MEDICAL PLANS OVERVIEW FOR WASHINGTON SMALL BUSINESSES

Transcription

1 MEDICAL PLANS OVERVIEW FOR WASHINGTON SMALL BUSINESSES WASHINGTON 2016 SMALL BUSINESS with 1 50 eligible employees. For coverage on or after Janary 1, 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 hors a day, seven days a week. access medical records doctor (no charge) schedle appointments refill prescriptions check lab reslts Kaiser Permanente mobile app digital membership card MEMBER DISCOUNTS: kp.org/choosehealthy CHP Active and Healthy offers members disconted access to recreational, cltral, fitness and wellness-centered bsinesses, retail services, eqipment, instrction, memberships, and tickets both regionally and nationally. CHP Active and Healthy fitness clb disconts TOOLS FOR EMPLOYERS: bsinessnet.kp.org These online services can help make yor job easier. online accont management benefit smmaries forms alternative and chiropractic care vitamins and spplements occpational health view and print grop agreements (contracts) FACILITIES AND SERVICES: kp.org/facilities Members have their choice of great primary care doctors and world-class specialists when they need them, at convenient locations. 37 medical offices 17 dental offices The Portland Clinic (7 locations) 8 Urgent Care locations 24-hor advice nrses health coach services INTEGRATED CARE UNDER ONE ROOF doctors pharmacy dentists labs and imaging services vision services electronic medical records TOP QUALITY CARE With or commitment to qality care, we make it easy for yo to stay healthy and feel yor best. Coordinated teamwork, combined with expertise, help make or doctors, nrses, and specialists better informed to provide the best care for yor needs. That is why 111 Kaiser Permanente primary care doctors and specialists made Portland Monthly's Top Docs & Nrses 2015" more than any other health care organization. As a member, yo can choose the doctor that's right for yo and switch at any time. GIVE US A CALL OR TALK TO YOUR BROKER We can answer yor qestions abot medical coverage, eligibility, plan design, or renewal. Please contact s or yor broker if yo wold like a booklet with more details abot or plans and options. Portland area Salem area All other areas TTY Langage interpretation services Fax accont.kp.org _NW-WA All plans offered and nderwritten by Kaiser Fondation Health Plan of the Northwest. 500 NE Mltnomah St., Site 100, Portland, OR

2 It starts with a plan All of or plans give yor employees what they need to be healthier and more prodctive every day prevention, health promotion, and care for ongoing health conditions. That s what we mean by a better way to take care of yor bsiness. Yo have lots of choices, from traditional HMOs to consmer-directed options to ot-of-area coverage to dental coverage. Here s a qick overview of what we offer. For plan specifics, contact yor Kaiser Permanente representative. Traditional copayment plan Predictable copayments and ot-of-pocket maximms make it easier for employees to manage their health care spending and give them financial peace of mind. Yo ll appreciate the variety of copayment options. Dedctible plans Yo ll get more options at an affordable cost. With the addition of an employee ot-of-pocket cost, monthly payments are lower than for traditional HMO plans, so yo ll be able to redce premims while still maintaining qality care and access to or physicians for yor employees. HSA and HRA options Offer lower premims than other plan types, pls tax savings. 3 With or HSA-qalified dedctible plans and dedctible plans with HRA, yor employees will have more control over their health care dollars, helpfl online decision-spport tools, and the same high-vale access to services as members of or traditional HMO plans. Ot-of-area An indemnity coverage soltion for employees who live or work otside the Kaiser Permanente and PHCS service areas. It provides first-dollar coverage for doctor s office visits and no-cost preventive care delivered by any licensed provider. Medicare plans Provides yor retirees over 65 with the benefits of Medicare and Kaiser Permanente s award-winning coverage. Dental plans Or traditional dental plan allows yo to choose from a wide range of options and mix and match dedctibles or office visit copayments for any plan combination. Or Dental Choice PPO is designed for flexibility and choice while providing comprehensive coverage, allowing members to see any dentist. Please contact yor Kaiser Permanente representative for help bilding yor health care strategy. 3 The tax references relate to federal income tax only. Conslt with yor financial or tax advisor for information abot state income tax laws.

