage, you may choose to pay the full monthly (COBRA) premium out of pocket. In this case, the Health Benefits Trust will send you a COBRA notice and election form explaining your coverage option and the cost.

13. when can I submit my enrollment form for coverage?

n Individual Provider: You should enroll as soon as you have authorization to work as an Individual Provider.


MISCELLANEOUS14. I am an Individual Provider. what if I report my hours to Social Service Payment System (SSPS) so late that they don’t make the $25 deduction from my check?

You will need to notify the Health Benefits Trust and mail in a check or money order for $25 payable to SEIU Healthcare NW Benefits Trust, PO Box 6, Mukilteo, WA 98275. You will also need to send a copy of your paycheck stub (aka Remittance Advice) and invoice showing you claimed at least 86 hours for that month.

It is very important to report your hours to SSPS in a timely manner to avoid having to make a payment by mail. Your health insurance provider may not be able to verify your eligibility and your coverage will be considered lapsed until we receive your check and supporting documentation.

15. Can I be covered by another plan at the same time that I’m enrolled in the Health Benefits Trust Plan and use it as secondary coverage?

Participants may not have comprehensive health care benefits or insurance through other individual, family, employment-based, military or veterans cover-age or insurance.

16. How do I notify you that my address has changed?

A request for an address change must be made to either your DSHS case worker or to Social Service Payment System (SSPS) directly if you are an Individual Pro-


Is dental or vision coverage included with this plan?


vider. If you are an Agency Provider, contact your employer to make this change.

17. I currently have coverage, but not through the Health Benefits Trust plan. Can I enroll in the Health Benefits Trust plan if my other current coverage terminates?

Yes.

18. I want to change my dental insurance provider, how can I do this?

Typically, this is only allowed during the annual open enrollment period that takes place in July of each year and has an August 1 effective date. If you are an Agency Provider, please contact your employer about open enrollment or other location change options available. If you are an Individual Provider, please call the Member Resource Center toll-free at 1-866-371-3200 about options for changing dental insurance providers.

19. If I cancel my insurance, can I enroll again later?

Yes, but if you have voluntarily cancelled your coverage, you will have to meet the initial eligibility requirements again in order to regain coverage. If you are an Agency provider, you cannot enroll again until the next annual open enrollment.

20. If I have coverage through my spouse, can I cancel that coverage and sign up for the Health Benefits Trust plan?

Yes, but please keep in mind the initial eligibility requirements when determining your cancellation date.

21. what benefit plans are offered by the Health Benefits Trust?

Currently, three insurance providers provide fully insured medical and/or dental coverage and one insurance provider provides self-insured dental coverage. Providers currently include: Group Health, Kaiser Permanente, Delta Dental Self-insured Dental, and Willamette Dental Group. Trust enrollees are automati-cally enrolled in the Group Health coverage unless they reside in the Kaiser Permanente service area (southwest Washington and Portland, OR areas). Trust enrollees have a choice of dental insurance providers.

22. what if I am currently on COBRA through another plan? Can I cancel COBRA and enroll?

Yes. There is a place on the enrollment application to indicate the current plan termination date.


LICIES

IS DENTAL OR VISION COVERAGE INCLUDED WITH THIS PLAN? Yes. Vision coverage is part of your medical plan administered by your medical insurance pro-vider – Group Health or Kaiser. You have the choice of dental coverage either through Delta Dental or Willamette.Is dental or vision

coverage included with this plan?


23. what if I have washington’s Basic Health Plan (BHP) coverage? Can I enroll in this plan?

Only if you cancel your BHP coverage. You cannot have both. There is a place on the Health Benefit Trust’s enrollment application to indicate the termination date of the current coverage.

24. when will my coverage be effective?

n Individual Providers: Call the Member Resource Center at 1-866-371-3200 to determine.

n Agency Providers: Please contact your Human Resources department to coordi-nate your enrollment.


26. what if I don’t want to see any doctors who practice with Group Health Medical Centers?

If you are a new enrollee in the Health Benefits Trust effective 8/1/2012 or later, and you live within 30 miles of a Group Health Medical Center or contracted provider, your health care coverage is only for using Group Health Medical Centers or con-tracted providers. There is no out-of-network coverage.

For all other enrollees, each time you seek health care services, you can choose to use your in-network providers, or not. Your highest level of benefits ($0 deductible) will be found using in-network providers: Group Health Physicians for the POS (Op-tions) plan and First Choice Health Network / Beech Street Network of Providers for the PPO (Options PPO) plan.

You will pay more out of pocket costs by using an out-of-network provider. For ex-ample, you will have a $500 deductible.

27. what does Group Health HMO vs. POS vs. PPO mean?

If you live within 30 miles of a Group Health facility or contracted provider, and your coverage begins 8/1/2012 or later, you will automatically be enrolled in the HMO plan. If you are already enrolled, then your coverage is through the POS Plan.

If you live beyond 30 miles, you will automatically be enrolled in the PPO plan.

In the POS and PPO Plans, you have the choice of in-network or out-of-network providers each time you seek service.

Group Health Specific Questions



LICIES

28. How do I look for a provider available to me through Group Health?

For POS Plan (within 30 miles of Group Health facilities):

On right hand side of www.ghc.org, under “Find a Doctor or Medical Facility” click on “Provider & Facility Directory”; then click on “Doctors and Other Providers”; then under “*Health plan provider network:” choose “Options PPO” or “Options POS” or “Options Select” (for the HMO plan)

For PPO Plan (all others): On right hand side of www.ghc.org, under “Find a Doctor or Medical Facility” click on “Provider & Facility Directory,” click on “Doctors and Other Providers”; then under “*Health plan provider network:” choose Options PPO.

