Need help with your Added Choice® plan? Join Kaiser Permanente's Talent Network. This amount will be paid to you in the event of your spouse or partner’s death from any cause. With the Kaiser Permanente plan, when you choose in-network care, you get access to providers at all Kaiser Permanente facilities. Kaiser Permanente provides mental health care and alcohol and drug treatment through the Kaiser Permanente Behavioral Health Services department. Employer and broker frequently asked questions. You can choose any licensed physician to provide care nationwide, and receive preventive care at little or no cost from in-network providers. It is printed on the far left-hand side under the Trust logo. Benefits will be paid according to the schedule of allowances. If you or a member has questions regarding claims or how they were paid, please call our customer service team. Not a Kaiser participant? Are you an employer or producer with questions about Added Choice®? Others view the Primary Care Physician (PCP) of Kaiser Permanente and the other HMO’s as a “gatekeeper” or a prison guard who is keeping them from going straight to a specialist when they deem it necessary. Find the details of your medical coverage in your Summary Plan Description booklet in the sidebar at right. Tier 0-Some highly cost-effective medications: Co-pay per 30-day supply $0. Physician as described in the Added Choice Service Agreement. Make sure you have a DeltaCare provider in your area and that they are accepting new patients before enrolling in this option. Coverage for Emergency services at a non-Network Facility is limited to the Allowed Amount. Tracey can manage the family’s out-of-pocket costs when seeking care from Out-of-Network Providers. Puget Sound area. Eligibility, claims or any other questions? To qualify, you must have worked at least 80 hours during your eligibility month (which was two months before the onset of your disability). What are the pharmacy choices under Dual Choice PPO? Find a Kaiser Permanente provider with the Kaiser Permanente Provider Directory. For care with Kaiser Permanente Providers in Georgia. Open enrollment webinars. Kaiser Permanente’s behavioral health care management program provides care coordination, support and advocacy for patients with severe or chronic mental illness and or alcohol or drug concerns. Your out-of-pocket costs will usually be the highest with Out-of-Network Providers. Go back to home. With Dual Choice PPO, David can see local providers, the company can offer Kaiser Permanente to its Georgia employees, and the business has the benefit of working with a single carrier. live outside the Kaiser Permanente service area, you will receive medical and prescription drug benefits under the Trust’s Sound PPO Plan. Dual Choice PPO plan allows access to In Network providers or any licensed provider. Your out-of-pocket costs will be higher than if you choose care inside the Kaiser Permanente network. Tracey receives care from her orthopedist, who is a Network Provider. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. Choose Kaiser Permanente physicians and specialists in Georgia. Learn about Georgia Kaiser Permanente Choice Products. * Including contact lens evaluations and examinations associated with their fitting. The Flexible Choice plan is composed of three benefit levels, which includes the convenience of our traditional HMO coverage. ... Kaiser Permanente Providers in Georgia. The Trust’s four-tier therapeutically based prescription plan is designed to promote the use of proven, cost-effective medications. Kaiser Permanente Providers. Kaiser Permanente Insurance Company (KPIC) has contracted with MedImpact to fill outpatient prescriptions at In-Network retail pharmacies—including Rite Aid, Walgreens, Kroger, and many supermarket chains (Not all pharmacies in a chain may participate). All Kaiser Permanente Medical Group physicians and network physicians are subject to the same quality review processes and certifications. In addition, you have access to a number of contracted community physicians in the area. Dependent Children Coverage Online features let you manage most of your care around the clock. In general, when you have a Kaiser WA plan, you’ll visit Kaiser Permanente Medical Centers to receive care and get prescriptions. From prevention to disease management and state-of-the-art treatment, our highly skilled and rigorously trained care teams work together with our members and patients to provide the right care at the right time and place. Send Kaiser an email. Kaiser Permanente plans are widely accepted at hospitals and doctor's offices across its coverage regions and states. With care and coverage working seamlessly together, Kaiser Permanente is uniquely designed to give you the information and support you need to live healthy. Why Kaiser Permanente is the right choice for you. Not a Kaiser Participant? Your Kaiser Permanente Provider in Georgia will coordinate your care. Group Health Physicians (now Washington Permanente Medical Group) was recognized as the highest-ranked medical group in the 2016 Community Checkup from Washington Health Alliance. A list of DeltaCare providers can be found at www.deltadentalwa.com. This