1. health and fitness

Helping you stay covered
Options for continuing your
membership for 2014
1014KPMC‑13/11‑13
All plans offered and underwritten by
Kaiser Foundation Health Plan of the Northwest.
500 NE Multnomah St., Suite 100, Portland, OR 97232.
Going through change can be stressful,
so it’s nice to know that continuing your
health care coverage doesn’t have to be.
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Staying covered
just got easier
Right now you have more options than ever before for
how you get and pay for coverage. And with the federal
Affordable Care Act (ACA), also known as health care
reform, you now have historic levels of choice and control.
Health coverage is something you just can’t afford to be
without. If you don’t have coverage, you’re putting your
health and your finances at risk. And even if you’re
healthy now, you need to protect your future.
By staying with Kaiser Permanente, you can rest easy.
You don’t have to worry about what to do or where to
go if you get sick, injured, or pregnant. There’s no
starting over with someone who doesn’t know you and
your health needs. You can keep the doctors you know
and trust, and if you have children they can have their
same pediatrician. You’re covered, with excellent care
and convenient facilities that offer multiple services
under one roof.
We want to make it simple and stress-free for you to
stay covered. We’ll even help guide you through the
process. If you have any questions about your plan
options, please visit kp.org/continuecoverage or call
Membership Services at 1-800-813-2000.
3
A few things to kno
Health care reform and you
The ACA has made the biggest change in the U.S.
health care system since Medicare was established in
1965. It gives you more protections and easy access to
high-quality health coverage. Visit kp.org/reform for
more details.
•
You can no longer be denied coverage, or dropped
from your plan, if you have a medical condition or
get sick.
•
You don’t have to pass a medical exam to qualify
for coverage.
•
No annual or lifetime dollar limits on essential
health benefits.
•
You can apply for federal financial assistance that
can help lower your health care costs.
Oregon’s and Washington’s state-run health insurance
marketplaces, Cover Oregon (coveroregon.com) and
Washington Healthplanfinder (wahealthplanfinder.org),
let you shop, compare, and buy health care coverage.
Or if you’d like, you can get your coverage directly from
us. The ACA requires most U.S. citizens and those
lawfully present in the U.S. to have minimum essential
health coverage starting January 1, 2014. If you don’t
have coverage or receive coverage from an employer,
and go without it for three months or longer (or one
month or longer if you had a previous coverage gap
that same year), you may be charged a tax penalty by
the government. Make sure you maintain your coverage
before it’s too late.
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ow before you start
Important dates to remember
Special enrollment
The loss of your employer-sponsored coverage
means you are eligible for a special enrollment
period. Your special enrollment period lasts
60 days after the date on which you lose (or
would lose) coverage.
For COBRA, State Continuation, and Temporary
Continuation of Coverage (TCC)
You have 60 days after receiving your COBRA
election notice to choose whether or not to sign
up. Contact your former employer to find out
whether you’re eligible and how you can enroll.
Open enrollment
Other than special enrollments, the only
time you can enroll through Cover Oregon,
Washington Healthplanfinder, or directly from
Kaiser Permanente is during the open enrollment
period. Open enrollment for 2014 coverage is
from October 1, 2013, through March 31, 2014.
Open enrollment for 2015 coverage will begin in
fall of 2014.
Take the first step toward staying covered
Find out all your options > > > Begin on page 6
You have so many new options at your
fingertips, so let us give you a step-by-step
guided tour.
Step 1 > Choose how you’d like to continue
your coverage
Step 2 > Explore your options
Step 3 > Stay covered
You can also visit kp.org/continuecoverage
to use our online tool. Just answer a few
simple questions and you can get plan
recommendations customized just for you.
If you have any questions, please call
Membership Services at 1-800-813-2000.
55
Step 1: Choose how you’d like to continue y
DIRECTLY THROUGH
KAISER PERMANENTE
>
See page 8
Kaiser Permanente for Individuals and Families
• Lots of plan types to choose from
• Coverage to fit your needs and budget
• A Kaiser Permanente health plan
specialist to help you find the right plan
Kaiser Permanente Senior Advantage (HMO) plan
Are you eligible for Medicare?
Kaiser Permanente coverage combined with
original Medicare. 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.
THROUGH THE HEALTH
INSURANCE MARKETPLACE
> See page 11
Kaiser Permanente for Individuals
and Families plans at Cover Oregon
& Washington Healthplanfinder
• Federal help with premiums and out-of-pocket
expenses if you qualify
• Shop, compare, and buy health care coverage
• A health plan specialist to help guide you through
coveroregon.com and wahealthplanfinder.org
6
your coverage
THROUGH YOUR
FORMER EMPLOYER
>
See page 13
COBRA, State Continuation, and TCC
• Easy way to temporarily keep your coverage
• Coverage is the same you had through your group
THROUGH STATE
AND CHARITABLE
HEALTH PROGRAMS
>
See page 14
Medicaid
• Coverage for low-income Oregon and
Washington residents who meet established
income guidelines
Child Health Program
• Coverage (including dental) for uninsured
children in grades K–12 whose family income
meets a certain qualifying level
Find out all your options
Visit kp.org/continuecoverage to use our
online tool. Just answer a few simple
questions and you can get plan
recommendations customized just for you.