Or call Group Health Customer Service toll free: 1-888-901-4636 • Findingaprovider • Specificbenefitquestions • Complexmedicalcarecasemanagement • Inpatientcarecasemanagement

WHO DO I CONTACT IF I HAVE QUESTIONS ABOUT MY BENEFITS?Contact your insurance provider directly for an explanation of benefits and/or questions you have about claims.

Group Health (POS, POS, HMO) 1-888-901-4636 www.ghc.org

kaiser Permanente 1-800-813-2000 www.kp.org

Delta Dental (Dental) 1-800-554-1907 www.deltadentalwa.com

willamette Dental 1-800-359-6019 www.willamettedental.com

WHO DO I CALL TO ENROLL OR ASK ELIGIBILITY QUESTIONS?n Individual Providers: Contact the Member Resource Center toll-free at 1-866-371-3200.

n Agency Providers: Contact your employer


FREQUENTLY ASKED QUESTIONSKaiser Permanente Specific Questions

30. what is kaiser Permanente’s service area?

If you live in any of the following counties/zip codes, your medical coverage will be provided by Kaiser Permanente’s HMO plan.

Washington counties: Clark, Cowlitz, Lewis 98591 98593 98596, Skamania 98639 98648, Wahkiakum 98612 98647

Oregon counties: Multnomah, Polk, Washington, Yamhill

31. Do I have out-of-network coverage under kaiser Permanente?

No (with the exception of emergency services). To access your comprehensive coverage, you must use a Kaiser Permanente provider/facility.

www.kp.org

Link to find Kaiser Permanente Providers

http://myseiu.be/mTdBBa

32. kaiser Permanente Membership Services

Or call Kaiser Permanente Membership Services toll free: 1-800-813-2000

• Chooseaprimarycareprovider• Specificbenefitquestions• Complexmedicalcarecasemanagement• Inpatientcarecasemanagement• Speaktoanadvicenurse• AskaboutKaiserPermanentefacilitiesacrossthecountry

33. Register for kaiser Online Access where you Can:

• E-mail your doctor’s office• View select test results• Order prescription refills (and have them mailed to you, with free shipping)• Request or cancel routine appointments• Review recent past office visits• See a list of your recent immunizations and allergies• Act for a family member (e-mail your child’s doctor, and more)• Receive a monthly e-newsletterRegister at https://members.kaiserpermanente.org/redirects/register

POLICIES


BENEFIT SUMMARIESThe following pages are benefit summaries, only, and are not intended to replace

the specifics of the individual plan’s Certificate of Coverage, Contract, or Evidence

of Insurance. If there is a contradiction, the Certificate of Coverage, Contract, or

Evidence of Insurance will take precedence.

IF YOU HAVE QUESTIONSIf you have questions about your plan’s coverage,

contact your health insurance provider.

Group Healthwww.ghc.org1-888-901-4636Mon.-Fri., 8 a.m.-5 p.m.

kaiser Permanente1-800-813-2000www.kp.org

Delta Dental 1-800-554-1907 www.deltadentalwa.com

willamette Dental1-800-359-6019www.willamettedental.com


WILLAMETTE DENTAL - Benefit SummariesQuestions?1-800-359-6019

www.willamettedental.com

NOTE: This is a benefit summary only and is not intended to replace the

specifics of the Self-funded Dental Plan Document. If there is a contradiction,

the Plan Document will govern.

IP Plan &Agency Plan


BENEFIT CO-PAYMENT

Annual Maximum No Annual Maximum*

Deductible No Deductible

General Office Visit $15 per Visit

DIAGNOSTIC AND PREVENTIVE SERVICES

Routine and Emergency Exams Covered at 100%

All X-rays Covered at 100%

Teeth Cleaning Covered at 100%

Fluoride Treatment Covered at 100%

Sealants Covered at 100%

Head and Neck Cancer Screening Covered at 100%

Oral Hygiene Instruction Covered at 100%

Periodontal Charting Covered at 100%

Periodontal Evaluation Covered at 100%

RESTORATIVE DENTISTRY

Fillings (Amalgam) Covered at 100%

Stainless Steel Crown Covered at 100%

Porcelain-Metal Crown $250

PROSTHETICS

Complete Upper or Lower Denture $400

Bridge (per Tooth) $250

ENDODONTICS AND PERIODONTICS

Root Canal Therapy – Anterior $85

Root Canal Therapy – Bicuspid $105

Root Canal Therapy – Molar $130

Osseous Surgery (per Quadrant) $150

Root Planing (per Quadrant) $75

ORAL SURGERY

Routine Extraction (Single Tooth) Covered at 100%

Surgical Extraction $100

ORTHODONTIA

Pre-Orthodontic Service $150**

Comprehensive Orthodontia Value Added Services Available

MISCELLANEOUS

Local Anesthesia (Novocain) Covered at 100%

Dental Lab Fees Covered at 100%

Nitrous Oxide $40 per Visit

Specialty Office Visit $30 per Visit

Emergency Office Visit $50 per Visit

Out of Area Emergency Care Reimbursement up to $250*TMJ has a $1000 annual maximum / $5000 lifetime maximum

IP Plan &Agency Plan

**Fee credited towards

comprehensive orthodontic

co-payment if patient accepts treatment plan.

Form No. 015-WA (4/08) Contract No. 001-WA (4/06)


This is a summary of the most frequently asked-about benefits. This chart does not explain benefits, cost sharing, out-of-pocket maximums, exclusions, or limitations, nor does it list all benefits and cost sharing. For a complete explana-

tion, please refer to the applicable EOC, or to the Disclosure Form for California, or to the Member Handbook for Hawaii.

