MEDICAL PLANS OVERVIEW FOR WASHINGTON SMALL BUSINESSES

Transcription

1 MEDICAL PLANS OVERVIEW FOR WASHINGTON SMALL BUSINESSES with 1 50 eligible employees. For coverage on or after January 1, WASHINGTON 2017 SMALL BUSINESS Why choose Kaiser Permanente ONLINE ACCESS ANYTIME, ANYWHERE: kp.org My Health Manager gives members access to information and tools to better manage their health. Use it 24 hours a day, seven days a week. access medical records doctor (no charge) schedule appointments refill prescriptions check lab results Kaiser Permanente mobile app digital membership card MEMBER DISCOUNTS: kp.org/choosehealthy CHP Active and Healthy offers members discounted access to recreational, cultural, fitness and wellnesscentered businesses, retail services, equipment, instruction, memberships, and tickets both regionally and nationally. CHP Active and Healthy fitness club discounts alternative and chiropractic care vitamins and supplements TOOLS FOR EMPLOYERS: businessnet.kp.org These online services can help make your job easier. online account management benefit summaries forms occupational health view and print group agreements (contracts) FACILITIES AND SERVICES: kp.org/facilities Members have their choice of primary care doctors and specialists when they need them, at convenient locations. 31 medical offices 18 dental offices The Portland Clinic (7 locations) 6 Urgent Care locations 24-hour advice nurses health coach services INTEGRATED CARE UNDER ONE ROOF doctors dentists labs and imaging services pharmacy vision services electronic medical records TOP QUALITY CARE With our commitment to quality care, we make it easier for you to stay healthy and feel your best. Coordinated teamwork, combined with expertise, help make our doctors, nurses, and specialists better informed to provide the best care for your needs. With 94 of our doctors and nurses recognized in Portland Monthly s 2016 Top Docs rankings,* it s easy to select your doctor, or request someone else whenever you like. GIVE US A CALL OR TALK TO YOUR BROKER We can answer your questions about medical coverage, eligibility, plan design, or renewal. Please contact us or your broker if you would like a booklet with more details about our plans and options. Portland area Salem area All other areas TTY Language interpretation services Fax *Based on data published in Portland Monthly, January 2016 account.kp.org _NW-WA_11/16 All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest. 500 NE Multnomah St., Suite 100, Portland, OR

2 It starts with a plan All of our plans give your employees what they need to be healthier and more productive every day prevention, health promotion, and care for ongoing health conditions. That s what we mean by a better way to take care of your business. You have lots of choices, from traditional HMOs to consumer-directed options to out-of-area coverage to dental coverage. Here s a quick overview of what we offer. For plan specifics, contact your Kaiser Permanente representative. Traditional copayment plan Predictable copayments and out-of-pocket maximums make it easier for employees to manage their health care spending and give them financial peace of mind. You ll appreciate the variety of copayment options. Deductible plans You ll get more options at an affordable cost. With the addition of an employee out-of-pocket cost, monthly payments are lower than for traditional HMO plans, so you ll be able to reduce premiums while still maintaining quality care and access to our physicians for your employees. Added Choice plans Provide flexibility. Give your employees the opportunity to keep their current doctor or have the option of seeing any licensed provider for covered services. With an Added Choice plan, members can access care from any licensed provider for covered services. Our Added Choice plans are also used as an indemnity coverage solution for employees who live or work outside the Kaiser Permanente and PHCS service areas. These plans provide first-dollar coverage for doctor s office visits and no-cost preventive care delivered by any licensed provider. HSA and HRA options Offer lower premiums than other plan types, plus tax savings.* With our HSA-qualified deductible plans and deductible plans with HRA, your employees will have more control over their health care dollars, helpful online decision-support tools, and the same high-value access to services as members of our traditional HMO plans. Medicare plans Provides your retirees over 65 with the benefits of Medicare and Kaiser Permanente s award-winning coverage. Dental plans Our traditional dental plan allows you to choose from a wide range of options and mix and match deductibles or office visit copayments for any plan combination. Our Dental Choice PPO is designed for flexibility and choice while providing comprehensive coverage, allowing members to see any dentist. Please contact your Kaiser Permanente representative for help building your health care strategy. *The tax references relate to federal income tax only. Consult with your financial or tax advisor for information about state income tax laws.

