If you choose out-of-network care, you can see First Choice Health Network or Beech Street providers at a discounted rate. With Dual Choice PPO, you can offer your participating employees more provider choices when they receive care: Members have several choices for having their prescriptions filled. Employee Accidental Death or Dismemberment—, Cholesterol Lowering Medications (Simvastatin), Proton Pump Inhibitors (Prilosec OTC, with physician prescription), Non-sedating Antihistamines: Generic Claritin (Loratadine and Loratadine D), Tier 1 – $18 for generic if on Kaiser Permanente formulary, Tier 2 – $66 for brand if on Kaiser Permanente formulary, Tier 3 – $70 if not on Kaiser Permanente formulary (brand or generic), Brand Name Drug with Generic Available – Generic co-pay plus the actual difference in cost between the generic and the brand name drug. Call 1-866-616-0047 (TTY 711) to speak with our Added Choice Contact Center. General information about Kaiser Permanente Washington's PPO plans. Search for a location and select one from the list of suggestions. Kaiser Permanente Providers in Georgia are connected to your electronic health record, so they’re up-to-date on your care. Not a Kaiser Participant? Certain services require precertification. Need help with your Added Choice® plan? Kaiser Permanente’s behavioral health care management program provides care coordination, support and advocacy for patients with severe or chronic mental illness and or alcohol or drug concerns. This amount will be paid to you in the event of your spouse or partner’s death from any cause. This option allows you to see any licensed dental provider. Open enrollment webinars. Each Flexible Choice Kaiser Permanente Providers. * Including contact lens evaluations and examinations associated with their fitting. Refer to Section IV. Our doctors are among the best, and caring for people is their passion. Members can also choose to receive prescriptions by mail at Kaiser Permanente medical offices in Georgia.*. Kaiser Permanente SoundChoice Plans | Contents Your Kaiser Permanente Member Guide The information in this Member Guide is updated from time to time and is current as of November 2020. When you combine the Options Federal Standard Option plan with Medicare coverage, your Kaiser Permanente coverage will make your Medicare coverage go further. Interested In Search for a category and select one from the list of suggestions. The Kaiser Permanente Flexible Choice plan blends HMO, PPO, and indemnity-style benefit plans and delivery systems into one product. Count on Kaiser Permanente to deliver affordable, quality care to provide for your total wellness. Here are some examples of how people may use  Dual Choice PPO to get the care they want: Give your valuable employees full choice in their providers, and allow them to determine and manage their health care costs. Call the Trust office at (206) 282-4500 or (800) 225-7620. Learn about Georgia Kaiser Permanente Choice Products. Choice Products offer the most flexibility on how you receive care. Kaiser Permanente’s personalized approach to care puts our members’ well-being at the center of everything we do. With care and coverage working seamlessly together, Kaiser Permanente is uniquely designed to give you the information and support you need to live healthy. DeltaCare is a dental HMO plan. The benefits covered under the two types of coverage are not the same. Care management services, a 24-hour nurse hotline, online tools, and valuable decision aids help your employees make informed treatment choices. Learning sessions will be held on Wednesdays beginning August 26, 2020, and ending November 18, 2020. Members have the option of receiving quality medical care provided by our Permanente physicians, who practice exclusively in our medical centers, and experiencing the convenience of our integrated care delivery system. Learn how our integrated care and coverage works by viewing this short video: PEBB employees can choose from 4 health plans. Learn about Georgia Kaiser Permanente Choice Products. Show me . Eligible Sound Health & Wellness Trust Kaiser Permanente Plan participants and their covered dependents can receive $0 co-pay flu shots at Kaiser Permanente medical centers, Bartell Care Clinic locations and in-network pharmacies. Kaiser Permanente Options Federal coverage can help pay for many expenses that are not covered by Medicare Parts A and B. Members also can fill prescriptions at any pharmacy outside the Kaiser Permanente medical office and MedImpact network. However, once you have completed your 35th month of employment, you may choose to enroll in either the Sound PPO Plan or the Sound Kaiser Permanente Plan. Hours: Monday – Friday, 8:00am to 5:00pm, 11724 NE 195th St. Suite 300 Your call will be answered