2014 Enrollment Book Baltimore City Public Schools. test results online. a wide range of specialists TP Schools.indd 1 10/23/13 12:41 PM

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1 2014 Enrollment Book Baltimore City Public Schools test results online excellent prenatal care I can choose my doctor a wide rane of specialists I can my doctor s office TP Schools.indd 1 10/23/13 12:41 PM

2 BALTIMORE CITY PUBLIC SCHOOLS EMPLOYEES Kaiser Permanente offers an affordable choice for you! We are ranked the number one health plan in Maryland, Virinia, and Washinton, D.C., and a cost-effective plan. 1,2 your choice of top doctors With Kaiser Permanente, you et a wide choice of doctors from many of the top medical schools in the country. Many of our doctors come from schools such as Harvard, Stanford, and Johns Hopkins, just to name a few. personalized care with 24/7 online access Use your computer or mobile device to your doctor s office, schedule routine appointments, view most lab test results, and refill most prescriptions, supported by your secure electronic health record. 3 urent care Get urent care durin the day, niht, or weekend at many Kaiser Permanente locations from our physicians. New Urent Care Plus locations are open 24/7 for your convenience and have extended treatment and observation capabilities. It s more than your averae urent care center. experience award-winnin care The National Committee for Quality Assurance (NCQA) has awarded its hihest accreditation status of Excellent to Kaiser Permanente of the Mid-Atlantic States for service and clinical quality that meet or exceed NCQA s riorous requirements for consumer protection and quality improvement. everythin under one roof Most of our locations include medical specialists and pharmacy, lab, and X-ray services, so you can do more durin one visit and travel less. state-of-the-art medical centers You have access to 29 Kaiser Permanente multi-specialty medical facilities in Maryland, Virinia, and Washinton, D.C., to serve you, some with 24/7 services. kp.or/midatlantic 1 NCQA Private Health Insurance Plan Rankins NCQA evaluated over 577 private health plans and ranked 484 of those based on clinical performance, member satisfaction, and NCQA Accreditation. 2 The Hewitt Health Value Initiatives (HHVI) prepares analysis of the financial efficacy and plan performance of Kaiser Permanente by comparin Kaiser Permanente s Financial Efficiency and Plan Performance results to those of other plans represented in the HHVI database. Results are reported for over 1,800 health plans in 140 market areas across the United States. 3 Available when you receive care at Kaiser Permanente facilities TP Schools.indd 2 10/23/13 12:41 PM

3 Better Informed. Better Toether. Choosin the riht Baltimore City Public Schools health care partner can be easier than you think. Nationwide, more than 9 million people turn to us as their trusted health care partner. Take a look and you ll see why Kaiser Permanente is your best choice. er us r d 2014 Baltimore City Public Schools benefits summary... 2 A better way to et and stay healthy... 4 Make the best choice for you and your family. You ll have access to reat Kaiser Permanente doctors, convenient facilities, and advanced technoloy. This makes it simple for you to et excellent, coordinated care. Excellent care... 6 You choose your own personal doctor. Plus, you et an entire care team who works with you. Your doctors, nurses, and specialists are connected to our electronic health record system, so they can work toether to provide the best care for your needs. Online access anytime, anywhere... 7 Stay better informed about your health and better able to manae it with online and mobile tools that help you et the information you want, when you want it. Expandin and rowin...10 As our members needs row, so do we. New medical centers have been added and others renovated in the Baltimore area to better serve you. The riht choice for ood health...11 Find out about the Kaiser Permanente difference, and see why it s the riht choice for you. Watch members share why they chose Kaiser Permanente at kp.or/thrive TP Schools.indd 1 10/23/13 12:41 PM

