2020 OE Self Guided PowerPoint Presentation - Full Version ... · July Fourth, Labor Day,...

County of San Bernardino

2020 Open Enrollment

Presentation for

Healthy togetherCare and coverage that fits your life

©2019 Kaiser Foundation Health Plan, Inc.


Why choose Kaiser Permanente?

Kaiser Permanente See how our care and coverage can help you thrive

Care and coverage

built around you

Healthy

resources

Your care,

your way

Manage your care

anytime, anywhere

Care away

from home

Quality care with

you at the center

Specialty careGreat care


Quality care with you at the center

Our physician-led care teams work together to

keep you healthy by delivering high-quality,

personalized care. You can expect:


Quality care from skilled doctors

Better care with a connected team

Personalized care for all members


Schedule

appointments

and get 24/7

medical advice

by phone.

Meet face-to-

face with a

doctor online.*

Email your

doctor’s office

with nonurgent

questions

anytime.

Visit your

doctor at your

local facility.

Your care, your way

Save yourself a

trip to the

doctor’s office

with a telephone

appointment.*

*When appropriate and available.




Care away from home

*This number can be dialed inside and outside the United States. Before the phone number, dial “001” for landlines and “+1” for mobile lines if you’re outside the

country. Long-distance charges may apply, and we can’t accept collect calls. The phone line is closed on major holidays (New Year’s Day, Easter, Memorial Day,

July Fourth, Labor Day, Thanksgiving, and Christmas). It closes early the day before a holiday at 10 p.m. Pacific time (PT), and it reopens the day after a holiday

at 4 a.m. PT.

• If you get hurt or sick while traveling, we’ll help

you get care. Our plans include emergency and

urgent care coverage from qualified providers

anywhere in the world.

• We can also help you before you leave town by

checking to see if you need a vaccination,

refilling eligible prescriptions, and more. Just

call us or go online:


24/7 Away from

Home Travel Line:

951-268-3900*

kp.org/travel



TRAVELING? YOU’RE COVERED!

*If you get care at a MinuteClinic or any other urgent care facility within a state

where Kaiser Permanente operates, you’ll be asked to pay up front for services

you receive and fIle a claim for reimbursement.

**If you get care at a MinuteClinic outside a state where Kaiser Permanente

operates, you’ll be charged your standard copay or co-insurance. With the

exception of Medicaid enrollees from regions outside California, all members

are eligible.

***You may be covered for medically necessary urgent care when you are

outside the country if the care can't be delayed until you get back home. Medi-

Cal members in Northern and Southern California are only covered for

emergency services requiring hospitalization in Canada or Mexico. Other

Medicaid members are not covered outside the US.



Care and coverage built around you

What’s integrated care? We strive for a simpler, seamless experience

in which the health plan and doctors work

together for you.

You get:

• Healthcare with less paperwork

• A care team that’s connected to each

other and you

• Many services under one roof


Specialty care


For more on specialty care, visit thrive.kp.org/healthier-outcomes.

Maternity care

For family planning

to first steps and

beyond, visit

kp.org/maternity

Mental health

Our members can access

mental health services

with no referral needed at

kp.org/mentalhealth

Cardiac care

Learn how we’re healing

hearts and saving lives with

advanced cardiac care at

kp.org/cardiaccare

No matter what life throws your way, you can count on us. Get access to quality

care from top-notch doctors across a wide range of specialties, including:


Healthy resources

1Classes vary at each location and some may require a fee.2Not available in all areas.

• Wellness Coaching by Phone

• Healthy lifestyle programs

• On-site health education classes

and support groups1

• Online videos, podcasts, recipes,

and more

• Reduced rates on health products

and services (for example, gym

memberships)

• Seasonal farmers markets2



Reach your health goals with wellness support


• Acupuncture

• Chiropractic care

• Gym memberships

• Massage therapy

• And more

.

Wellness Coaching by Phone

We’ve helped thousands of

members reach their health goals.

If you need a little extra support, we

offer Coaching by phone at no cost.