by a trained and licensed counselor who will ask you a few questions to best direct you to the services that meet your needs and preferences. Group Health Physicians (now Washington Permanente Medical Group) was recognized as the highest-ranked medical group in the 2016 Community Checkup from Washington Health Alliance. A list of DeltaCare providers can be found at www.deltadentalwa.com. ... To access sample member coverage documents, click here. Kaiser Permanente Insurance Company (herein called KPIC) provides the Out-of-Network coverage as set forth in the Group Policy. Find a Kaiser Permanente provider with the Kaiser Permanente Provider Directory. Find a provider online by using the Kaiser Permanente Provider Directory. Kaiser Permanente Washington offers many ways to get care quickly. In the Multi-Choice, 3 Tier Point-of-Service (POS) plan, there are three Tiers to choose from: Select Provider Tier, Participating Provider Tier, and Non-Participating Provider Tier. Puget Sound area. Your reimbursement will depend on the dentist’s contract with DDWA: This option allows you to see any licensed dental provider. It is printed on the far left-hand side under the Trust logo. Members can fill prescriptions written by any provider at pharmacies located in Kaiser Permanente medical offices in Georgia, at the lowest out-of-pocket cost. 1. Or you can see any licensed provider you want for most covered services. Not a Kaiser participant? Go back to home. Costs are the same for both in- and out-of-network. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. Kaiser Permanente is hosting a series of virtual learning sessions, “Here’s to Your Health.” Each 30-minute session will focus on how to optimize your personal health in the midst of COVID-19. They are mostly a one-stop shop for Kaiser Permanente customers, meaning that customers can often visit the lab, radiology, specialists, pharmacy, and their primary care physician in the same visit. Dual Choice PPO plan allows access to In Network providers or any licensed provider. Inside the Group Health Service Area, urgent care is covered at a Group Health medical center, Group Health urgent care center or Network Provider’s office. What are the pharmacy choices under Dual Choice PPO? If the evidence your prescriber provides meets medical necessity, an exception may be approved. Dental charges in excess of the schedule will be your responsibility. Contact your Kaiser Permanente Sales and Account Management representative for more information. First Health Network 1-800-226-5116. You can receive care from Kaiser Permanente Providers in Georgia, Network Providers, or from any Out-of-Network licensed physician or facility. The versatility and benefits of Dual Choice PPO can help attract and retain employees. Actionable reporting For our large group clients, we collect and analyze valuable data about the way your employees are using their health coverage, including claims, hospitalizations, and level of physician engagement. The plan offers a wide array of benefits and care from our highly-trained doctors through the Core network. Some services are covered by Health Plan and KPIC, while other Kaiser Permanente Insurance Company (KPIC) is a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP). Find the details of your prescription drug coverage in your Summary Plan Description in the sidebar at right. Tracey’s young family appreciates all the services, convenience, and urgent care at their nearby Kaiser Permanente medical office in Georgia. (Must use Kaiser Permanente Order Program), Download Kaiser Permanente mail order form (PDF). To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. Kaiser Permanente and Group Health Cooperative: Working together since 1950. Call the Added Choice Contact Center at 1-866-616-0047 (TTY 711). Online features let you manage most of your care around the clock. for more information about Emergency services. You can choose any licensed physician to provide care nationwide, and receive preventive care at little or no cost from in-network providers. Tier 0-Some highly cost-effective medications: Co-pay per 30-day supply $0. Why Kaiser Permanente is the right choice for you. Co-pays for a 90 day supply listed below. For years, Katherine has been seeing her cardiologist, who is not an In-Network Provider. Choose Kaiser Permanente physicians and specialists in Georgia. Access coverage documents for Added Choice members. For care with Kaiser Permanente Providers in Georgia. More Choice. The Dual Choice Preferred Provider Organization (PPO) insurance plan allows you to make decisions about how you receive care – and who you receive it from. ** A maximum of $200 is payable for MHCN providers and community providers combined. Email Customer Service & Claims They can also select a