A BETTER WAY to take care

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1 2015 SMALL BUSINESS HEALTH Colorado Small Business Enrollment Guide A BETTER WAY to take care of your employees and your business

2 Choose BETTER. Choose a better way that s right for you You put a lot into making your business a success which means you keep a close eye on the bottom line. And since your employees play a role in that success, you want them to be healthy and productive. Together, we can tailor a solution that meets the needs of your business and your workers. Partner with us and you ll get health care that s supported by the experience and innovation that can help you strengthen your business now and for the future. And each of your employees will get personalized care Kaiser Permanente doctors or network of providers, no-cost online health improvement resources, and awardwinning programs to help them manage chronic conditions. With our help, you can have lower overall costs, healthier, more productive employees, and improved performance for your company. It s a better way to take care of business. Welcome to your Kaiser Permanente for Colorado Small Business Enrollment Guide. This guide will help you understand what health care means for you, your employees and how to select the right health plan to meet all of those needs. Read on to learn why Kaiser Permanente is the best choice for you and your family. What s inside Understanding health care Why efficient health care matters Your partner for better health The power to choose Excellent care Online access anytime, anywhere Convenient classes, resources, and more Choosing the right plan for your business Health plan benefit highlights HealthWorks Wellness resources Kaiser Permanente Select: Colorado Springs and surrounding areas Resources

3 2015 SMALL BUSINESS HEALTH Choose a health care partner who s more effective at keeping your employees and your bottom line healthy. Choose better. Choose Kaiser Permanente. We reduced costly medication errors by 57% increasing safety keeps employees healthier and more productive. 7 Aligned incentives We focus on outcomes, not profits. According to Aon Hewitt, we re 16% more cost-efficient than the all-plan average. 1 Pharmacy Top-ranked for medication management. 6 #1 in the nation on 17 out of 28 care measures, many of which target preventable conditions. 5 A BETTER WAY to manage costs Excellent care You re at the center of everything we do, which is why the personalized care you get today leads to healthier tomorrows. Our board-certified specialists and multidisciplinary care teams are pioneering new ways to prevent, detect, and treat illness. Prevention Nationally recognized leader in preventive care. Quality care National leader in clinical quality across all markets we serve 3 Kaiser Permanente Colorado ranked Highest in Member Satisfaction among Commercial Health Plans in Colorado in J.D. Power Member Satisfaction Study for the 7th year in a row! 4 Please refer to resources on page 11. 3

4 Colorado Small 2015 Business SMALL BUSINESS Enrollment HEALTH Guide Why efficient health care matters Of members who participated in online healthy lifestyle programs, 90% better managed their diabetes, 87% improved their back pain, and 61% decreased their stress. 9 We reduced heart attack deaths by 89%, avoiding relating medical costs and productivity losses. 10 To successfully manage your total costs and improve business performance you need a partner who addresses the health of your employees early, consistently, and effectively, before your costs escalate. As you re looking at health care providers, consider the following questions: How many insurance plans work with your employee and their doctor to see if they are up to date on preventive care, such as diabetes tests? We re focused on prevention, we help your employees stay healthy- not just treat them when they are sick. We work closely with your employee and their doctor to help with: Recommended prevention screenings based on age and gender Care coordination for members with complex or multiple health conditions, including diabetes, asthma, chronic obstructive pulmonary disease (COPD), heart disease, or high blood pressure Wellness coaching to help you lose weight, get active, manage stress, or make healthier food choices Education and online resources Coordination of care after a hospital stay Medication management and pharmacy questions Do your other health care options reward quality and minimize waste? The traditional, fee-for-service system rewards more care more visits, more tests, and more procedures instead of the right care. You and your employees end up paying for this in the form of higher medical costs. One-third of medical costs can be attributed to wasteful, nonrecommended care. 8 4

5 2015 SMALL BUSINESS HEALTH Your partner for better health Making smart decisions about you and your employees health may be easier than you think, whether you re looking for a new plan or choosing health coverage for the first time. Take a look at all you get with your membership, and you ll see how Kaiser Permanente can help you live a healthier life. The power to choose Now you have more options than ever before. By shopping with Connect for Health Colorado, your employees may now select any health plan within the premium range you choose and you pay one simple bill. With Kaiser Permanente you have the best options for you and your employees. With a comprehensive network of great doctors and convenient facilities to choose from, it s easier to get the care you need when you need it. We ve carefully selected our doctors so your employees can make the right choice for their family. Your employees can select and change their physician at anytime. 12 At our Kaiser Permanente medical offices, care happens all under one roof to make it more convenient for you and your employees. And when your employees get care with fewer delays, they get better faster. Members in Northern and Southern Colorado have a choice: they can receive care at one of our network physicians in their plan, or visit a Kaiser Permanente medical office and have their health care needs met under one roof. This approach combines choice, convenience, and assurance of quality, patientcentered care. Team approach to excellent care Kaiser Permanente offers the largest network of Kaiser Permanente doctors in the nation connected by leading-edge EHR system. Supported by our secure health record system, Kaiser Permanente doctors, nurses, and specialists are better prepared to deliver the right care at the right time even if you go to different Kaiser Permanente locations in your area. This way, you and your employees are treated as a person, not a symptom. 5