Delta Dental – In Service Area

Group NameDelta Dental PPO - Program # 00018

Effective August 1, 2012

Washington Dental Service - Delta DentalPO Box 75983 Seattle, WA 98175-0983

Customer Service (206) 522-1300

Toll-free (800) 554-1907

Monday – Friday 8 a.m. to 5 p.m PST

NOTE: This is a brief summary of benefits only and does not constitute a contract. You will

receive a benefits booklet that completely details your Delta Dental PPO dental benefits.

Please feel free to call our Customer Service Department if you have any questions.


PAYMENT LEVELS

Members utilizing “Delta Dental PPO”

Dentists

Members utilizing “Non-PPO Dentists”

Class I - Diagnostic & PreventiveExams, cleanings, x-rays, sealants,

fluoride treatment100% 80%

Class II - BasicFillings, periodontal maintenance,

periodontics, endodontics, oral surgery

100% 60%

Class III – Major Crowns, onlays, dentures, partials,

bridges, implants80% 40%

Maximum per Benefit PeriodBenefit period: January 1 –

December 31$1,000 $1,000

Deductible – waived on Class IPer person per benefit period

$0 $50

Benefit Summary

Highlights of Covered BenefitsCLASS I – DIAGNOSTIC & PREvENTIvE

• Exams (covered twice in a benefit period)

• Regular Cleanings (covered twice in a benefit period or up to four times for patients

with advanced periodontal disease)

• Bitewing X-rays (covered once in a benefit period)

CLASS II - BASIC

• Fillings (covered on the same surface per tooth once every two years)

• Oral Surgery & Simple Extractions

• Periodontics

• Periodontal Cleanings (covered twice in a benefit period or up to four times for patients


• Endodontics (root canals covered once per tooth in a two year period)

CLASS III - mAJOR

• Crowns (covered once in a seven year period per tooth)

• Dentures (covered once in a seven year period per tooth)

• Bridges (covered once in a seven year period per tooth)

• Onlays (covered once in a seven year period per tooth)


This is a summary of the most frequently asked-about benefits. This chart does not explain benefits, cost sharing, out-of-pocket maximums, exclusions, or limitations, nor does it list all benefits and cost sharing. For a complete explana-

tion, please refer to the applicable EOC, or to the Disclosure Form for California, or to the Member Handbook for Hawaii.

Delta Dental - Out of Service Area

Group NameDelta Dental PPO - Program # 00018

Effective August 1, 2012

Washington Dental Service/Delta DentalPO Box 75983 Seattle, WA 98175-0983

Customer Service (206) 522-1300

Toll-free (800) 554-1907

Monday – Friday 8 a.m. to 5 p.m PST

NOTE: This is a brief summary of benefits only and does not constitute a contract. You will

receive a benefits booklet that completely details your Delta Dental PPO dental benefits.

Please feel free to call our Customer Service Department if you have any questions.


PAYMENT LEVELS

Members utilizing “Delta Dental PPO”

Dentists

Members utilizing “Non-PPO Dentists”

Class I - Diagnostic & PreventiveExams, cleanings, x-rays, sealants,

fluoride treatment100% 100%

Class II - BasicFillings, periodontal maintenance,

periodontics, endodontics, oral surgery

100% 80%

Class III – Major Crowns, onlays, dentures, partials,

bridges, implants80% 50%

Maximum per Benefit PeriodBenefit period: January 1 –

December 31$1,000 $1,000

Deductible – waived on Class IPer person per benefit period

$0 $50

Benefit Summary

Highlights of Covered BenefitsCLASS I – DIAGNOSTIC & PREvENTIvE

• Exams (covered twice in a benefit period)

• Regular Cleanings (covered twice in a benefit period or up to four times for patients


• Bitewing X-rays (covered once in a benefit period)

CLASS II - BASIC

• Fillings (covered on the same surface per tooth once every two years)

• Oral Surgery & Simple Extractions

• Periodontics

• Periodontal Cleanings (covered twice in a benefit period or up to four times for patients


• Endodontics (root canals covered once per tooth in a two year period)

CLASS III - mAJOR

• Crowns (covered once in a seven year period per tooth)

• Dentures (covered once in a seven year period per tooth)

• Bridges (covered once in a seven year period per tooth)

• Onlays (covered once in a seven year period per tooth)


How to use your Delta Dental PPO programThe dental plan offered to your group is Delta Dental PPO, a preferred provider plan.

You can choose any dentist – in or out of the PPO network – at the time of treatment.

However, if you select a dentist who is part of the Delta Dental PPO network, you will

receive a higher level of benefits and your out-of-pocket expenses may be lower.

Washington Dental Service/Delta Dental in Seattle, Washington, will handle all customer

service and claims for your plan. Until you receive your identification card(s), tell your

dentist you are covered by Washington Dental Service/Delta Dental and give him or her

your employer name and the program number.

Delta Dental PPO dentistsYou will receive a higher level of benefits by choosing a Delta Dental PPO dentist. Delta

Dental PPO dentists complete claim forms and submit them directly to Washington

Dental Service/Delta Dental. PPO dentists receive payment based on their lower,

pre-approved PPO fees and they cannot charge you more than these fees. You are

responsible only for your stated deductible, coinsurance and/or amounts in excess of

the program maximums. You can find a Delta Dental PPO dentist in your area by visiting

their web site at www.DeltaDentalWA.com. Go to “Looking for a Dentist” and click on

“Find a Dentist.” This will bring you to our online dentist directory. For dentists outside

of Washington state, click on the green “search the national Delta Dental directory” link

under the Mileage section. Be sure to select the Delta Dental PPO plan and follow the

prompts.