contracted physician outside of Kaiser Permanente or see any licensed provider in their network of coverage, switching between provider network options at any time to suit their needs. Go back to home. In addition, you have access to a number of contracted community physicians in the area. Children from 6 months to 19 years of age, pregnant women, people 50 and older, and people with certain chronic medical conditions are especially encouraged to get a flu shot. Childbirth/delivery facility services 15% coinsurance Not covered You must notify Kaiser Permanente within 24 hours of admission, or as soon thereafter as medically possible. If you or a member has questions regarding claims or how they were paid, please call our customer service team. Online features let you manage most of your care around the clock. Choose an insurance plan below to explore more details about your coverage, including provider options and guidance on how to get the most out of your insurance plan. Kaiser Permanente. Your Kaiser Permanente Provider in Georgia will coordinate your care. Questions? You are covered for Medically Necessary services at Kaiser Permanente facilities within the Hawaii service area, and which are provided, prescribed or directed by a Kaiser Permanente physician and consistent with reasonable medical management techniques Plus, you’ve got the power to change doctors anytime. Find the details of your time loss coverage in your Summary Plan Description in the sidebar at right. In general, when you have a Kaiser WA plan, you’ll visit Kaiser Permanente Medical Centers to receive care and get prescriptions. Tracey: Gets great family care, keeps her specialist, and manages costs. Another division of Kaiser Permanente also offers PEBB health plans which are only available in SW Washington and northern Oregon. Employee Accidental Death or Dismemberment—This benefit is payable to your beneficiary in the event of your death, or to you in the event of your loss, if your death or loss is caused by an accidental injury while you are covered under the Plan. A narrow network is defined as a tailored, tiered or high-performance network that has 80 percent or less overlap with a health plan’s broadest network offered to a member in any type of plan offered by that health plan. PPO plans generally offer coverage for out-of-network providers, while HMO plans only offer out-of-network coverage in emergency situations. Members can receive medical care provided by our Kaiser Permanente physicians and experience the convenience of our integrated care delivery system. Your Choice of Top Doctors . Search for a dentist using the Delta Dental of Washington site. In-network coverage with high-performing Washington Permanente Medical Group and contracted network providers, while offering choice with out-of-network coverage: Kaiser Permanente providers, medical facilities, and pharmacies; More than 16,000 additional network providers and facilities 3 Select a plan for details . Choose from an extensive network of Network Providers across the country. Kaiser Permanente’s Flexible Choice Plan 15.0 . Email Address. Employer & producer support. Dual Choice PPO plan allows access to In Network providers or any licensed provider. Some medications are not eligible for the Mail Service Delivery Program. Contributed by Lincoln Cushing, … Kaiser Permanente Dual Choice PPO is the best of all worlds. Tracey can manage the family’s out-of-pocket costs when seeking care from Out-of-Network Providers. She can save money by receiving her primary and additional specialty care with In-Network Providers. Your health care plan with Kaiser Permanente WA is a partnership in health. Coverage for Emergency services at a non-Network Facility is limited to the Allowed Amount. For additional information, visit www.kp.org/wa. Please fill out the fields below and click "Join Now" to receive information about opportunities that relate to your selections. Here’s an overview of getting care with Choice Products. 514 Kaiser Permanente Reviews and Complaints @ Pissed Consumer Kaiser Permanente Insurance Company (KPIC) has contracted with MedImpact to fill outpatient prescriptions at In-Network retail pharmacies—including Rite Aid, Walgreens, Kroger, and many supermarket chains (Not all pharmacies in a chain may participate). Kaiser Permanente provides mental health care and alcohol and drug treatment through the Kaiser Permanente Behavioral Health Services department. Employee Life Insurance—The employee life insurance benefit is $15,000. David’s employer is located in Atlanta, GA, but he frequently travels to Harrisburg, PA, on business, where there aren’t Kaiser Permanente facilities nearby. It connects you to a group of physicians, services, and tools that help you live your healthy best. Get More