Small Group Plan Guide. New Plan Designs: a streamlined product portfolio offering flexible plan pairings to meet the needs of small business

Transcription

1 Small Group Plan Guide New Plan Designs: a streamlined product portfolio offering flexible plan pairings to meet the needs of small business EFFECTIVE AS OF APRIL 1, 2012

2 different is good nlike your other health insurance options, Kaiser Permanente provides both the health plan and the health care. The result is a tangible difference for our customers: State-of-the-art medical care, greater convenience, lower costs, and outstanding levels of satisfaction. Yes, it s different. And clearly, our difference is good. a different model igh quality care doesn t need to be expensive. With our unique model, Kaiser Permanente makes it convenient for members to get state-of-the-art medical care. This helps our customers maintain a healthy, productive workforce and helps drive down health care costs through: our difference makes a difference 3

3 Plan Pairings Guide With Kaiser Permanente, you have the flexibility to select plans and pairings that meet the needs of your group. You can choose to offer any one of our 11 in-network MO plans as a stand alone plan, or Small Group Plan Portfolio Options If you would like to offer a Multi-Choice option, you will need to pair it with a plan. Please use the provided grid to help make your selection. Pairings in green offer exceptional value and choice. Pairings in yellow provide you with additional options, but these plan pairings will be priced higher. Pairings POS/0/15/S1 POS/500/20/S1 POS/1000/20/S1 POS/1500/20/S1 POS/2000/20/S1 POS/2500/20/S1 POS/3000/40/S1 POS/5000/40/S1 /0/15/S1 /0/25/S1 /500/20/S1 4 5 /1000/20/S1 /1500/20/S1 /2000/20/S1 /2500/20/S1 /3000/40/S1 KEY Recommended pairing Pairing will be priced higher Pairing restricted /4000/40/S1 /5000/40/S1 /00/40/S1

4 MO Plans /0/15/S1 /0/25/S1 /500/20/S1 /1000/20/S1 /1500/20/S1 /2000/20/S1 Deductible $0 $0 Coinsurance Maximum $0 $0 $0 $0 $0 $0 Maximum Benefit While Covered nlimited 1 nlimited 1 nlimited 1 nlimited 1 nlimited 1 nlimited 1 Coinsurance Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% $15 copay Preventive Services Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% $150 copay $150 copay $150 copay $150 copay $150 copay $150 copay $50 copay $50 copay $50 copay Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% $50 copay $50 copay Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% 6 Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% 7 Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Mental ealth 3 Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 50% Plan pays 50% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% 1 Some benefits may have limitations. Deductible does not apply. This is a summary description and is not intended to replace the Group Agreement, Group Policy, Evidence of Coverage, which contain the Refills must be obtained at a Kaiser Permanente Pharmacy or through ome Delivery.

5 MO Plans /2500/20/S1 /3000/40/S1 /4000/40/S1 /5000/40/S1 /00/40/S1 Deductible Coinsurance Maximum $0 $0 $0 $0 $0 Maximum Benefit While Covered nlimited 1 nlimited 1 nlimited 1 nlimited 1 nlimited 1 Coinsurance Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% $50 copay $50 copay $50 copay $50 copay $50 copay $50 copay $50 copay $50 copay Preventive Services Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% $150 copay $150 copay $150 copay $150 copay $150 copay Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% 8 Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% 9 Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Mental ealth 3 $50 copay $50 copay $50 copay $50 copay Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% $50 copay $50 copay $50 copay $50 copay 1 Some benefits may have limitations. Deductible does not apply. This is a summary description and is not intended to replace the Group Agreement, Group Policy, Evidence of Coverage, which contain the Refills must be obtained at a Kaiser Permanente Pharmacy or through ome Delivery.

6 MO Service Area PICKENS DAWSON 5 FORSYT ALL Forsyth 985 olly Springs 400 MADISON TownPark Alpharetta Sugar ill Buford 85 West Marietta FLTON BARROW COBB East Cobb Lawrenceville Athens Glenlake 11 Gwinnett 10 West Cobb ATENS- PALDING Piedmont Specialty CLARKE Snellville 85 Cumberland Crescent 78 Brookwood at Peachtree GWINNETT 285 OCONEE OGLETORPE Douglasville Downtown Decatur Peachtree Center 285 Panola WALTON 20 Cascade 166 Conyers DOGLAS BARTOW CEROKEE 285 DEKALB Stonecrest 20 CARROLL Newnan 85 FLTON Southwood Fayette CLAYTON 6 ROCKDALE Southwood Specialty FAYETTE ENRY enry Towne Centre NEWTON KEY Kaiser Permanente Affiliated ospitals* COWETA BTTS SPALDING * The hospital that you will be admitted to is determined by the primary care physician you select.