6 2015 SMALL BUSINESS HEALTH Online access anytime, anywhere Stay better informed about health and better able to manage it with online and mobile tools that help you and your employees get the support you need. Your employees can their Kaiser Permanente physician, refill most prescriptions, make appointments online with a Kaiser Permanente physician, view test results online, and get advice from a registered nurse 24 hours a day. Convenient classes, resources, and more Empower your employees to take their health beyond checkups with a partner that provides the inspiration and information you need to live life to the fullest. Fit wellness into your schedule, no matter how busy the day is. With the many health classes offered, there s something for everyone. Wellness classes, wellness coaching, and much more. Classes vary by location and some may require a fee. A focus on prevention Preventive screenings help keep you and your employees healthy by providing an early alert for many health conditions. That way, they can be treated before they become serious. Under health care reform, many are available at no charge. Here are some examples of preventive care services: Routine preventive physical exams Well-child visits (0 23 months) Well-woman visits Immunizations Annual flu shots Routine preventive laboratory tests Flexible sigmoidoscopies and colonoscopies Bone density scans Tuberculosis tests Autism screenings Mammograms Contraceptive care and counseling Breastfeeding support For a complete list of our preventive care services, visit kp.org/prevention. 6

7 2015 SMALL BUSINESS HEALTH HealthWorks Wellness resources for members HealthWorks by Kaiser Permanente provides health tools and wellness programs that work for you. HealthMedia Succeed total health assessment 1 Respond confidentially to questions on stress, physical activity, nutrition, and other health behaviors. You will then receive a personalized report detailing your risk status with suggestions for improvements. Additionally, you may choose to share your results with your healthcare team. To take the total health assessment, visit kp.org/succeed. ChooseHealthy discounts At ChooseHealthy, you ll find savings on services that will put your health in a whole new light with a variety of health professionals who ll provide their expertise at a price you can afford. Chiropractic Care 25% off regular rates. Acupuncture 25% off regular rates. Massage Therapy 25% off regular rates. Health clubs preferred membership rates at select clubs. ChooseHealthy online store 15-40% off suggested retail prices on hundreds of health products. FitnessCoach.com tools to help you achieve your health and fitness goals. Visit kp.org/choosehealthy to learn more about network providers and other services. 7

8 2015 SMALL BUSINESS HEALTH Kaiser Permanente Select Colorado Springs and surrounding areas An affordable, high quality health care plan for the Colorado Springs area. Maximize Your Health and Your Health Dollars KP Select is all about keeping you healthy and keeping your health care costs down. Members who choose the KP Select plan will benefit from the same high quality care from Kaiser Permanente at an affordable price, while following a few guidelines. This plan provides Colorado Springs and surrounding areas coverage at any Kaiser Permanente medical offices in Colorado, includes care at more than 400 network providers, hospital visits exclusively at Memorial Hospital North, Memorial Hospital Central, and Children's Hospital at Memorial Hospital in Colorado Springs for nonemergency hospital care, and refills for maintenance medication must be filled at a Kaiser Permanente medical office pharmacy or through Kaiser Permanente mail order. The KP Select health plan will be available for individuals, families, small groups, and large groups in the Colorado Springs area. KP Select Plan: Members who choose the new KP Select plan will: Have access to a network of more than 400 providers in the Colorado Springs area or with any Kaiser Permanente physician. There is no coverage for unauthorized care out of the network, except in case of an emergency. Fill maintenance medication prescriptions (birth control, high blood pressure, diabetes, cholesterol, thyroid, etc.) at a Kaiser Permanente medical office pharmacy or through Kaiser Permanente mail order. Non-maintenance medications for acute conditions, such as infections (antibiotics) or pain, can be filled immediately at a Kaiser Permanente medical office pharmacy or a network pharmacy. Visit Memorial Hospital North, Memorial Hospital Central, and Children's Hospital at Memorial Hospital in Colorado Springs exclusively for nonemergency hospital care. Use a preferred Ambulatory Surgery Centers (Audubon, Colorado Springs Health Partners, and Printers Park) for scheduled outpatient surgeries. In an emergency, member should dial 911 or go to the nearest hospital. Where to Get Care The KP Select Network 8 When you sign up for KP Select, you can receive care from any Kaiser Permanente physician and have access to a comprehensive group of more than 400 providers in the Colorado Springs area. You also can choose any network KP Select provider. If you seek care from a provider not on the KP Select provider list without a prior authorization, you will be responsible for payment.