Non-PPO dentists You are not limited to visiting a Delta Dental PPO dentist. By choosing a non-PPO dentist,

your benefits will be paid at a lower benefit level. You may also be responsible for having

the dentist complete and sign claim forms. Claim payments to Delta Dental Premier

dentists will be based off their maximum allowable fee with Delta Dental. They cannot

charge you above these allowable fees. Claim payment for nonparticipating dentists will

be based on Delta Dental’s maximum allowable fees for nonparticipating dentists in the

state in which services are performed. You will be responsible for any balance remaining.

Please be aware that Delta Dental has no control over nonparticipating dentists’ charges

or billing procedures.

Please Note: This is a brief summary of benefits only and does not constitute a contract. You will receive a benefits booklet that completely details your Delta Dental PPO dental benefits. Please feel free to call our Customer Service Department if you have any questions.


Kaiser Medical Plan B - Individual and Agency Providers

Summary of Medical Benefits

Washington Traditional Plan B Individual and Agency ProvidersAugust 1, 2012 through July 31, 2013

All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest.

500 NE Multnomah St., Suite 100, Portland, OR 97232

Questions? Call Membership Services (M-F, 8 am-6 pm) or visit kp.org

Portland area: 503-813-2000

All other areas: 1-800-813-2000

TTY: 1-800-735-2900

Language Interpretation Services, all areas: 1-800-324-8010

NOTE: This is not a contract. This benefit summary does not fully describe your

benefit coverage with Kaiser Foundation Health Plan of the Northwest. For more

details on your benefit coverage, claims review, and adjudication procedures,

please see your Evidence of Coverage (EOC) or call Membership Services. In the

case of conflict between this summary and the EOC, the EOC will prevail.


Kaiser Plan B - Individual and Agency ProvidersOut-of-pocket Maximum (Not all services apply to the maximum; refer to your Evidence of Coverage for clarification.) You pay

For one Member $750 per calendar year

For an entire Family (AP workers Only) $2,250 per calendar year

Preventive Care Services You pay

Prenatal care and first postpartum visit $0

Immunizations $0

Preventive tests $0

Outpatient Services

Primary care visit $15

Specialty care visit $15

Routine eye exam $10

Allergy shots and other injections $5

Urgent Care visit $30

Emergency department visit $200 (Waived if admitted)

Outpatient surgery visit $50

Physician-referred acupuncture and naturopathy visit $15

Spinal and Extremity Manipulation therapy

(after 12 visits, prior authorization needed) $15

Inpatient Hospital Services$100 per admission

Ambulance Services $75 per transport

Chemical Dependency Services

Outpatient Services $15

Inpatient hospital & residential Services $100 per admission

Mental Health Services



Outpatient Durable Medical Equipment (DME), External Prosthetic Devices, and Orthotic Devices

20% Coinsurance

Outpatient Laboratory, X-ray, Imaging, and Special Diagnostic Procedures

$0 per department visit; $50 for specialized scans, i.e., MRI, CT, PET

Outpatient Rehabilitative Therapy Services (up to 20 visits per therapy per Calendar Year)

Physical, Speech, and Occupational therapies $15

All other therapies $15

(Not all services apply to the maximum; refer to your Evidence of Coverage forclarification.)


Out-of-pocket Maximum (Not all services apply to the maximum; refer to your Evidence of Coverage for clarification.) You pay

For one Member $750 per calendar year

For an entire Family (AP workers Only) $2,250 per calendar year

Preventive Care Services You pay

Prenatal care and first postpartum visit $0

Immunizations $0

Preventive tests $0

Outpatient Services

Primary care visit $15

Specialty care visit $15

Routine eye exam $10

Allergy shots and other injections $5

Urgent Care visit $30

Emergency department visit $200 (Waived if admitted)

Outpatient surgery visit $50

Physician-referred acupuncture and naturopathy visit $15

Spinal and Extremity Manipulation therapy

(after 12 visits, prior authorization needed) $15

Inpatient Hospital Services$100 per admission

Ambulance Services $75 per transport

Chemical Dependency Services



Mental Health Services



Outpatient Durable Medical Equipment (DME), External Prosthetic Devices, and Orthotic Devices

20% Coinsurance

Outpatient Laboratory, X-ray, Imaging, and Special Diagnostic Procedures

$0 per department visit; $50 for specialized scans, i.e., MRI, CT, PET

Outpatient Rehabilitative Therapy Services (up to 20 visits per therapy per Calendar Year)

Physical, Speech, and Occupational therapies $15

All other therapies $15

Skilled Nursing Facility Services

(up to 100 days per Calendar Year) $0

Optional Benefits

Alternative Care (self-referred) Not covered

Hearing Aids Not covered

Outpatient Prescription Drugs, Supplies, and Supplements

$5 generic/$25 brand/$50 approved nonformulary brand & generic up to 30-day supply; up to 90-day supply of maintenance drugs for two Co-payments when you use mail delivery.

Vision Hardware Optical Services Balance after $200 allowance every 24 months

Travel Services Not covered

Exclusions and Limitations

The Services listed below are either completely excluded from coverage or partially limited. This applies to all Services that would otherwise be covered and is in addition to the exclusions and limitations that apply only to a particular Service as listed in the description of that Service in your Evidence of Coverage, to be provided after you enroll for coverage.

