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 deductible 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

3 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. 1 2 Determine whether you ll offer 1 or 2 plans To offer 2 plans: You must have at least 10 employees. You can offer any combination of Core and Access PPO plans. Groups with 10 to 24 employees must have at least 3 employees 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. Groups with more than 25 employees must have at least 5 employees enrolled in each plan. 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* 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 deductible. 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. 3 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 $ $$ $$$ $$$$ Cost to members when they get care (Copays, deductible, coinsurance) $$$$ $$$ $$ $ 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

4 2018 Kaiser Foundation Health Plan of Washington plans Core Provider Network Bronze HSA Silver HSA Features In Network In Network Plan type HSA-qualified HSA-qualified Annual medical deductible (individual/family) $4,750/$9,500 $3,000/$6,000 Annual out-of-pocket maximum (individual/family) $6,550/$13,100 $5,000/$10,000 Benefits Preventive care Routine physical exam, mammogram, etc. No charge No charge Outpatient services (per visit or procedure) Primary care office visit 40% after deductible 10% after deductible Speciality care office visit 40% after deductible 10% after deductible Most X-rays 40% after deductible 10% after deductible Most lab tests 40% after deductible 10% after deductible MRI, CT, PET 40% after deductible 10% after deductible Outpatient surgery 40% after deductible 10% after deductible Mental health visit 40% after deductible 10% after deductible Inpatient hospital care Room and board, surgery, anesthesia, X-rays, lab tests, medications, mental health care 40% after deductible 10% after deductible Maternity Routine prenatal care visits, first postpartum visit No charge No charge Delivery and inpatient well-baby care 40% after deductible 10% after deductible Worldwide emergency and urgent care Emergency department visit 40% after deductible 10% after deductible Urgent care visit 40% after deductible 10% after deductible Prescription drugs (up to 30-day supply) Tier 1: Preferred generic 50% after deductible 20% after deductible Tier 2: Preferred brand 50% after deductible 30% after deductible Tier 3: Non-preferred generic and brand 50% after deductible 50% after deductible Tier 4: Specialty 50% after deductible 50% after deductible Whole health Healthy Services: 10 chiropractic visits and 12 acupuncture visits 40% after deductible 10% after deductible 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 NOTE: This is an overview of benefits. The contents are not to be accepted or construed as a substitute for the provisions of the medical coverage agreement. Other terms and conditions may apply. A list of excluded services and other limitations can be found in each plan s Summary of Benefits and Coverage document. 4 SMALL GROUP

5 Silver VisitsPlus Silver VisitsPlus Silver - EO In Network In Network In Network Deductible Deductible Deductible $1,800/$3,600 $2,500/$5,000 $2,500/$5,000 $7,150/$14,300 $7,350/$14,700 $7,350/$14,700 No charge No charge No charge Unlimited office visits prior to deductible Unlimited office visits prior to deductible $20 after deductible $35 $35 $45 after deductible $50 $50 $20 after deductible $35 $35 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. No charge No charge No charge $20 after deductible; outside service area 20% after deductible $35; outside service area 30% after deductible $35; outside service area 30% after deductible $20 $20 $20 $50 $50 $50 50% 50% 50% 50% 50% 50% $20 after deductible $35 $35 Dental coverage is required for those under age 19 and accompanies all Kaiser Permanente medical plans. See dental flyer for details, as well as information on optional dental coverage for adults and families. SPECIALTY CARE: Allergy and Immunology Anesthesiology Audiology Cardiology (pediatric and cardio vascular disease) Critical Care Medicine Dentistry Dermatology Endocrinology Enterostomal Therapy Gastroenterology Genetics Hematology Hepatology Infectious Disease Massage Therapy Neonatal-Perinatal Medicine Nephrology Neurology Nutrition (non-preventive) Occupational Medicine Occupational Therapy Oncology Ophthalmology Orthopedics Otolaryngology (ear, nose, and throat) Pain Management Pathology Physiatry (rehabilitation) Physical Therapy Podiatry Pulmonary Medicine/Disease Radiology (nuclear medicine, radiation therapy) Respiratory Therapy Rheumatology Speech Therapy Sports Medicine General Surgery Urology COMPARE YOUR PLAN OPTIONS 5