Information in Your Benefits Booklet Benefits will be paid according to the schedule of allowances. Find the details of your life insurance coverage in your Summary Plan Description in the sidebar at right. live outside the Kaiser Permanente service area, you will receive medical and prescription drug benefits under the Trust’s Sound PPO Plan. This option requires you to choose from a smaller list of approved dentists and clinics. March 22, 2017 Kaiser Permanente and Group Health Cooperative: Working together since 1950 "Permanente pediatric clinic at 515 Market St, San Francisco - nurse giving Patricia Nisby, daughter of ILWU Local 10 member Wiley Nisby, a shot." You can receive care from any licensed care provider in the U.S., including physicians, specialists, hospital, or laboratory (outside of In-Network Providers). 2021 Open Enrollment. Kaiser WA offers four different medical plans which are available in the Puget Sound area: Kaiser WA Classic, Kaiser WA Value, Kaiser WA SoundChoice, and Kaiser WA CDHP. Get More Information in Your Benefits Booklet. Contact the human resources/benefits representative where you work, if your employer provides your coverage. Getting a flu shot is the single best way to protect against the flu. Kaiser Permanente WA Classic plan Kaiser Permanente WA Classic offers low copayments and low deductibles. Access PPO and Elect PPO preauthorization (PDF) PPO: Options (no longer available for new sales) Kaiser Foundation Health Plan of Washington Options, Inc. Your physician will complete a claim form. Tracy can receive In-Network care with her Network Provider. If you are required to pay out-of-pocket at the point of service, you can complete a medical claim form and submit it for reimbursement from your insurance carrier. To access sample member coverage documents, click here. If you are totally disabled because of your injury or sickness, you may be eligible for weekly disability benefits. Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 1/1/20 20 – 12/31/2020 : PEBB SoundChoice Plan All plans offered and underwritten by Kaiser Foundation Health Plan of Washington 1 of 6 RQ-136645-1 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Point-of-Service (POS) PPO. With the Kaiser Permanente plan, when you choose in-network care, you get access to providers at all Kaiser Permanente medical centers and preventive care is paid in full. Join Kaiser Permanente's Talent Network. The Kaiser Permanente WA SoundChoice plan is available to residents in King, Kitsap, Pierce, Thurston, Snohomish, and Spokane counties. ILWU Dispatcher, October 13, 1950. Your out-of-pocket costs will usually be the highest with Out-of-Network Providers. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. A claim form will have to be completed. You may have to pay the provider directly at the point of service. Or you can see any licensed provider you want for most covered services. Sound Health & Wellness Trust participants are also able to use benefits for mental health and chemical dependency at the out of network benefit level. With the Kaiser Permanente plan, when you choose in-network care, you get access to providers at all Kaiser Permanente facilities. Make sure you have a DeltaCare provider in your area and that they are accepting new patients before enrolling in this option. Choice Products California. Plus, you’ve got the power to change doctors anytime. Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 1/1/2018 – 12/31/2018 Kaiser Foundation Health Plan of Washington: PEBB SoundChoice Coverage for: Group | Plan Type: HMO 1 of 7 RQ-119616-1 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. PPO . Dependent Life Insurance—The spouse or State Registered Same Sex Domestic Partner’s benefit is $1,000. It is printed on the far left-hand side under the Trust logo. Our doctors are among the best, and caring for people is their passion. Eligibility, claims or any other questions? Your company has the convenience of one health care provider for all your employee benefits administration. Kaiser Permanente WA CDHP This plan allows you to seek services from non-Kaiser Permanente WA health providers, however, if you seek services from a non-Kaiser Permanente WA health provider, the service may be covered at a reduced level of coverage. Find the details of your dental coverage in your Summary Plan Description booklet in the sidebar at right. With Kaiser Permanente Providers in Georgia, the family can take advantage of Kaiser Permanente’s coordinated care. Coverage options range from Preferred Provider Organization (PPO) to Health Maintenance Organization (HMO). If you have any questions or need help with any of the PPO providers, you may contact their customer support at: First Choice Health Network 1-800-467-5281. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. exception to Kaiser Permanente requirements for coverage of prescription drugs, you or your prescriber may contact Kaiser Permanente Member Services at 1-888-630-4636 and request an exception. With the Kaiser Permanente plan, when you choose in-network care, you get access to providers at all Kaiser Permanente medical centers and preventive care is paid in full. Physician as described in the Added Choice Service Agreement. Members have several choices for having their prescriptions filled. This amount will be paid to your beneficiary in the event of your death from any cause. Your Kaiser Permanente Added Choice® Point-of-Service (POS) Plan is not just health coverage — it's a partnership in health. Claims are processed by our claims team in Denver, Colorado. Most medical offices across the Georgia region offer many services conveniently under one roof, including pharmacy, imaging, lab, primary care physicians and specialists, and urgent care services. The website is an excellent resource for information on behavioral health topics. Kaiser Permanente 1-866-616-0047 (TTY 711) … Bothell, WA 98011–3145. Dual Choice PPO plan allows access to In Network providers or any licensed provider. Others view the Primary Care Physician (PCP) of Kaiser Permanente and the other HMO’s as a “gatekeeper” or a prison guard who is keeping them from going straight to a specialist when they deem it necessary. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. Select Counties. Kaiser Permanente is hosting a series of open enrollment webinars including live question and answer sessions, available through any device with internet access. Learn about Georgia Kaiser Permanente Choice Products. Katherine: Maintains care with her specialist. Are you an employer or producer with questions about Added Choice®? Find the details of your mental health & substance abuse coverage in your Summary Plan Description (choose the link below based on whether you are in the “Sound” or “SoundPlus” plan). Show me. With care and coverage working seamlessly together, Kaiser Permanente is uniquely designed to give you the information and support you need to live healthy. Learn about Georgia Kaiser Permanente Choice Products. Employers in MD, D.C., and VA can learn about the health care plan that combines HMO and DHMO options giving provider choice for employees. Employer and broker frequently asked questions. Call Kaiser Permanente Behavioral Health Services at: (888) 287-2680 (in Western Washington); or (800) 851-3177 (in Central or Eastern Washington and North Idaho). When you combine the Options Federal Standard Option plan with Medicare coverage, your Kaiser Permanente coverage will make your Medicare coverage go further. We’ve contracted with Private Healthcare Systems (PHCS) Network for Kaiser Permanente Insurance Company to manage provider costs. Dual Choice PPO plan allows access to In Network providers or any licensed provider. You must notify Kaiser Permanente within 24 hours of admission, or as soon thereafter as medically possible. Kaiser Permanente plans are widely accepted at hospitals and doctor's offices across its coverage regions and states. Member Support. Your time-loss payments will range from $135 to $225 per week (less Social Security taxes), depending on the number of hours you worked during your eligibility month. Kaiser Permanente Options Federal coverage can help pay for many expenses that are not covered by Medicare Parts A and B. Core Access PPO. Lowest out-of-pocket costs compared to care with Out-of-Network Providers. Enter First Name. Download the full list of what counts toward your Jan 1, 2022 HRA in English or Spanish. Tracey receives care from her orthopedist, who is a Network Provider. From prevention to disease management and state-of-the-art treatment, our highly skilled and rigorously trained care teams work together with our members and patients to provide the right care at the right time and place. It is printed on the far left-hand side under the Trust logo. Contact Kaiser Permanente at any time through our. Access coverage documents for Added Choice members. Kaiser Permanente Providers in ... pharmacy services, worldwide emergency coverage, and customized case management services for serious or complicated illnesses. General information about Kaiser Permanente Washington's PPO plans. You can choose any licensed physician to provide care nationwide, and receive preventive care at little or no cost from in-network providers. Most Kaiser Permanente medical offices in Georgia have on-site pharmacies. All Kaiser Permanente Medical Group physicians and network physicians are subject to the same quality review processes and certifications. Core Access PPO. With Dual Choice PPO, David can see local providers, the company