3 The right plan for yor bsiness Choosing a health plan that s right for yor bsiness is now easier than ever! Yo have the ability to cstomize a base medical plan with vision hardware and eye exams, based on yor company s needs and bdget. Follow the steps below and create a plan that will help yo and yor bsiness to thrive. STEP 1: CHOOSE YOUR MEDICAL PLAN(S) (See pages 4 to 7 for plan details) Traditional plans Platinm 0/20 Gold 0/30 Silver 0/50 Dedctible plans Platinm 250/20 Gold 500/20 Gold 1000/20 Silver 1500/35 Silver 2000/35 Silver 3500/40 Bronze 4500/50 Bronze 6600/35 HSA-Qalified High Dedctible Health plans Silver 2600/25% HSA Bronze 3800/50% HSA Bronze 5000/60 HSA Added Choice Dedctible plans* Platinm 250/10 3T POS Gold 600/35 3T POS Gold 1000/35 3T POS Silver 2000/40 3T POS *If yo have employees who both live and work otside of or service area, we may be able to set them p on an Added Choice plan. Rates and approval sbject to nderwriting. POS OOA plans: Grops mst meet nderwriting reqirements to prchase. STEP 2: CHOOSE YOUR OPTIONAL BUY-UP COVERAGE All of or base medical plans can be paired with the following vision coverage by-p option: Adlt vision hardware and exam: $200 hardware benefit allowance every 24 months and primary care office visit cost share applies for exam. STEP 3: APPLY OR RENEW YOUR COVERAGE New grops: Complete the Washington Small Bsiness employer application and sbmit it to a Kaiser Permanente sales exective by the 20th of the month prior to the effective date. Renewing grops: We will provide yo with coverage options that best match the plan(s) yor bsiness offers today, bt yo can choose from any of or other plans available to small employers if yo prefer. Please complete and sbmit the Renewal Decision Form to yor Kaiser Permanente accont 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 freqently asked-abot benefits within or plan offerings. Traditional plans Dedctible plans HSA-qalified high dedctible plans PLAN NAME PLATINUM 0/20 0/30 0/50 PLATINUM 250/20 500/ / / / /40 BRONZE 4500/50 BRONZE 6600/ /25% HSA BRONZE 3800/50% HSA BRONZE 5000/60 HSA DEDUCTIBLE (INDIVIDUAL/FAMILY) $0 $0 $0 $250/ $500 $500/ $1,000 $1,000/ $2,000 $1,500/ $3,000 $3,500/ $7,000 $4,500/ $9,000 $6,600/ $13,200 $2,600/ $5,200 $3,800/ $7,600 $5,000/ $10,000 OUT-OF-POCKET MAXIMUM (INCLUDES DEDUCTIBLE) $3,000/ $6,000 $5,000/ $10,000 $4,500/ $9,000 $5,000/ $10,000 $5,200/ $10,400 $6,450/ $12,900 $6,350/ $12,700 BENEFIT ANNUAL BENEFIT MAXIMUM $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 PRIMARY $20 $30 $50 $20 $20 $20 $35 $35 $40 $50 3 visits at $35 prior to dedctible/coins. After 3 visits are satisfied, benefit is 50% 25% 50% $60 SPECIALTY CARE URGENT CARE $30 $40 $60 $30 $30 $30 $50 $50 $50 $60 50% 25% 50% $70 $40 $50 $70 $40 $40 $40 $50 $60 $70 $70 $100 25% 50% 50% LAB PER VISIT $20 $30 $50 $10 $20 $20 $40 $40 $40 $60 50% 25% 50% 50% X-RAY PER VISIT $20 $30 $60 $10 $20 $20 $40 $40 $40 $60 50% 25% 50% 50% CT, MRI, PET SCANS $75 $300 $300 $75 $300 $300 25% 25% 30% 40% 50% 25% 50% 50% OUTPATIENT THERAPIES PER VISIT $30 $40 $60 $30 $30 $30 $50 $50 $50 $60 50% 25% 50% 50% OUTPATIENT SURGERY $100 35% 50% 10% 20% 20% 25% 25% 30% 40% 50% 25% 50% 50% HOSPITAL INPATIENT CARE $300/day $1,500/admit $500/day $2,500/admit 50% 10% 20% 20% 25% 25% 30% 40% 50% 25% 50% 50% EMERGENCY DEPARTMENT VISIT $150 $200 50% 10% 20% 20% 25% 25% 30% 40% 50% 25% 50% 50% *Sbject to drg dedctible. Sbject to dedctible. Offered only otside WA Healthplanfinder. ADULT VISION BUY-UP OPTION: All of or base medical plans can be paired with the following vision coverage by-p option: Adlt vision hardware and exam: $200 hardware benefit allowance every 24 months and primary care office visit cost share applies to exam.