6 2018 Kaiser Foundation Health Plan of Washington plans Core Provider Network Gold VisitsPlus Gold HD Features In Network In Network Plan type Deductible Deductible Annual medical deductible (individual/family) $750/$1,500 $1,200/$2,400 Annual out-of-pocket maximum (individual/family) $4,500/$9,000 $5,500/$11,000 Benefits Preventive care Routine physical exam, mammogram, etc. No charge No charge Outpatient services (per visit or procedure) Unlimited office visits prior to deductible Primary care office visit $10 after deductible $10 Speciality care office visit $20 after deductible $30 Most X-rays 20% after deductible 20% after deductible Most lab tests 20% after deductible 20% after deductible MRI, CT, PET 20% after deductible 20% after deductible Outpatient surgery 20% after deductible 20% after deductible Mental health visit $10 after deductible $10 Inpatient hospital care Room and board, surgery, anesthesia, X-rays, lab tests, medications, mental health care 20% after deductible 20% after deductible Maternity Routine prenatal care visits, first postpartum visit No charge No charge Delivery and inpatient well-baby care 20% after deductible 20% after deductible Worldwide emergency and urgent care Emergency department visit 20% after deductible 20% after deductible Urgent care visit Prescription drugs (up to 30-day supply) $10 after deductible; outside service area 20% after deductible $10; outside service area 20% after deductible Tier 1: Preferred generic $10 $10 Tier 2: Preferred brand $30 $30 Tier 3: Non-preferred generic and brand 40% 40% Tier 4: Specialty 40% 40% Whole health Healthy Services: 10 chiropractic visits and 12 acupuncture visits $10 after deductible $10 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 NOTE: This is an overview of benefits. The contents are not to be accepted or construed as a substitute for the provisions of the medical coverage agreement. Other terms and conditions may apply. A list of excluded services and other limitations can be found in each plan s Summary of Benefits and Coverage document. 6 SMALL GROUP

7 VisitsPlus Gold VisitsPlus Gold - EO VisitsPlus Platinum In Network In Network In Network Deductible Deductible Deductible $600/$1,200 $600/$1,200 $250/$500 $5,500/$11,000 $5,500/$11,000 $2,500/$5,000 No charge No charge No charge Unlimited office visits prior to deductible Unlimited office visits prior to deductible Unlimited office visits prior to deductible $10 $10 $10 $30 $30 $25 $10 $10 $10 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. No charge No charge No charge $10; outside service area 20% after deductible $10; outside service area 20% after deductible $10; outside service area 10% after deductible $15 $15 $7 $45 $45 $25 40% 40% 40% 40% 40% 40% $10 $10 $10 Dental coverage is required for those under age 19 and accompanies all Kaiser Permanente medical plans. See dental flyer for details, as well as information on optional dental coverage for adults and families. SPECIALTY CARE: Allergy and Immunology Anesthesiology Audiology Cardiology (pediatric and cardio vascular disease) Critical Care Medicine Dentistry Dermatology Endocrinology Enterostomal Therapy Gastroenterology Genetics Hematology Hepatology Infectious Disease Massage Therapy Neonatal-Perinatal Medicine Nephrology Neurology Nutrition (non-preventive) Occupational Medicine Occupational Therapy Oncology Ophthalmology Orthopedics Otolaryngology (ear, nose, and throat) Pain Management Pathology Physiatry (rehabilitation) Physical Therapy Podiatry Pulmonary Medicine/Disease Radiology (nuclear medicine, radiation therapy) Respiratory Therapy Rheumatology Speech Therapy Sports Medicine General Surgery Urology COMPARE YOUR PLAN OPTIONS 7