Certain exams and Services; Cosmetic Services; Custodial Services; Dental Services. Except when Medically Necessary for Members who have a medical condition that would place undue risk if performed in a dental office. The procedure must be approved.; Designated blood donations; Detained or confined members; Employer responsibility; Experimental or investigational Services; Eye surgery; Family Services. Services provided by a member of your immediate family.; Genetic testing; Government agency responsibility; Hearing aids. Unless the Hearing Aid rider has been purchased.; Hypnotherapy; Non-medically Necessary Services; Nonreusable medical supplies; Outpatient Prescription Drugs. Unless the Outpatient Prescription Drug rider has been purchased. Kaiser Permanente formulary applies. We cover non-formulary drugs only when you meet exception criteria unless specifically covered by your prescription drug plan.; Services related to a non-covered Service; Sexual reassignment surgery; Supportive care and other Services; Travel and lodging. Limited to: (a) Medically Necessary “Ambulance Services” in this Summary, and (b) certain expenses that we preauthorize.; Travel Services. All travel-related Services including travel-only immunizations (such as yellow fever, typhoid, and Japanese encephalitis), unless the Travel Services rider has been purchased.; vision hardware optical Services. Unless the Vision Hardware Optical Services rider has been purchased.; vision therapy and orthoptics or eye exercises; Professional Services for fitting and follow-up care for contact lenses; Low-vision aids.

This is not a contract. This benefit summary does not fully describe your benefit coverage with Kaiser Foundation Health Plan of the Northwest. For more details on your benefit coverage, claims review, and adjudication procedures, please see your Evidence of Coverage (EOC) or call Membership Services. In the case of conflict between this summary and the EOC, the EOC will prevail.


Group Health Options - Plan B HMO Individual and Agency Providers

Summary of Medical Benefits Group Number: 1363700 - IP HmO

Group Number: 1363800 - AP HmO

Effective Date: 8/1/2012

Health Plan: Options Select

Ref: RQ-58241

This is a brief summary of benefits. THIS IS NOT A CONTRACT OR CERTIFICATE

OF COVERAGE. All benefit descriptions, including alternative care, are for

medically necessary services. The Member will be charged the lesser of the cost

share for the covered service or the actual charge for that service. For full coverage

provisions, including limitations, please refer to your certificate of coverage.

In accordance with the Patient Protection and Affordable Care Act of 2010,

• The lifetime maximum on the dollar value of covered essential health benefits

no longer applies. Members whose coverage ended by reason of reaching a

lifetime limit under this plan are eligible to enroll in this plan, and

• Dependent children who are under the age of twenty-six (26) are eligible to

enroll in this plan.


Benefits Inside Network

Plan deductible No annual deductible

Individual deductible carryover Not applicable

Plan coinsurance No plan coinsurance

Out-of-pocket limit

Individual out-of-pocket limit: $1,000 per calendar year

Family out-of-pocket limit (AP workers Only): $2,000 per calendar year

Out-of-pocket expenses for the following covered services are included in the out-of-pocket limit: Inpatient services, outpatient services, emergency services at a Managed Health Care Network (MHCN) or non-MHCN facility and ambulance services.

Pre-existing condition (PEC) waiting period No PEC

Lifetime maximum Unlimited

Outpatient services (Office visits) $15 co-pay

Hospital servicesInpatient services: $100 co-pay, per day for up to 5 days per admit

Outpatient surgery: $50 co-pay

Prescription drugs(some injectable drugs may be

covered under Outpatient services)

Value based/formulary generic/formulary brand $4/$8/$25 co-pay per 30 day supply

Prescription mail order $5 discount per 30 day supply

AcupunctureCovered up to 8 visits per medical diagnosis per calendar year without prior authorization; additional visits when approved by the plan

$15 co-pay

Ambulance services Plan pays 80%, you pay 20%

Chemical dependencyInpatient: $100 co-pay, per day for up to 5 days per admit

Outpatient: $15 co-pay

Devices, equipment and suppliesDurable medical equipmentOrthopedic appliancesPost- mastectomy bras limited

to two (2) every six (6) months

Ostomy suppliesProsthetic devices

Covered at 50%

Diabetic supplies

Insulin, needles, syringes and lancets-see Prescription drugs. External insulin pumps, blood glucose monitors, testing reagents and supplies-see Devices, equipment and supplies. When Devices, equipment and supplies or Prescription drugs are covered and have benefit limits, diabetic supplies are not subject to these limits.

Diagnostic lab and X-ray services

Inpatient: Covered under Hospital services

Outpatient: Covered in full. MRI/PET/CT - $50 co-pay

High end radiology imaging services such as CT, MR and PET must be determined Medically Necessary and require prior authorization except when associated with Emergency care or inpatient services.

Emergency services(co-pay waived if admitted)

$200 co-pay at a designated facility

$200 co-pay at a non designated facility

Hearing exams (routine) $15 co-pay

Group Health Plan B HMO - Individual and Agency Providers


Hearing hardware Not covered

Home health services Covered in full. No visit limit.

Hospice services Covered in full

Infertility services Not covered

Manipulative therapyCovered up to 10 visits per calendar year without prior authorization

$15 co-pay

Massage services See Rehabilitation services

Maternity servicesInpatient: $100 co-pay, per day for up to 5 days per admit

Outpatient: $15 co-pay. Routine care not subject to outpatient services co-pay.

Mental HealthInpatient: $100 co-pay, per day for up to 5 days per admit


NaturopathyCovered up to 3 visits per medical diagnosis per calendar year without prior authorization; additional visits when approved by plan

$15 co-pay

Newborn ServicesInitial hospital stay: See Hospital Services; Office visits: See Outpatient Services; Routine well care: See Preventive care. Any applicable cost share for newborn services is separate from that of the mother.

Obesity-related surgery (bariatric) Not covered

Organ transplantsDonor search & harvest applies

to lifetime max

Unlimited, no waiting period

Inpatient: $100 co-pay, per day for up to 5 days per admit


Preventive care Well-care physicals,

immunizations, Pap smear exams, mammograms

Covered in full

Women's preventive care services (including contraceptive drugs and devices and sterilization) are covered in full.

