Your out-of-pocket costs will be higher than if you choose care inside the Kaiser Permanente network. Access coverage documents for Added Choice members. You must notify Kaiser Permanente within 24 hours of admission, or as soon thereafter as medically possible. 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. Kaiser Permanente Insurance Company (herein called KPIC) provides the Out-of-Network coverage as set forth in the Group Policy. 2021 Open Enrollment. Learn how our integrated care and coverage works by viewing this short video: PEBB employees can choose from 4 health plans. 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. Tier 1-Current generics, some future generics: Co-pay per 30-day supply: $6 on Kaiser Permanente formulary. Employer & producer support. Call 1-866-616-0047 (TTY 711) to speak with our Added Choice Contact Center. The versatility and benefits of Dual Choice PPO can help attract and retain employees. Some medications are not eligible for the Mail Service Delivery Program. Your out-of-pocket costs will usually be the highest with Out-of-Network Providers. 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. Contributed by Lincoln Cushing, … You MUST choose a DeltaCare primary care dentist who coordinates all of your care, including any referrals to specialists. March 22, 2017 Kaiser Permanente and Group Health Cooperative: Working together since 1950 "Permanente pediatric clinic at 515 Market St, San Francisco - nurse giving Patricia Nisby, daughter of ILWU Local 10 member Wiley Nisby, a shot." Learning sessions will be held on Wednesdays beginning August 26, 2020, and ending November 18, 2020. 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. 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. Find the details of your life insurance coverage in your Summary Plan Description in the sidebar at right. Newborn services cost shares are separate from that of the mother. 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. 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. Find a Kaiser Permanente provider with the Kaiser Permanente Provider Directory. It is printed on the far left-hand side under the Trust logo. Kaiser Permanente provides mental health care and alcohol and drug treatment through the Kaiser Permanente Behavioral Health Services department. 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. Coverage for a description of their benefits. Under this plan you cannot just see any licensed dentist for treatment. You may have to pay the provider directly at the point of service. You can see any specialist you choose without a referral. Plus, you’ve got the power to change doctors anytime. This option requires you to choose from a smaller list of approved dentists and clinics. Kaiser Permanente Washington offers many ways to get care quickly. 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. With Kaiser Permanente Providers in Georgia, the family can take advantage of Kaiser Permanente’s coordinated care. Urgent Care. Check here for more about pharmacy services, finding doctors and facilities, and the benefits of Dual Choice PPO. General information about Kaiser Permanente Washington's PPO plans. Choose from an extensive network of Network Providers across the country. 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. Dependent Life Insurance—The spouse or State Registered Same Sex Domestic Partner’s benefit is $1,000. Show me . Kaiser Permanente Options Federal coverage can help pay for many expenses that are not covered by Medicare Parts A and B. 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. Email Address. Show me. Your Choice of Top Doctors . This EOC is a statement of benefits, exclusions and other provisions as set forth in the Group medical coverage agreement between Kaiser Foundation Health Plan of Washington (“KFHPWA”) and the Group. It is printed on the far left-hand side under the Trust logo. 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. 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. Email Eligibility & COBRA, (206) 282-4500 or (800) 225-7620 Kaiser Permanente Providers in ... pharmacy services, worldwide emergency coverage, and customized case management services for serious or complicated illnesses. Dual Choice PPO plan allows access to In Network providers or any licensed provider. PEBB members can conveniently get open enrollment information from Kaiser Permanente. 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. When you combine the Options Federal Standard Option plan with Medicare coverage, your Kaiser Permanente coverage will make your Medicare coverage go further. The Flexible Choice plan is composed of three benefit levels, which includes the convenience of our traditional HMO coverage. If you choose out-of-network care, you can see First Choice Health Network or Beech Street providers at a discounted rate. Why Kaiser Permanente is the right choice for you. This amount will be paid to you in the event of your spouse or partner’s death from any cause. A claim form will have to be completed. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. Find the details of your prescription drug coverage in your Summary Plan Description in the sidebar at right. The Kaiser Permanente WA SoundChoice plan is available to residents in King, Kitsap, Pierce, Thurston, Snohomish, and Spokane counties. The benefits covered under the two types of coverage are not the same. Search for a location and select one from the list of suggestions. Puget Sound area. Are you an employer or producer with questions about Added Choice®? Call the Trust office at (206) 282-4500 or (800) 225-7620. Members have several choices for having their prescriptions filled. Your physician will complete a claim form. 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. Send Kaiser an email. Your Kaiser Permanente Added Choice® Point-of-Service (POS) Plan is not just health coverage — it's a partnership in health. 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. The plan offers a wide array of benefits and care from our highly-trained doctors through the Core network. 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. Certain services require precertification. Your out-of-pocket costs will be higher than if you choose care inside the Kaiser Permanente network. For additional information, or to find a provider, contact Kaiser Permanente WA at (888) 901-4636 or visit Kaiser Permanente WA for PEBB. Questions? 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. 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. Choice Products California. It is printed on the far left-hand side under the Trust logo. This amount will be paid to your beneficiary in the event of your death from any cause. 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. Benefits will be paid according to the schedule of allowances. Choice Products offer the most flexibility on how you receive care. ... Dual Choice PPO also includes: preventive care, pharmacy services, worldwide emergency coverage, and customized case management services for serious or complicated illnesses. Your Kaiser Permanente Provider in Georgia will coordinate your care. Select Counties. Members can receive medical care provided by our Kaiser Permanente physicians and experience the convenience of our integrated care delivery system. Not a Kaiser participant? Your reimbursement will depend on the dentist’s contract with DDWA: This option allows you to see any licensed dental provider. What are the pharmacy choices under Dual Choice PPO? Dual Choice PPO plan allows access to In Network providers or any licensed provider. 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. Call the Added Choice Contact Center at 1-866-616-0047 (TTY 711). Enter First Name. Find a provider online by using the Kaiser Permanente Provider Directory. Please fill out the fields below and click "Join Now" to receive information about opportunities that relate to your selections. for more information about Emergency services. Our doctors are among the best, and caring for people is their passion. Inside the Group Health Service Area, urgent care is covered at a Group Health medical center, Group Health urgent care center or Network Provider’s office. 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. In-network coverage with high-performing Washington Permanente Medical Group and contracted network providers, while offering choice with out-of-network coverage: Kaiser Permanente providers, medical facilities, and pharmacies; More than 16,000 additional network providers and facilities 3 For Employers only, please visit cas.kp.org to view your group documents. Go back to home. ... Kaiser Permanente Providers in Georgia. Kaiser Permanente Options Federal coverage can help pay for many expenses that are not covered by Medicare Parts A and B. Your Choice of Top Doctors . Or you can see any licensed provider you want for most covered services. 6. Interested In Search for a category and select one from the list of suggestions. Members can also choose to receive prescriptions by mail at Kaiser Permanente medical offices in Georgia.*. 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). PPO . Go back to home. Show me. If you or a member has questions regarding claims or how they were paid, please call our customer service team. You can choose any licensed physician to provide care nationwide, and receive preventive care at little or no cost from in-network providers. All Kaiser Permanente Medical Group physicians and network physicians are subject to the same quality review processes and certifications. Get More Information in Your Benefits Booklet. Learn about Georgia Kaiser Permanente Choice Products. Kaiser Permanente. This division is called Kaiser Permanente NW to distinguish it from the Puget Sound Kaiser … Tracy can receive In-Network care with her Network Provider. 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). 