Visiting Member Program. Your benefits
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- Nathaniel Hector Greer
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1 Visiting Member Program Your benefits
2 Our Visiting Member Program is one more way Kaiser Permanente cares for you. Your visiting member benefits ensure that you can receive a variety of services when temporarily visiting another Kaiser Permanente or Group Health Cooperative service area. If you get a migraine in Baltimore, need physical therapy in Portland, or come down with the flu in Denver, we ll be there for you. Who is a visiting member? The Visiting Member Program applies to Kaiser Permanente group members, individual plan members, and members with Medicare. You are a visiting member if you are temporarily in another Kaiser Permanente or Group Health service area. You may receive visiting member benefits for up to 90 days. If you are a dependent child and you attend an accredited college or accredited vocational school, the 90-day limit on visiting member benefits does not apply to you. Proof of student status may be requested by the other service area. If you will be moving permanently to another Kaiser Permanente or Group Health service area or visiting for more than 90 days, please contact Member Services in your home service area. Phone numbers are listed in the back of this brochure for your convenience. 2 Federal employees group If your Kaiser Permanente membership is through the Federal Employees Health Benefit Program (FEHBP), you have different travel benefits from those described here. For more information, please see our brochure, Kaiser Permanente Travel Benefits for Federal Employees, available from Member Services.
3 Government programs other than Medicare If your Kaiser Permanente membership is through a government program other than Medicare, such as Medicaid, Medi-Cal, or Quest-Net, your visiting member benefits may be different from those described here. Please call Member Services in your home service area for information. Where are visiting member benefits available? Visiting member benefits are available to you from Kaiser Permanente in our service areas nationwide when they are provided or arranged by a Plan physician in the service area you are visiting. They are also available to you in the service areas of our allied health plan, Group Health. For information about service area and facility locations, please call Member Services in your home service area or in the service area you will be visiting. Phone numbers are listed in the back of this brochure. In California, there are two service areas: Northern California and Southern California. If you are enrolled in one service area but live in the other, please call California Member Services to see if visiting member benefits apply to you in California. 3
4 Your visiting member benefits The following visiting member benefits are covered when they are provided or arranged by a Plan physician in the service area you are visiting. The benefits may not be the same as those you receive in your home service area and are subject to the exclusions listed on page 6. Except for outpatient prescription drugs, these benefits are provided at no charge to you. Benefits Hospital inpatient care (subject to the mental health and chemical dependency benefits on next page) Physician services Prescription drugs Outpatient care (subject to all of the other benefits below and on next page) Office visits Outpatient surgery Physical, occupational, and speech therapy (up to two months per condition)* Allergy tests and allergy injections Prenatal and postnatal care Dialysis care X-ray and laboratory In or out of the hospital 4 Outpatient prescription drugs Covered only if you have an outpatient prescription drug benefit (regular home service area copayments, exclusions, and limitations apply)
5 Mental health services* Up to 20 outpatient visits per calendar year for short-term therapy Up to 10 hospital inpatient days per calendar year for crisis intervention Chemical dependency services* Medical detoxification (inpatient or outpatient) Outpatient services (up to 20 visits per calendar year) Skilled nursing facility care Up to 100 days per calendar year Home health care Home health care services inside a Kaiser Permanente or Group Health service area Hospice care** Home-based hospice inside a Kaiser Permanente or Group Health service area * Mid-Atlantic States members: If your Kaiser Permanente membership is through a Maryland-based contract, your mental health, chemical dependency, and physical, occupational, and speech therapy benefits are different from those described here. Please call Mid-Atlantic States Member Services for more information. ** Hospice care for Kaiser Permanente Senior Advantage, Medicare Plus, or Medicare Cost members with Medicare Parts A and B is covered directly by Medicare, not Kaiser Permanente. 5