7 Multi-Choice Plans POS/0/15/S1 POS/500/20/S1 Select PPO (PCS Network) Deductible $0 Coinsurance Maximum $0 Maximum Benefit While Covered nlimited 1 $2,000,000 combined Coinsurance Plan pays 100% $15 copay Plan pays 100% Plan pays 100% $150 copay $150 copay $150 copay $50 copay $50 copay Plan pays 100% 12 Plan pays 100% Plan pays 100% 13 Plan pays 100% Mental ealth 3 Plan pays 100% Plan pays 50% Preferred Generic Drugs $15 copay Preferred Brand Drugs $50 copay All Non-Preferred Drugs Not applicable Select PPO (PCS Network) Deductible Coinsurance Maximum $0 Maximum Benefit While Covered nlimited 1 $2,000,000 combined Coinsurance Plan pays 100% $50 copay Plan pays 100% Plan pays 100% $150 copay $150 copay $150 copay Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Mental ealth 3 Plan pays 100% Plan pays 100% Plan pays 100% Preferred Generic Drugs $15 copay Preferred Brand Drugs $50 copay All Non-Preferred Drugs Not applicable 1 Some benefits may have limitations. Deductible does not apply. This is a summary description and is not intended to replace the Group Agreement, Group Policy, Evidence of Coverage, which contain the Evidence of Coverage.

8 Multi-Choice Plans POS/1000/20/S1 POS/1500/20/S1 Select PPO (PCS Network) Deductible Coinsurance Maximum $0 Maximum Benefit While Covered nlimited 1 $2,000,000 combined Coinsurance Plan pays 100% $50 copay Plan pays 100% Plan pays 100% $150 copay $150 copay $150 copay Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% 14 Plan pays 100% Plan pays 100% 15 Plan pays 100% Plan pays 100% Mental ealth 3 Plan pays 100% Plan pays 100% Plan pays 100% Preferred Generic Drugs $15 copay Preferred Brand Drugs $50 copay All Non-Preferred Drugs Not applicable Select PPO (PCS Network) Deductible Coinsurance Maximum $0 Maximum Benefit While Covered nlimited 1 $2,000,000 combined Coinsurance Plan pays 100% $50 copay Plan pays 100% Plan pays 100% $150 copay $150 copay $150 copay Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Mental ealth 3 Plan pays 100% Plan pays 100% Plan pays 100% Preferred Generic Drugs $15 copay Preferred Brand Drugs $50 copay All Non-Preferred Drugs Not applicable 1 Some benefits may have limitations. Deductible does not apply. This is a summary description and is not intended to replace the Group Agreement, Group Policy, Evidence of Coverage, which contain the Evidence of Coverage.

9 Multi-Choice Plans POS/2000/20/S1 POS/2500/20/S1 Select PPO (PCS Network) Deductible Coinsurance Maximum $0 Maximum Benefit While Covered nlimited 1 $2,000,000 combined Coinsurance Plan pays 100% $50 copay Plan pays 100% Plan pays 100% $150 copay $150 copay $150 copay Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% 16 Plan pays 100% Plan pays 100% 17 Plan pays 100% Plan pays 100% Mental ealth 3 Plan pays 100% Plan pays 100% Plan pays 100% Preferred Generic Drugs $15 copay Preferred Brand Drugs $50 copay All Non-Preferred Drugs Not applicable Select PPO (PCS Network) Deductible Coinsurance Maximum $0 Maximum Benefit While Covered nlimited 1 $2,000,000 combined Coinsurance Plan pays 100% $50 copay Plan pays 100% Plan pays 100% $150 copay $150 copay $150 copay Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Mental ealth 3 Plan pays 100% Plan pays 100% Plan pays 100% Preferred Generic Drugs $15 copay Preferred Brand Drugs $50 copay All Non-Preferred Drugs Not applicable 1 Some benefits may have limitations. Deductible does not apply. This is a summary description and is not intended to replace the Group Agreement, Group Policy, Evidence of Coverage, which contain the complete provisions and the Evidence of Coverage.

10 Multi-Choice Plans POS/3000/40/S1 POS/5000/40/S1 Select PPO (PCS Network) Deductible Coinsurance Maximum $0 Maximum Benefit While Covered nlimited 1 $2,000,000 combined Coinsurance Plan pays 100% $50 copay $50 copay Plan pays 100% Plan pays 100% $150 copay $150 copay $150 copay Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% 18 Plan pays 100% Plan pays 100% 19 Plan pays 100% Plan pays 100% Mental ealth 3 $50 copay Plan pays 100% Plan pays 100% Plan pays 100% $50 copay Preferred Generic Drugs $15 copay Preferred Brand Drugs $50 copay All Non-Preferred Drugs Not applicable Select PPO (PCS Network) Deductible Coinsurance Maximum $0 Maximum Benefit While Covered nlimited 1 $2,000,000 combined Coinsurance Plan pays 100% $50 copay $50 copay Plan pays 100% Plan pays 100% $150 copay $150 copay $150 copay Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Mental ealth 3 $50 copay Plan pays 100% Plan pays 100% Plan pays 100% $50 copay Preferred Generic Drugs $15 copay Preferred Brand Drugs $50 copay All Non-Preferred Drugs Not applicable 1 Some benefits may have limitations. Deductible does not apply. This is a summary description and is not intended to replace the Group Agreement, Group Policy, Evidence of Coverage, which contain the complete provisions and the Evidence of Coverage.

