A BETTER WAY TO TAKE CARE OF BUSINESS SMALL BUSINESS WASHINGTON Compare your plan options

Transcription

1 A BETTER WAY TO TAKE CARE OF BUSINESS SMALL BUSINESS WASHINGTON 2018 Compare your plan options

2 We are different in a very good way Kaiser Permanente combines diverse and reasonably priced plans with a fully integrated health care delivery system. Our providers, pharmacies, and lab services all work together, often under one roof, to provide high-quality, cost-effective care. Our plans encourage your employees to adopt healthier lifestyles, which translates into a healthier workforce, higher productivity, less absenteeism, fewer accidents on the job and savings for you. With a 24 hour Consulting Nurse helpline, care management programs, and convenient online services, we make it easy for members to play an active role in their own health care. Diverse portfolio of products We believe that small employers need the same flexibility and choice as bigger companies, at a reasonable price. We offer Core and Access PPO plans covering all metal levels: Bronze, Silver, Gold, and Platinum. You ll find: Lower premiums A selection of plans Integrated, coordinated care with our HMO plans Preferred provider organization (PPO) plans, with access to regional and national networks that maximize employees flexibility Health savings account (HSA) compatible plans Dental plans, with pediatric and optional adult and family options offered through Delta Dental of Washington Plans that are easy for you to administer, and easy for your employees to use The right plan for your business Follow these three easy steps to customize a health plan that fits your company s size, needs, and budget. Components include a base medical plan and optional adult and family dental benefits Determine whether you ll offer multiple plans To offer up to 3 plans: You must have at least 10 employees. You can offer any combination of Core and Access PPO plans. Groups with 10 to 50 employees must have at least one employee enrolled in each plan. Federal regulations require that groups must have at least one common law employee in order to offer group medical coverage. That means there must be at least one employee on the payroll who is not the owner or the spouse of the owner. Decide on your provider network(s) CORE Offered by Kaiser Foundation Health Plan of Washington Thousands of quality providers and facilities, including: More than 1,000 providers at Kaiser Permanente medical offices* 25 Kaiser Permanente medical offices and pharmacies* More than 9,000 additional network providers and facilities* ACCESS PPO Offered by Kaiser Foundation Health Plan of Washington Options, Inc. Hundreds of thousands of providers and facilities nationwide, including: Kaiser Permanente medical offices and pharmacies Most providers and designated pharmacies in our service area, including UW Medicine, Swedish Physicians, MultiCare, CHI Franciscan, PeaceHealth, Providence, and more First Choice Health network providers for Oregon, Alaska, Montana, Idaho, and Washington First Health Network providers for all other states in the United States OptumRx network pharmacies Choose your coverage level(s) All our plans include the same benefits. The main differences are seen in the monthly premiums versus the member s cost shares. *OIC Provider Network Form A Bronze Silver Gold Platinum Monthly premium $ $$ $$$ $$$$ Cost to members when they get care (Copays,, coinsurance) $$$$ $$$ $$ $ Plan and benefit details Employee Only (EO) plan These include coverage for employees only. Because spouses and dependents are not eligible, they may seek coverage through Washington Healthplanfinder and receive tax credits, when applicable. VisitsPlus plans These include unlimited office visits for only a copay and are not subject to the. Plan availability Kaiser Permanente Washington s small business plans are available in these Washington counties: Benton, Columbia, Franklin, Island, King, Kitsap, Kittitas, Lewis, Mason, Pierce, San Juan, Skagit, Snohomish, Spokane, Thurston, Walla Walla, Whatcom, Whitman, Yakima. Apply for coverage or renew New groups Complete the 2018 master application for small groups and submit it to a Kaiser Permanente sales executive by the 20th of the month prior to the effective date. Renewing groups We will provide you with coverage options that best match the plan or plans your business offers today. Or you can choose from any of the other plans we offer to small employers. Please complete the 2018 master application for small groups and submit it to your Kaiser Permanente account manager no later than the 10th of the month prior to the anniversary date. COMPARE YOUR PLAN OPTIONS 3