5 Traditional plans Dedctible plans HSA-qalified high dedctible plans PLAN NAME PLATINUM 0/20 0/30 0/50 PLATINUM 250/20 500/ / / / /40 BRONZE 4500/50 BRONZE 6600/ /25% HSA BRONZE 3800/50% HSA BRONZE 5000/60 HSA BENEFIT PRESCRIPTION DRUGS (30-DAY SUPPLY) $5 generic $15 brand $50 brand non $60 brand non 50% brand non $5 generic $15 brand $50 brand non $60 brand non $60 brand non 30% brand non 30% brand non 30% brand non (Sbject to $200 drg dedctible) $60 brand 50% brand non $30 generic 30% brand 50% brand non 30% brand non $80 brand 50% brand non $60 brand 50% brand non PEDIATRIC DENTAL All embedded pediatric dental plans are Dental Choice (PPO) plans Preventive and diagnostic services (oral exam, X-rays, teeth cleaning, floride treatments) Basic restorative services (rotine fillings, basic crowns, simple extractions) $0 $0 20% $0 $0 $0 20% 20% 20% 20% 20% 20% 20% 20% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% Major restoration services (gold or porcelain crowns, inlays, bridge abttments, pontics) 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% *Senior Advantage plans cannot be modified. Sbject to dedctible. Offered only otside WA Healthplanfinder. ADULT VISION BUY-UP OPTION: All of or base medical plans can be paired with the following vision coverage by-p option: Adlt vision hardware and exam: $200 hardware benefit allowance every 24 months and primary care office visit cost share applies to exam.

6 WASHINGTON PLAN COMPARISON This is a high-level overview and plan comparison of the most freqently asked-abot benefits within or plan offerings. Senior Advantage plans Added Choice/dedctible point-of-service plans PLAN NAME Standard* Vale* Platinm 250/10 3T POS 600/35 3T POS 1000/35 3T POS 2000/40 3T POS DEDUCTIBLE (INDIVIDUAL/FAMILY) $0 $0 $250/ $500 Tier 1 Tier 2 Tier 3 Tier 1 Tier 2 Tier 3 Tier 1 Tier 2 Tier 3 Tier 1 Tier 2 Tier 3 $500/ $1,000 $750/ $1,500 $600/ $1,200 $1,800/ $3,600 $4,500/ $9,000 $1,000/ $2,000 $6,000/ $12,000 / $8,000 $6,000/ $12,000 OUT-OF-POCKET MAXIMUM (INCLUDES DEDUCTIBLE) $600 per member $1,000 per member $3,000/ $6,000 $6,000/ $12,000 $6,000/ $12,000 $8,000/ $16,000 $3,000/ $6,000 $5,000/ $10,000 $9,000/ $18,000 $5,250/ $10,500 $12,000/ $24,000 BENEFIT ANNUAL BENEFIT MAXIMUM PRIMARY SPECIALTY CARE URGENT CARE $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $10 $20 $10 $25 35% $35 $60 50% $35 $60 50% $40 $60 50% $10 $20 $20 $35 35% $45 $70 50% $45 $70 50% $50 $70 50% $15 $25 $40 $55 35% $60 $80 50% $75 $100 50% $55 $75 50% LAB PER VISIT $0 $0 10% 25% 35% $35 40% 50% $35 40% 50% 25% 40% 50% X-RAY PER VISIT $0 $0 $10 $25 35% 30% 40% 50% $35 40% 50% 25% 40% 50% CT, MRI, PET SCANS $0 $0 $100 25% 35% $200 50% 50% $200 40% 50% 25% 40% 50% OUTPATIENT THERAPIES PER VISIT $10 $20 $20 $35 35% $45 $70 50% $45 $70 50% $50 $70 50% OUTPATIENT SURGERY HOSPITAL INPATIENT CARE EMERGENCY DEPARTMENT VISIT $10 $50 10% 25% 35% 30% 50% 50% 25% 40% 50% 25% 40% 50% $0 $200/admit 10% 25% 35% 30% 50% 50% 25% 40% 50% 25% 40% 50% $50 $50 $100 $100 $100 30% 30% 30% 25% 25% 25% 25% 25% 25% *Senior Advantage plans cannot be modified. Sbject to dedctible. Offered only otside WA Healthplanfinder. ADULT VISION BUY-UP OPTION: All of or base medical plans can be paired with the following vision coverage by-p option: Adlt vision hardware and exam: $200 hardware benefit allowance every 24 months and primary care office visit cost share applies to exam.