Rehabilitation services(Occupational, speech,

physical including services for neurodevelopmentally disabled children age six and under)

Rehabilitation visits are a total of combined therapy visits per calendar year

Inpatient: 60 days per calendar year $100 co-pay, per day for up to 5 days per admit

Outpatient: 60 visits per calendar year $15 co-pay

Skilled nursing facility Covered in full up to 60 days per calendar year

Sterilization (vasectomy, tubal ligation)



Women's sterilization procedures are covered in full.

Temporomandibular Joint (TMJ) services

$1,000 per calendar year; $5,000 lifetime max



Tobacco cessation counseling Quit for Life Program - covered in full

Routine vision care(1 visit every 12 months)

$15 co-pay

Optical hardwareLenses, including contact lenses

and frames$200 per 24 months


Group Health Options Plan B POS Group Health Options Plan B PPO Individual and Agency Providers

Summary of Medical BenefitsGroup Number: 6356700 - IP POS

Group Number: 6356800 - IP PPO

Group Number: 6356200 - AGENCY POS

Group Number: 6356300 - AGENCY PPO

Effective Date: 8/1/2012

Health Plan Options

Ref: RQ-58241

This is a brief summary of benefits. THIS IS NOT A CONTRACT OR

CERTIFICATE OF COVERAGE. All benefit descriptions, including alternative care,

are for medically necessary services. The Member will be charged the lesser of

the cost share for the covered service or the actual charge for that service. For

full coverage provisions, including limitations, please refer to your certificate of

coverage.

In accordance with the Patient Protection and Affordable Care Act of 2010,

• The lifetime maximum on the dollar value of covered essential health benefits

no longer applies. Members whose coverage ended by reason of reaching a

lifetime limit under this plan are eligible to enroll in this plan, and

• Dependent children who are under the age of twenty-six (26) are eligible to

enroll in this plan.


Benefits Inside Network Outside Network

Plan deductible No annual deductible

Individual deductible: $500 per calendar year

Family deductible (AP workers only): $1,000 per calendar year

Individual deductible carryover Not applicable 4th quarter carryover applies

Plan coinsurance No plan coinsurance Plan pays 80%, you pay 20% of the Usual, Customary and Reasonable (UCR) charges.

Out-of-pocket limit


Family out-of-pocket limit (AP workers only): $2,000 per calendar year

Out-of-pocket expenses for the following covered services are included in the out-of-pocket limit:

Inpatient services, outpatient services, emergency services at a Managed Health Care Network (MHCN) facility and ambulance services.


Family out-of-pocket limit (AP workers only): $4,000 per calendar year

Out-of-pocket expenses for the following covered services are included in the out-of-pocket limit:

Plan coinsurance, emergency services at a non-Managed Health Care Network (MHCN) facility.

Pre-existing condition (PEC) waiting period No PEC Same as in-network

Lifetime maximum Unlimited Same as in-network maximum

Outpatient services (Office visits) $15 co-pay

$15 co-pay, deductible and coinsurance apply

Hospital servicesInpatient services: $100 co-pay, per day for up to 5 days per admit

Outpatient surgery: $50 co-pay

Inpatient services: $100 co-pay, per day for up to 5 days per admit

Deductible and coinsurance apply

Outpatient surgery: $50 co-pay, deductible and coinsurance apply

Prescription drugs(some injectable drugs may be covered

under Outpatient services)

Value based/formulary generic/formulary brand/non-formulary $4/$8/$25/$50 co-pay per 30 day supply

Formulary generic/formulary brand/non-formulary $13/$30/$55 co-pay per 30 day supply

Prescription mail order $5 discount per 30 day supply Not covered

Acupuncture

Covered up to 8 visits per medical diagnosis per calendar year without prior authorization; additional visits when approved by the plan

$15 co-pay


Ambulance services Plan pays 80%, you pay 20% Same as in-network

Chemical dependencyInpatient: $100 co-pay, per day for up to 5 days per admit




Outpatient: $15 co-pay, deductible and coinsurance apply

Devices, equipment and supplies Durable medical equipmentOrthopedic appliancesPost-mastectomy bras limited to two (2)

every six (6) monthsOstomy suppliesProsthetic devices

Covered at 50% Covered at 50%, deductible applies

Group Health Options Plan B POS, PPO - Individual and Agency Providers


Diabetic supplies



Diagnostic lab and X-ray services


Outpatient: MRI/PET/CT - $50 co-pay



Outpatient: MRI/PET/CT - $50 co-pay


Emergency services(co-pay waived if admitted)

$200 co-pay $200 co-pay

Hearing exams (routine) $15 co-pay $15 co-pay, deductible and coinsurance apply

Hearing hardware Not covered Not covered

Home health services Covered in full. No visit limit. No visit limit Deductible and coinsurance apply

Hospice services Covered in full Deductible and coinsurance apply

Infertility services Not covered Not covered

Manipulative therapyCovered up to 10 visits per calendar year without prior authorization

$15 co-pay

Visit limits shared with in-network


Massage services See Rehabilitation services See Rehabilitation services

Maternity services


Outpatient: $15 co-pay. Routine care not subject to outpatient services co-pay.



Outpatient: $15 co-pay, deductible and coinsurance apply. Routine care not subject to outpatient services co-pay.

Mental HealthInpatient: $100 co-pay, per day for up to 5 days per admit





Naturopathy

Covered up to 3 visits per medical diagnosis per calendar year without prior authorization; additional visits when approved by plan

$15 co-pay


Newborn Services

Initial hospital stay: See Hospital Services; Office visits: See Outpatient Services; Routine well care: See Preventive care. Any applicable cost share for newborn services is separate from that of the mother.

Initial hospital stay: See Hospital Services; Office visits: See Outpatient Services; Routine well care: See Preventive care. Any applicable cost share for newborn services is separate from that of the mother.