can offer Kaiser Permanente to its Georgia employees, and the business has the benefit of working with a single carrier. However, you don’t receive coverage if you use a provider outside the plan’s network.The exception is the consumer-directed health plan (CDHP), which has a large network that includes providers nationwide. It is printed on the far left-hand side under the Trust logo. Your Choice of Top Doctors . Show me. Email Eligibility & COBRA, (206) 282-4500 or (800) 225-7620 Your out-of-pocket costs will be higher than if you choose care inside the Kaiser Permanente network. *A program operated or arranged by a health plan distributes prescription drugs to members via mail. You can see most specialists without a referral. Urgent Care. Plan hospitals, plan physicians, and other plan providers, and the services available at plan facilities, are subject to change at any time without notice. Kaiser Permanente has locations throughout Puget Sound and encompasses a wide array of doctors and other professionals. Under this plan you cannot just see any licensed dentist for treatment. The Trust’s four-tier therapeutically based prescription plan is designed to promote the use of proven, cost-effective medications. Why choose Kaiser Permanente for your health care coverage? ... Kaiser Permanente Providers in Georgia. Newborn services cost shares are separate from that of the mother. Onboarding includes: Comprehensive New Member Welcome handbooks, an onboarding call from customer specialists, and a help line for any questions, from accessing care to transferring prescriptions. However, she can continue to see her doctor who is an Out-of-Network Provider. Having more providers to choose from gives your valued employees what they need to be healthier and more productive every day. In addition, you have access to a number of contracted community physicians in the area. These may include, but are not limited to, drugs that are time or temperature sensitive, drugs that cannot legally be sent by U.S. mail, and drugs that require professional administration or observation. For Employers only, please visit cas.kp.org to view your group documents. Dependent Children Coverage Phone lines are open Monday-Friday, 8 a.m. to 5 p.m. After-hours crisis care is provided by a strong system of Consulting Nurses and on-call psychiatrists. PEBB members can conveniently get open enrollment information from Kaiser Permanente. Check here for more about pharmacy services, finding doctors and facilities, and the benefits of Dual Choice PPO. Out-of-network coverage for all PPO Plans: Any licensed provider in the U.S. not directly contracted with Kaiser Permanente and First Choice Health and First Health Network. This division is called Kaiser Permanente NW to distinguish it from the Puget Sound Kaiser … Need a coverage document? This EOC is a statement of benefits, exclusions and other provisions as set forth in the Group medical coverage agreement between Kaiser Foundation Health Plan of Washington (“KFHPWA”) and the Group. Find the details of your medical coverage in your Summary Plan Description booklet in the sidebar at right. Show me. Send Kaiser an email. The Sound Health & Wellness Trust is a Taft-Hartley trust managed jointly by unions and employers and providing benefits to more than 51,000 participants. Participating unions include: UFCW Local 21, UFCW Local 1439, Teamsters Local 38, and UFCW Local 367. Coverage for a description of their benefits. You MUST choose a DeltaCare primary care dentist who coordinates all of your care, including any referrals to specialists. If you choose out-of-network care, you can see First Choice Health Network or Beech Street providers at a discounted rate. You’re free to choose whatever provider you prefer, whenever you receive care. From online chats with clinicians to urgent or emergency care when traveling – in person, online, or on the phone – you have access to care when you need it. Spokane area. Your Kaiser Permanente Added Choice® Point-of-Service (POS) Plan is not just health coverage — it's a partnership in health. Your dental coverage in your Summary plan Description in the sidebar at... * you must choose a DeltaCare provider in your area and that are! Accepted at hospitals and doctor 's offices across its coverage regions and states change. With questions about Added Choice® Point-of-Service ( POS ) plan is composed of benefit... By Medicare Parts a and B disability benefits healthy best other kaiser permanente sound choice coverage Choice total wellness series of enrollment..., 2020 community providers combined a member has questions regarding claims or how they were paid, visit. ( herein called KPIC ) provides the Out-of-Network coverage in your area and they! 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