live. work. play. healthier. together.

Transcription

1 Kaiser Permanente See how our care and coverage can help you thrive live. work. play. healthier. together Open Enrollment Presentation for State of Colorado Copyright 2016 Kaiser Permanente.

2 Today s agenda Here s what we ll cover in today s presentation: Your health plan options Locations near you Your care experience Resources

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4 Deductible HMO (DHMO) Pay little or no cost for preventive care. Most of your preventive care services are covered at little or no out-of-pocket cost to you, whether or not you ve reached your deductible. Routine physical exam / well-woman / well-child exam Preventive mammogram Preventive colonoscopy Cholesterol screening

5 Deductible HMO (DHMO) What is a copayment? Copayment is a set dollar amount you ll pay for certain services covered by your plan. What is a deductible? A Deductible is the amount you pay for covered services each plan year before Kaiser Permanente starts paying. Depending on your plan, you may pay copays for some services without having to reach your deductible first.

6 Deductible HMO (DHMO) What is coinsurance? Coinsurance is a percentage you pay for certain services after you meet your deductible. You will pay copayments and coinsurance for any applicable services until you meet your annual out-of-pocket maximum.

7 Deductible HMO (DHMO) Enjoy a limit on your expenses (OPM). There s a limit on how much you ll pay for covered medical services each year. This is called your out-of-pocket maximum (OPM). Covered services subject to your deductible and coinsurance, and most services subject to copayments, accumulate toward your OPM. Once you reach your out-of-pocket maximum, we ll pay the full cost of covered services for the rest of the contract year. For the DHMO plan, each covered family member has their own individual OPM.

8 State of Colorado 2017/18 DHMO This table highlights some of the benefits of your group: Annual deductible per plan year Annual out-of-pocket maximum (OPM) per plan year $750 individual / $1,500 family $2,000 individual / $4,000 family Each person in the family has an individual Deductible and OPM. The Deductible is included in OPM. Covered service Preventive care Doctor s office visit Diagnostic lab test Imaging (x-ray, MRI, CT/PET scan) Outpatient surgery Hospitalization Emergency care Retail prescriptions (30-day supply) Mail order (up to a 90 day supply) for 2 copays You pay No cost for most services $30 copay PCP/$50 copay Specialist/10% coinsurance after deductible for covered services received during a visit No cost 10% coinsurance after the deductible is met 10% coinsurance after the deductible is met 10% coinsurance after the deductible is met $500 copay /10% coinsurance after deductible for MRI, CT/PET scans $10 copay generic/$30 copay preferred brand/20% coinsurance up to $100 per drug per fill specialty drugs This is only a summary of some benefits. Please see your Evidence of Coverage (EOC) for more information about coverage, limitations and exclusions for all benefits, including those not listed in this summary.

9 Overview of how your High Deductible (HDHP) works ANNUAL OPM COPAYMENTS AND COINSURANCE DEDUCTIBLE (full charges) PREMIUM July 1st June 30th

10 State of Colorado 2017/18 HDHP This table highlights some of the benefits of your group: Annual deductible per plan year Annual out-of-pocket maximum (OPM) per plan year $1,500 subscriber only / $3,000 family $3,000 subscriber only / $6,000 family You must meet the family Deductible before plan moves to coinsurance. Deductible is included in the OPM. Covered service Preventive care Doctor s office visit Diagnostic lab tests Imaging (x-ray, MRI, CT/PET scan) Outpatient surgery Hospitalization Emergency care Retail prescriptions (30-day supply) Mail order (up to a 90 day supply) for 2 copays after deductible You pay No cost for most services 20% coinsurance after the deductible is met 20% coinsurance after the deductible is met 20% coinsurance after the deductible is met 20% coinsurance after the deductible is met 20% coinsurance after the deductible is met 20% coinsurance after the deductible is met $10 copay generic/$30 preferred brand/20% coinsurance up to $100 per drug per fill specialty drugs after the deductible is met This is only a summary of some benefits. Please see your Evidence of Coverage (EOC) for more information about coverage, limitations and exclusions for all benefits, including those not listed in this summary.

11 State of Colorado 2017/18 HDHP You have an option to open a Health Savings Account (HSA). An HSA is a savings account that works with an HSA-Qualified High Deductible HMO (HDHP) plan. If you enroll in our HDHP and sign up for a Health Savings Account (HSA) with Optum Bank at the State will deposit $60 to your account each month. You can also contribute money to your HSA each year and use those funds to pay for qualified medical expenses, now or in the future. You own the money in this account, which you can grow and take with you even if you change jobs or retire.