3 2018 Kaiser Foundation Health Plan of Washington plans Core Provider Network Bronze HSA Silver HSA Silver VisitsPlus Silver VisitsPlus Silver - EO Features In Network In Network In Network In Network In Network Plan type HSA-qualified HSA-qualified Deductible Deductible Deductible Annual medical (individual/family) $4,750/$9,500 $3,000/$6,000 $1,800/$3,600 $2,500/$5,000 $2,500/$5,000 Annual out-of-pocket maximum (individual/family) $6,550/$13,100 $5,000/$10,000 $7,150/$14,300 $7,350/$14,700 $7,350/$14,700 Routine physical exam, mammogram, etc. No charge No charge No charge No charge No charge Outpatient services (per visit or procedure) to to Primary care office visit 40% after 10% after $20 after $35 $35 Speciality care office visit 40% after 10% after $45 after $50 $50 Most X-rays 40% after 10% after 20% after 30% after 30% after Most lab tests 40% after 10% after 20% after 30% after 30% after MRI, CT, PET 40% after 10% after 20% after 30% after 30% after Outpatient surgery 40% after 10% after 20% after 30% after 30% after Mental health visit 40% after 10% after $20 after $35 $35 40% after 10% after 20% after 30% after 30% after New prescription drug benefit The prescription drug benefit is changing in We are moving from a three-tier structure to a four-tier structure. Tier 1: Preferred generic Tier 2: Preferred brand Tier 3: Non-preferred generic and brand Tier 4: Specialty See the benefit grid for specific cost shares by plan design for both network pharmacy and mail-order prescriptions. Routine prenatal care visits, first postpartum visit No charge No charge No charge No charge No charge Delivery and inpatient well-baby care 40% after 10% after 20% after 30% after 30% after Emergency department visit 40% after 10% after 20% after 30% after 30% after Urgent care visit 40% after 10% after $20 after ; outside service area 20% after $35; outside service area 30% after $35; outside service area 30% after Tier 1: Preferred generic 50% after 20% after $20 $20 $20 Tier 2: Preferred brand 50% after 30% after $50 $50 $50 Tier 3: Non-preferred generic and brand 50% after 50% after 50% 50% 50% Tier 4: Specialty 50% after 50% after 50% 50% 50% 40% after 10% after $20 after $35 $35 Dental coverage is required for those under age 19 and accompanies all Kaiser Permanente See dental flyer for details, as well as information on optional dental coverage for adults and families. EO = employee only PRIMARY CARE: Acupuncture Chemical Dependency/Substance Abuse Chiropractic/Manipulative Therapy Emergency Medicine Family Medicine Family Planning Internal Medicine Mental Health Midwifery Naturopathy Obstetrics/Gynecology Optometry Osteopathy Pediatrics Urgent Care Women s Health Care 4 SMALL GROUP COMPARE YOUR PLAN OPTIONS 5