4 Your 2014 Baltimore City Public Schools Benefits Summary 2 PLAN DETAILS Copayments Coinsurance (Plan pays / Member pays) Member Pays $5 (PCP) / $10 (Specialty) 100% / 0% except as otherwise indicated Deductible None Maximum Annual Copayment Individual: $1,100 Family: $3,600 Lifetime Maximum Benefit-specific lifetime maximums BENEFITS Outpatient Services Preventive Health Office Visit Preventive Health Screenin Tests Office Visits for Illness Primary Care Office Visit Specialty Care Office Visit Routine Prenatal Visit (after confirmation of prenancy) and First Postnatal Visit Dianostic Tests and Procedures, X-rays and Laboratory Services Specialty Imain (e.., CT, MRI, PET scan and Nuclear Medicine) Outpatient Surery (other than in provider s office) Hospital Services Inpatient Hospital Care, includin Inpatient Maternity Care Inpatient Physician Services Chemical Dependency and Mental Health Services Inpatient hospital care Outpatient Services Therapy & Rehabilitation Services Inpatient Hospital Care Outpatient Services* Infertility Services Office Visits All other covered services for treatment of infertility (In vitro fertilization benefit limited to 3 attempts per live birth and a lifetime maximum Health Plan benefit of $100,000) $5 per visit (Copayment waived for children under ae 5) $10 per visit $5 per visit for individual therapy; $5 per visit for roup therapy $10 per visit 50% of allowable chare 50% of allowable chare * Physical therapy limited to 30 visits and 90 consecutive days of occupational or speech therapy per contract year per injury, incident, or condition. No coverae is provided for any therapy that the Plan Physician determines cannot achieve measurable improvement in function within two-month period TP Schools.indd 2 10/23/13 12:41 PM

5 BENEFITS (CONT D) Urent Care and Emerency Services Urent Care Office Visit After hours Urent Care or Urent Care Center Hospital Emerency Room (waived if admitted as inpatient) Ambulance Hospital Alternatives Skilled Nursin Facility (limited to 100 days per contract year) Home Health Care (limited to 2 hours per visit; intermittent care shall not exceed 3 visits in one day) Hospice Care Other Services Durable Medical Equipment (DME) Basic DME Oxyen Equipment Prosthetics Internal Prosthetics External Prosthetics Vision Office visit for medical conditions of the eye Routine eye refractions to determine need for vision correction Eyelass Frames and Lenses Contact Lenses Member Pays $5 per visit (PCP) / $10 per visit (Specialty) $10 per visit $50 per visit for first 3 months, then 50% of allowable chare thereafter $5 per visit (PCP) / $10 per visit (Specialty) $5 per visit with Optometrist / $10 per visit with Ophthalmoloist (referral required) Member receives 25% discount off retail price when purchased from Plan Providers Member receives 15% discount off retail price on initial pair of contact lenses only, when purchased from Plan Providers Baltimore City Public Schools provide separate vision, dental, and prescription dru plans. This Benefit and Service Summary contains only a partial, eneral description of the plan benefits and services and does not fully describe the exclusions and limitations associated to this benefit plan. To request a full list of Exclusions and Limitations for Mid-Lare Groups, please call Member Services at , , or (TTY for the deaf, hard of hearin, or speech impaired). Monday throuh Friday, 7:30 a.m. 5:30 p.m. Once enrolled for coverae, you will receive your KFHP-MAS Evidence of Coverae (EOC) which contains a complete listin of services, limitations, eneral and benefit specific exclusions and a description of all the terms and conditions of coverae. Your EOC provides you with information on what services and supplies will not be covered, reardless of whether the service is medically necessary. Kaiser Permanente shall not be bound by the exclusions and limitations listed herein, but rather, the benefits, services, exclusions and limitations listed in your EOC. Consult the plan documents, that is, Evidence of Coverae, to determine overnin contractual provisions, includin detailed benefits, exclusions, and limitations relatin to the benefit plan. The Affordable Care Act (the Act ) requires all roup health plans to make a Summary of Benefits and Coverae (SBC) available to all plan members after September 23, An SBC is a 4-pae summary of your benefits coverae in a standard, user-friendly format dictated by the Act. You can access an electronic copy of your SBC on Employee Self Service at You may also request a hard copy be mailed to you by callin Kaiser Permanente Member Services at If you have any questions, call Kaiser Permanente Member Services at Exclusions: (1) Internally implanted breast prosthetics for cosmetic purposes; (2) Repair or replacement of prosthetics due to loss or misuse; (3) Microprocessor and robotic-controlled external prosthetics not covered under the Medicare Coverae Database TP Schools.indd 3 10/23/13 12:41 PM