9 2015 SMALL BUSINESS HEALTH Primary Care is available through any Kaiser Permanente provider, as well as through Colorado Springs Health Partners, Mountain View Medical Group and Colorado Health Medical Group/University of Colorado Health. Specialty Care will also be available through these groups and a select group of network providers in the area. Please be sure to choose only providers in the KP Select Kaiser Permanente Provider Directory. The most current list of providers can be found on kp.org. Just click on Locate our services, then Find doctors and locations. You can request a printed copy of the directory by calling Member Services at / TTY: Hospital, Emergency, Inpatient, and Urgent Care Members on the KP Select plan who need to be cared for in the hospital will visit Memorial Hospital North, Memorial Hospital Central, and Children's Hospital at Memorial Hospital in Colorado Springs exclusively for non- emergency hospital care. In an emergency, member should dial 911 or go to the nearest hospital. Scheduled outpatient surgeries can be arranged at a preferred Ambulatory Surgery Center including Audubon, Colorado Springs Health Partners, and Printers Park. Urgent care is available at any contracted Kaiser Permanente facility. The most current list of urgent care locations may be found on the facility search at kp.org/locations. Vision/Dental Coverage Medical plans will include routine eye exams and dental coverage only for children up to 19 years old. Prescriptions and Pharmacy Benefit Members who choose the new KP Select plan will enjoy these benefits: You can have your first fill of a prescription done at a Kaiser Permanente medical office pharmacy or a network pharmacy. Refills for maintenance medication (birth control, high blood pressure, diabetes, cholesterol, thyroid, etc.) at a Kaiser Permanente medical office pharmacy or through Kaiser Permanente mail order. Most prescriptions will be mailed directly to you via first-class mail at no additional charge to you within just a few days. Kaiser Permanente also has pharmacies conveniently located with our medical office building at 4105 Briargate Parkway, Suite 125, Colorado Springs, CO Fill non-maintenance medications for acute conditions, such as infections (antibiotics) or pain, immediately at a Kaiser Permanente medical office pharmacy or a network pharmacy. Refill 24 hours a day, seven days a week at kp.org or by calling / TTY: Please call in your refill(s) at least 10 days before you run out of your current supply. To find out more about the prescription benefit, members can call Member Services at / TTY: or call the Clinical Pharmacy Call Center toll free at / TTY: , 8 a.m. to 6 p.m., weekdays. Disclaimer This information provided here is a summary only. For a list of services available with your plan see your Summary of Benefits and Coverage. The information provided here is not a contract and is not intended for use as a Summary Plan Description, a Certificate of Coverage, nor is it designed to serve as your Evidence of Coverage. Upon enrollment, your Evidence of Coverage or Certificate of Insurance will contain a description of your coverage, including benefits, exclusions, and limitations. Your Evidence of Coverage or Certificate of Insurance will prevail over this or any other plan summary. 9

10 2015 SMALL BUSINESS HEALTH Product Plans Annual Deductible (Ind./Family) Annual Out-of-Pocket Maximum (Ind./Family) HMO Plans Deductible HMO Plans HSA-Qualified Plans Health Reimbursement Account (HRA) Plans Employers allocate $500, $600, or $700 per Employee KP CO Gold 0/30 KP Select CO Gold 0/30 KP CO Gold 500/20 KP Select CO Gold 500/20 KP CO Silver 1200/35 KP Select CO Silver 1200/35 KP CO Silver 1500/50 KP Select CO Silver 1500/50 KP CO Bronze 4500/50 KP Select CO Bronze 4500/50 KP CO Silver 2000/30/HSA KP Select CO Silver 2000/30/HSA KP CO Bronze 3500/40/HSA KP SelectCO Bronze 3500/40/HSA KP CO Bronze 4500/50%/HSA KP Select CO Bronze 4500/50%/HSA KP CO Gold HRA 1500/30 KP Select CO Gold HRA 1500/30 KP CO Silver HRA 2500/50/HSA KP SelectCO Silver HRA 2500/50/HSA None $6,350/$12,700 $500/$1,000 $6,350/$12,700 $1,200/$2,400 $6,350/$12,700 $1,500/$3,000 $6,350/$12,700 $4,500/$9,000 $6,350/$12,700 $2,000/$4,000 $6,350/$12,700 $3,500/$7,000 $6,350/$12,700 $4,500/$9,000 $6,350/$12,700 $1,500/$3,000 $6,350/$12,700 $2,500/$5,000 $6,350/$12,700 PPO (For employees who reside outside of our service area.) KP CO Silver PPO 1500/40 $1,500/$3,000 In-network $6,350/$12,700 In-network * For specialty drugs, member pays coinsurance up to $250 per drug dispensed for retail and mail order prescriptions. Small business off the exchange will need to choose either KP Select OR the Kaiser Permanente Southern Colorado network product.