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. It connects you to a group of physicians, services, and tools that help you live your healthy best. She can save money by receiving her primary and additional specialty care with In-Network Providers. Count on Kaiser Permanente to deliver affordable, quality care to provide for your total wellness. Here’s an overview of getting care with Choice Products. Our doctors are among the best, and caring for people is their passion. You can receive care from any licensed care provider in the U.S., including physicians, specialists, hospital, or laboratory (outside of In-Network Providers). 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. Your time-loss payments will range from $135 to $225 per week (less Social Security taxes), depending on the number of hours you worked during your eligibility month. For additional information, visit www.kp.org/wa. Bothell, WA 98011–3145. Search for a dentist using the Delta Dental of Washington site. Hours: Monday – Friday, 8:00am to 5:00pm, 11724 NE 195th St. Suite 300 Point-of-Service (POS) PPO. You can see most specialists without a referral. Learn about Georgia Kaiser Permanente Choice Products. Kaiser Permanente’s Flexible Choice Plan 15.0 . 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. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. Kaiser Permanente Providers. With the Kaiser Permanente plan, when you choose in-network care, you get access to providers at all Kaiser Permanente facilities. Tier 0-Some highly cost-effective medications: Co-pay per 30-day supply $0. Core Access PPO. You can choose any licensed physician to provide care nationwide, and receive preventive care at little or no cost from in-network providers. Tracey: Gets great family care, keeps her specialist, and manages costs. Core Access PPO. Choose Kaiser Permanente physicians and specialists in Georgia. When you combine the Options Federal Standard Option plan with Medicare coverage, your Kaiser Permanente coverage will make your Medicare coverage go further. This option allows you to see any licensed dental provider. ** A maximum of $200 is payable for MHCN providers and community providers combined. Learn about Georgia Kaiser Permanente Choice Products. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. 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. 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 Download the full list of what counts toward your Jan 1, 2022 HRA in English or Spanish. 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). Learn about Georgia Kaiser Permanente Choice Products. Dual Choice PPO plan allows access to In Network providers or any licensed provider. You can receive care from Kaiser Permanente Providers in Georgia, Network Providers, or from any Out-of-Network licensed physician or facility. Your Kaiser Permanente Added Choice® Point-of-Service (POS) Plan is not just health coverage — it's a partnership in health. Need a coverage document? Refer to Section IV. You choose your own doctor and you can change your doctor at any time. Kaiser Permanente 1-866-616-0047 (TTY 711) … Out-of-network coverage for all PPO Plans: Any licensed provider in the U.S. not directly contracted with Kaiser Permanente and First Choice Health and First Health Network. Kaiser Permanente Providers in Georgia are connected to your electronic health record, so they’re up-to-date on your care. The Kaiser Permanente Flexible Choice plan blends HMO, PPO, and indemnity-style benefit plans and delivery systems into one product. Find the details of your dental coverage in your Summary Plan Description booklet in the sidebar at right. live outside the Kaiser Permanente service area, you will receive medical and prescription drug benefits under the Trust’s Sound PPO Plan. Eligibility, claims or any other questions? Online features let you manage most of your care around the clock. It is printed on the far left-hand side under the Trust logo. Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 1/1/20 20 – 12/31/2020 : PEBB SoundChoice Plan All plans offered and underwritten by Kaiser Foundation Health Plan of Washington 1 of 6 RQ-136645-1 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Kaiser Permanente plans are widely accepted at hospitals and doctor's offices across its coverage regions and states. Make sure you have a DeltaCare provider in your area and that they are accepting new patients before enrolling in this option. Kaiser Permanente Insurance Company (KPIC) is a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP). In addition, you have access to a number of contracted community physicians in the area. Plus, you’ve got the power to change doctors anytime. 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. 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). Need help with your Added Choice® plan? However, she can continue to see her doctor who is an Out-of-Network Provider. Each Flexible Choice In general, when you have a Kaiser WA plan, you’ll visit Kaiser Permanente Medical Centers to receive care and get prescriptions. 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. We’ve contracted with Private Healthcare Systems (PHCS) Network for Kaiser Permanente Insurance Company to manage provider costs. Your company has the convenience of one health care provider for all your employee benefits administration. 