Get healthy. Stay healthy. Kaiser Permanente. Kaiser Permanente. Health Plan. kp.org

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1 Get healthy. Stay healthy. Kaiser Permanente Kaiser Permanente Student Student Health Plan Health Plan w i t h d e d u c t i b l e kp.org

2 Table of Contents The Basics 3 How It Works 4 Frequently Asked Questions 7 Glossary of Health Plan Terms 8 before you begin Are you already covered? If you don t already have health care coverage, be reminded that some schools require it. To check your school s requirements for health care coverage, contact your school administrator. If your school requires health care coverage, you may waive enrollment in the Kaiser Permanente Student Health Plan with Deductible if you have proof of existing health care coverage for example, an individual plan in your name, coverage under your parent s plan, or coverage under your employer s plan. Simply complete the online waiver form at studentnet.kp.org or contact your school administrator. This document is only an introductory brochure about the Kaiser Permanente Student Health Plan with Deductible. The Evidence of Coverage (EOC) contains a complete explanation of benefits, exclusions, and limitations. You may contact your school administrator for a copy. 2

3 Kaiser Permanente Student Health Plan THE Basics w i t h d e d u c t i b l e The Kaiser Permanente Student Health Plan with Deductible provides flexible coverage all year round. You have access to care and services at Kaiser Permanente facilities, and you re covered for emergency services anytime, anywhere in the world.* Plus, we offer a wealth of online and offline health tools to help you achieve a well-balanced life on your own schedule, so you can stay on top of it all classes, activities, dating, whatever. Are you eligible? All full-time undergraduate or graduate students are eligible for coverage, except those eligible for Medicare. You must be enrolled in enough on-campus classes to meet your school s requirements for full-time status, as of your school s last add/drop registration deadline. Internet-based courses don t count toward full-time status. If you have questions about your eligibility, please contact your school administrator. If you re a part-time student, or if you don t meet all of the eligibility requirements for the Student Health Plan with Deductible, you may be eligible for coverage under a Kaiser Permanente Individual and Family Plans. For more information, go to buykp.org. 3

4 Kaiser Permanente Student Health Plan HOW IT WORKS w i t h d e d u c t i b l e Whenever you come in for care, you ll be asked for a deposit toward the full charges for the covered care you receive. You ll be billed later for any remaining charges for your care or for additional services received during your visit. Keep in mind that for doctor s office visits and certain preventive care services, you ll only pay a copayment (copay) or coinsurance, even if you haven t met your deductible. Once you meet your deductible, you ll pay either a copay or coinsurance for covered services. On January 1 of the next year, you start over and pay the full charges for certain services until you reach your deductible. The Kaiser Permanente Student Health Plan with Deductible has a set amount known as the medical deductible. From the start of each calendar year, for services that apply to your deductible, you ll pay full charges for those services until you meet your deductible. A cap on expenses The Kaiser Permanente Student Health Plan with Deductible offers you peace of mind by setting a cap on certain out-of-pocket expenses each calendar year. The cap is known as your annual out-of-pocket maximum. For most services, when you spend money on your care whether it s your copay, coinsurance, or costs that apply toward your deductible that amount counts toward your annual out-of-pocket maximum. Once you reach this limit, we ll pay for most covered services for the rest of the calendar year. This means that should you have a serious illness or accident after you ve reached your deductible, your medical expenses will only exceed your deductible up to the maximum out-of-pocket amount. Year-round coverage On campus If your school has a student health center, you can get care there while school is in session and during school-designated breaks and vacations, if the student health center is open during those times. If you choose to receive services that are offered at your student health center, then later decide to visit a Kaiser Permanente facility for additional services, we ll collaborate with campus health center staff at your request to coordinate the smooth transfer of your care. Please refer to your school s list of offered services, as costs charged by the student health center may be different than costs at a Kaiser Permanente facility. 4