3 The right plan for your business Choosing a health plan that s right for your business is now easier than ever! You have the ability to customize a base medical plan with vision hardware and eye exams, based on your company s needs and budget. Follow the steps below and create a plan that will help you and your business to thrive. STEP 1: CHOOSE YOUR MEDICAL PLAN(S) (See pages 4 to 11 for plan details) Traditional plans KP WA Platinum 0/20 (2017) KP WA Gold 0/30 (2017) KP WA Silver 0/50 (2017) Deductible plans KP WA Platinum 250/20 (2017) KP WA Gold 500/20 (2017) KP WA Gold 1000/20 (2017) KP WA Silver 1500/35 (2017) KP WA Silver 2000/35 (2017) KP WA Silver 3500/40 (2017) KP WA Bronze 5000/50 (2017) KP WA Bronze 6600/35 (2017) HSA-Qualified High Deductible Health plans KP WA Silver 2600/25% HSA (2017) KP WA Bronze 5200/20 HSA (2017) Added Choice Deductible plans* KP WA Platinum 250/10 3T POS (2017) KP WA Gold 600/35 3T POS (2017) KP WA Gold 1000/35 3T POS (2017) KP WA Silver 2000/40 3T POS (2017) *If you have employees who both live and work outside of our service area, we may be able to set them up on an Added Choice plan. Rates and approval subject to underwriting. STEP 2: CHOOSE YOUR OPTIONAL BUY-UP COVERAGE Adult vision hardware and exam: $200 hardware benefit allowance every 2-year period and primary care office visit cost share applies for exam. STEP 3: APPLY OR RENEW YOUR COVERAGE New groups: Complete the Washington Small Business employer application and submit it to a Kaiser Permanente sales executive by the 20th of the month prior to the effective date. Renewing groups: We will provide you with coverage options that best match the plan(s) your business offers today, but you can choose from any of our other plans available to small employers if you prefer. Please complete and submit the Renewal Decision Form to your Kaiser Permanente account manager no later than the 15th of the month prior to the anniversary date.

4 WASHINGTON PLAN COMPARISON This is a high-level overview and plan comparison of the most frequently asked-about benefits within our plan offerings. Traditional plans PLAN NAME KP WA PLATINUM 0/20 (2017) KP WA GOLD 0/30 (2017) KP WA SILVER 0/50 (2017) DEDUCTIBLE PER MEMBER $0 $0 $0 DEDUCTIBLE PER FAMILY $0 $0 $0 OUT-OF-POCKET MAXIMUM PER MEMBER $3,000 $5,000 $6,850 OUT-OF-POCKET MAXIMUM PER FAMILY $6,000 $10,000 $13,700 OFFICE VISITS PRIMARY CARE $20 $30 $50 OFFICE VISITS URGENT CARE $40 $50 $70 OFFICE VISITS PREVENTIVE CARE $0 $0 $0 OFFICE VISITS PRENATAL CARE $0 $0 $0 OFFICE VISITS SPECIALTY CARE $30 $40 $60 OUTPATIENT SURGERY $100 35% 50% OUTPATIENT THERAPIES $30 $40 $60 LAB VISITS $20 $30 $50 X-RAYS AND SPECIAL DIAGNOSTIC PROCEDURES $20 $30 $60 CT, MRI, PET SCANS $75 $300 $300 EMERGENCY CARE $150 $200 50% INPATIENT HOSPITAL CARE $300/day, $1,500 admit $500/day, $2,500/admit 50% $5 generic $15 brand preferred $50 brand non-preferred $10 generic $20 brand preferred $60 brand non-preferred $20 generic $40 brand preferred 50% brand non-preferred $0 0% 20%

5 Deductible plans PLAN NAME KP WA PLATINUM 250/20 (2017) KP WA GOLD 500/20 (2017) KP WA GOLD 1000/20 (2017) KP WA SILVER 1500/35 (2017) DEDUCTIBLE PER MEMBER $250 $500 $1,000 $1,500 DEDUCTIBLE PER FAMILY $500 $1,000 $2,000 $3,000 OUT-OF-POCKET MAXIMUM PER MEMBER $2,000 $5,350 $5,000 $7,150 OUT-OF-POCKET MAXIMUM PER FAMILY $4,000 $10,700 $10,000 $14,300 OFFICE VISITS PRIMARY CARE $20 $20 $20 $35 OFFICE VISITS URGENT CARE $40 $40 $40 $50 OFFICE VISITS PREVENTIVE CARE $0 $0 $0 $0 OFFICE VISITS PRENATAL CARE $0 $0 $0 $0 OFFICE VISITS SPECIALTY CARE $30 $30 $30 $50 OUTPATIENT SURGERY 10% u 20% u 20% u 30% u OUTPATIENT THERAPIES $30 $30 $30 $50 LAB VISITS $10 $20 $20 $40 X-RAYS AND SPECIAL DIAGNOSTIC PROCEDURES $10 $20 $20 $40 CT, MRI, PET SCANS $75 $300 $300 30% u EMERGENCY CARE 10% u 20% u 20% u 30% u INPATIENT HOSPITAL CARE 10% u 20% u 20% u 30% u $5 generic $15 brand preferred $50 brand non-preferred $10 generic $20 brand preferred $60 brand non-preferred $10 generic $20 brand preferred $60 brand non-preferred $20 generic $40 brand preferred 30% brand non-preferred $0 $0 $0 20% 50% 50%