6 Other benefits When visiting another service area, you may purchase items such as those listed below through Kaiser Permanente or Group Health. Eyeglasses Durable medical equipment Prosthetics and orthotics Hearing aids If these items are included in your benefits plan in your home service area, Kaiser Permanente in your home service area will reimburse you for their cost according to your benefits coverage. Specific benefits information and instructions for filing a claim are available from Member Services in your home service area. Services requiring preauthorization The following services require preauthorization from your home service area. If these services are part of your benefits plan in your home service area, they may also be available to you when visiting another Kaiser Permanente or Group Health service area. Please contact Member Services in your home service area for more information. Inpatient physical rehabilitation Mental health hospital services in excess of 10 days Residential facility admissions for chemical dependency 6 Outpatient mental health or chemical dependency benefits beyond 20 visits
7
8 Visiting member benefits exclusions The following services are not covered under your visiting member benefits. ( Services include equipment and supplies.) However, some of these services, such as emergency services, may be covered under your home service area benefits, and copays will apply. Please call Member Services in your home service area for more information. Services that are not medically necessary Physical examinations and related services for insurance, employment, or licensing Drugs for the treatment of sexual dysfunction disorders Dental care and dental X-rays Services to reverse voluntary infertility Infertility services Services related to conception by artificial means, such as IVF and GIFT Experimental services and all clinical trials Cosmetic surgery or other services primarily to change appearance Custodial care and care provided in an intermediate care facility Services related to sexual reassignment Transplants and related care Complementary and alternative medicine services, such as chiropractic services Services received as a result of a written referral from a Plan provider in your home service area Emergency services, including emergency ambulance services Services that are excluded or limited in your home service area 8
9 How to arrange for care It s a good idea to make your appointment as far ahead of time as possible if you know you re going to need routine or follow-up care, such as blood tests or a prenatal checkup. To arrange for care, call Member Services in the service area you are visiting, speak directly to a representative, and explain that you are a visiting member. Member Services will then give you the information you need (Plan facility or physician name, phone number, location) to make an appointment. And don t forget to take your Health Plan ID card with you when you leave home! Kaiser Permanente may change the Visiting Member Program at any time. The Kaiser Permanente or Group Health service areas where you may obtain visiting member benefits may change at any time. If you have any questions, please call Member Services in your home service area. 9
10 Kaiser Permanente Member Services If you would like more information about your visiting member benefits, please call Member Services in your home service area. If you would like to make an appointment for care in the service area you will be visiting, please call Member Services in that area. We look forward to meeting your health care needs. 10 * Coachella Valley (Palm Springs area), Southern California Visiting member benefits are not available in the Coachella Valley to Kaiser Permanente Senior Advantage Individual Plan (nongroup) members, except for outpatient prescription drugs (if you have an outpatient prescription drug benefit). * Western Ventura County (Oxnard/Ventura area), Southern California Visiting member benefits are not available in Western Ventura County to Kaiser Permanente Senior Advantage Group and Individual Plan (nongroup) members, except for outpatient prescription drugs (if you have an outpatient prescription drug benefit). ** Colorado Springs You need a Colorado Springs ID number and primary care physician assignment to receive routine, follow-up, or nonemergency care. Please call Colorado Springs Customer Service at for more information.
11 California* (TTY) M Sun., 7 a.m. 7 p.m. Colorado (Denver/Boulder/Longmont) (303) (from Denver Metro area) (from other areas) (303) (TTY) M F, 8 a.m. 5 p.m. (Colorado Springs)** (719) (TTY) M F, 8 a.m. 5 p.m. District of Columbia (301) (TTY) M F, 7:30 a.m. 5:30 p.m. Georgia (Metro-Atlanta area) (404) (TTY) M F, 8:30 a.m. 9 p.m. Sat. Sun., 8 a.m. 2 p.m. Hawaii (Oahu, Maui, Hawaii, and Kauai) (808) (from Oahu) (from outside Oahu) (808) (TTY) M F, 8 a.m. 5 p.m. Sat., 8 a.m. noon Idaho (northern only) Group Health (TTY) M F, 7:30 a.m. 5 p.m. Maryland (Baltimore and Suburban D.C.) (301) (TTY) M F, 7:30 a.m. 5:30 p.m. Ohio (northeast) (TTY) M Th, 8:15 a.m. 5 p.m. F, 9:30 a.m. 5 p.m. Oregon (northwest) (503) (from Portland) (from other areas) (TTY) M F, 8 a.m. 6 p.m. Virginia (northern) (301) (TTY) M F, 7:30 a.m. 5:30 p.m. Washington (southwest) Kaiser Permanente (TTY) M F, 8 a.m. 6 p.m. (western/central/eastern) Group Health (TTY) M F, 7:30 a.m. 5 p.m. Note: TTY numbers require special telephone equipment and are only for people who have difficulties with hearing or speaking.
