Helping you stay covered. with Kaiser Permanente

Transcription

1 Helping you stay covered with Kaiser Permanente

2 What s inside How do I stay covered?... 2 When do I need to enroll?... 4 What are my options?... 6 Kaiser Permanente for Individuals and Families... 8 Medi-Cal...11 Medi-Cal Access Program Kaiser Permanente Child Health Program Major Risk Medical Insurance Program (MRMIP) Kaiser Permanente Senior Advantage Plan...15 COBRA and Cal-COBRA...16 Federal Employees Health Benefits Program Temporary Continuation of Coverage (TCC)...17 Questions?

3 How do I stay covered? If a recent change is affecting your health coverage, we re here to help. It s important to act quickly, and in this guide we ll show you how. If you want more help at any time, we re just a click or call away (see below). Rest assured, you may have several options for staying with Kaiser Permanente. Some of them might be newly available as a result of the Affordable Care Act (ACA). Other options might be available to you if you qualify for financial aid. Connect with Kaiser Permanente By staying with Kaiser Permanente, you can: Keep the doctors you know and trust. Keep getting excellent care at nearby medical offices that offer many services under one roof.* Keep managing your health and prescriptions through our resources online, over the phone, and at our facilities. We want to make this as simple as possible for you. We ll help you figure out your deadline and find the right plan for your needs and budget. No matter what plan you choose, you ll get the same great care and services from Kaiser Permanente. Go online for customized options Go to kp.org/exploreoptions, where you ll be guided through a few simple questions, then given options that fit your needs. Talk to a representative If you d like someone to personally take you through your options, you can call our Member Service Contact Center at For TTY, call 711. *When receiving care at a Kaiser Permanente facility 2 Need help? kp.org/exploreoptions Questions?

4 When do I need to enroll? Act quickly to meet deadlines Depending on your situation, you may have to apply for health care coverage very soon. Here are 3 enrollment options and their time frames for applying for coverage. Special enrollment The loss of your employer-sponsored coverage means you re eligible for a special enrollment period. It can begin before you lose coverage and lasts 60 days after the date you lose (or would lose) coverage. If you sign up before your coverage ends, your new coverage may begin immediately and you won t have any gap in coverage. Open enrollment Unless you qualify for a special enrollment period, the only time you can enroll through Covered California or directly with Kaiser Permanente is during the open enrollment period. Open enrollment for 2016 coverage is from November 1, 2015, through January 31, If you qualify for Medi-Cal, you can sign up anytime during the year. COBRA, Cal-COBRA, and Federal Employees Health Benefits Program Temporary Continuation of Coverage (TCC) You can sign up within 60 days of when you get your COBRA election notice or TCC election notice or the date you lose coverage, whichever is later. Contact your former employer to find out whether you re eligible and how you can sign up. How do I qualify for a special enrollment period? Most people who are losing coverage will qualify for special enrollment. To find out if you qualify, visit kp.org/ specialenrollment or call our Member Service Contact Center at For TTY, call Need help? kp.org/exploreoptions Questions?

5 What are my options? Your options depend on your situation. Do any of these sound like you? Find the statement that best fits your situation and continue on to read more about each option available to you. I m going through employment changes. Whether you re losing your job or your employer no longer offers coverage, there are several ways to stay with Kaiser Permanente, including: Kaiser Permanente for Individuals and Families Medi-Cal COBRA or Cal-COBRA Temporary Continuation of Coverage I m no longer on my parent s plan. If you re 26 you can t stay on your parent s plan, but you have options to get your own Kaiser Permanente plan or continue your previous coverage, including: Kaiser Permanente for Individuals and Families I m interested in financial aid. No matter your employment status or age, there are a number of ways to get help (if you qualify), including: Kaiser Permanente for Individuals and Families Medi-Cal Kaiser Permanente Child Health Program I m over 65 years of age. Kaiser Permanente Senior Advantage (HMO) Plan Are you eligible for Medicare? Kaiser Permanente coverage combined with Medicare benefits. Includes Medicare Part D prescription drug coverage. If you re a Kaiser Permanente Senior Advantage member whose group coverage is ending, you may have already received information from us about our Kaiser Permanente Senior Advantage plan for individuals. If you want more information, please contact us to learn how you can continue your Kaiser Permanente membership. Medi-Cal Temporary Continuation of Coverage 6 Need help? kp.org/exploreoptions Questions?