6 WASHINGTON PLAN COMPARISON This is a high-level overview and plan comparison of the most frequently asked-about benefits within our plan offerings. Deductible plans PLAN NAME KP WA SILVER 2000/35 (2017) KP WA SILVER 3500/40 (2017) KP WA BRONZE 5000/50 (2017) KP WA BRONZE 6600/35 (2017) DEDUCTIBLE PER MEMBER $2,000 $3,500 $5,000 $6,600 DEDUCTIBLE PER FAMILY $4,000 $7,000 $10,000 $13,200 OUT-OF-POCKET MAXIMUM PER MEMBER $7,150 $6,850 $7,150 $7,150 OUT-OF-POCKET MAXIMUM PER FAMILY $14,300 $13,700 $14,300 $14,300 OFFICE VISITS PRIMARY CARE $35 $40 $50 $40 up to 3 visits then 50% u OFFICE VISITS URGENT CARE $50 $70 30% u $100 u OFFICE VISITS PREVENTIVE CARE $0 $0 $0 $0 OFFICE VISITS PRENATAL CARE $0 $0 $0 $0 OFFICE VISITS SPECIALTY CARE $50 $50 $60 u 50% u OUTPATIENT SURGERY 30% u 30% u 30% u 50% u OUTPATIENT THERAPIES $50 $50 $60 u 50% u LAB VISITS $40 $40 30% u 50% u X-RAYS AND SPECIAL DIAGNOSTIC PROCEDURES $40 $40 30% u 50% u CT, MRI, PET SCANS 30% u 30% u 30% u 50% u EMERGENCY CARE 30% u 30% u 30% u 50% u INPATIENT HOSPITAL CARE 30% u 30% u 30% u 50% u $20 generic $40 brand preferred 30% brand non-preferred $20 generic $40 brand preferred 30% brand non-preferred (Subject to $700 drug deductible) $25 generic $60 brand preferred u 50% brand non-preferred u u (Subject to $400 drug deductible) $30 generic 30% brand preferred u 50% brand non-preferred u u 20% 20% 20% 20% 50% 50%

7 HSA-qualified high deductible plans Added Choice/deductible point-of-service plans PLAN NAME KP WA SILVER 2600/25% HSA (2017) KP WA BRONZE 5200/20 HSA (2017) KP WA PLATINUM 250/10 3T POS (2017) Tier 1 Tier 2 Tier 3 DEDUCTIBLE PER MEMBER $2,600 $5,200 $250 $500 $750 DEDUCTIBLE PER FAMILY $5,200 $10,400 $500 $1,000 $1,500 OUT-OF-POCKET MAXIMUM PER MEMBER $5,200 $6,550 $2,000 $3,000 $6,000 OUT-OF-POCKET MAXIMUM PER FAMILY $10,400 $13,100 $4,000 $6,000 $12,000 OFFICE VISITS PRIMARY CARE 25% u $20 u $10 $25 35% u OFFICE VISITS URGENT CARE 25% u 50% u $40 $55 35% u OFFICE VISITS PREVENTIVE CARE $0 $0 $0 $0 35% u OFFICE VISITS PRENATAL CARE $0 $0 $0 $0 35% u OFFICE VISITS SPECIALTY CARE 25% u $30 u $20 $35 35% u OUTPATIENT SURGERY 25% u 50% u 10% u 25% u 35% u OUTPATIENT THERAPIES 25% u $30 u $20 $35 35% u LAB VISITS 25% u 50% u 10% u 25% u 35% u X-RAYS AND SPECIAL DIAGNOSTIC PROCEDURES 25% u 50% u $10 $25 35% u CT, MRI, PET SCANS 25% u 50% u $100 25% u 35% u EMERGENCY CARE 25% u 50% u $100 u INPATIENT HOSPITAL CARE 25% u 50% u 10% u 25% u 35% u $20 generic u $40 brand preferred u 30% brand nonpreferred u u $20 generic u 50% brand preferred u 50% brand nonpreferred u u $10 generic $20 brand preferred $50 brand non-preferred $15 generic $30 brand preferred 50% brand non-preferred Not covered 20% u 20% u $0 $0 $0 50% u 50% u 50% u 50% u