6 A better way for Baltimore City Public Schools employees to et and stay healthy Stay in chare of your health. It s simple to make the riht choices when you ve ot reat doctors, convenient facilities, and a care team that puts you front and center. A wide choice of top doctors Kaiser Permanente doctors are skilled and compassionate, so you can count on ettin reat care for you and your family. You may choose to receive care in any Kaiser Permanente medical center in Maryland, Virinia, and Washinton, D.C., from a wide rane of physicians many of whom have been named top doctors in publications such as Washintonian maazine and Baltimore maazine. Personalized care: Your connection starts here With Kaiser Permanente, you et a choice of primary care physicians (PCPs) for you and your family. Women ae 18 and older may also select an Ob/Gyn. Your personal physician is your partner and your health advocate. All Kaiser Permanente physicians work closely toether to help you et well and stay well. Supportin your PCP and you are doctors, nurses, and specialists who take the time to know you and your health needs. Connected by your secure electronic health record, your entire care team is always up to speed and ready to take care of you. Havin a team that knows you and is focused on you can lead to quicker, better dianoses and treatments. Everythin under one roof Most of our Baltimore-area Kaiser Permanente locations conveniently offer many services under one roof. In our larest centers, there are more than 20 services to make care convenient for you. You can visit your primary care physician, the lab, radioloy, specialists, and pharmacy, often in one visit to the medical center enablin you to drive and park once. That could help you save time and avoid drivin all over the Beltway. Additionally, urent care centers are located in many Kaiser Permanente medical centers includin White Marsh some are open 24/7 with an advanced observation unit. Your electronic health record brins it all toether Our innovative electronic health record system is securely linked to every Kaiser Permanente facility in your reion, so you et coordinated care wherever you o TP Schools.indd 4 10/23/13 12:41 PM

7 Convenience is built into our medical centers Medical centers combine state-of-the-art technoloy, expert physicians, and most services, so you have more time to do what you enjoy.* Urent care Your doctor s office Radioloy Specialty doctors Vision care Pharmacy Lab Visit kp.or/facilities for locations where services are available. See how Kaiser Permanente has helped members at kp.or/carestories. Your medical record Your electronic health record is updated with each visit, whether you see your personal physician or another Kaiser Permanente doctor. From department to department and facility to facility, your record is available to your providers wherever you o. Pharmacy, lab, and X-ray If your doctor prescribes you medications or orders lab tests, there s no paperwork to take with you in most cases. Just visit any Kaiser Permanente pharmacy, and the pharmacist or technician will pull up your doctor s orders. The same is true at our labs and radioloy departments. Better visits You et the convenience of bein able to take care of multiple services in one trip, with virtually no paperwork. At most locations, your doctor, specialists, lab services, radioloy, and pharmacy are all toether in one place. *Many of the features described in this document are available only for services received at Kaiser Permanente facilities TP Schools.indd 5 10/23/13 12:41 PM