If you have any questions, please call
Membership Services at 1-800-813-2000.
7
DIRECTLY THROUGH KAISER PERMANENTE
Step 2: Explore your options
Kaiser Permanente for Individuals and
Families plans
Choose from a range of plans to fit your needs and
budget. You can pick one plan for your entire family or
separate plans for each person.
Shopping for a Kaiser Permanente plan
You can select from several levels of coverage.
BRONZE
•
•
•
•
SILVER
GOLD
MINIMUM
COVERAGE
All plan levels offer the same essential health
benefits (such as doctor visits, hospital care,
prescriptions, and maternity care) and include
most preventive services for no charge.
The categories don’t reflect the quality or amount
of care the plans provide. You’ll still receive the
same Kaiser Permanente care that you are used to.
The main difference is how you pay for coverage.
Our Bronze plans generally offer lower premiums
and higher out-of-pocket costs. Gold plans
generally have higher premiums and lower
out-of-pocket costs.
To qualify for the minimum coverage plan, you
must be under 30 when the plan goes into effect.
If you’re 30 or older, you must prove financial
hardship or lack of affordable coverage with a
certificate from the health insurance marketplace.
Conversion coverage (Washington state)
If you are no longer eligible for health care benefits
under your employer’s plan with Kaiser Foundation
Health Plan of the Northwest (KFHPNW), and you are
not eligible to enroll in a different group plan offered
by your employer, you may enroll in one of our plans
for individuals and families. To be eligible for this
conversion coverage, you must live within the
KFHPNW service area and must not have coverage
under another health plan. For more information on
our plans for individuals and families, please visit
buykp.org.
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Are you eligible for Medicare?
Kaiser Permanente Senior Advantage
(HMO) plan
With Senior Advantage, you get all of
the benefits of Kaiser Permanente
membership, including Part D
prescription drug coverage, combined
with Original Medicare. Plus, you can
keep seeing your Plan doctor and
continue to receive the quality care
you’ve come to expect as a Kaiser
Permanente member.
If you are a Kaiser Permanente
Senior Advantage member whose
group coverage is ending, you don’t
need to do anything right now. We’ll
send you information about our
individual plan coverage (which is
different from your group coverage),
and what you need to do to continue
your membership. If you have any
questions, call Membership Services
at 1-877-221-8221 or 711 (TTY for
the deaf, hard of hearing, or speech
impaired), seven days a week, from
8 a.m. to 8 p.m.
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DIRECTLY THROUGH KAISER PERMANENTE
Kaiser Permanente is an HMO plan with a
Medicare contract.
You must reside in the Kaiser Permanente
Medicare health plan service area in which
you enroll.
Benefits, formulary, pharmacy network,
provider network, premium and/or
copayments/coinsurance may change on
January 1 of each year.
The benefit information provided is a brief
summary, not a complete description of
benefits. For more information contact the
plan. Limitations, copayments, and
restrictions may apply.
H9003_NWCOC1113 accepted
Step 3: Pick a plan and stay covered
Contact us now
If you’d like to buy your new
individual or family plan directly
through Kaiser Permanente, call us
at 1-800-494-5314 or visit us at
buykp.org. We’ll help you compare
plans, get a quote, and find the plan
that’s right for you.
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THROUGH THE HEALTH INSURANCE MARKETPLACE
Step 2: Explore your options
Kaiser Permanente for Individuals and
Families plans through Cover Oregon
& Washington Healthplanfinder
Health insurance marketplaces, sometimes known
as the health insurance “exchanges,” are federal or
state-run markets where you can buy health care
coverage and apply for financial assistance from
the federal government. In Oregon, it’s called
Cover Oregon, and you can find it online at
coveroregon.com. In Washington, the state
exchange is Washington Healthplanfinder, online
at wahealthplanfinder.org.
You can buy your Kaiser Permanente plan
directly from us, Cover Oregon, or Washington
Healthplanfinder. We have tools and support
that can help you find the Kaiser Permanente plan
that works best for you, even if you buy through
the marketplaces.
Getting federal financial assistance
To get federal financial help in paying for care and
coverage, you’ll need to buy your plan through
Cover Oregon or Washington Healthplanfinder.
• Help is available for premiums and out-ofpocket expenses.
• If you qualify, the federal government can pay
Kaiser Permanente any financial assistance on
your behalf.
• Assistance will be on a sliding scale, based on
income and family size.