Obesity-related surgery(bariatric)

Not covered Not covered

Organ transplantsDonor search & harvest applies to

lifetime max

Unlimited, no waiting period



Shared with in-network




Preventive careWell-care physicals, immunizations,

Pap smear exams, mammograms

Covered in full

Women’s preventive care services (including contraceptive drugs and devices and sterilization) are covered in full.

$300 per person; $600 per family per calendar year

Coinsurance applies

Women’s preventive care services (including contraceptive drugs and devices and sterilization) are subject to the applicable Preventive Care cost share and benefit maximums.

Routine mammograms: Deductible and coinsurance apply

Rehabilitation services(Occupational, speech, physical

including services for neurodevelopmentally disabled children age six and under)

Rehabilitation visits are a total of combined therapy visits per calendar year

Inpatient: 60 days per calendar year

$100 co-pay, per day for up to 5 days per admit

Outpatient: 60 visits per calendar year

$15 co-pay

Inpatient: Day limits shared with in-network

$100 co-pay, per day for up to 5 days per admit

Deductible and coinsurance apply Outpatient: Visit limits shared with in-network


Skilled nursing facility Covered in full up to 60 days per calendar year

Day limits shared with in-network benefit, deductible and coinsurance apply

Sterilization (vasectomy, tubal ligation)



Women’s sterilization procedures are covered in full.




Women’s sterilization procedures are covered subject to the applicable Preventive Care cost share and benefit maximums.

Temporomandibular Joint (TMJ) services

$1,000 per calendar year; $5,000 lifetime max



Shared with in-network




Tobacco cessation counseling Quit for Life Program - covered in full

Applicable cost shares apply

Routine vision care (1 visit every 12 months) $15 co-pay


Optical hardwareLenses, including contact

lenses and frames$200 per 24 months Shared with in-network


When you have questions or a complaint about health or dental coverage:Call the Customer Service Department of your insurer, or for the Trust’s self-

funded dental plan, Delta Dental:

Group Health

1-800-542-6312

www.ghc.org

kaiser Permanente

1-800-813-2000

www.kp.org

willamette Dental

Oregon: 1-800-461-8994

Washington: 1-800-359-6019

www.willamettedental.com

Self-funded Dental Plan

Claims Administered by

Delta Dental

1-800-547-9515

What if I Have a Health Insurance or Dental Coverage Question or an Appeal?

QUESTIONS & APPEALS


www.deltadentalwa.com

When you have an appeal:An appeal is a request to reconsider a decision to deny, modify, reduce, or

end payment, coverage or authorization of coverage (known as an “adverse

decision”).

The appeal process for each of the Trust’s health and dental plans is different.

You should review the Summary Plan Description of appeals procedures in

your Benefits Summary provided by your insurer or, in the case of the Trust’s

self-funded dental coverage, by Delta Dental. The Summary Plan Description

contains a full explanation of the appeals process.

You may also call the Customer Service Department of your insurer or, in the case

of the Trust’s self-funded dental coverage, Delta Dental, for specific information

about the appeals process. Those numbers are listed on the previous page.

Your rights in an appeal:

• You must submit your appeals within 180 calendar days of the date you

received notice of an “adverse decision.” Keep track of these deadlines

as appeals that are filed late may not be considered.

• You may request an expedited 72-hour review of your appeal when the

adverse determination could jeopardize your life or health.

• You may request all of the documents relevant to your request and the

decision by the insurer or administrator.

• You may submit additional comments, documents or other information to

support your appeal.

More information about how to file an appeal can be found at “How to Appeal

a Health Care Insurance Decision, A Guide for Consumers in Washington

State” on the Office of the Insurance Commissioner’s website,

www.insurance.wa.gov/consumers/health/Appeal/Table-of-Contents.shtml

QUESTIONS & APPEALS


About This Guide

This handbook is intended to be an overview of your benefits and a general

resource. For more detailed information about your health and dental ben-

efits, you should consult the Summary Plan Description (SPD) and Certificate

of Coverage for those benefits. This handbook is not a “Plan document” or

the official SPD. In case of any conflict between this document and any “Plan

document,” the terms of the Plan Document shall govern.

The handbook is not a promise of benefits. All benefits described in the hand-

book are provided pursuant to existing collective bargaining agreements (CBA)

and employer participation agreements with the SEIU Healthcare NW Health

Benefits Trust and Training Partnership. Should the CBA or other agreements

with the Health Benefits Trust and/or Training Partnership terminate, change

or otherwise become ineffective, the benefits described in this book may also

terminate or change.

Equal Opportunity

The SEIU Healthcare NW Training Partnership (“Partnership”) admits students

regardless of race, color, national origin, ethnic origin, gender, age, disability

and sexual orientation to all the rights, privileges, programs, and activities gen-

erally accorded or made available to students by the Training Partnership. It

does not discriminate on the basis of race, color, national origin, ethnic origin,

gender, age, disability and sexual orientation in administration of its training

and educational policies, admissions policies, scholarship and loan programs,

and other Training Partnership administered programs.

NOTICES


GLOSSARYAAA – Area Agency on Aging

ABT – Accelerated Basic Training

ADSA – Aging and Disability Services Administration Department of Department of Social and Health Services serving adults with chronic illnesses or conditions and people with developmental disabilities.

AP – Agency Provider A Home Care Aide who works for an agency – agency provider

ARC – Advocates for the Rights of Citizens with Developmental Disabilities

ARNP – Advanced Registered Nurse Practitioner. Can be a Primary Care Pro-vider.

BHP – Basic Health Plan of Washington

CNA – Certified Nursing Assistant

CE – Continuing Education Supplemental training required for skills development

COBRA – A private-pay insurance that covers you if you have a lapse in cover-age or you are between jobs

cultural competency – An awareness of the customs, beliefs and religious practices of others

DDD – Division of Developmental Disabilities

diagnostic imaging – MRI (Magnetic Resonance Imaging), X-rays, mammograms

DME – Durable Medical Equipment Walkers, crutches, etc.