option allows you to see any licensed dental provider. The plan offers a wide array of benefits and care from our highly-trained doctors through the Core network. Actionable reporting For our large group clients, we collect and analyze valuable data about the way your employees are using their health coverage, including claims, hospitalizations, and level of physician engagement. It is printed on the far left-hand side under the Trust logo. Costs are the same for both in- and out-of-network. Kaiser Permanente Providers in ... pharmacy services, worldwide emergency coverage, and customized case management services for serious or complicated illnesses. Kaiser Permanente. For years, Katherine has been seeing her cardiologist, who is not an In-Network Provider. Your physician will complete a claim form. Under this plan you cannot just see any licensed dentist for treatment. Search for a location and select one from the list of suggestions. For additional information, or to find a provider, contact Kaiser Permanente WA at (888) 901-4636 or visit Kaiser Permanente WA for PEBB. A claim form will have to be completed. It is printed on the far left-hand side under the Trust logo. Dependent Life Insurance—The spouse or State Registered Same Sex Domestic Partner’s benefit is $1,000. If you are required to pay out-of-pocket at the point of service, you can complete a medical claim form and submit it for reimbursement from your insurance carrier. Our doctors are among the best, and caring for people is their passion. Find a provider online by using the Kaiser Permanente Provider Directory. Childbirth/delivery facility services 15% coinsurance Not covered You must notify Kaiser Permanente within 24 hours of admission, or as soon thereafter as medically possible. More Choice. Get More Information in Your Benefits Booklet Spokane area. Learning sessions will be held on Wednesdays beginning August 26, 2020, and ending November 18, 2020. Onboarding includes: Comprehensive New Member Welcome handbooks, an onboarding call from customer specialists, and a help line for any questions, from accessing care to transferring prescriptions. Dual Choice PPO plan allows access to In Network providers or any licensed provider. Members have several choices for having their prescriptions filled. Access PPO and Elect PPO preauthorization (PDF) PPO: Options (no longer available for new sales) Kaiser Foundation Health Plan of Washington Options, Inc. You can choose any licensed physician to provide care nationwide, and receive preventive care at little or no cost from in-network providers. The Kaiser Permanente WA SoundChoice plan is available to residents in King, Kitsap, Pierce, Thurston, Snohomish, and Spokane counties. If the evidence your prescriber provides meets medical necessity, an exception may be approved. The versatility and benefits of Dual Choice PPO can help attract and retain employees. PPO plans generally offer coverage for out-of-network providers, while HMO plans only offer out-of-network coverage in emergency situations. Employee Accidental Death or Dismemberment—This benefit is payable to your beneficiary in the event of your death, or to you in the event of your loss, if your death or loss is caused by an accidental injury while you are covered under the Plan. Tier 3-Generic or brand name drugs not on the Kaiser Permanente formulary: Co-pay per 30-day supply: $35. With care and coverage working seamlessly together, Kaiser Permanente is uniquely designed to give you the information and support you need to live healthy. 1. Dual Choice PPO plan allows access to In Network providers or any licensed provider. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. From online chats with clinicians to urgent or emergency care when traveling – in person, online, or on the phone – you have access to care when you need it. Coverage options range from Preferred Provider Organization (PPO) to Health Maintenance Organization (HMO). Go back to home. However, you don’t receive coverage if you use a provider outside the plan’s network.The exception is the consumer-directed health plan (CDHP), which has a large network that includes providers nationwide. Online features let you manage most of your care around the clock. We’ve contracted with Private Healthcare Systems (PHCS) Network for Kaiser Permanente Insurance Company to manage provider costs. Core Access PPO. Email Address. Employer & producer support. However, once you have completed your 35th month of employment, you may choose to enroll in either the Sound PPO Plan or the Sound Kaiser Permanente Plan. Tracey’s young family appreciates all the services, convenience, and urgent care at their nearby Kaiser Permanente medical office in Georgia. Enter First Name. Some medications are not eligible for the Mail Service Delivery Program. Kaiser Permanente Insurance Company (KPIC) is a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP). Kaiser Permanente Options Federal coverage can help pay for many expenses that are not covered by Medicare Parts A and B. You choose your own doctor and you can change your doctor at any time. Bothell, WA 98011–3145. Find the details of your mental health & substance abuse coverage in your Summary