8 Excellent care Kaiser Permanente doctors believe that preventin illness and disease is the key to a healthy life. And when you re sick, your physician and other Kaiser Permanente health professionals collaborate to care for you with advanced health information and technoloy in hand. What you need, when you need it your doctor s office with nonurent questions. Refill most prescriptions online with free shippin. Make routine appointments with a call or click. View recent office visits and most test results online. Get same-day, after-hours, and weekend services at many locations. Call for advice from a reistered nurse, 24 hours a day. Travel freely; you re covered for emerency care worldwide. Easy access to specialty care You have access to specialists who are experts in their fields. They re ready to help dianose and treat you to help you live the healthiest life possible. And referrals have been revolutionized. At Kaiser Permanente, your doctor can typically book a specialty appointment for you on the spot so that you leave with a confirmed appointment rather than a paper referral that leaves you doin the lework to et care. A focus on you and your family Our care model virtually eliminates the burden of administrative hassles, insurance claim forms, and other paperwork for Kaiser Permanente doctors, nurses, and specialists. And unlike most practitioners, Kaiser Permanente doctors aren t paid by procedure or rewarded for cuttin costs, so there s no incentive to under-treat or over-treat. They re free to focus on what they do best deliverin reat care that s riht for you. Learn more about the doctors available in the Baltimore Metropolitan area at kp.or/doctor. Top reasons to join Kaiser Permanente Expert physicians Our medical roup is always expandin with new physicians. Our doctors are board certified or must be within 5 years of hire to remain a part of our medical roup. And it s touh to become one of those hires. Only 1 in 10 who applies is accepted as a Kaiser Permanente doctor. At home or on the o My Health Manaer on kp.or is your personal link to your electronic health record. This set of online tools helps you stay connected and informed about your health. You can also download a mobile app for your smartphone TP Schools.indd 6 10/23/13 12:41 PM

9 Online access anytime, anywhere Plu into your health with a variety of online and mobile tools that help you et the information you want, when you want it. Whether you re on the o or just takin advantae of a quiet moment at home, we ve ot you covered. It s easy to et connected Members reistered on kp.or have secure access to My Health Manaer, the online tool that helps you manae your care at our facilities.* your Kaiser Permanente doctor s office. Read most lab test results. Get electronic reminders for appointments, screenins, refills, and more. Request most prescription refills. Take care of a family member, such as a child or parent, usin these features. * Available when you receive care at Kaiser Permanente facilities. A website full of healthy ideas Get informed and inspired on our award-winnin website, kp.or. Take chare of your health with articles, wellness topics, and health calculators. Our music channels, podcasts, fitness videos, and recipes from world-class chefs can help you find new ways to live well. Good health on the o Manae your care at home, work, or play with our mobile app. It puts all the convenient features of My Health Manaer riht in the palm of your hand. You can download the complimentary Kaiser Permanente app from the App Store sm or Goole Play. App Store is a service mark of Apple, Inc., and Goole Play is a trademark of Goole, Inc. For a uided tour of My Health Manaer, visit kp.or/experience. Better care You et reat care, backed by innovative technoloy. Your care team can securely access your up-to-date health information and make sure you et care that s riht for you. Better doctors You et top Kaiser Permanente doctors who aren t burdened with excessive insurance paperwork and aren t paid by procedure. Their only focus and incentive is workin toether with you to deliver the care you really need. Better access You et information and tools that make it easy for you to et and stay healthy includin easy, online appointment schedulin, access to your doctor s office, telephone health advice, and powerful online tools TP Schools.indd 7 10/23/13 12:41 PM

10 Our locations To find a location near you, visit kp.or/facilities or download a complimentary app for your smartphone or mobile device from the App Store or from Goole Play. Carroll 83 Baltimore Hartford Harford VA Loudoun Frederick Towson White Marsh 40 Woodlawn 70 Balt. City Frederick City Plaza Howard Montomery Columbia South Baltimore Gaithersbur Gateway County 267 Shady Grove Ashburn Kensinton Severna Park Summit Behavioral Health Center Silver Sprin Anne Arundel Reston Annapolis 495 Prince Geore s Fair Oaks Tysons DC Laro Corner Falls Church Fairfax Camp Sprins Manassas Burke Marlow Sprinfield Heihts Prince William Prince Geore s Woodbride CharlesC alvert Fauquier Charles DC MD Stafford Culpepper City of 495 Fredericksbur Fredericksbur Kin Geore Northwest Orane (Not available for Medicare Plus enrollees) West- D.C. Medical Kaiser moreland Spotsylvania Office Buildin Permanente Capitol Hill Caroline Louisa Hanover 95 These centers open 24/7 Urent care Lab Pharmacy Radioloy TP Schools.indd 8 10/23/13 10/21/13 12:41 12:29 PM