6 Kaiser Permanente for Individuals and Families What is it? This is a range of Kaiser Permanente plans to fit your needs and budget. You can pick one plan for your entire family or separate plans for each person. You can select from several levels of coverage. Platinum and Gold plans offer higher levels of coverage, usually with higher premiums and lower out-of-pocket costs. Silver and Bronze plans usually have lower premiums and higher out-of-pocket costs. All plan levels offer most of the same health benefits (such as doctor visits, hospital care, prescriptions, and maternity care). They also include most preventive services for no charge. Who is it for? Anyone can get a Platinum, Gold, Silver, or Bronze plan. We also offer Minimum Essential Coverage plans for people under 30, as well as people who have a certificate from Covered California proving financial hardship or a lack of affordable coverage. How do I get a plan?* You can shop for a plan directly through Kaiser Permanente or through California s state-run Health Insurance Marketplace, Covered California. However, to get federal financial help, you must buy your plan through Covered California. * You must reside or work in the Kaiser Permanente health plan service area in which you enroll. How do I know if I qualify for federal financial help? You can get a plan with or without financial help. The chart on this page shows the estimated family income levels that can help you figure out if you may qualify for help paying premiums. A few things to know about federal financial help, if you qualify: Help is available for a portion of premiums and out-of-pocket expenses. The federal government will pay Kaiser Permanente any financial help on your behalf. Help will be on a sliding scale, based on income and family size. Help paying premiums is also based on the cost of the second-lowest Silver plan offered through your exchange. Do you qualify for financial aid?* The numbers change slightly every year, so it s important to contact us to check the amounts. Number of people in household Annual family income level 1 $47,080 or below 2 $63,720 or below 3 $80,360 or below 4 $97,000 or below 5 $113,640 or below 6 $130,280 or below 7 $146,920 or below 8 $163,560 or below *These amounts are effective as of January 1, Need help? kp.org/exploreoptions Questions?

7 Kaiser Permanente for Individuals and Families What if I don t qualify for financial help? Even if you can t get help from the federal government, you can buy a Kaiser Permanente plan directly from us or through Covered California. You may also qualify for Medi-Cal. Where can I find more information? To compare individual or family plans, get a quote, and see if you re eligible for federal financial help, go to buykp.org. Medi-Cal What is it? Medi-Cal is a state health coverage program available to people who have low incomes and limited resources. If you lose your job or have a life-changing event, you may be eligible for Medi-Cal. Because Kaiser Permanente participates in Medi-Cal, you might also be able to keep your same doctor and continue your care with Kaiser Permanente. Who is it for? To qualify, individuals must meet certain requirements. For instance, you must be a U.S. citizen or legal permanent resident and have a certain income level based on the Federal Poverty Level Guidelines. Where can I find more information? Call our Medicaid Assistance Center at , Monday through Friday from 8 a.m. to 5 p.m. PT. For TTY, call 711. Visit kp.org/medi-cal. Contact your county Social Services office. 10 Need help? kp.org/exploreoptions Questions?

