Helping you stay covered with Kaiser Permanente
What s inside How do I stay covered?... 2 When do I need to enroll?... 4 What are my options?... 6 Kaiser Permanente for Individuals and Families... 8 Medi-Cal...10 Kaiser Permanente Child Health Program...11 Kaiser Permanente Community Health Care Program (Northern California)... 12 Major Risk Medical Insurance Program (MRMIP)... 13 Kaiser Permanente Senior Advantage Plan...14 COBRA and Cal-COBRA...15 Temporary Continuation of Coverage (TCC)...16 Questions? 1-800-464-4000 1
How do I stay covered? If a recent change is affecting your health coverage, we re here to help. It s important to act quickly, and in this guide we ll show you how. If you want more help at any time, we re just a click or call away (see below). Rest assured, you may have several options for staying with Kaiser Permanente. Other options might be available to you if you qualify for financial aid. Connect with Kaiser Permanente Go online for customized options Go to kp.org/exploreoptions, where you ll be guided through a few simple questions, then given options that fit your needs. Talk to a representative If you d like someone to personally take you through your options, you can call our Member Service Contact Center at 1-800-464-4000. For TTY, call 711. 2 Need help? kp.org/exploreoptions
By staying with Kaiser Permanente, you can: Keep the doctors you know and trust. Keep getting excellent care at nearby medical offices that offer many services under one roof.* Keep managing your health and prescriptions through our resources online, over the phone, and at our facilities. We want to make this as simple as possible for you. We ll help you figure out your deadline and find the right plan for your needs and budget. No matter what plan you choose, you ll get the same great care and services from Kaiser Permanente. *When receiving care at a Kaiser Permanente facility Questions? 1-800-464-4000 3
When do I need to enroll? Act quickly to meet deadlines Depending on your situation, you may have to apply for health care coverage very soon. Here are 3 enrollment options and their time frames for applying for coverage. Special enrollment The loss of your employer-sponsored coverage means you re eligible for a special enrollment period. It can begin before you lose coverage and lasts 60 days after the date you lose (or would lose) coverage. If you sign up before your coverage ends, your new coverage may begin so that you won t have any gap in coverage. Open enrollment Unless you qualify for a special enrollment period, the only time you can enroll through Covered California or directly with Kaiser Permanente is during the open enrollment period. Open enrollment for 2018 coverage is from November 1, 2017, through January 31, 2018. If you qualify for Medi-Cal, you can sign up anytime during the year. 4 Need help? kp.org/exploreoptions
COBRA, Cal-COBRA, and Federal Employees Health Benefits Program Temporary Continuation of Coverage (TCC) You can sign up within 60 days of when you get your COBRA election notice or TCC election notice or the date you lose coverage, whichever is later. Contact your former employer to find out whether you re eligible and how you can sign up. How do I qualify for a special enrollment period? Most people who are losing coverage will qualify for special enrollment. To find out if you qualify, visit kp.org/ specialenrollment or call our Member Service Contact Center at 1-800-464-4000. For TTY, call 711. Questions? 1-800-464-4000 5
What are my options? Your options depend on your situation. Do any of these sound like you? Find the statement that best fits your situation and continue on to read more about each option available to you. I m going through employment changes. Whether you re losing your job or your employer no longer offers coverage, there may be several options to stay with Kaiser Permanente, including: Kaiser Permanente for Individuals and Families Medi-Cal COBRA or Cal-COBRA Temporary Continuation of Coverage I m no longer on my parent s plan. If you re 26 you can t stay on your parent s plan, but you have options to get your own Kaiser Permanente plan or continue your previous coverage, including: Kaiser Permanente for Individuals and Families Medi-Cal Temporary Continuation of Coverage 6 Need help? kp.org/exploreoptions
I m interested in financial aid. No matter your employment status or age, there are a number of ways to get help (if you qualify), including: Kaiser Permanente for Individuals and Families Medi-Cal Kaiser Permanente s Child Health Program I m over 65 years of age. Kaiser Permanente Senior Advantage (HMO) Plan Are you eligible for Medicare? Kaiser Permanente coverage combined with Medicare benefits. Includes Medicare Part D prescription drug coverage. If you re a Kaiser Permanente Senior Advantage member whose group coverage is ending, you may have already received information from us about our Kaiser Permanente Senior Advantage plan for individuals. If you want more information, please contact us to learn how you can continue your Kaiser Permanente membership. Questions? 1-800-464-4000 7