8 WASHINGTON PLAN COMPARISON This is a high-level overview and plan comparison of the most frequently asked-about benefits within our plan offerings. Added Choice/deductible point-of-service plans PLAN NAME KP WA GOLD 600/35 3T POS (2017) Tier 1 Tier 2 Tier 3 DEDUCTIBLE PER MEMBER $600 $1,800 $4,500 DEDUCTIBLE PER FAMILY $1,200 $3,600 $9,000 OUT-OF-POCKET MAXIMUM PER MEMBER $2,000 $6,000 $8,000 OUT-OF-POCKET MAXIMUM PER FAMILY $4,000 $12,000 $16,000 OFFICE VISITS PRIMARY CARE $35 $60 50% u OFFICE VISITS URGENT CARE $60 $80 50% u OFFICE VISITS PREVENTIVE CARE $0 $0 50% u OFFICE VISITS PRENATAL CARE $0 $0 50% u OFFICE VISITS SPECIALTY CARE $45 $70 50% u OUTPATIENT SURGERY 30% u 50% u 50% u OUTPATIENT THERAPIES $45 $70 50% u LAB VISITS $35 40% u 50% u X-RAYS AND SPECIAL DIAGNOSTIC PROCEDURES 30% 40% u 50% u CT, MRI, PET SCANS $200 u 50% u 50% u EMERGENCY CARE 30% u INPATIENT HOSPITAL CARE 30% u 50% u 50% u $10 generic $20 brand preferred $60 brand non-preferred $25 generic $75 brand preferred 50% brand non-preferred Not covered $0 $0 $0

9 Added Choice/deductible point-of-service plans PLAN NAME KP WA GOLD 1000/35 3T POS (2017) Tier 1 Tier 2 Tier 3 DEDUCTIBLE PER MEMBER $1,000 $2,000 $6,000 DEDUCTIBLE PER FAMILY $2,000 $4,000 $12,000 OUT-OF-POCKET MAXIMUM PER MEMBER $3,000 $5,000 $9,000 OUT-OF-POCKET MAXIMUM PER FAMILY $6,000 $10,000 $18,000 OFFICE VISITS PRIMARY CARE $35 $60 50% u OFFICE VISITS URGENT CARE $75 $100 50% u OFFICE VISITS PREVENTIVE CARE $0 $0 50% u OFFICE VISITS PRENATAL CARE $0 $0 50% u OFFICE VISITS SPECIALTY CARE $45 $70 50% u OUTPATIENT SURGERY 25% u 40% u 50% u OUTPATIENT THERAPIES $45 $70 50% u LAB VISITS $35 40% u 50% u X-RAYS AND SPECIAL DIAGNOSTIC PROCEDURES $35 40% u 50% u CT, MRI, PET SCANS $200 40% u 50% u EMERGENCY CARE 25% u INPATIENT HOSPITAL CARE 25% u 40% u 50% u $10 generic $20 brand preferred $60 brand non-preferred $25 generic $75 brand preferred 50% brand non-preferred Not covered $0 $0 $0

10 WASHINGTON PLAN COMPARISON This is a high-level overview and plan comparison of the most frequently asked-about benefits within our plan offerings. Added Choice/deductible point-of-service plans PLAN NAME KP WA SILVER 2000/40 3T POS (2017) Tier 1 Tier 2 Tier 3 DEDUCTIBLE PER MEMBER $2,000 $4,000 $6,000 DEDUCTIBLE PER FAMILY $4,000 $8,000 $12,000 OUT-OF-POCKET MAXIMUM PER MEMBER $5,750 $7,150 $12,000 OUT-OF-POCKET MAXIMUM PER FAMILY $11,500 $14,300 $24,000 OFFICE VISITS PRIMARY CARE $40 $60 50% u OFFICE VISITS URGENT CARE $55 $75 50% u OFFICE VISITS PREVENTIVE CARE $0 $0 50% u OFFICE VISITS PRENATAL CARE $0 $0 50% u OFFICE VISITS SPECIALTY CARE $50 $70 50% u OUTPATIENT SURGERY 30% u 40% u 50% u OUTPATIENT THERAPIES $50 $70 50% u LAB VISITS 30% u 40% u 50% u X-RAYS AND SPECIAL DIAGNOSTIC PROCEDURES 30% u 40% u 50% u CT, MRI, PET SCANS 30% u 40% u 50% u EMERGENCY CARE 30% u INPATIENT HOSPITAL CARE 30% u 40% u 50% u $20 generic $40 brand preferred $50 brand non-preferred $30 generic $60 brand preferred 50% brand non-preferred Not covered 20% 20% 20%