8 2018 Kaiser Foundation Health Plan of Washington Options, Inc. plans Access PPO Provider Network Features Plan type 8 SMALL GROUP Enhanced Access PPO Bronze HSA Standard HSA-qualified Out of Network Annual medical deductible (individual/family) $4,750/$9,500 $9,500/$19,000 Annual out-of-pocket maximum (individual/family) $6,550/$13,100 $19,650/$39,300 Benefits Preventive care Routine physical exam, mammogram, etc. No charge No charge 50% after deductible Outpatient services (per visit or procedure) Primary care office visit 30% after deductible 40% after deductible 50% after deductible Speciality care office visit 30% after deductible 40% after deductible 50% after deductible Most X-rays 40% after deductible 40% after deductible 50% after deductible Most lab tests 40% after deductible 40% after deductible 50% after deductible MRI, CT, PET 40% after deductible 40% after deductible 50% after deductible Outpatient surgery 40% after deductible 40% after deductible 50% after deductible Mental health visit 30% after deductible 40% after deductible 50% after deductible Inpatient hospital care Room and board, surgery, anesthesia, X-rays, lab tests, medications, mental health care Maternity 40% after deductible 40% after deductible 50% after deductible Routine prenatal care visits, first postpartum visit No charge No charge 50% after deductible Delivery and inpatient well-baby care 40% after deductible 40% after deductible 50% after deductible Worldwide emergency and urgent care Emergency department visit 40% after deductible Urgent care visit 30% after deductible 40% after deductible 50% after deductible Prescription drugs (up to 30-day supply) Tier 1: Preferred generic 45% after deductible 50% after deductible Not covered Tier 2: Preferred brand 45% after deductible 50% after deductible Not covered Tier 3: Non-preferred generic and brand 50% after deductible 50% after deductible Not covered Tier 4: Specialty 50% after deductible 50% after deductible Not covered Whole health Healthy Services: 10 chiropractic visits and 12 acupuncture visits 30% after deductible 50% after deductible 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 SPECIALTY CARE: Allergy and Immunology Anesthesiology Audiology Cardiology (pediatric and cardio vascular disease) Critical Care Medicine Dentistry Dermatology Endocrinology Enterostomal Therapy Gastroenterology Genetics Hematology Hepatology Infectious Disease Massage Therapy Neonatal-Perinatal Medicine Nephrology Neurology Nutrition (non-preventive) Occupational Medicine Occupational Therapy Oncology Ophthalmology Orthopedics Otolaryngology (ear, nose, and throat) Pain Management Pathology Physiatry (rehabilitation) Physical Therapy Podiatry Pulmonary Medicine/Disease Radiology (nuclear medicine, radiation therapy) Respiratory Therapy Rheumatology Speech Therapy Sports Medicine General Surgery Urology NOTE: This is an overview of benefits. The contents are not to be accepted or construed as a substitute for the provisions of the medical coverage agreement. Other terms and conditions may apply. A list of excluded services and other limitations can be found in each plan s Summary of Benefits and Coverage document.

9 Enhanced Access PPO Silver HSA Standard HSA-qualified Out of Network Enhanced Access PPO VisitsPlus Silver Standard Deductible Out of Network $3,000/$6,000 $6,000/$12,000 $2,500/$5,000 $5,000/$10,000 $5,000/$10,000 $15,000/$30,000 $7,350/$14,700 $22,050/$44,100 No charge No charge 50% after deductible No charge No charge 50% after deductible Unlimited office visits prior to deductible 10% after deductible 20% after deductible 50% after deductible $25 $35 50% after deductible 10% after deductible 20% after deductible 50% after deductible $45 $55 50% after deductible 20% after deductible 20% after deductible 50% after deductible 30% after deductible 30% after deductible 50% after deductible 20% after deductible 20% after deductible 50% after deductible 30% after deductible 30% after deductible 50% after deductible 20% after deductible 20% after deductible 50% after deductible 30% after deductible 30% after deductible 50% after deductible 20% after deductible 20% after deductible 50% after deductible 30% after deductible 30% after deductible 50% after deductible 10% after deductible 20% after deductible 50% after deductible $25 $35 50% after deductible 20% after deductible 20% after deductible 50% after deductible 30% after deductible 30% after deductible 50% after deductible No charge No charge 50% after deductible No charge No charge 50% after deductible 20% after deductible 20% after deductible 50% after deductible 30% after deductible 30% after deductible 50% after deductible 20% after deductible 30% after deductible 10% after deductible 20% after deductible 50% after deductible $25 $35 50% after deductible 15% after deductible 20% after deductible Not covered $20 $25 Not covered 25% after deductible 30% after deductible Not covered $50 $55 Not covered 50% after deductible 50% after deductible Not covered 50% 50% Not covered 50% after deductible 50% after deductible Not covered 50% 50% Not covered 10% after deductible 50% after deductible $25 50% after deductible 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 medical plans. See dental flyer for details, as well as information on optional dental coverage for adults and families. COMPARE YOUR PLAN OPTIONS 9

