2018 Open Enrollment Presentation for Open Enrollment presentation for VMware

Transcription

1 2018 Open Enrollment Presentation for 2019 Open Enrollment presentation for VMware Sam Yee, Regional Account Manager November Copyright Copyright Kaiser Foundation Kaiser Foundation Health Health Plan, Inc. Plan, Inc.

2 2019 Open Enrollment Agenda What s new for 2019 Overview of the Deductible HMO plan Tools and Resources 2

3 How is the Kaiser Permanente Deductible HMO Plan different 3

4 WHY CHOOSE KAISER PERMANENTE? Same care and convenience Same great doctors Same personalized attention Same convenient locations Same online tools Same healthy resources Same Medical Record Number (MRN) A different way to pay for your care 4

5 WHY CHOOSE KAISER PERMANENTE? Preventive care at no cost Because finding and treating problems before they get serious is an important part of staying healthy, you get most preventive care at no cost even before you reach your deductible. Preventive care includes: Cancer screenings Cholesterol and high blood pressure screenings Diabetes screenings Immunizations Routine prenatal care Well-child visits 5

6 WHY CHOOSE KAISER PERMANENTE? Convenient care management On kp.org or with the KP app, you can stay on top of your care 24/7 with these convenient features:* Schedule and cancel routine appointments. View most lab results as soon as they are available. Refill most prescriptions with no charge for shipping. your doctor s office with nonurgent questions. Print vaccination records for school, sports, or camp. Manage a family member s health. *Available when you receive care at Kaiser Permanente facilities. 6

7 Key terms 7

8 KEY TERMS Key terms Deductible: The amount you pay for covered services each year before Kaiser Permanente starts paying. You may pay copays for some services without having to reach your deductible. Out-of-pocket maximum: The most you ll pay for covered services each year. For a small number of services, you may need to keep paying copays or coinsurance after reaching your out-of-pocket maximum. Note: Your deductible and out-of-pocket maximum will reset on January 1st. 8

9 KEY TERMS Key terms (continued) Copay: The set amount you pay for covered services for example, a $20 copay for an office visit. Coinsurance: A percentage of the charges that you pay for covered services for example, a 10% coinsurance for a $200 procedure means you pay just $20. 9

10 How your plan works 10

11 PREVENTIVE CARE SERVICES AND DOCTOR S OFFICE VISITS DEDUCTIBLE HMO PLAN How your deductible plan works January 1st December 31st You ll pay full charges for covered services, including emergency, hospital care, X-rays, therapy visits, and lab tests before meeting your plan deductible. After meeting your plan deductible, you ll start paying less for these services a copay or coinsurance until you reach your out-of-pocket maximum. 11

12 YOUR PLAN BENEFITS Family deductibles and out-of-pocket maximums If your family is covered under your plan: Each family member has an individual deductible, and the family as a whole has a deductible. Each family member has an individual out-of-pocket maximum, and the family as a whole has an out-of-pocket maximum. Your individual deductible is $250 Your family deductible is $500. Your individual out-of-pocket maximum is $1,500. Your family out-of-pocket maximum is $3,

13 Your plan benefits 13

14 YOUR PLAN BENEFITS Highlights of this plan s benefits* Deductible: $250 individual / $250 family member / $500 family Out-of-pocket maximum: $1,500 individual / $1,500 family member / $3,000 family Covered service Routine physical exams Primary care office visits Specialty care office visits Lab tests X-ray Outpatient surgery Hospitalization Urgent care visits Emergency Department visits Generic prescription drugs Generic refills through mail order service Brand-name prescription drugs Brand-name refills through mail order service Specialty prescription drugs You pay No charge $20 Copay (Plan Deductible doesn t apply) $30 Copay (Plan Deductible doesn t apply) 10% Coinsurance after Plan Deductible 10% Coinsurance after Plan Deductible 10% Coinsurance after Plan Deductible 10% Coinsurance after Plan Deductible $20 Copay (Plan Deductible doesn t apply) 10% Coinsurance after Plan Deductible $10 Copay for a 30-day supply (Plan Deductible doesn t apply) $20 Copay for up to a 100-day supply (Plan Deductible doesn t apply) $20 Copay for a 30-day supply (Plan Deductible doesn t apply) $40 Copay for up to a 100-day supply (Plan Deductible doesn t apply) $20 Copay for a 30-day supply (Plan Deductible doesn t apply) *This is just a summary of some examples of covered services and their corresponding copay and coinsurance amounts. Please see your Evidence of Coverage for information about coverage, limitations, and exclusions for all benefits, including those not listed in this summary. 14