12 State of Colorado 2017/18 HDHP You receive triple tax advantages with your HSA funds. The funds in your HSA are not considered part of your wages, so they re not subject to federal income taxes. HSA funds used to pay for qualified medical expenses are not subject to taxes. Any investment earnings in an HSA are tax-free so long as they re used for qualified medical expenses, which may include deductible, copay and coinsurance.

13 Pick a plan that s right for you

14 Pick a plan that s right for you

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16 Denver/Boulder: convenient locations and access 22 medical offices in Denver/Boulder area. Pharmacies in all locations. State of Colorado members can access care and services at any Kaiser Permanente medical office in our other Colorado service areas: Northern Colorado, Southern Colorado and Mountain Colorado.

17 Southern CO: convenient locations and access 3 medical offices in Southern Colorado: two in Colorado Springs and one in Pueblo. Community providers in addition to our medical offices. We partner with local hospitals for inpatient care. After the 1 st fill of a maintenance medication, Southern Colorado members need to fill Rx either at a Kaiser Permanente medical office or through our mail order service.

18 Northern CO: convenient locations and access 4 medical offices: Loveland, Fort Collins (2) and Greeley. NEW 80+ primary care physicians at 20 network offices specialists and. ancillary providers at 130+ network offices. 3 Banner Health hospitals. Pharmacies in all 4 of our medical offices, but also contract with network pharmacies. KPCO Medical Office Expanded Network Primary Care Expanded Network Specialty Care Banner Hospitals

19 Northern CO: convenient locations and access Kaiser Permanente will be hosting a special event at one of our Fort Collins medical offices in April for State of Colorado employees and their families. Watch your mailbox for an invitation. We hope you ll stop by for a few minutes and get to know us a little better.firsthand. Grab some food, have some fun and learn ways to live, work and play, a little healthier.

20 Coverage available in the mountains Kaiser Permanente offers coverage to State of Colorado employees and their family members who live in Eagle and Summit counties. State of Colorado employees who live in the MTCO service area will see the Kaiser Permanente plans as enrollment options when completing their enrollment through Benefitsolver. Eligibility is based on home address being in one of the following zip codes: 80423, 80424, 80426, 80435, 80443, 80463, 80497, 80498, 81620, 81631, 81632, 81637, 81645, 81649, 81655, 81657,

21 Mountain CO: convenient locations and access Frisco Medical Office 226 Lusher Court., Suite 104 Frisco, CO Two primary care physicians Network providers in pediatrics, urology, psychiatry, optometry/ophthalmology, obstetrics/gynecology Full support services: radiology, laboratory, contracts with network pharmacies, contracts for DME, home health, behavioral health, PT/OT/SP, hospice, infusion, and SNF

22 Mountain CO: convenient locations and access Edwards Medical Office 56 Edwards Village Blvd., Suite 208 Edwards, CO Three primary care physicians Network providers locally with Colorado Mountain Medical and Valley View Hospital Full support services: radiology, laboratory, contracts with network pharmacies, contracts for DME, home health, behavioral health, PT/OT/SP, hospice, infusion, and SNF

23 Mountain CO: convenient locations and access In-network pharmacy locations: Eagle County Summit County Eagle Pharmacy, Eagle City Market Pharmacy, Avon Walmart Pharmacy, Avon Eagle Vail Pharmacy, Vail City Market Pharmacy, Eagle City Market Pharmacy, Vail Edwards Medical Center, Edwards Costco Pharmacy, Gypsum Vail Valley Pharmacy, Edwards Walgreens, Avon Walmart Pharmacy, Frisco City Market Pharmacy, Dillon City Market Pharmacy, Breckenridge Target Pharmacy, Silverthorne Safeway Pharmacy, Frisco Walgreens, Dillon

24 your care experience

25 Colorado Permanente Medical Group Family Practice Family Practice Pediatricians Pediatricians Internists Internists OB/GYN OB/GYN Specialists Specialists

26 Get the right care: when you need it, how you want it Routine Care Regular visits to your doctor to catch health problems early, when they re easier to treat. Urgent Care Illnesses or injuries that require attention soon, but aren t emergencies. Specialty Care 1 Services from doctors trained in specific areas of care. Emergency Care 2 When your health is in danger and you need immediate care. 1 Medicaid members need a referral from a primary care physician for specialty care. 2 If you have a medical emergency, call 911 or go to the nearest hospital.

