KAISER PERMANENTE 2023 Washington Enrollment Guide User Guide

KAISER PERMANENTE 2023 Washington Enrollment Guide

Go where you feel like your best self
We can help you get to your healthy place — no matter where it is. Care at Kaiser Permanente feels easier and faster, with the help of connected caregivers, more ways to get care, and support for a healthy mind, body, and spirit. Welcome to care for all that is you.

Important open enrollment dates for 2023

• The open enrollment period for 2023 coverage runs from November 1, 2022, through January 15, 2023.

• You can change or apply for coverage through Kaiser Foundation Health Plan of Washington, or we can help you apply through Washington Healthplanfinder.

• For coverage that starts on January 1, 2023, we must receive your Application for health coverage no later than December 15, 2022.

• Enrolling during a special
  enrollment period

• Are you getting married, moving, or losing your health coverage? You can also enroll or change your coverage at other times throughout the year if you have a qualifying life event.

• Visit kp.org/specialenrollment for a list of qualifying life events and instructions.

Want to talk? We’re here to help. A Kaiser Permanente enrollment specialist can answer your questions — like where to get care or what healthy extras are included. Call 1-800-494-5314 (TTY 711).

Built to make your life easier

Kaiser Permanente combines care and coverage — which makes us different than your other healthcare options. Your doctors and health plan work together to make high-quality health care easier to get. That means you’ll have peace of mind knowing care for your total health is there when and where you need it — from your doctor’s office to your living room. To see what it’s like to be a member, visit kp.org/myhealthyplace. “ I really appreciate the coordination of care. Every doctor and specialist can access my records, and I don’t have to waste valuable time repeating medical histories.” —Lisa, Kaiser Permanente member

Care centered around you

Care at Kaiser Permanente isn’t one-size-fits-all. Our physician-led teams work together to make sure the care you get is tailored to your needs. Your Kaiser Permanente care team is part of the same network, making it easier to share information, see your health history, and deliver high-quality, personalized care — when and where you need it.
Your healthy place should reflect all that is you
We believe your story, background, and values are as important as your health history. To help deliver care that’s sensitive to your culture, ethnicity, and lifestyle, we:

• Hire doctors and staff who speak more than one language
• Offer phone interpretation services in more than 150 languages
• Improved health outcomes among diverse populations for conditions like high blood pressure, diabetes, and colon cancer.

• Share your health history and any concerns with your personal doctor.
• Your doctor coordinates your care, so you don’t have to worry about where to go or who to call next.
• Future care teams have a full picture of your Kaiser Permanente health history — without you having to repeat your story
• With your health records in hand, your care team knows your needs in the moment and reminds you to schedule checkups and tests. Plus, you can view your records 24/7.

Convenient ways to get care

• Visit us in person at a location near you.
• Talk to a health care professional by phone or video.

24-hour virtual care on your schedule
If a trip to the doctor’s office doesn’t fit your schedule, it’s easy to get fast, personalized support — daytime, nighttime, anytime.

• Schedule a phone or video visit with a doctor or clinician.2
• Get 24/7 care advice by phone.
• Email your Kaiser Permanente doctor’s office with nonurgent questions.
• Use our e-visit questionnaire to get personalized care advice for certain conditions, order many tests, and get some prescriptions online.
• Chat online with a Kaiser Permanente clinician for advice.2

Prescription delivery

Fill prescriptions online or with the Kaiser Permanente Washington mobile app.4

• Have most delivered directly to your front door.
• Order them for same-day pickup
• Get same-day or next-day delivery for an additional fee.5

Kaiser Permanente Washington mobile app
Manage your health 24/7 with our app. It’s an easy, convenient way to do everything described above — anytime, anywhere.6

Care away from home

You’re covered for urgent and emergency care anywhere in the world. And if you’re planning to travel, we can help you stay on top of your health when you’re away from home. We’ll work with you to see if you need a vaccination, refill prescriptions, and more.

Industry-leading clinical quality

We’re known for catching problems early with preventive care. But if your health needs serious attention, our specialty care has you covered. In 2021, Kaiser Permanente led the nation as the top performer in 42 effectiveness-of- care measures. The closest national competitor led in only 14.7

Specialty care when you need it
No matter your needs — mental health, maternity, cancer care, heart health, and more — you’ll have access to great doctors, advanced technology, and evidence-based care to help you recover quickly.

A collaborative approach to care
With one of the largest multispecialty medical groups in the country, we can help connect you with the right specialist who’ll create a personalized plan for your care. To learn how our specialists work together in a connected system, visit kp.org/specialtycare.

Support for ongoing conditions
If you have a condition like diabetes or heart disease, you can enroll in a disease management program for personal coaching and support. With a well- rounded approach backed by proven best practices and advanced technology, we’ll help you get the care you need to continue living life to the fullest.

A better experience from the start

We guide you through each step of joining Kaiser Permanente, so you get the care you need without missing a beat.

• Search profiles to find the right doctor
  Our online doctor profiles let you browse the many doctors and locations in your area, even before you enroll. So you can join knowing you’ve found a doctor who fits your needs.

• Transition your care
  Easily move prescriptions and schedule a visit with a doctor who’s close to your home, work, or school. From day one, you’ll have the support you need to help reach your health goals.

• Connect to care online
  After you enroll, create an account at kp.org and download the Kaiser Permanente Washington mobile app.6 Then manage your health on your schedule — whenever, wherever.