DSHS – Department of Social and Health Services

HCS – Home Community Services The Home Community Services (HCS) Division of DSHS promotes, plans, develops and provides long-term care services for persons with disabilities and older adults who may need state funds (Medicaid) to help pay for them.

health insurance provider – The company that manages your health insurance, for example Group Health, Kaiser Permanente.


GLOSSARYHealth Risk Assessment or Health Profile – An online health assessment or questionnaire that assesses your general health and wellness through a series of questions

IP – Individual Provider A Home Care Aide that provides care to a consumer living in his or her home and whose employer of record is the Department of Social and Health Services.

LPN – Licensed Practical Nurse

MFOC – Modified Fundamentals of Caregiving

MRC – Member Resource Center

NDC – Nurse Delegated Core

NDD – Nurse Delegation Diabetes

orthopedic appliances – braces, splints, etc.

PCP – Primary Care Provider The doctor or ARNP you choose to oversee your care

POS – Point of Service Insurance pays percentage of doctor visit that is out-of-network

PPO – Preferred Provider Organization A provider who is in-network

RN – Registered Nurse

RNA – Registered Nurse’s Assistant

S&O – Safety and Orientation

TBI – Traumatic Brain Injury

Training wizard – A computer program that assists you in getting started at the Training Partnership www.myseiubenefits.org/wizard

Home Care Aide (HCA) Provide care to a consumer living in his or her home. Employed by a private homecare agency or DSHS.

Agency Provider (AP)Provide care to a consumer living in his or her home. Employed by a private homecare agency.

Certified Home Care Aide

Provide care to a consumer living in his or her home having succesfully passed the DOH certification exam. Employed by a private homecare agency or DSHS.

Individual Provider (IP)Provide care to a consumer living in his or her home. Employer of record is DSHS.

Credentialed Agency Provider

This is an AP with a current healthcare credential as a Registered Nurse (RN), Licensed Practical Nurse (LPN), Nursing Assistant Certified (NAC), Physical Therapist, Occupational Therapist or Medicare-Certified Home Health Aide.

Credentialed Individual Provider

This is an IP with a current healthcare credential as a Registered Nurse (RN), Licensed Practical Nurse (LPN), Nursing Assistant Certified (NAC), Physical Therapist, Occupational Therapist or Medicare-Certified Home Health Aide.


This is an IP who provides care to his/her own adult child and contracted through Home and Community Services (HCS) and/or an Area Agency on Aging (AAA).

Parent DD Individual Provider (DDD)

This is an IP who provides care to his/her own adult child with a developmental disability and is contracted through the Department of Developmental Disabilities (DDD).

Limited Service Provider (HCS/AAA/DDD)

This is any IP who provides care 20 hours a month or less for one consumer.

Adult Child Individual Provider

An adult child providing care for his/her biological, step or adoptive parent.

HOME CARE AIDE CATEGORIES Effective Jan. 7, 2012

The Training Partnership provides training to a variety of Home Care Aides. The chart below describes the different categories of HCAs


TRAINING STANDARDS UPDATED JUNE 2012

ORIEN

TATION

AN

D SA

FETYB

ASIC TRA

ININ

GCO

NTIN

UIN

G

EDU

CATION

Orientation 2 HoursSafety Training 3 Hours

Accelerated Basic Training 30 Hours

Basic Training 70 Hours

Parent Provider (DDD Only) Class 7 Hours

Continuing Education 12 HoursHCA CertificationRequired?

Agency Provider (AP)

Completed prior to

providing careCom

pleted prior to providing care

Not requiredW

ithin 120 days of em

ployment

Not required12 hours/year for the renewal of certification

Yes

Individual Provider (IP)

Completed prior to

providing careCom


Not requiredW


ployment

Not required12 hours/year for the renewal of certification

Yes

Individual Providers or Agency Providers hired before 1/7/2012

Not requiredNot required


Not required

As of 7/1/2012, 12 credits/year by your birthday. Use training wizard at www.m

yseiubenefits.org/wizard or call the M

RC to see your requirement.

No

Credentialed AP (per RCW

18.88B.041)Not required



12 hours/year by their birthday

No

Credentialed IP (per RCW

18.88B.041)Not required



12 hours/year by their birthday

No


Completed prior to

providing careCom


Within 120 days

of employm

entNot required

Not requiredNot required, unless voluntarily certificed as a HCA.

No

Parent DD IP (DDD)Com


Completed prior

to providing careNot required

Not requiredW


ployment

Not required, unless voluntarily certificed as a HCA.

No

Limited Service Provider

Completed prior to

providing careCom


Within 120 days

of employm

entNot required

Not requiredNot required, unless voluntarily certificed as a HCA.

No

Adult Child Individual Provider (HCS/AAA/DDD)

Completed prior to

providing careCom


Within 120 days

of employm

entNot required

Not required12 hours/year by birthday

No


2013-2013 YOUR BENEFITS BOOKA GUIDE TO TRAINING & HEALTH BENEFITS

Featured Inside:• Updated Training Standards and Benefits• Ways to stay healthy, save money and save time• How to take Online Continuing Education

635 Andover Park W. Suite 200, Tukwila, WA 98188

www.MYSEIUBENEFITS.ORG

PRSRT STD US POSTAGE

PAIDPERMIT NO. 1632

SEATTLE WA

TP-HBT-BB-102

SECOND EDITION

STP000GK0BB02ENG

Documents

Training Partnership and Health Benefits Trust 2012-2013 Benefits Book