Plan Description (choose the link below based on whether you are in the “Sound” or “SoundPlus” plan). Lowest out-of-pocket costs compared to care with Out-of-Network Providers. Contact the human resources/benefits representative where you work, if your employer provides your coverage. Show me. General information about Kaiser Permanente Washington's PPO plans. It connects you to a group of physicians, services, and tools that help you live your healthy best. Your Choice of Top Doctors . Email Eligibility & COBRA, (206) 282-4500 or (800) 225-7620 Learn about Georgia Kaiser Permanente Choice Products. Your Kaiser Permanente Added Choice® Point-of-Service (POS) Plan is not just health coverage — it's a partnership in health. Your call will be answered by a trained and licensed counselor who will ask you a few questions to best direct you to the services that meet your needs and preferences. Core Access PPO. Co-pays for a 90 day supply listed below. You MUST choose a DeltaCare primary care dentist who coordinates all of your care, including any referrals to specialists. The Sound Health & Wellness Trust is a Taft-Hartley trust managed jointly by unions and employers and providing benefits to more than 51,000 participants. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. Get More Information in Your Benefits Booklet. Dual Choice PPO plan allows access to In Network providers or any licensed provider. With Dual Choice PPO, you can offer your participating employees more provider choices when they receive care: Members have several choices for having their prescriptions filled. Coverage for a description of their benefits. Show me. Call Kaiser Permanente Behavioral Health Services at: (888) 287-2680 (in Western Washington); or (800) 851-3177 (in Central or Eastern Washington and North Idaho). To access sample member coverage documents, click here. ** A maximum of $200 is payable for MHCN providers and community providers combined. Kaiser Permanente Insurance Company (herein called KPIC) provides the Out-of-Network coverage as set forth in the Group Policy. Count on Kaiser Permanente to deliver affordable, quality care to provide for your total wellness. These may include, but are not limited to, drugs that are time or temperature sensitive, drugs that cannot legally be sent by U.S. mail, and drugs that require professional administration or observation. Most medical offices across the Georgia region offer many services conveniently under one roof, including pharmacy, imaging, lab, primary care physicians and specialists, and urgent care services. Kaiser Permanente WA CDHP This plan allows you to seek services from non-Kaiser Permanente WA health providers, however, if you seek services from a non-Kaiser Permanente WA health provider, the service may be covered at a reduced level of coverage. Or you can see any licensed provider you want for most covered services. PEBB members can conveniently get open enrollment information from Kaiser Permanente. Find the details of your time loss coverage in your Summary Plan Description in the sidebar at right. Please fill out the fields below and click "Join Now" to receive information about opportunities that relate to your selections. Your out-of-pocket costs will be higher than if you choose care inside the Kaiser Permanente network. Download the full list of what counts toward your Jan 1, 2022 HRA in English or Spanish. The benefits covered under the two types of coverage are not the same. You must notify Kaiser Permanente within 24 hours of admission, or as soon thereafter as medically possible. Need a coverage document? Your health care plan with Kaiser Permanente WA is a partnership in health. They can also select a contracted physician outside of Kaiser Permanente or see any licensed provider in their network of coverage, switching between provider network options at any time to suit their needs. Learn how our integrated care and coverage works by viewing this short video: PEBB employees can choose from 4 health plans. Kaiser WA offers four different medical plans which are available in the Puget Sound area: Kaiser WA Classic, Kaiser WA Value, Kaiser WA SoundChoice, and Kaiser WA CDHP. Dental charges in excess of the schedule will be your responsibility. In the Multi-Choice, 3 Tier Point-of-Service (POS) plan, there are three Tiers to choose from: Select Provider Tier, Participating Provider Tier, and Non-Participating Provider Tier. Find the details of your vision coverage in your Summary Plan Description booklet (choose the link below based on whether you are in the “Sound” or “SoundPlus” plan). Kaiser Permanente and Group Health Cooperative: Working together since 1950. Our doctors are among the best, and caring for people is their passion. Access coverage documents for Added Choice members. PPO . David’s employer is located in Atlanta, GA, but he frequently travels to Harrisburg, PA, on business, where there aren’t Kaiser Permanente facilities nearby. For additional information, visit www.kp.org/wa. Another division of Kaiser Permanente also offers PEBB health plans which are only available in SW Washington and northern Oregon. *A program operated or arranged by a health plan distributes prescription drugs to members via mail. You’re free to choose whatever provider you prefer, whenever you receive care. Refer to Section IV. In addition, you have access to a number of contracted community physicians in the area. Questions? Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 1/1/2018 – 12/31/2018 Kaiser Foundation Health Plan of Washington: PEBB SoundChoice Coverage for: Group | Plan Type: HMO 1 of 7 RQ-119616-1 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Select a plan for details . 2021 Open Enrollment. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. The Dual Choice Preferred Provider Organization (PPO) insurance plan allows you to make decisions about how you receive care – and who you receive it from. Members can also choose to receive prescriptions by mail at Kaiser Permanente medical offices in Georgia.*. Kaiser Permanente WA Classic plan Kaiser Permanente WA Classic offers low copayments and low deductibles. Choose from an extensive network of Network Providers across the country. 514 Kaiser Permanente Reviews and Complaints @ Pissed Consumer Kaiser Permanente Options Federal coverage can help pay for many expenses that are not covered by Medicare Parts A and B. Access coverage documents for Added Choice members. Kaiser Permanente Washington offers many ways to get care quickly. This option requires you to choose from a smaller list of approved dentists and clinics. For Employers only, please visit cas.kp.org to view your group documents. The website is an excellent resource for information on behavioral health topics. Email Customer Service & Claims Select Counties. Contact Kaiser Permanente at any time through our. A narrow network is defined as a tailored, tiered or high-performance network that has 80 percent or less overlap with a health plan’s broadest network offered to a member in any type of plan offered by that health plan. General information about Kaiser Permanente Washington's PPO plans. Each Flexible Choice Sound Plan Kaiser Permanente Summary Plan Description 4-2017, SoundPlus Plan Kaiser Permanente Summary Plan Description 4-2017, For medical, prescription drug and vision claims, call Kaiser Permanent at (206) 630-4636 or toll free (888) 901-4636. Phone lines are open Monday-Friday, 8 a.m. to 5 p.m. After-hours crisis care is provided by a strong system of Consulting Nurses and on-call psychiatrists. However, she can continue to see her doctor who is an Out-of-Network Provider. Participating unions include: UFCW Local 21, UFCW Local 1439, Teamsters Local 38, and UFCW Local 367. When you combine the Options Federal Standard Option plan with Medicare coverage, your Kaiser Permanente coverage will make your Medicare coverage go further. Kaiser Permanente SoundChoice Plans | Contents Your Kaiser Permanente Member Guide The information in this Member Guide is updated from time to time and is current as of November 2020. Plan hospitals, plan physicians, and other plan providers, and the services available at plan facilities, are subject to change at any time without notice. Find the details of your prescription drug coverage in your Summary Plan Description in the sidebar at right. Learn about Georgia Kaiser Permanente Choice Products. ILWU Dispatcher, October 13, 1950. Member Support. Your Kaiser Permanente Added Choice® Point-of-Service (POS) Plan is not just health coverage — it's a partnership in health. Learn about Georgia Kaiser Permanente Choice Products. Members can fill prescriptions written by any provider at pharmacies located in Kaiser Permanente medical offices in Georgia, at the lowest out-of-pocket cost. Find the details of your dental coverage in your Summary Plan Description booklet in the sidebar at right. This amount will be paid to your beneficiary in the event of your death from any cause. Kaiser Permanente has locations throughout Puget Sound and encompasses a wide array of doctors and other professionals. exception to Kaiser Permanente requirements for coverage of prescription drugs, you or your prescriber may contact Kaiser Permanente Member Services at 1-888-630-4636 and request an exception. You can see any specialist you choose without a referral. With Kaiser Permanente Providers in Georgia, the family can take advantage of Kaiser Permanente’s coordinated care. Contributed by Lincoln Cushing, … Sound Health & Wellness Trust participants are also able to use benefits for mental health and chemical dependency at the out of network benefit level. It is printed on the far left-hand side under the Trust logo. Search for a dentist using the Delta Dental of Washington site. Enter Last Name. Kaiser Permanente’s Flexible Choice Plan 15.0 . Members also can fill prescriptions at any pharmacy outside the Kaiser Permanente medical office and MedImpact network. Your Choice of Top Doctors . You are covered for Medically Necessary services at Kaiser Permanente facilities within the Hawaii service area, and which are provided, prescribed or directed by a Kaiser Permanente physician and consistent with reasonable medical management techniques Your reimbursement will depend on the dentist’s contract with DDWA: This option allows you to see any licensed dental provider. Getting a flu shot is the single best way to protect against the flu. Kaiser Permanente Providers in Georgia are connected to your electronic health record, so they’re up-to-date on your care. Urgent Care. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. This division is called Kaiser Permanente NW to distinguish it from the Puget Sound Kaiser … Or you can see any licensed provider you want for most covered services. And the additional providers in our HMO network share our dedication to quality care access and better health outcomes for members. Why Kaiser Permanente is the right choice for you. Members can receive medical care provided by our Kaiser Permanente physicians and experience the convenience of our integrated care delivery system. The Kaiser Permanente Flexible Choice plan blends HMO, PPO, and indemnity-style benefit plans and delivery systems into one product. If you choose out-of-network care, you can see First Choice Health Network or Beech Street providers at a discounted rate. Show me. Kaiser Permanente is hosting a series of open enrollment webinars including live question and answer sessions, available through any device with internet access. Call the Trust office at (206) 282-4500 or (800) 225-7620. If you are totally disabled because of your injury or sickness, you may be eligible for weekly disability benefits. Claims are processed by our claims team in Denver, Colorado. Employee Accidental Death or Dismemberment—, Cholesterol Lowering Medications (Simvastatin), Proton Pump Inhibitors (Prilosec OTC, with physician prescription), Non-sedating Antihistamines: Generic Claritin (Loratadine and Loratadine D), Tier 1 – $18 for generic if on Kaiser Permanente formulary, Tier 2 – $66 for brand if on Kaiser Permanente formulary, Tier 3 – $70 if not on Kaiser Permanente formulary (brand or generic), Brand Name Drug with Generic Available – Generic co-pay plus the actual difference in cost between the generic and the brand name drug. Here’s an overview of getting care with Choice Products. Members have the option of receiving quality medical care provided by our Permanente physicians, who practice exclusively in our medical centers, and experiencing the convenience of our integrated care delivery system. Your company has the convenience of one health care provider for all your employee benefits administration. Tracey: Gets great family care, keeps her specialist, and manages costs. 6. DeltaCare is a dental HMO plan. Some services are covered by Health Plan and KPIC, while other (Must use Kaiser Permanente Order Program), Download Kaiser Permanente mail order form (PDF). Find the details of your life insurance coverage in your Summary Plan Description in the sidebar at right. Hours: Monday – Friday, 8:00am to 5:00pm, 11724 NE 195th St. Suite 300 With the Kaiser Permanente plan, when you choose in-network care, you get access to providers at all Kaiser Permanente medical centers and preventive care is paid in full. Employers in MD, D.C., and VA can learn about the health care plan that combines HMO and DHMO options giving provider choice for employees. If you have any questions or need help with any of the PPO providers, you may contact their customer support at: First Choice Health Network 1-800-467-5281. Most Kaiser Permanente medical offices in Georgia have on-site pharmacies. Children from 6 months to 19 years of age, pregnant women, people 50 and older, and people with certain chronic medical conditions are especially encouraged to get a flu shot. Kaiser Permanente Dual Choice PPO is the best of all worlds. She can save money by receiving her primary and additional specialty care with In-Network Providers. First Health Network 1-800-226-5116. Tracy can receive In-Network care with her Network Provider. Your Benefits With the Trust Eligible Sound Health & Wellness Trust Kaiser Permanente Plan participants and their covered dependents can receive $0 co-pay flu shots at Kaiser Permanente medical centers, Bartell Care Clinic locations and in-network pharmacies. Why choose Kaiser Permanente for your health care coverage? With the Kaiser Permanente plan, when you choose in-network care, you get access to providers at all Kaiser Permanente medical centers and preventive care is paid in full. You can see most specialists without a referral. You can receive care from any licensed care provider in the U.S., including physicians, specialists, hospital, or laboratory (outside of In-Network Providers). Tier 2-Most brand drugs, and more costly or less desirable future generics: Co-pay per 30-day supply: $22 for brand on Kaiser Permanente formulary. They are mostly a one-stop shop for Kaiser Permanente customers, meaning that customers can often visit the lab, radiology, specialists, pharmacy, and their primary care physician in the same visit. Kaiser Permanente Medical centers are based throughout the regions covered by Kaiser Permanente. Kaiser Permanente’s personalized approach to care puts our members’ well-being at the center of everything we do. Kaiser Permanente 1-866-616-0047 (TTY 711) … In the event of your spouse or Partner ’ s death from any Out-of-Network licensed to! 206 ) 282-4500 or ( 800 ) 225-7620 coverage are not covered by Medicare a! 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