10 2018 Kaiser Foundation Health Plan of Washington Options, Inc. plans Access PPO Provider Network Features Plan type Access PPO VisitsPlus Silver - EO Enhanced Standard Deductible Out of Network Annual medical deductible (individual/family) $2,500/$5,000 $5,000/$10,000 Annual out-of-pocket maximum (individual/family) $7,350/$14,700 $22,050/$44,100 Benefits Preventive care Routine physical exam, mammogram, etc. No charge No charge 50% after deductible Outpatient services (per visit or procedure) Unlimited office visits prior to deductible Primary care office visit $25 $35 50% after deductible Speciality care office visit $45 $55 50% after deductible Most X-rays 30% after deductible 30% after deductible 50% after deductible Most lab tests 30% after deductible 30% after deductible 50% after deductible MRI, CT, PET 30% after deductible 30% after deductible 50% after deductible Outpatient surgery 30% after deductible 30% after deductible 50% after deductible Mental health visit $25 $35 50% after deductible Inpatient hospital care Room and board, surgery, anesthesia, X-rays, lab tests, medications, mental health care Maternity 30% after deductible 30% after deductible 50% after deductible Routine prenatal care visits, first postpartum visit No charge No charge 50% after deductible Delivery and inpatient well-baby care 30% after deductible 30% after deductible 50% after deductible Worldwide emergency and urgent care Emergency department visit 30% after deductible Urgent care visit $25 $35 50% after deductible Prescription drugs (up to 30-day supply) Tier 1: Preferred generic $20 $25 Not covered Tier 2: Preferred brand $50 $55 Not covered Tier 3: Non-preferred generic and brand 50% 50% Not covered Tier 4: Specialty 50% 50% Not covered Whole health Healthy Services: 10 chiropractic visits and 12 acupuncture visits EO = employee only 10 SMALL GROUP $25 50% after deductible 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 SPECIALTY CARE: Allergy and Immunology Anesthesiology Audiology Cardiology (pediatric and cardio vascular disease) Critical Care Medicine Dentistry Dermatology Endocrinology Enterostomal Therapy Gastroenterology Genetics Hematology Hepatology Infectious Disease Massage Therapy Neonatal-Perinatal Medicine Nephrology Neurology Nutrition (non-preventive) Occupational Medicine Occupational Therapy Oncology Ophthalmology Orthopedics Otolaryngology (ear, nose, and throat) Pain Management Pathology Physiatry (rehabilitation) Physical Therapy Podiatry Pulmonary Medicine/Disease Radiology (nuclear medicine, radiation therapy) Respiratory Therapy Rheumatology Speech Therapy Sports Medicine General Surgery Urology NOTE: This is an overview of benefits. The contents are not to be accepted or construed as a substitute for the provisions of the medical coverage agreement. Other terms and conditions may apply. A list of excluded services and other limitations can be found in each plan s Summary of Benefits and Coverage document.

11 Enhanced Access PPO VisitsPlus Gold Standard Deductible Out of Network Enhanced Access PPO VisitsPlus Platinum Standard Deductible Out of Network $600/$1,200 $1,200/$2,400 $250/$500 $500/$1,000 $5,000/$10,000 $15,000/$30,000 $2,500/$5,000 $7,500/$15,000 No charge No charge 50% after deductible No charge No charge 50% after deductible Unlimited office visits prior to deductible Unlimited office visits prior to deductible $10 $20 50% after deductible $10 $20 50% after deductible $30 $40 50% after deductible $25 $35 50% after deductible 20% after deductible 20% after deductible 50% after deductible 10% after deductible 10% after deductible 50% after deductible 20% after deductible 20% after deductible 50% after deductible 10% after deductible 10% after deductible 50% after deductible 20% after deductible 20% after deductible 50% after deductible 10% after deductible 10% after deductible 50% after deductible 20% after deductible 20% after deductible 50% after deductible 10% after deductible 10% after deductible 50% after deductible $10 $20 50% after deductible $10 $20 50% after deductible 20% after deductible 20% after deductible 50% after deductible 10% after deductible 10% after deductible 50% after deductible No charge No charge 50% after deductible No charge No charge 50% after deductible 20% after deductible 20% after deductible 50% after deductible 10% after deductible 10% after deductible 50% after deductible 20% after deductible 10% after deductible $10 $20 50% after deductible $10 $20 50% after deductible $15 $20 Not covered $5 $10 Not covered $45 $50 Not covered $15 $20 Not covered 40% 40% Not covered 40% 40% Not covered 40% 40% Not covered 40% 40% Not covered $10 50% after deductible $10 50% after deductible 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 medical plans. See dental flyer for details, as well as information on optional dental coverage for adults and families. COMPARE YOUR PLAN OPTIONS 11

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