12 kaiserpermanente.org r99 July 2005 H0524 Member and Marketing Communications
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This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.kaiserpermanente.org or by calling 1-800-464-4000. Important
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.ump.hca.wa.gov or by calling 1-888-849-3681 (TTY 711).
St Olaf College Coverage Period: Beginning on or after 09-01-2014
St Olaf College Summary of Benefits and Coverage: What this Plan covers & What it Costs Coverage Period: Beginning on or after 09-01-2014 Coverage for: Single and family coverage Plan Type: PPO This is
Important Questions Answers Why this Matters: What is the overall deductible?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at http://knowyourbenefits.dfa.ms.gov or by calling 1-866-586-2781.
UMC Health Plan Operations Coverage Period: 01/01/2013-12/31/2013
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthplanoperations@umchealthsystem.com or by calling
Wellesley College Health Insurance Program Information
Wellesley College Health Insurance Program Information Beginning August 15, 2013 Health Services All Wellesley College students, including Davis Scholars and Exchange students are encouraged to seek services
The Healthy Michigan Plan Handbook
The Healthy Michigan Plan Handbook Introduction The Healthy Michigan Plan is a health care program through the Michigan Department of Community Health (MDCH). The Healthy Michigan Plan provides health
PPO Option January 1, 2015 December 31, 2015
COST SHARING LIFETIME LIMITS Calendar Year Deductible Individual Family Calendar Year Out-of-Pocket Maximum Individual Family None None $500 includes copays $1500 includes copays $100 $300 $1,000 includes
Western Health Advantage: City of Sacramento HSA ABHP Coverage Period: 1/1/2016-12/31/2016
Coverage For: Self Plan Type: HMO This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.westernhealth.com or
Coverage for: Individual, Family Plan Type: PPO. Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bbsionline.com or by calling 1-866-927-2200. Important
Covered Benefits. Covered. Must meet current federal and state guidelines. Abortions. Covered. Allergy Testing. Covered. Audiology. Covered.
Covered Benefits Services Abortions Allergy Testing Audiology Birth Control Services Blood & Blood Plasma Bone Mass Measurement (bone density) Case Management Chemotherapy Chiropractor Services (manipulation/subluxation)
Kaiser Permanente Senior Advantage (HMO) with Part D Evidence of Coverage for VEBA - POST 65 RETIREE PLAN
EOC #3 - Kaiser Foundation Health Plan, Inc. Southern California Region A nonprofit corporation and a Medicare Advantage Organization Kaiser Permanente Senior Advantage (HMO) with Part D Evidence of Coverage
FACULTY (IFO) CANDIDATE BENEFITS SUMMARY
Human Resources Office Rev. Jan. 2013 FACULTY (IFO) CANDIDATE BENEFITS SUMMARY The benefits listed are subject to change pending state and federal legislation and changes in the negotiated agreements.
What is the overall deductible? $250 per person/$500 per family. Are there other deductibles for specific services? No.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.etf.wi.gov or by calling 1-877-533-5020. Important Questions
$100 Individual. Deductible
PLAN FEATURES Deductible $100 Individual (per calendar year) $200 Family Unless otherwise indicated, the deductible must be met prior to benefits being payable. Member cost sharing for certain services,
Health Insurance - How Does This Plan Work
: Nationwide Mutual Insurance - Georgia Coverage Period: 01/01/2015 12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual + Family Plan Type: HMO This
Schedule of Benefits HARVARD PILGRIM LAHEY HEALTH VALUE HMO MASSACHUSETTS MEMBER COST SHARING
Schedule of s HARVARD PILGRIM LAHEY HEALTH VALUE HMO MASSACHUSETTS ID: MD0000003378_ X Please Note: In this plan, Members have access to network benefits only from the providers in the Harvard Pilgrim-Lahey