27 Get the right care: when you need it, how you want it Phone Save yourself an office visit by scheduling a call with a doctor. 1 In Person Same-day appointments are often available. Chat Online Connect in real time with a Kaiser Permanente physician. Video Visit Online alternative to an in-person appointment. 1, 2 Message your doctor s office with nonurgent questions, anytime. 1 E-Visit Online consultations are available for some medical conditions. 1 These features are available when you receive care at Kaiser Permanente medical offices. 2 Check with your doctor s office to find out if video visits are available to you.

28 Get the right care: when you need it, how you want it

29 Get the right care: when you need it, how you want it Video: Kaiser Permanente video visits: not just for millennials!

30 How the team supports you and your doctor Adult and Pediatric Surgeons Health Educators Adult and Pediatric Medical Specialists Clinical Pharmacists Adult and Pediatric Hospitals and Emergency Room Doctors Nurse Care Coordinators Mental Health Specialists

31 Kaiser Permanente Colorado patient talks about the quality and service from her care team Video: My Kaiser Permanente Care Team Was Wonderful

32 resources

33 Call before you go our advice team is here for you 24/7 For medical advice anytime, day or night, call (TTY 711). If you have an illness or injury, call our medical advice team (time permitting). They can assess your situation and direct you to the most appropriate care setting, if an in-person visit is needed. Or, they can help you handle the problem at home until your next appointment.

34 Skip the trip and get it quick Look into the State of Colorado s enhanced mail-order prescription benefit and sign up for convenience and savings. 3 easy options to order your prescriptions through our mail order pharmacy: Visit kp.org/pharmacy center and follow the prompts to order online. Call our Automated Refill Line at , and leave the appropriate information. If you need to speak to a pharmacist, call us directly at or , weekdays, 8 a.m. 6 p.m.

35 Manage your health, anytime, anywhere Online at kp.org, or with our mobile app, you can stay on top of your care 24/7 with these convenient features:* Access your electronic ID card Schedule and cancel routine appointments View most lab results as soon as they are available Refill most prescriptions, with no charge for shipping when you order online your doctor s office with nonurgent questions Print vaccination records for school, sports, or camp Use tools to help you manage your coverage and costs Manage a family member s health *Available when you receive care at Kaiser Permanente facilities.

36 Manage your health, anytime, anywhere To use your digital member ID card, tap the card icon at the bottom of the Kaiser Permanente app dashboard.

37 Get a cost estimate at Members need to be registered on kp.org to use this secure tool. Provides the average cost of a service in your area, applies your plan benefits and how much you ve spent on care thus far for the year. It will provide a low, likely and high cost for the service, including your member portion of the cost. Available when you receive care at Kaiser Permanente medical offices.

38 Centers for Complementary Medicine We will be expanding to additional medical offices at the end of April, 2017: Greeley: chiropractic Loveland: chiropractic Briargate (Colorado Springs): chiropractic Baseline (Boulder): acupuncture (open now!) and massage therapy The Kaiser Permanente Centers for Complementary Medicine have earned a high degree of member satisfaction.

39 Health classes: Get inspired and find support groups at our medical offices, and get help improving your health.* Healthy lifestyle programs: Our personalized online programs can help you lose weight, reduce stress, quit smoking, and more at no cost to members. Wellness coaching: Our wellness coaches will work one-on-one with you to help you achieve your health goals no cost to members, and no referrals needed. Special rates for members: Get reduced rates on variety of products and services, like gym memberships and massage therapy through ChooseHealthy. Online wellness tools: You have access to health calculators, podcasts, recipes, fitness videos and more on our award-winning website kp.org. * Classes vary at each location and some may require a fee. ChooseHealthy is a product of American Specialty Health Administrators, Inc., a subsidiary of American Specialty Health Incorporated (ASH). ChooseHealthy and the ChooseHealthy logo are federally registered trademarks of ASH. Please note that this is a discount program; it is not insurance.

40 We stand for health. Yours. Whether you re a long-time member or considering Kaiser Permanente for the first time, you can get all of the information you need at my.kp.org/stateofcolorado. Get answers to frequently asked questions about what makes Kaiser Permanente different. View high-level information about your plan options. Watch 2-minute videos highlighting how to choose a health plan and why to select Kaiser Permanente. Find Kaiser Permanente locations, physicians and community providers. my.kp.org/stateofcolorado StateOEKaiser@kp.org

41 questions 2017 Open Enrollment Presentation for State of Colorado