5 At Kaiser Permanente facilities You can get care at a Kaiser Permanente facility yearround. You can often find primary care, specialists, lab, X-ray, pharmacy services, and more, all in one place. Many of our locations provide same-day, after-hours, and weekend appointments. With our electronic medical record system, our physicians have immediate access to the most up-to-date information about your health, so they can provide you with the best possible care when you need it. Get to know your doctor The choice of your primary care doctor should be yours, not ours. We encourage you to select a Kaiser Permanente personal physician from one of our primary care departments as soon as you become a member. Use our clinical staff directory at kp.org to learn more about our doctors and to choose the one who s right for you. You can also select your personal physician or change your doctor for any reason by calling our Member Service Call Center at one of the numbers on the back of this brochure. At Kaiser Permanente, our doctors work collaboratively to share best practices and make specialty care referrals easier, so you don t just get a doctor you get the support of an entire health care team, including nurses, specialists, and health educators, working together to help you meet your health goals. When you need care If you need care quickly, but it s not an emergency* You can receive care at any Kaiser Permanente facility. Many of our facilities offer same-day appointments. You can also call us to speak to an advice nurse who can help assess your symptoms, provide advice when appropriate, and answer questions about your medical concerns. If you need care after regular office hours We try to make it as easy as possible for you to get care when you need it. You can get same-day, after-hours, and weekend appointments at many Kaiser Permanente locations. You ll also find valuable health information at kp.org, 24 hours a day, seven days a week. If you need to be hospitalized Under the Student Health Plan with Deductible, you re covered for all hospital-related care, including Emergency Department visits, inpatient care, and outpatient surgery. Filling your prescriptions You can fill your prescriptions at Kaiser Permanente pharmacies year-round, whether or not school is in session. Just present your member ID card and pay a simple copayment. Our pharmacies are conveniently located in or near our medical centers and medical offices. You can even order prescription refills by phone or online through My Health Manager at kp.org. (This service is not available in all areas.) 5

6 Additional coverage and services We provide coverage for routine vision exams for the health of your eyes. You can also visit our optical centers for a wide selection of designer frames and a full range of lens options for both glasses and contacts. If you re going on a trip, you can take advantage of our travel clinic services. Our Travel Kit explains where and how to get care when you re away from home or school. To obtain a Travel Kit, call our Member Service Call Center at one of the numbers on the back of this brochure. Manage your health online Our Web site provides health and drug information, facility and clinician listings, and much more. As a member, you can visit kp.org anytime to request routine appointments, order prescription refills, get most lab test results, and your doctor s office with nonurgent health questions or concerns. These secure features are part of My Health Manager, a one-stop online resource that helps you keep track of your health care. (Some services are not available in all areas.) Health care is not just for the sick Things like sleeping well, relieving stress, managing depression, losing weight, and eating right can have as much impact as advanced medical procedures. That s why we offer a variety of wellness programs, tons of online information, health and fitness classes, and even some friendly motivation to help keep you healthy for a long time. At many of our locations, we offer classes like tai chi and yoga to help you reach your personal fitness and wellness goals. You can choose from a variety of Healthy Living classes and programs on topics that include: Asthma Depression Diabetes Fitness Heart health managing ongoing health conditions Nutrition Smoking cessation Stress management Weight loss Quality care for our members Kaiser Permanente has been widely recognized for the quality of our care and service. Kaiser Permanente in California earned Excellent accreditation from the National Committee for Quality Assurance (NCQA), the nation s leading independent reviewer of health plan quality for consumers and employers. ** Excellent is the top rating granted by NCQA, based on service and access to care, preventive measures, physician credentialing, how well members recover from illness, and how well they live with chronic conditions. 6