11 Senior Advantage Plan* PLAN NAME DEDUCTIBLE PER MEMBER $0 DEDUCTIBLE PER FAMILY $0 OUT-OF-POCKET MAXIMUM PER MEMBER $1,000 OUT-OF-POCKET MAXIMUM PER FAMILY N/A OFFICE VISITS PRIMARY CARE $20 OFFICE VISITS URGENT CARE $25 OFFICE VISITS PREVENTIVE CARE $0 OFFICE VISITS PRENATAL CARE $0 OFFICE VISITS SPECIALTY CARE $20 OUTPATIENT SURGERY $50 OUTPATIENT THERAPIES $20 LAB VISITS $0 X-RAYS AND SPECIAL DIAGNOSTIC PROCEDURES $0 CT, MRI, PET SCANS $0 EMERGENCY CARE $50 INPATIENT HOSPITAL CARE $200/admit $20/$40 Catastrophic coverage = $3 generic/$7 brand after TrOOP ($4,950) ALTERNATIVE CARE $20 self-referred chiropractic / naturopathic /acupuncture $25 self-referred massage copay PEDIATRIC DENTAL (ALL EMBEDDED PEDIATRIC DENTAL PLANS ARE DENTAL CHOICE [PPO] PLANS) N/A N/A N/A CHP network only.

12 BUNDLED PLAN OPTIONS WHEN YOU PURCHASE COVERAGE OUTSIDE WASHINGTON HEALTHPLANFINDER You can offer two or three medical plans in a bundle, with the following limitations: Only one traditional plan per bundle. Only one Added Choice plan per bundle. Once you select your plan offerings, employees choose the plan that best meets their needs. DOMESTIC PARTNER COVERAGE (SAME AND OPPOSITE SEX) Employers may elect to include opposite-sex domestic partners as eligible dependents. Same-sex coverage is offered on all small-group contracts in compliance with state laws. PLAN HIGHLIGHTS Out-of-pocket maximum: All benefits displayed accumulate to the out-of-pocket maximum. Pediatric benefits: All plans include pediatric vision exams at $0 and pediatric vision hardware at no charge for one pair of standard frames or 12-month supply of contact lenses per calendar year. ADULT VISION S Vision exam: Covered at primary office visit cost share when buy-up option purchased. Hardware benefit: Vision hardware allowance of $200 every 2-year period for ages 19 and older. ALTERNATIVE CARE (SELF-REFERRED) Acupuncture (up to 12 visits per year; additional visits require prior authorization). Spinal and extremity manipulation therapy (up to 10 visits per year; additional visits require prior authorization). EXPLANATION OF ADDED CHOICE S Tier 1 services, in most cases, are provided by Select Providers and Select Facilities. The Evidence of Coverage provides a complete definition of Select Providers and Select Facilities and explains when Tier 1 services are provided by other providers and facilities. Tier 2 services are provided by PPO providers and facilities. Refer to the Evidence of Coverage for a complete definition of PPO providers and facilities. Tier 3 are services provided by non-participating providers and facilities. Refer to the Evidence of Coverage for a complete definition of non-participating providers and facilities. Deductible and out-of-pocket maximum amounts cross accumulate between tiers 1 and 2. There is a separate deductible and out-of-pocket maximum amount in Tier 3, which does not accumulate across any other tiers. IMPORTANT INFORMATION Contact your sales executive or account manager to get more information about health plans for small businesses. Our written material covers: Rates and factors that affect rates and rate adjustments. Renewing coverage. Geographic areas. Underwriting guidelines. TOP-RANKED PLANS IN OREGON AND WASHINGTON BY NCQA Kaiser Foundation Health Plan of the Northwest s commercial health plans are the highest rated plans in quality and performance among health plans in Oregon and Washington, according to the National Committee for Quality Assurance s Private Health Insurance Plan Ratings for * *NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA s HEDIS (Healthcare Effectiveness Data and Information Set) reporting system is the most widely used performance measurement tool in health care. HEDIS is a registered trademark of NCQA. This brochure provides summaries of various plans and is not a contract. These plans are subject to exclusions and limitations. Plan details, including all benefits, exclusions, and limitations, are provided in the Evidence of Coverage (EOC). For specific plan information about the plans referred to in this brochure, see the following forms: EWSGTRAD0117 EWSGHDHP0117 EWSGDEDRXD0117 EWSGDED0117 EWSG3TPOSDED0117 To obtain an EOC for a particular plan, call the Client Services Unit at account.kp.org _NW-WA_11/ Kaiser Foundation Health Plan of the Northwest