This chart will give you an idea of whether you and
your family may qualify:
Number of people in household
Annual family income level*
1
2
3
4
5
6
7
8
$45,960 or below
$62,040 or below
$78,120 or below
$94,200 or below
$110,280 or below
$126,360 or below
$142,440 or below
$158,520 or below
*2013 modified adjusted gross income levels; assistance will be based on your
estimated 2014 modified adjusted gross income.
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THROUGH THE HEALTH INSURANCE MARKETPLACE
Shopping for a Kaiser Permanente plan
You can select from several levels of coverage.
BRONZE
•
•
•
•
SILVER
GOLD
MINIMUM
COVERAGE
All plan levels offer the same essential health
benefits (such as doctor visits, hospital care,
prescriptions, and maternity care) and include
many preventive services for no charge.
The categories don’t reflect the quality or amount
of care the plans provide.
The main difference is how you pay for coverage.
Our Bronze plans generally offer lower premiums
and higher out-of-pocket costs. Gold plans
generally have higher premiums and lower out-ofpocket costs.
To qualify for the minimum coverage plan, you must
be under 30 when the plan goes into effect. If
you’re 30 or older, you must prove financial
hardship or lack of affordable coverage. Federal
financial assistance is not available with this plan.
What if you don’t qualify for federal financial assistance?
Even if you can’t get assistance from the federal
government, you can still buy a Kaiser Permanente plan
directly from us or through the marketplaces. We have
lots of plan options.
Step 3: Contact us and stay covered
Contact us now
For help with Cover Oregon or Washington
Healthplanfinder and finding the Kaiser
Permanente plan that works best for you,
please visit kp.org/continuecoverage or call
Membership Services at 1-800-813-2000.
Explore plans and rates
12
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Buykp.org lets you compare individual or family
plans, get a quote, and see if you might be
eligible for financial assistance. There’s even an
easy-to-use online tool to give you an estimate
of how much federal assistance you may
receive to help pay your premium.
THROUGH YOUR FORMER EMPLOYER
Step 2: Explore your options
COBRA, State Continuation, and TCC
If you lose your group coverage, you may be
eligible for temporary continuation of the same
coverage through COBRA, State Continuation, or
TCC (TCC is for eligible Federal Employees Health
Benefits Program (FEHBP) members only).
COBRA
Most employers with at least 20 employees must
offer COBRA coverage. All eligible family members
who were covered under your original group plan
may apply.
State Continuation
If you are not eligible for COBRA, Medicare or
other group coverage, and your coverage was
through an employer with fewer than 20
employees, you may be eligible for State
Continuation coverage. To be eligible, you must
have been covered by your group plan for at least
three consecutive months.
In Oregon, the employer is required to offer state
continuation coverage. In Washington, the
employer may opt out of State Continuation
coverage or offer KFHPNW conversion coverage.
Temporary Continuation of Coverage (TCC)
If you were covered under the FEHBP, you may be
eligible for TCC. You must notify your employing
office within 60 days of a qualifying event in order to
obtain TCC for a child who loses FEHBP coverage.
Step 3: Call your employer and stay covered
Act now
For COBRA, State Continuation, and 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.
If you have any questions, please visit
kp.org/continuecoverage or call Membership
Services at 1-800-813-2000.
1313
THROUGH STATE AND CHARITABLE HEALTH PROGRAMS
Step 2: Explore your options
State and charitable health programs
For people with unique needs and circumstances,
there are several different types of programs
available. Here’s a look at some options and how to
find out if you qualify.
Medicaid
Who may be eligible?
Oregon and Washington residents who meet
established income guidelines and certain
qualifying conditions.
For more information on eligibility and how
to apply:
• Call your county social services office, ask for
a Medicaid eligibility worker.
• Visit your county website.
• Visit the Oregon Health Authority website at
oregon.gov/oha or the Washington State Health
Care Authority website at hca.wa.gov.
Child Health Program (Oregon)
Children who do not qualify for federal financial
assistance in the marketplace (Cover Oregon)
may qualify for the Child Health Program.
Who may be eligible?
Children who:
• are enrolled in grades K-12
• are not eligible for health care coverage
• are in families with income ≤ 300 percent of
the Federal Income Guidelines
For more information:
• Call Membership Services at 1-800-813-2000,
8 a.m.–6 p.m., Monday through Friday. TTY
users, call 711.
• Visit us at info.kp.org/childhealthplan.
Step 3: Contact us and stay covered
Contact us now
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For help understanding your options and
finding the right fit for you and your family, visit
kp.org/continuecoverage or call Membership
Services at 1-800-813-2000.
1515
Losing your health coverage?
Look inside ...
kp.org/continuecoverage
Kaiser Permanente
Membership Services
Monday–Friday, 8 a.m. to 6 p.m.
1-800-813-2000
711 (TTY)
Language interpretation services:
1-800-324-8010
1014KPMC‑13/11‑13
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©2013 Kaiser Foundation Health Plan of the Northwest