7 FREQUENTLY ASKED QUESTIONS When does my coverage start? Your coverage dates are based on when your term begins and ends. Check the dates at studentnet.kp.org or contact your school administrator. Coverage for your spouse and children starts at the same time your coverage begins. As an international student, am I eligible for coverage? Yes. You get the same benefits as any other enrolled student no matter what country you re from. The plan also has provisions for medical evacuation and repatriation. When do I enroll? You (and your dependents, if any) can enroll during the open enrollment period. Check the enrollment period at studentnet.kp.org or contact your school administrator. Can I get a refund if I withdraw before the school s last add/drop date? If you ve paid for coverage for the term, you can get a full refund if you withdraw from school within your school s add/drop registration period, and as long as you and your dependents (if dependent coverage is offered) have not used any health care services. You can t get a refund if you withdraw from school after you ve paid for coverage for the term and after your school s add/drop registration period ends. You (and your dependents, if any) will be covered until the end of the current term. If you re called to active duty in the military service, you can receive a partial refund for the time you would not be able to use the health coverage while on active duty. If you re part of the U.S. Military Reserve forces or the California National Guard and are called to active duty as part of the Iraq or Afghanistan conflicts, you can have your coverage reinstated when you return. Can I enroll my spouse and children in the Student Health Plan with Deductible, too? If your school has chosen to cover dependents, you may enroll your spouse and children in the Student Health Plan with Deductible during the open enrollment period. Check with your school administrator about dependent coverage. If you re already enrolled in the Student Health Plan with Deductible and you marry, have a child, or adopt a child, you ll need to submit a Change of Enrollment form to your school administrator within 31 days after your family member first becomes eligible. 7

8 Glossary of Health Plan Terms Annual out-of-pocket maximum The maximum amount you ll pay for certain covered services in a calendar year. Once you ve reached that maximum, you won t have to pay any deductibles, copayments, or coinsurance for most covered services for the rest of the calendar year. Not all services apply toward the annual out-of-pocket maximum. Benefits Summary Your resource document for general information about your cost share and covered benefits as selected by your school under the Student Health Plan with Deductible. Coinsurance The percentage of charges you pay when receiving certain covered services. For example, 30 percent coinsurance for hospitalization means you pay 30 percent of the full charges for covered hospital services. Coinsurance varies depending on your plan. Copayment (copay) The fixed amount you pay when you receive certain covered medical services or prescriptions. For example, a $10 office visit copay means you pay $10 for each office visit. Copayments vary depending on your plan. Deductible A fixed amount of money you must pay in a calendar year before we ll pay for certain covered services (not including copays or coinsurance). Not all services may apply to the deductible. Deposit The amount you pay for care at the time of service before reaching your deductible. The deposit may not be the full amount you owe for the services you receive during the visit. Evidence of Coverage (EOC) The document that provides a complete explanation of the benefits, exclusions, and limitations under your plan. To get a copy, contact your school administrator. Kaiser Foundation Health Plan, Inc. (KFHP) KFHP is a nonprofit, public benefit corporation that enrolls members, collects dues, and contracts with the Permanente Medical Groups, Kaiser Foundation Hospitals, and affiliated providers to provide health care to members. KFHP underwrites the Kaiser Permanente Student Health Plan with Deductible. Kaiser Permanente Member Service Call Center Weekdays, 7 a.m. 7 p.m. Weekends, 7 a.m. 3 p.m English Spanish Chinese dialects tty for the deaf, hard of hearing, or speech impaired Once you re a member, you can call us for more information about: Benefits and coverage Enrollment and eligibility Copayments and billing Adding or deleting dependents Getting a copy of your Benefits Summary Name and/or address changes other services, including health education classes and support groups * If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs, (2) active labor when there isn t enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child s) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder. To use these secure features for the first time, all you need to do is register at kp.org/register. Then sign on with your user ID and password. Kaiser Permanente members typically have coverage for medically necessary eye examinations, and some members may be able to apply a supplemental benefit to their purchases. Otherwise, the services and products described here are provided on a fee-for-service basis, separate from and not covered under your health plan benefits, and you are financially responsible to pay for them. Clinical services are provided by providers or contractors of The Permanente Medical Group, Inc. Kaiser Foundation Health Plan, Inc., and Kaiser Foundation Hospitals may receive compensation for providing facilities and/or other support in connection with these services. For specific information about your health plan benefits, please see your Evidence of Coverage. Classes vary by location. Some classes may require a fee. ** Commercial HMO and Medicare-contracted product lines, National Committee for Quality Assurance Health Plan Report Card. View the complete report online at hprc.ncqa.org. kp.org Please recycle. This material was produced from eco-responsible resources. Member and Marketing Communications May