15 Getting care 15

16 GETTING CARE Visit kp.org/deductibleplans Access information and tools to help you better understand and manage your deductible plan coverage and costs. For example, you can: View claims summaries. View and pay medical bills. Use the Estimates tool Sample fee list 16

17 GETTING CARE Before your visit getting an estimate Use our online Estimates tool to: Get an estimate of how much a treatment, procedure, test, or other medical service will cost. Track how close you are to reaching your deductible and out-of-pocket maximum. See how it works kp.org/costestimates/video Call , weekdays from 7 a.m. to 5 p.m. 17

18 GETTING CARE During your visit paying for care When you check in for your visit, you ll be asked to make a payment. You can expect to get a bill later for any remaining amount you owe. 18

19 GETTING CARE After your visit what to expect You ll get an Explanation of Benefits (EOB) statement to help you track the care you ve received and how close you are to reaching your deductible and out-of-pocket maximum. You ll also get a bill if your payment at check-in didn t cover the full cost of the services you received. 19

20 HEALTHY TOGETHER Questions? Call our Member Service Contact Center, 24 hours a day, 7 days a week (closed holidays) English 711 TTY 20

21 Additional Resources 21

22 Kaiser Permanente See how our care and coverage can help you thrive Additional Resources Care and coverage built around you What s integrated care? A simpler, seamless experience in which the health plan and doctors work together for you. You get: Hassle-free health care with less paperwork A care team that s connected to each other and you Many services under one roof 22

23 Kaiser Permanente See how our care and coverage can help you thrive Additional Resources Your care, your way Visit your doctor at your local facility. Meet face-toface with a doctor online.* your doctor s office with nonurgent questions anytime. Save yourself a trip to the doctor s office with a telephone appointment.* Schedule appointments and get 24/7 medical advice by phone. *When appropriate and available. 23

24 Kaiser Permanente See how our care and coverage can help you thrive Additional Resources World-class specialty care No matter what life throws your way, you can count on us. Get access to excellent care from top-notch doctors across a wide range of specialties, including: Maternity care For family planning to first steps and beyond, visit kp.org/maternity Mental health Our members can access mental health services with no referral needed at kp.org/mentalhealth Cardiac care Learn how we re healing hearts and saving lives with advanced cardiac care at kp.org/cardiaccare For more on specialty care, visit thrive.kp.org/healthier-outcomes. 24

25 Kaiser Permanente See how our care and coverage can help you thrive Additional Resources Care away from home If you get hurt or sick while traveling, we ll help you get care. Our plans include emergency and urgent care coverage from qualified providers anywhere in the world. We can also help you before you leave town by checking to see if you need a vaccination, refilling eligible prescriptions, and more. Just call us or go online: 24/7 Away from Home Travel Line: * kp.org/travel *This number can be dialed inside and outside the United States. Before the phone number, dial 001 for landlines and +1 for mobile lines if you re outside the country. Long-distance charges may apply, and we can t accept collect calls. The phone line is closed on major holidays (New Year s Day, Easter, Memorial Day, July Fourth, Labor Day, Thanksgiving, and Christmas). It closes early the day before a holiday at 10 p.m. Pacific time (PT), and it reopens the day after a holiday at 4 a.m. PT. 25

26 Kaiser Permanente See how our care and coverage can help you thrive Additional Resources Healthy resources Wellness Coaching by Phone kp.org/wellnesscoach Healthy Lifestyle programs kp.org/healthylifestyles On-site Health Education Classes and support groups 1 kp.org/classes Online videos, podcasts, recipes, and more kp.org/healthyliving Seasonal Farmers Markets 2 kp.org/farmersmarkets 1 Classes vary at each location and some may require a fee. 2 Not available in all areas. 26

27 Kaiser Permanente See how our care and coverage can help you thrive Additional Resources Northern California 21 medical centers 59 medical offices 2 affiliated plan hospitals 11 affiliated medical offices N Map not to scale 27

28 Kaiser Permanente See how our care and coverage can help you thrive Additional Resources New locations in Northern California Open now Sacramento Downtown Commons Medical Offices San Jose Skyport Medical Offices Santa Cruz Medical Offices Santa Rosa Mercury Way Medical Offices Scotts Valley Medical Offices Watsonville Community Hospital Watsonville Medical Offices Santa Cruz Medical Offices Coming NEW in Spring 2019: Dublin Medical Office and Cancer Center Visit kp.org/locations Scotts Valley Medical Offices 28

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