Member discount programs

We offer special discounts on health-

related products and services to

members. Discount programs vary

by region and can include:


Manage your care anytime, anywhere

At kp.org or with the Kaiser Permanente app, you can stay on top of your care 24/7:1,2

• Schedule and cancel routine

appointments

• Fill most prescriptions

• Choose your doctor and

change anytime

• View most lab test results

• Email your Kaiser

Permanente doctor’s office

with nonurgent questions

• Manage your coverage and

estimate costs3

• View and pay bills

• Manage a family member’s

health care4

1Available when you get care at Kaiser Permanente facilities.2To use the Kaiser Permanente app, you must be a Kaiser Permanente member registered on kp.org.3These tools are not available on the app.4Online features change when children reach age 12. Teens are entitled to additional privacy protection under state laws. When your child turns 12

years old, you will still be able to manage care for your teen, with modified access to certain features.



Ready for an easy switch?

There’s a lot to do when you’re changing health plans. That’s why Kaiser Permanente offers a single

online destination that shows how easy it is to:

Choose your new doctor


Learn more at kp.org/easyswitch.

Seamlessly transfer your care

and prescriptions

Get care on your schedule


kp.org/newmember

welcome site

ID card and

quick guide to

getting started

Personalized

welcome bookWelcome call

Welcome letter from

primary care doctor

Anytime Typically within 1 to 10 days of your start date After you choose a doctor

What new members can expect



Yearly deductible $ 0 individual / 0 family

Maximum yearly out-of-pocket costs $1,500 individual / 3,000 family

Covered service You pay

Preventive care $ 0 copay

Doctor’s office visit $10 copay

Lab tests and radiology $0 copay

Outpatient surgery $10

Hospitalization $ 0

Emergency care $ 50

Prescribed medications (100-day

supply)

$10 copay (generic medication) / $15 copay (brand name

medication) /$15 copay 30 day supply(specialty medication)*

Traditional HMO Plan – High Option

Pre-65 RetireesThis table shows some benefits of your group and is provided as an example only:

*This is a summary of some benefits and their copays and coinsurance. For specific information about your covered health plan benefits, limitations, and

exclusions, including those not listed in this summary, please see your Evidence of Coverage.






Preventive care $ 0 copay ( routine physical exams)



Outpatient surgery $10 per procedure

Hospitalization $ 0

Emergency care $ 50


supply)

$10 copay (generic medication) / $20 copay (brand name

medication) / 20% coinsurance(not to exceed $100) 100 day

supply(specialty medication)*

Traditional HMO Plan - High Option

Post-65 Retirees (KPSA)This table shows some benefits of your group and is provided as an example only:





Yearly deductible $500 individual / 1,000 family

Maximum yearly out-of-pocket costs $3, 000 individual / 6,000 family


Preventive care $0 copay


Lab tests and radiology $10 copay /after plan deductible

Outpatient surgery 20% coinsurance*after plan deductible

Hospitalization 20% coinsurance* after plan deductible

Emergency care 20% coinsurance* after plan deductible


supply)

$10 copay (generic medication) / $30 copay after plan

deductible (brand name medication) / $30 copay -30 day

supply after plan deductible (specialty medication)*

Deductible HMO Plan – Low Option










Doctor’s office visit $ 25 copay


Outpatient surgery $ 25 per procedure

Hospitalization $ 500 per admission

Emergency care $ 50

Prescribed medications (30-day supply) $10 copay (generic medication) / $25 copay (brand name

medication) / 20% coinsurance(not to exceed $100) 100 day

supply(specialty medication)*

Traditional HMO Plan – Low Option

Post-65 Retirees (KPSA)This table shows some benefits of your group and is provided as an example only:





Yearly deductible $ 1,500 individual / $2,800 family / $3,000 Family

Maximum yearly out-of-pocket costs $4,000 individual / $ 8,000 family



Doctor’s office visit $ 20% Coinsurance after Plan deductible

Lab tests and radiology $ 20% Coinsurance after Plan deductible

Outpatient surgery $ 20% Coinsurance after Plan deductible

Hospitalization $ 20% Coinsurance after Plan deductible

Emergency care $ 20% Coinsurance after Plan deductible


supply)

$10 copay (generic medication) after plan deductible / $30

copay (brand name medication) after plan deductible /$ 30

copay 30 day supply(specialty medication)* after plan

deductible

HSA Option (HDHP)