11 2015 SMALL BUSINESS HEALTH Primary Care Office Visit Specialist Office Visit Inpatient Hospital Prescription Drugs (Generic/Brand/Non- Preferred/Specialty) $30 $60 $500 per day up to $2,000 per admission $15/$45/50%/20% * $20 $40 20% after deductible $15/$45/50%/20% * $35 $65 35% after deductible $50 $70 35% after deductible $500 separate prescription drug deductible on tiers 2-4 $15/$45/50%/35% * $500 separate prescription drug deductible on tiers 2-4 $15/$45/50%/35% * $50 $70 after deductible 40% after deductible $20/40%/40%/40% * After plan deductible $30 after deductible $50 after deductible 15% after deductible $10/$30/15%/15% after plan deductible $40 after deductible $60 after deductible 30% after deductible $20/$45/30%/30% after plan deductible 50% after deductible 50% after deductible 50% after deductible 50%/50%/50%/50% after plan deductible $30 $50 25% after deductible $15/$45/50%/25% * $50 after deductible $70 after deductible 40% after deductible $15/$45/40%/40% After plan deductible $40 In-network $60 In-network 30% after deductible In-network $500 separate prescription drug deductible on tiers 2-4 $15/$45/50%/30% * In-network 11

12 2015 SMALL BUSINESS HEALTH Children's Dental Plan Benefits Kaiser Permanente and Delta Dental of Colorado know good oral health is an important component of overall health. This is why Delta Dental of Colorado and Kaiser Permanente have partnered to include a child dental plan through Delta Dental of Colorado. Employee's children (up to age 19) can receive any of the procedures listed below each calendar year at no additional out-of-pocket cost to you or your employees. Diagnostic & Preventive Services Frequency Limit Per Calendar Year Oral Evaluations 2 Cleanings 2 Fluoride 2 Sealants 1 per tooth Bitewing/X-rays 1 Basic Services (Type II) Fillings, Simple Extractions, Root Canal 2 Major Services (Type III) Crowns 1 Here to help you in a time of change When the landmark Affordable Care Act became law, it ushered in the most comprehensive changes for health care in 45 years. The scope of change is enormous and it will be a challenging time. We re here to support you and provide information you need to make the right decisions for your business.. Kaiser Permanente is strongly positioned to fulfill the promise of health care reform. Helping members stay healthy has been the cornerstone of our integrated approach to care from the beginning. This approach to total health supported by leading-edge technology and a broad range of benefits maximizes your investment in a healthy workforce. 12

13 2015 SMALL BUSINESS HEALTH Resources 1 Hewitt Health Value Initiative benchmarking study Kaiser Foundation Health Plan, Inc., Aon Hewitt, March 22, To get a copy of the Hewitt Health Value Initiative report for your region, contact your account manager. 2 Uncoordinated Care: A Survey of Physician and Patient Experience, California HealthCare Foundation, See note 1. 4 Kaiser Foundation Health Plan of Colorado, Inc. received the highest numerical score among commercial health plans in the Colorado region in the proprietary J.D. Power 2014 U.S. Member Health Plan StudySM. Study based on 34,315 total member responses, measuring five plans in the Colorado Region (excludes Medicare and Medicaid). Proprietary study results are based on experiences and perceptions of members surveyed December 2013-January Your experiences may vary. Visit jdpower.com. 5 Kaiser Permanente 2012 HEDIS scores. Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compass and represent all non- PPO lines of business. Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality. The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA. Quality Compass 2012 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass and HEDIS are registered trademarks of NCQA. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality. 6 See note 5. 7 Kaiser Permanente Colorado data from one hospital site, A. Benedict Cosimi, MD, Modern Day Bloodletting: Is That Laboratory Test Necessary? Archives of Surgery, May Healthy Lifestyle Programs Outcomes, Kaiser Permanente Internet Services Group, April Thomas Delate, PhD, et al., Reduced Health Care Expenditures After Enrollment in a Collaborative Cardiac Care Service, Pharmacotherapy, November Results from our cardiac rehabilitation program in Colorado. 13

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16 Kaiser Foundation Health Plan, Inc., of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Colorado marketplace Kaiser Permanente _15_SG_Bro