Kaiser Permanente for Individuals and Families What is it? This is a range of Kaiser Permanente plans to fit your needs and budget. You can pick one plan for your entire family or separate plans for each person. You can select from several levels of coverage. Platinum and Gold plans offer higher levels of coverage, usually with higher premiums and lower out-of-pocket costs when accessing care. Silver and Bronze plans usually have lower premiums and higher out-of-pocket costs. All plan levels offer most of the same health benefits (such as doctor visits, hospital care, prescriptions, and maternity care). They also include most preventive services for no charge. Who is it for? Anyone can get a Platinum, Gold, Silver, or Bronze plan. We also offer Minimum Essential Coverage plans for people younger than 30 on the effective date or for people who have a certificate of exemption from Covered California that shows financial hardship or a lack of affordable coverage. We won t be able to process your application without the certificate of exemption if you are 30 and older. How do I get a plan?* You can shop for a plan directly through Kaiser Permanente or through California s state-run health insurance marketplace, Covered California. However, to get federal financial help, you must buy your plan through Covered California. * You must reside or work in the Kaiser Permanente health plan service area in which you enroll. 8 Need help? kp.org/exploreoptions
How do I know if I qualify for federal financial help? You can get a plan with or without financial help. The chart on this page shows the estimated family income levels that can help you figure out if you may qualify for help paying premiums. A few things to know about federal financial help, if you qualify: Help is available for a portion of premiums and out-of-pocket expenses. The federal government will pay Kaiser Permanente any financial help on your behalf. Help will be on a sliding scale, based on income and family size. Help paying premiums is also based on the cost of the second-lowest Silver plan offered through your exchange. What if I don t qualify for financial help? Even if you can t get help from the federal government, you can buy a Kaiser Permanente plan directly from us or through Covered California. You may also qualify for Medi-Cal. Where can I find more information? To compare individual or family plans, get a quote, and see if you re eligible for federal financial help, go to buykp.org. Questions? 1-800-464-4000 9
Medi-Cal What is it? Medi-Cal is a state health coverage program available to people who have low incomes and limited resources. If you lose your job or have a life-changing event, you may be eligible for Medi-Cal. Because Kaiser Permanente participates in Medi-Cal, you might also be able to keep your same doctor and continue your care with Kaiser Permanente. Who is it for? To qualify, individuals must meet certain requirements. For instance, you must have a certain income level based on the Federal Poverty Level Guidelines. Where can I find more information? Call our Medicaid Assistance Center at 1-800-237-5100, Monday through Friday from 8 a.m. to 5 p.m. Pacific time. For TTY, call 711. Visit kp.org/medi-cal. Contact your county Social Services office. 10 Need help? kp.org/exploreoptions
Kaiser Permanente s Child Health Program What is it? This program offers a Kaiser Permanente subsidy to help pay the premiums for one of our Individual and Family plans. It also offers medical financial aid to help pay out-of-pocket costs for services at Kaiser Permanente locations. Who may be eligible?* Children who: Are under 19 years of age Do not have access to any other public or private health coverage (such as, but not limited to, Medi-Cal, Covered California, and job-based coverage) Live in a household with incomes less than 300% of the federal poverty level. (Children under 19 years of age living in households with incomes between 0% and 266% of the federal poverty level are eligible for Medi-Cal.) Enrollment is limited to the charitable, subsidized program, and subject to availability. For more information: Call our Member Service Contact Center at 1-800-464-4000. For TTY, call 711. Visit us at info.kp.org/childhealthplan. * You must reside or work in the Kaiser Permanente health plan service area in which you enroll. Questions? 1-800-464-4000 11
Kaiser Permanente Community Health Care Program What is it? A Kaiser Permanente subsidy program that helps pay for health coverage for low-income individuals who have no access to private or public health coverage, and meet specific geographic, income, and eligibility requirements. Who may be eligible? Eligibility will be considered for individuals who are uninsured and: Live within specified Northern California counties Are enrolled in a Kaiser Permanente Individuals and Families health plan Are under 26 years of age at the time of the effective date of the Kaiser Permanente plan Live in a household with incomes less than 300% of the federal poverty level Do not have access to any other public or private health coverage including, but not limited to, Medi-Cal, Medicare, a job-based health plan, or coverage through Covered California. Children under 19 years of age living in households with incomes between 0% and 266% of the federal poverty level are eligible for Medi-Cal. For more information: Call the Member Service Contact Center at 1-800-464-4000, 24 hours a day, 7 days a week. TTY users call 711. Or visit kp.org/communityhealthcareprogram. 12 Need help? kp.org/exploreoptions