Map not to scale

Southern California


15 medical centers

125 medical offices

10 affiliated plan hospitals

4 affiliated medical offices



Opening soon

• Baldwin Park Medical Offices 2

Open now

• Baldwin Hills–Crenshaw Medical Offices

• Carson Medical Offices

• Chino Grand Medical Offices

• Hollywood Romaine Medical Offices

• Irwindale Medical Offices

• La Habra Medical Offices

• Murrieta Medical Offices

• Playa Vista Medical Offices

• Porter Ranch Medical Offices

• San Diego Medical Center

• Santa Clarita Medical Offices 2

• Ventura Market Street Medical Offices

• Viewridge Medical Offices

New locations in Southern California

Porter Ranch Medical Offices

San Diego Medical Center


Thank youThank you



Retiring at 65? Enroll at just the right time.

Your Group Medicare Health Plan Enroll-at-65 checklist

•As your birthday approaches, use this checklist to learn what steps to take and when to take them

to enroll in Medicare. If you get health coverage through your employer, union, or trust

fund, these to-dos will help you confidently choose the right plan for you, meet your enrollment

deadline, and avoid costly late enrollment penalties.

•Let’s get started: Mark your calendar with your Initial Enrollment Period

•Your Initial Enrollment Period is the official time you can enroll in a Medicare health plan. It lasts

7 months — beginning 3 months before your 65th birthday, including the month of your birthday,

and ending 3 months after.

•4–6 months before

you turn 65

o Learn about your

•organization’s Medicare

requirements and options.

Contact your benefits

administrator or check your

organization’s website or

enrollment materials to find

out if they offer a Medicare

health plan, if you’ll be

automatically enrolled, and

more.

o Visit

kp.org/learnandenroll to

learn about Medicare

basics. It’s important to

know what to look for in a

plan and how Medicare star

quality ratings can help you

compare plans. Watch our

helpful online videos,

including “Medicare Part B

Simplified” and “Group

Medicare: 4 Simple Steps.”

o Not a Kaiser

Permanente Medicare

health plan member, but

want to enroll? Ask your

benefits administrator how to

enroll in a Kaiser Permanente

Medicare health plan.

•3 months before

you turn 65

o Contact Social Security,

enroll in Part B, and request

your Medicare card. Confirm

your Medicare eligibility and

find out the earliest date you

can get your card. You’ll need

the information on your

Medicare card to enroll — and

it can take up to 2 months to

receive it.

o Enroll now — you don’t

have to wait until your

birthday. If you have your

Medicare card, sign up now.

o Consider enrolling with

us online. It’s easy and

secure. Visit

kp.org/learnandenrollto

see if you can enroll online

with Kaiser Permanente.

•When you turn 65,

and up to 3 months

after

o If you’re retiring at 65,

don’t delay. If you retire at

65 and don’t sign up before

your enrollment period ends

— 3 months after your

birthday — you may have to

pay a costly, ongoing late

enrollment penalty.

•(continues)


Questions? We’re here to help.

Kaiser Permanente Medicare Learning

Center: Visit us at kp.org/learnandenrollto

watch videos, read about Medicare basics, or get

help planning for your future. You’ll find plenty

of resources to learn what you need to know in

a way that works for you.

Kaiser Permanente licensed sales specialist:

Call 1-877-547-4909 (TTY 711), 7 days a week,

8 a.m. to 8 p.m. Our experienced team can

answer your questions and help guide you — even

if you don’t qualify for Medicare benefits, your

organization doesn’t offer them, or you have another

special situation.

Other helpful resources:

Medicare:

Call 1-800-633-4227,

24 hours a day, 7 days a week

(TTY 1-877-486-2048).

Visit Medicare.gov.

Social Security

office: Call 1-800-

772-1213, Monday

through Friday, 7

a.m. to 7 p.m.

(TTY 1-800-325-

0778). Visit

SocialSecurity.g

ov.

•Working past 65? See our Group Medicare Health Plan-Ahead checklist.