4 2018 Kaiser Foundation Health Plan of Washington plans Core Provider Network Gold VisitsPlus Gold HD VisitsPlus Gold VisitsPlus Gold - EO VisitsPlus Platinum Features In Network In Network In Network In Network In Network Plan type Deductible Deductible Deductible Deductible Deductible Annual medical (individual/family) $750/$1,500 $1,200/$2,400 $600/$1,200 $600/$1,200 $250/$500 Annual out-of-pocket maximum (individual/family) $4,500/$9,000 $5,500/$11,000 $5,500/$11,000 $5,500/$11,000 $2,500/$5,000 Routine physical exam, mammogram, etc. No charge No charge No charge No charge No charge Outpatient services (per visit or procedure) to to to to Primary care office visit $10 after $10 $10 $10 $10 Speciality care office visit $20 after $30 $30 $30 $25 Most X-rays 20% after 20% after 20% after 20% after 10% after Most lab tests 20% after 20% after 20% after 20% after 10% after MRI, CT, PET 20% after 20% after 20% after 20% after 10% after Outpatient surgery 20% after 20% after 20% after 20% after 10% after Mental health visit $10 after $10 $10 $10 $10 20% after 20% after 20% after 20% after 10% after New prescription drug benefit The prescription drug benefit is changing in We are moving from a three-tier structure to a four-tier structure. Tier 1: Preferred generic Tier 2: Preferred brand Tier 3: Non-preferred generic and brand Tier 4: Specialty See the benefit grid for specific cost shares by plan design for both network pharmacy and mail-order prescriptions. Routine prenatal care visits, first postpartum visit No charge No charge No charge No charge No charge Delivery and inpatient well-baby care 20% after 20% after 20% after 20% after 10% after Emergency department visit 20% after 20% after 20% after 20% after 10% after Urgent care visit $10 after ; outside service area 20% after $10; outside service area 20% after $10; outside service area 20% after $10; outside service area 20% after $10; outside service area 10% after Tier 1: Preferred generic $10 $10 $15 $15 $7 Tier 2: Preferred brand $30 $30 $45 $45 $25 Tier 3: Non-preferred generic and brand 40% 40% 40% 40% 40% Tier 4: Specialty 40% 40% 40% 40% 40% $10 after $10 $10 $10 $10 Dental coverage is required for those under age 19 and accompanies all Kaiser Permanente See dental flyer for details, as well as information on optional dental coverage for adults and families. EO = employee only PRIMARY CARE: Acupuncture Chemical Dependency/Substance Abuse Chiropractic/Manipulative Therapy Family Medicine Family Planning Internal Medicine Mental Health Midwifery Naturopathy Obstetrics/Gynecology Optometry Osteopathy Pediatrics Urgent Care Women s Health Care 6 SMALL GROUP COMPARE YOUR PLAN OPTIONS 7

5 2018 Kaiser Foundation Health Plan of Washington Options, Inc. plans Access PPO Provider Network Features Access PPO Bronze HSA Access PPO Silver HSA Access PPO VisitsPlus Silver Plan type HSA-qualified HSA-qualified Deductible Annual medical (individual/family) $4,750/$9,500 $9,500/$19,000 $3,000/$6,000 $6,000/$12,000 $2,500/$5,000 $5,000/$10,000 Annual out-of-pocket maximum (individual/family) $6,550/$13,100 $19,650/$39,300 $5,000/$10,000 $15,000/$30,000 $7,350/$14,700 $22,050/$44,100 Routine physical exam, mammogram, etc. No charge No charge 50% after No charge No charge 50% after No charge No charge 50% after Outpatient services (per visit or procedure) to Primary care office visit 30% after 40% after 50% after 10% after 20% after 50% after $25 $35 50% after Speciality care office visit 30% after 40% after 50% after 10% after 20% after 50% after $45 $55 50% after Most X-rays 40% after 40% after 50% after 20% after 20% after 50% after 30% after 30% after 50% after Most lab tests 40% after 40% after 50% after 20% after 20% after 50% after 30% after 30% after 50% after MRI, CT, PET 40% after 40% after 50% after 20% after 20% after 50% after 30% after 30% after 50% after Outpatient surgery 40% after 40% after 50% after 20% after 20% after 50% after 30% after 30% after 50% after Mental health visit 30% after 40% after 50% after 10% after 20% after 50% after $25 $35 50% after 40% after 40% after 50% after 20% after 20% after 50% after 30% after 30% after 50% after Routine prenatal care visits, first postpartum visit No charge No charge 50% after No charge No charge 50% after No charge No charge 50% after Delivery and inpatient well-baby care 40% after 40% after 50% after 20% after 20% after 50% after 30% after 30% after 50% after Emergency department visit 40% after 20% after 30% after Urgent care visit 30% after 40% after 50% after 10% after 20% after 50% after $25 $35 50% after Tier 1: Preferred generic 45% after 50% after Not covered 15% after 20% after Not covered $20 $25 Not covered Tier 2: Preferred brand 45% after 50% after Not covered 25% after 30% after Not covered $50 $55 Not covered Tier 3: Non-preferred generic and brand 50% after 50% after Not covered 50% after 50% after Not covered 50% 50% Not covered Tier 4: Specialty 50% after 50% after Not covered 50% after 50% after Not covered 50% 50% Not covered 30% after 50% after 10% after 50% after $25 50% after PRIMARY CARE: Acupuncture Chemical Dependency/Substance Abuse Chiropractic/Manipulative Therapy Family Medicine Family Planning Internal Medicine Mental Health Midwifery Naturopathy Obstetrics/Gynecology Optometry Osteopathy Pediatrics Urgent Care Women s Health Care 8 SMALL GROUP New prescription drug benefit The prescription drug benefit is changing in We are moving from a three-tier structure to a four-tier structure. See the benefit grid for specific cost shares by plan design for both network pharmacy and mail-order prescriptions. Dental coverage is required for those under age 19 and accompanies all Kaiser Permanente See dental flyer for details, as well as information on optional dental coverage for adults and families. COMPARE YOUR PLAN OPTIONS 9