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. Select a plan for details . With care and coverage working seamlessly together, Kaiser Permanente is uniquely designed to give you the information and support you need to live healthy. To qualify, you must have worked at least 80 hours during your eligibility month (which was two months before the onset of your disability). 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. The Trust’s four-tier therapeutically based prescription plan is designed to promote the use of proven, cost-effective medications. 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. Employer and broker frequently asked questions. Find the details of your time loss coverage in your Summary Plan Description in the sidebar at right. Kaiser Permanente WA Classic plan Kaiser Permanente WA Classic offers low copayments and low deductibles. Online features let you manage most of your care around the clock. Find the details of your medical coverage in your Summary Plan Description booklet in the sidebar at right. Join Kaiser Permanente's Talent Network. Open enrollment webinars. Care management services, a 24-hour nurse hotline, online tools, and valuable decision aids help your employees make informed treatment choices. If the evidence your prescriber provides meets medical necessity, an exception may be approved. Get More Information in Your Benefits Booklet Choose an insurance plan below to explore more details about your coverage, including provider options and guidance on how to get the most out of your insurance plan. Participating unions include: UFCW Local 21, UFCW Local 1439, Teamsters Local 38, and UFCW Local 367. Tracey’s young family appreciates all the services, convenience, and urgent care at their nearby Kaiser Permanente medical office in Georgia. Kaiser Permanente has locations throughout Puget Sound and encompasses a wide array of doctors and other professionals. Kaiser Permanente Medical centers are based throughout the regions covered by Kaiser Permanente. 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. Lowest out-of-pocket costs compared to care with Out-of-Network Providers. A list of DeltaCare providers can be found at www.deltadentalwa.com. And the additional providers in our HMO network share our dedication to quality care access and better health outcomes for members. Access PPO and Elect PPO preauthorization (PDF) PPO: Options (no longer available for new sales) Kaiser Foundation Health Plan of Washington Options, Inc. Spokane area. Dependent Children Coverage To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. Plan hospitals, plan physicians, and other plan providers, and the services available at plan facilities, are subject to change at any time without notice. Show me. Kaiser Permanente and Group Health Cooperative: Working together since 1950. *A program operated or arranged by a health plan distributes prescription drugs to members via mail. Tier 3-Generic or brand name drugs not on the Kaiser Permanente formulary: Co-pay per 30-day supply: $35. Most Kaiser Permanente medical offices in Georgia have on-site pharmacies. It is printed on the far left-hand side under the Trust logo. You’re free to choose whatever provider you prefer, whenever you receive care. Why choose Kaiser Permanente for your health care coverage? Here are some examples of how people may use  Dual Choice PPO to get the care they want: Give your valuable employees full choice in their providers, and allow them to determine and manage their health care costs. Your health care plan with Kaiser Permanente WA is a partnership in health. For years, Katherine has been seeing her cardiologist, who is not an In-Network Provider. General information about Kaiser Permanente Washington's PPO plans. 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. Physician as described in the Added Choice Service Agreement. 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. DeltaCare is a dental HMO plan. ILWU Dispatcher, October 13, 1950. Contact Kaiser Permanente at any time through our. Members also can fill prescriptions at any pharmacy outside the Kaiser Permanente medical office and MedImpact network. PPO plans generally offer coverage for out-of-network providers, while HMO plans only offer out-of-network coverage in emergency situations. Access coverage documents for Added Choice members. 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. 1. 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. 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. Not a Kaiser Participant? Kaiser Permanente Dual Choice PPO is the best of all worlds. See her doctor who is a Taft-Hartley Trust managed jointly by unions and employers and benefits. Dentist ’ s contract with DDWA: this option allows you to see any licensed dental provider doctors... Physician as described in the event of your medical coverage in your Summary plan Description the! Employer or producer with questions kaiser permanente sound choice coverage Added Choice® Point-of-Service ( POS ) plan is composed three. 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