7 Senior Advantage plans Added Choice/dedctible point-of-service plans PLAN NAME Standard* Vale* Platinm 250/10 3T POS 600/35 3T POS 1000/35 3T POS 2000/40 3T POS BENEFIT Tier 1 Tier 2 Tier 3 Tier 1 Tier 2 Tier 3 Tier 1 Tier 2 Tier 3 Tier 1 Tier 2 Tier 3 PRESCRIPTION DRUGS (30-DAY SUPPLY) 50%/$25 max Catastrophic coverage = $3 gen / $7 brand after TrOOP $20/$40 Catastrophic coverage = $5 gen / $10 brand after TrOOP ($4,550) $50 brand non $15 generic $30 brand 50% brand non Not covered $60 brand non $25 generic $75 brand 50% brand non Not covered $60 brand non $25 generic $75 brand 50% brand non Not covered $50 brand non $30 generic $60 brand 50% brand non Not covered PEDIATRIC DENTAL All embedded pediatric dental plans are Dental Choice (PPO) plans Preventive and Diagnostic Services (oral exam, X-rays, teeth cleaning, floride treatments) N/A N/A $0 $0 $0 $0 $0 $0 $0 $0 $0 20% 20% 20% Basic Restorative Services (rotine fillings, basic crowns, simple extractions) N/A N/A 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% Major Restoration Services (gold or porcelain crowns, inlays, bridge abttments, pontics) N/A N/A 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% *Senior Advantage plans cannot be modified. Sbject to dedctible. Offered only otside WA Healthplanfinder. ADULT VISION BUY-UP OPTION: All of or base medical plans can be paired with the following vision coverage by-p option: Adlt vision hardware and exam: $200 hardware benefit allowance every 24 months and primary care office visit cost share applies to exam.

8 BUNDLED PLAN OPTIONS WHEN YOU PURCHASE COVERAGE OUTSIDE WASHINGTON HEALTHPLANFINDER Yo can offer two or three medical plans in a bndle, with the following limitations: Only one traditional plan per bndle. Only one Added Choice plan per bndle. Senior Advantage plans may not be bndled. Once yo select yor plan offerings, employees choose the plan that best meets their needs. DOMESTIC PARTNER COVERAGE (SAME AND OPPOSITE SEX) Employers may elect to inclde opposite-sex domestic partners as eligible dependents. Same-sex coverage is offered on all small-grop contracts in compliance with state laws. PLAN HIGHLIGHTS Ot-of-pocket maximm: All benefits displayed accmlate to the ot-ofpocket maximm. Pediatric benefits: All plans inclde pediatric vision exams at $0 and pediatric vision hardware at no charge for one pair of standard frames or 12-month spply of contact lenses per calendar year. ADULT VISION BENEFITS Vision exam: Covered at primary office visit cost share. Hardware benefit: Vision hardware allowance of $200 every 24 months for ages 19 and older. EXPLANATION OF ADDED CHOICE BENEFITS 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. Dedctible and ot-of-pocket maximm amonts cross accmlate between tiers 1 and 2. There is a separate dedctible and ot-of-pocket maximm amont in Tier 3, which does not accmlate across any other tiers. IMPORTANT INFORMATION Contact yor sales exective or accont manager to get more information abot health plans for small bsinesses. Or written material covers: Rates and factors that affect rates and rate adjstments. Renewing coverage. Geographic areas. Underwriting gidelines. TOP-RANKED PLANS IN OREGON AND WASHINGTON BY NCQA Kaiser Fondation Health Plan of the Northwest is nmber 1 in qality and performance among commercial health plans in Oregon and Washington (and nmber 5 in the nation), according to the National Committee for Qality Assrance s Private Health Insrance Plan Rankings for * * NCQA is a private, nonprofit organization dedicated to improving health care qality. 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 reporting system (Healthcare Effectiveness Data and Information Set) is the most widely sed performance measrement tool in health care. HEDIS is a registered trademark of NCQA. This brochre provides smmaries of varios plans and is not a contract. These plans are sbject to exclsions and limitations. Plan details, inclding all benefits, exclsions, and limitations, are provided in the Evidence of Coverage (EOC). For specific plan information abot the plans referred to in this brochre, see the following forms: EWSGTRADG0116 EWSGDEDB0116 EWSGTRADS0116 accont.kp.org EWSGHDHPS0116 EWSGDEDPG0116 EWSGHDHPB EWSG3TPOSDEDP0116 EWSGDEDS0116 To obtain an EOC for a particlar plan, call the Client Services Unit at _NW-WA 2016 Kaiser Fondation Health Plan of the Northwest