•In California, Maryland and the District of Columbia, Kaiser Permanente is an HMO plan and a Cost plan with a Medicare

contract. In Hawaii, Oregon, Washington, Colorado, and Georgia, Kaiser Permanente is an HMO plan with a Medicare

contract. In Virginia, Kaiser Permanente is a Cost 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 and at other times in

accord with your group’s contract with us. This information is not a complete description of benefits. Contact the plan for

more information. Limitations, copayments, and restrictions may apply.

•MRM 60615810_MAI January 2018


Working past age 65? Make life easier, prepare early.

Your Group Medicare Health Plan-Ahead checklist

•Even if you plan to continue working, there are some steps you should take before you turn 65 to

prepare for Medicare enrollment. If you get health coverage through your employer, union, or

trust fund, use this checklist. These to-dos will help you confidently choose the right plan for you,

meet your deadlines, and avoid costly penalties later.

•Let’s get started: Mark your calendar with your Special Enrollment Period

•If you’re planning to work past age 65, your Special Enrollment Period is the official time to enroll in

a Medicare health plan once you retire. This 8-month period starts when your employment ends or

when your group coverage ends — whichever comes first.

•4–6 months before

you turn 65

o Visit

kp.org/learnandenroll to

learn about Medicare

basics. It’s important to

know what to look for in a

plan and how Medicare star

quality ratings can help you

compare plans. Watch our

helpful online videos,

including “Medicare Part B

Simplified” and “Group

Medicare: 4 Simple Steps.”

o Not a Kaiser

Permanente Medicare

health plan member, but

want to enroll with us

once you do retire? Ask

your benefits administrator

how to enroll in a Kaiser

Permanente Medicare health

plan.

•3 months before

you turn 65

o Contact Social

Security and request

your

•Medicare card. Confirm

your Medicare eligibility and

review the steps to get your

card. You’ll need the

information on your

Medicare card once you do

enroll — and it can take up

to 2 months to receive it.

o Tell your benefits

administrator that you

plan to continue working

past 65. Also, explore your

Medicare options and see if

there are any requirements

you must complete before

you turn 65.

o Find out if your

•organization requires

you to sign up for

Medicare Part B when you

turn 65 — even if you’re

staying on your current

Kaiser Permanente health

plan.

•When your employment

or group coverage ends,

and up to 8 months after

o Enroll during this time

to avoid a costly

penalty. Your enrollment

period begins when your

employment or your group

coverage ends, whichever

comes first. If you don’t

sign up for Medicare Parts

A and B before your 8-

month enrollment period

ends, you may have to pay

an ongoing late enrollment

penalty.

o Consider enrolling

with us online. It’s easy

and secure. Visit kp.org/

learnandenroll to see if

you can enroll online with

Kaiser Permanente.

•(continues)


Questions? We’re here to help.

Kaiser Permanente Medicare Learning

Center: Visit us at kp.org/learnandenrollto

watch videos, read about Medicare basics, or get

help planning for your future. You’ll find plenty

of resources to learn what you need to know in

a way that works for you.

Kaiser Permanente licensed sales specialist:

Call 1-877-547-4909 (TTY 711), 7 days a week,

8 a.m. to 8 p.m. Our experienced team can

answer your questions and help guide you — even

if you don’t qualify for Medicare benefits, your

organization doesn’t offer them, or you have another

special situation.

Other helpful resources:

Medicare:

Call 1-800-633-4227,

24 hours a day, 7 days a week

(TTY 1-877-486-2048).

Or visit Medicare.gov.

Social Security office:

Call 1-800-772-1213,

Monday through Friday,

7 a.m. to 7 p.m.

(TTY 1-800-325-0778).

Or visit SocialSecurity.gov.

•Retiring at 65? See our Group Medicare health plan Enroll-at-65 checklist.

•In California, Maryland and the District of Columbia, Kaiser Permanente is an HMO plan and a Cost plan with a Medicare

contract. In Hawaii, Oregon, Washington, Colorado, and Georgia, Kaiser Permanente is an HMO plan with a Medicare

contract. In Virginia, Kaiser Permanente is a Cost 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 and at other times in accord

with your group’s contract with us. This information is not a complete description of benefits. Contact the plan for more

information. Limitations, copayments, and restrictions may apply.

•MRM 60615810_CTW January 2018

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2020 OE Self Guided PowerPoint Presentation - Full Version ... · July Fourth, Labor Day,...

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