11 Multi-Choice Service Area PICKENS 5 DAWSON FORSYT ALL BARTOW CEROKEE Forsyth 985 olly Springs MADISON 400 TownPark Alpharetta Sugar ill Buford 85 West Marietta FLTON BARROW COBB East Cobb Lawrenceville Athens Glenlake West Cobb Gwinnett ATENS- Piedmont Specialty CLARKE 400 Snellville Cumberland Crescent PALDING 78 Brookwood at Peachtree GWINNETT OCONEE OGLETORPE 285 Downtown Decatur Douglasville Peachtree Center 285 WALTON Panola 20 Cascade 166 Conyers CARROLL Newnan DOGLAS 85 FLTON FAYETTE Southwood Fayette 285 CLAYTON 6 DEKALB Stonecrest Southwood Specialty ENRY ROCKDALE enry Towne Centre 20 NEWTON KEY Kaiser Permanente Affiliated ospitals* COWETA SPALDING BTTS ** The hospital that you will be admitted to is determined by the primary care physician you select. Some locations are available in specific cases.

12 Benefits of Fixed Dollar Contribution SA-Qualified Deductible MO Plans When it s time to decide on your plan options, choosing a fixed dollar contribution can benefit your company s bottom line. What is a fixed dollar contribution? aving a fixed dollar contribution means choosing a Kaiser This way, you maintain a fixed dollar contribution level ere s an example. Let s say you ve decided to offer both an MO plan and the company contributing at a rate of 50%. The MO typically you d have an employee and employer cost of Kaiser Permanente SA-Qualifed Deductible MO Plans Our SA-Qualified Deductible MO plans are designed to lower premiums, while still providing the coverage and health resources needed to keep members healthy. As a core benefit, we offer a wide range of preventive care other services, a deductible and coinsurance will apply. plan as an option your employees can buy up on a dollarfor-dollar basis to obtain. After the deductible is met, members will either be contribution, you ll keep your costs lower by contributing ow does a fixed dollar contribution provide value to fully covered, or traditional health care coverage with qualified medical expenses. your company s bottom line? coinsurance will apply, depending on the plan they select. you ll provide your employees with a choice of plans and When you choose a Kaiser Permanente MO as your the high quality, award-winning care they deserve. coordinated SA program that enables you to offer your standard plan offering, you have the potential to save of-pocket maximum. The out-of-pocket maximum is the clients increased flexibility and choice. With these SA most a member will ever have to pay for covered health accounts, your clients can avoid the inconvenience of costs lower, while providing your employees with a choice services in a given year. Once the out-of-pocket maximum having to search for an SA provider. We ve done the of plans and the high quality, award-winning care they has been reached, Kaiser Permanente will be responsible deserve. Additionally, you ll know exactly what your annual for 100 percent of the allowable charges for these services okay too. Our SA-qualified plans are designed to work 22 contribution will be up front, regardless of which plans your for the remainder of the calendar year. 23 with all SA providers. As with all of our MO plans, members enrolled in our budget later in the year. Visit wellsfargo.com/hsa for more information. SA-Qualified Deductible MO plans will have access to doctors at our medical facilities in metro-atlanta and Athens. SA Administrator Wells Fargo Bank administrator for the SA accounts. Affordable and easy to use, the SA accounts help people take charge of their health care dollars and their future. Kaiser Permanente provides and administers the health Self-Only and Family (2+) Plan Combinations Fixed Dollar Contribution PLAN A PLAN B PLAN C PLAN D PLAN E Self-Only* Self-Only* Self-Only* Self-Only* Self-Only* MO Multi-Choice MO Multi-Choice Deductible $1,200* $2,400 $2,850* $5,700 $1,200* $2,400 $2,850* $5,700 $5,000* $10,000 Plan Cost $260 $380 $260 $380 Out-of-Pocket Max $1,200* $2,400 $2,850* $5,700 $3,600* $7,200 $4,850* $9,700 $5,000* $10,000 Employer Contribution $130 ($260x50%) $190 ($380x50%) $130 ($260x50%) $130 (benchmarked) Maximum Benefit While Covered nlimited nlimited nlimited nlimited nlimited Employee Contribution $130 $190 $130 $250 (buy-up) Coinsurance Plan pays 100% (after anual deductible) Plan pays 100% (after anual deductible) Plan pays 80% (after anual deductible) Plan pays 80% (after anual deductible) Plan pays 100% (after anual deductible) Your Potential Savings = Preventive visits Plan pays 100% All other covered services Subject to Annual Deductible and Coinsurance * These plans have a non-embedded deductible and require any one or any combination of family members to meet the deductible before the co-insurance takes effect. This is a summary description and is not intended to replace the Group Agreement, Group Policy, Evidence of Coverage, which contain the complete provisions of this coverage. Some