6 2018 Kaiser Foundation Health Plan of Washington Options, Inc. plans Access PPO Provider Network Features Access PPO VisitsPlus Silver - EO Access PPO VisitsPlus Gold Access PPO VisitsPlus Platinum Plan type Deductible Deductible Deductible Annual medical (individual/family) $2,500/$5,000 $5,000/$10,000 $600/$1,200 $1,200/$2,400 $250/$500 $500/$1,000 Annual out-of-pocket maximum (individual/family) $7,350/$14,700 $22,050/$44,100 $5,000/$10,000 $15,000/$30,000 $2,500/$5,000 $7,500/$15,000 Routine physical exam, mammogram, etc. No charge No charge 50% after No charge No charge 50% after No charge No charge 50% after Outpatient services (per visit or procedure) to to to Primary care office visit $25 $35 50% after $10 $20 50% after $10 $20 50% after Speciality care office visit $45 $55 50% after $30 $40 50% after $25 $35 50% after Most X-rays 30% after 30% after 50% after 20% after 20% after 50% after 10% after 10% after 50% after Most lab tests 30% after 30% after 50% after 20% after 20% after 50% after 10% after 10% after 50% after MRI, CT, PET 30% after 30% after 50% after 20% after 20% after 50% after 10% after 10% after 50% after Outpatient surgery 30% after 30% after 50% after 20% after 20% after 50% after 10% after 10% after 50% after Mental health visit $25 $35 50% after $10 $20 50% after $10 $20 50% after 30% after 30% after 50% after 20% after 20% after 50% after 10% after 10% after 50% after Routine prenatal care visits, first postpartum visit No charge No charge 50% after No charge No charge 50% after No charge No charge 50% after Delivery and inpatient well-baby care 30% after 30% after 50% after 20% after 20% after 50% after 10% after 10% after 50% after Emergency department visit 30% after 20% after 10% after Urgent care visit $25 $35 50% after $10 $20 50% after $10 $20 50% after Tier 1: Preferred generic $20 $25 Not covered $15 $20 Not covered $5 $10 Not covered Tier 2: Preferred brand $50 $55 Not covered $45 $50 Not covered $15 $20 Not covered Tier 3: Non-preferred generic and brand 50% 50% Not covered 40% 40% Not covered 40% 40% Not covered Tier 4: Specialty 50% 50% Not covered 40% 40% Not covered 40% 40% Not covered EO = employee only PRIMARY CARE: Acupuncture Chemical Dependency/Substance Abuse Chiropractic/Manipulative Therapy Family Medicine Family Planning Internal Medicine Mental Health Midwifery Naturopathy Obstetrics/Gynecology Optometry Osteopathy Pediatrics Urgent Care Women s Health Care $25 50% after $10 50% after $10 50% after New prescription drug benefit The prescription drug benefit is changing in We are moving from a three-tier structure to a four-tier structure. See the benefit grid for specific cost shares by plan design for both network pharmacy and mail-order prescriptions. Dental coverage is required for those under age 19 and accompanies all Kaiser Permanente See dental flyer for details, as well as information on optional dental coverage for adults and families. 10 SMALL GROUP COMPARE YOUR PLAN OPTIONS 11

7 For more information Contact your producer (agent/broker) Contact your Kaiser Permanente sales representative directly or call Visit kp.org/wa/sbg SG