Major Risk Medical Insurance Program (MRMIP) What is it? This is health insurance for individuals and their families who were denied coverage before health care reform because of pre-existing conditions. Who may be eligible? People living in California who: Are not eligible for both Part A and Part B of Medicare, unless eligible solely because of end-stage renal disease (ESRD) Are not eligible to purchase any health insurance for continuation of benefits under COBRA or Cal-COBRA Were unable to secure adequate coverage before health care reform Where can I find more information? Call 1-800-289-6574, Monday through Friday from 8 a.m. to 8 p.m., and Saturday from 8 a.m. to 5 p.m. To learn more about the MRMIP program, visit www.dhcs.ca.gov/services/pages/ MajorRiskMedicalInsuranceProgram.aspx. Questions? 1-800-464-4000 13
Kaiser Permanente Senior Advantage Plan With Senior Advantage, you get all the benefits of a Kaiser Permanente membership, along with the convenience of having your Medicare services covered under one plan. Plus, you can keep seeing your Kaiser Permanente doctor and continue to receive the quality care you ve come to expect as a Kaiser Permanente member. Connect with Kaiser Permanente If you are a Kaiser Permanente Senior Advantage member whose group coverage is ending, we ll send you information about our individual plan coverage (which is different from your group coverage). If you have any questions about what you need to do to continue your membership, call our Member Service Contact Center at 1-800-443-0815 or 711 (TTY for the deaf, hard of hearing, or speech impaired), seven days a week, from 8 a.m. to 8 p.m. Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. The provider network may change at any time. You will receive notice when necessary. Y0043_N014611 accepted 14 Need help? kp.org/exploreoptions
COBRA and Cal-COBRA If you lose your group coverage, you may be eligible for temporary continuation of the same coverage through COBRA or Cal-COBRA continuation of coverage. COBRA Most employers with at least 20 full-time employees must offer COBRA coverage. Cal-COBRA If your coverage was through an employer with fewer than 20 employees, you may be eligible for Cal-COBRA coverage. Also, if you ve had COBRA coverage for 18 months, you may be eligible for 18 more months of Cal-COBRA coverage. Call your employer and stay covered You ll need to contact your former employer to find out whether you re eligible, what the premiums are, and how you can enroll. Questions? 1-800-464-4000 15
Temporary Continuation of Coverage (TCC) What is it? Federal employees and family members who lose their Federal Employees Health Benefits (FEHB) coverage because of a qualifying life event may be eligible for Temporary Continuation of Coverage (TCC). Who may be eligible? Eligibility for TCC is based on specific qualifying life events. This may include when: You lose your FEHB coverage because you leave federal service or tribal employment Your children lose FEHB coverage because they reach age 26 Your former spouse loses FEHB coverage because of divorce or annulment TCC allows former employees to continue their FEHB coverage for up to 18 months and former family members (children and former spouses) to continue FEHB coverage for up to 36 months. Call your federal agency and stay covered Please contact your federal agency s human resource or retirement office to determine TCC eligibility for you and/or your family members, premium costs, and enrollment steps and timelines. You and your family members must notify your agency within 60 days after a qualifying life event in order to obtain TCC. 16 Need help? kp.org/exploreoptions
Kaiser Permanente does not discriminate on the basis of age, race, ethnicity, color, national origin, cultural background, ancestry, religion, sex, gender identity, gender expression, sexual orientation, marital status, physical or mental disability, source of payment, genetic information, citizenship, primary language, or immigration status. Language assistance is available at no cost to you, 24 hours a day, 7 days a week. You can request interpreter services, materials translated into your language, or in alternative formats. Just call us at 1-800-464-4000, 24 hours a day, 7 days a week (closed holidays). TTY users call 711. Spanish: Contamos con asistencia de idiomas sin costo alguno para usted 24 horas al día, 7 días a la semana. Puede solicitar los servicios de un intérprete, que los materiales se traduzcan a su idioma o en formatos alternativos. Solo llame al 1-800-788-0616, 24 horas al día, 7 días a la semana (cerrado los días festivos). Los usuarios de TTY, deben llamar al 711. Chinese: 您每週 7 天, 每天 24 小時均可獲得免費語言協助 您可以申請口譯服務 要求將資料翻譯成您所用語言或轉換為其他格式 我們每週 7 天, 每天 24 小時均歡迎您打電話 1-800-757-7585 前來聯絡 ( 節假日休息 ) 聽障及語障專線 (TTY) 使用者請撥 711 Questions? 1-800-464-4000 17
kp.org/exploreoptions Please recycle. 60880008 January 2018 DST 00200063