11 What s new in your area With medical centers close to where you live and work, health care has never been more convenient. Maryland Annapolis Camp Sprins City Plaza Columbia Gateway Frederick Gaithersbur Kensinton Laro Marlow Heihts Prince Geore s Severna Park Shady Grove Silver Sprin South Baltimore County Summit Behavioral Health Center Towson White Marsh Woodlawn Virinia Ashburn Burke Fair Oaks Falls Church Fredericksbur (Not available for Medicare Plus enrollees) Manassas Reston Sprinfield Tysons Corner Woodbride Washinton, D.C. Capitol Hill Northwest D.C. Medical Office Buildin For information about the services all our medical centers provide, visit kp.or/facilities. 9 12:29 PM TP Schools.indd 9 10/23/13 12:41 PM

12 Expandin and rowin Kaiser Permanente is committed to the people of the Baltimore and Washinton, D.C., areas. By buildin new state-of-the-art medical centers and expandin others, your access to quality health care is even more convenient. Gaithersbur Medical Center More than 30 specialties, some available 24/7, includin urent care. Tysons Corner Medical Center More than 20 specialties, includin 24/7 urent care and other services. Northwest D.C. Medical Office Buildin New, completely renovated center featurin a pharmacy, primary care, and more. Now open South Baltimore County Medical Center This is our larest medical center in the Baltimore area and features some 24/7 services, includin urent care. Kaiser Permanente Ashburn Medical Center Now with 29,000 square feet featurin Ob/Gyn, behavioral health, primary care, and more. Kaiser Permanente Capitol Hill Medical Center Located in the heart of Washinton, D.C., with 156,000 square feet and includin many 24/7 services, includin urent care. Expanded Laro Medical Center Now the larest medical center in the reion. 10 Watch members share why they chose Kaiser Permanente TP Schools.indd 10 10/23/13 12:42 PM

13 The riht choice for ood health Kaiser Permanente is uniquely structured to ive you everythin you need all toether in one easy-to-use packae. See how havin the riht health care partner can make all the difference. The experience With some health plans With Kaiser Permanente* Choosin your doctor. Pick from a lon list of physicians who will accept your insurance. View our doctors profiles online to find the one who is riht for you. Makin an appointment. Call. Get placed on hold. Call aain. Schedule or cancel routine appointments online. Durin your visit. Your doctor flips throuh a bi folder of paper records and possibly repeats tests. Your doctor and health care team have immediate access to your electronic health record. Bein referred to a specialist. Get a few names of people your doctor knows, or maybe has just heard of. Now it s up to you. E-referrals are simple and virtually seamless. Your doctor can typically book a specialty appointment for you on the spot so that you leave with a confirmed appointment. Askin routine questions without a visit. Leave a messae for your doctor and hope you et a call back. your doctor s office and et a reply, normally within 48 hours. kp.or/midatlantic *When you see a Kaiser Permanente physician TP Schools.indd 3 10/23/13 12:42 PM

14 Notes TP Schools.indd 4 10/23/13 12:42 PM

15 Notes TP Schools.indd 5 10/23/13 12:42 PM

16 Visit us at kp.or/midatlantic or call Member Services, Monday Friday, 7:30 a.m. 5:30 p.m., except holidays, at: TTY Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc East Jefferson Street Rockville, MD kp.or/midatlantic _BaltCityGdrPSEmp_P_br 10/1/13 12/31/ TP Schools.indd 4 10/23/13 12:40 PM