8 Medi-Cal Access Program What is it? If you have a baby on the way, you may be eligible for low-cost health care coverage and prenatal care through California s Medi-Cal Access Program. Who may be eligible? Pregnant women living in California who meet established income guidelines and are: Pregnant but not more than 30 weeks pregnant, as of the application date Not a recipient of no-cost Medi-Cal or Medicare Part A and Part B benefits, as of the application date Uninsured or covered by private insurance with a separate maternity deductible or copayment of more than $500 Where can I find more information? Call , Monday through Friday from 8 a.m. to 8 p.m., and Saturday from 8 a.m. to 5 p.m. Visit the AIM program website at mrmib.ca.gov/mrmib/ aim.html. Kaiser Permanente Child Health Program What is it? This program offers a Kaiser Permanente subsidy to help pay the premiums for one of our Individual and Family plans. It also offers medical financial aid to help pay out-of-pocket costs for services at Kaiser Permanente locations. Who may be eligible?* Children who: Are under 19 years of age Do not have access to any other public or private health coverage (such as, but not limited to, Medi-Cal, Covered California, and job-based coverage) Live in a household with incomes up to 300% of the federal poverty level Enrollment is limited to the charitable, subsidized program, and subject to availability. For more information: Call our Member Service Contact Center at For TTY, call 711. Visit us at info.kp.org/childhealthplan. * You must reside or work in the Kaiser Permanente health plan service area in which you enroll. 12 Need help? kp.org/exploreoptions Questions?

9 Major Risk Medical Insurance Program (MRMIP) What is it? This is health insurance for individuals and their families who were denied coverage before health care reform because of pre-existing conditions. Who may be eligible? People living in California who: Are not eligible for both Part A and Part B of Medicare, unless eligible solely because of end-stage renal disease (ESRD) Are not eligible to purchase any health insurance for continuation of benefits under COBRA or Cal-COBRA Were unable to secure adequate coverage before health care reform Where can I find more information? Call , Monday through Friday from 8 a.m. to 8 p.m., and Saturday from 8 a.m. to 5 p.m. Visit the MRMIP program website at mrmib.ca.gov/mrmib/ mrmip.shtml. Kaiser Permanente Senior Advantage Plan With Senior Advantage, you get all the benefits of a Kaiser Permanente membership, along with the convenience of having your Medicare services covered under one plan. Plus, you can keep seeing your Kaiser Permanente doctor and continue to receive the quality care you ve come to expect as a Kaiser Permanente member. Connect with Kaiser Permanente If you are a Kaiser Permanente Senior Advantage member whose group coverage is ending, we ll send you information about our individual plan coverage (which is different from your group coverage). If you have any questions about what you need to do to continue your membership, call our Member Service Contact Center at or 711 (TTY for the deaf, hard of hearing, or speech impaired), seven days a week, from 8 a.m. to 8 p.m. Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. The provider network may change at any time. You will receive notice when necessary. Y0043_N accepted 14 Need help? kp.org/exploreoptions Questions?

10 COBRA and Cal-COBRA If you lose your group coverage, you may be eligible for temporary continuation of the same coverage through COBRA or Cal-COBRA. COBRA Most employers with at least 20 full-time employees must offer COBRA coverage. Cal-COBRA If your coverage was through an employer with fewer than 20 employees, you may be eligible for Cal-COBRA coverage. Also, if you ve had COBRA coverage for 18 months, you may be eligible for 18 more months of Cal-COBRA coverage. Call your employer and stay covered You ll need to contact your former employer to find out whether you re eligible, what the premiums are, and how you can enroll. Federal Employees Health Benefits Program Temporary Continuation of Coverage (TCC) TCC is for eligible Federal Employees Health Benefits (FEHB) Program members only. If you were covered under the FEHB Program, you may be eligible for TCC. You must notify your employing office within 60 days of a qualifying event in order to get TCC for a child who loses FEHB coverage. TCC enrollments and premiums always begin 32 days after regular coverage ends. Call your employer and stay covered For TCC plans, you ll need to contact your former employer to find out whether you re eligible, what the premiums are, and how you can enroll. 16 Need help? kp.org/exploreoptions Questions?

11 Notes Notes Need help? kp.org/exploreoptions Questions?

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13 kp.org/exploreoptions Please recycle February 2016 DST