Health care doesn’t have to be confusing
If you don’t know an HMO from an HSA, you’re not alone. But rest assured — we’re here to make health care easier to understand. Get help learning the basics at kp.org/learnthebasics.

Making the most of your membership

Good health goes beyond the doctor’s office. Find your healthy place by exploring some of the convenient features and extras available to members.8 Many of these resources are available at no additional cost.

• ChooseHealthy™ complementary care discounts
  You can get up to 25% off participating provider standard fees for acupuncture, chiropractic care, and massage therapy when you make an appointment through the ChooseHealthy specialty providers discount program. Complementary care services may also be covered by your plan benefits when you use providers in your plan network.

• Discounts for members
  Enjoy discounts on products and services that can help you stay healthy such as fitness classes, wellness coaching, and more. Explore your options at kp.org/wa/member-perks. And find the myStrength® mental health app and other wellness resources at kp.org/wa/mhw.

• Healthy lifestyle programs
  Connect to better health with online programs to help you lose weight, quit smoking, reduce stress, and more.

• Wellness coaching
  Get help reaching your health goals by working one-on-one with a wellness coach by phone.

Extras for your total health

• Use meditation and mindfulness to build mental resilience, reduce stress, and improve sleep.
• Set mental health goals, track progress, and get support managing depression, anxiety, and more.
• Choose from thousands of on-demand workout videos and get reduced rates on livestream and in-person classes

Care meets you where you are

When you’re a member, you get access to our doctors and facilities — conveniently located near where you live, work, and play. And when you can’t come to us, you can get the care you need when you need it.2

Your choice of doctors and locations
Visit kp.org/doctors to see all Kaiser Permanente locations near you and browse our online doctor profiles. You can choose your personal doctor and change anytime, for any reason.

Doctor and facility counts include affiliated medical professionals and locations. These statistics are from multiple Kaiser Permanente locations in various states.

Choosing your health plan

We offer a variety of plans to help fit your needs and budget. All of them offer the same quality care, but the way they split the costs is different.

Kaiser Permanente Virtual Plus™ plans
On these plans, your monthly premium is lower and you’ll start most care with a virtual care visit. Choose from 24/7 online chat, video or advice line, e-visits, scheduled video visits and phone appointments, and email for nonurgent issues — all at no additional cost. You’ll get the care and prescriptions you need, or help finding inperson care.
Copay or coinsurance plans
Copay or coinsurance plans are the simplest. You know in advance how much you’ll pay for care like doctor visits and prescriptions. This amount is called your copay. Your monthly premium is higher, but you’ll pay much less when you get care.

Deductible plans — gold, silver, bronze, and Basics Plus

With a deductible plan, your monthly premium is lower, but you’ll need to pay the full charges for most covered services until you reach a set amount, known as your deductible. Then you’ll start paying less — a copay or coinsurance. Depending on your plan, some services, like office visits or prescriptions, may be available at a copay or coinsurance before you reach your deductible.
HSA-qualified high deductible health plans — silver and bronze
HSA-qualified deductible health plans are deductible plans that give you the option of setting up a health savings account (HSA) to pay for eligible health care costs, including copays, coinsurance, and deductible payments. You won’t pay federal taxes on the money in this account.  You can use your HSA anytime to pay forcare, including some services that may not be covered by your plan, like eyeglasses, adult dental care,or chiropractic services.10 If you have money left in your HSA at the end of the year, it will roll over for you to use the next year.

1. Kaiser Permanente improved blood pressure control in our Black/African-American members with hypertension, raised colorectal cancer screening rates in our Hispanic/Latino members, and improved blood sugar control in our members with diabetes. Self-reported race and ethnicity data are captured in KP HealthConnect, and HEDIS® measures are updated quarterly in the interregional CORE Datamart.
2. When appropriate and available. If you travel out of state, phone appointments and video visits may not be available due to state laws that may prevent doctors from providing care across state lines. Laws differ by state.
3. High deductible health plans may require a copay or coinsurance for phone appointments and video visits.
4. Available on most prescription orders; additional fees may apply. For more information, contact the pharmacy.
5. Same-day and next-day prescription delivery services may be available for an additional fee. These services are not covered under your health plan benefits and may be limited to specific prescription drugs, pharmacies, and areas. Order cutoff times and delivery days may vary by pharmacy location. Kaiser Permanente is not responsible for delivery delays by mail carriers. Kaiser Permanente may discontinue same-day and next-day prescription delivery services at any time without notice and other restrictions may apply. Medicaid beneficiaries should ask their pharmacy for more information about prescriptions.
6. These features are available when you get care from Kaiser Permanente facilities. To use the Kaiser Permanente app, you must be a Kaiser Permanente member registered on kp.org.
7. Kaiser Permanente 2021 HEDIS® scores. Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compass® and represent all lines of business. Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality. The source for data contained in this publication is Quality Compass 2021 and is used with the permission of NCQA. Quality Compass 2021 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass® and HEDIS® are registered trademarks of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality.
8. Some of these services may not be covered under your health plan benefits or subject to the terms set forth in your Evidence of Coverage or other plan documents. Services that aren’t health plan benefits may be discontinued at any time without notice.
9. Kaiser Permanente Telehealth Insights Dashboard.
10. For a complete list of services you can use your HSA to pay for, see Publication 502, Medical and Dental Expenses, at irs.gov.

Notice of Nondiscrimination

Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc. (“Kaiser Permanente”) comply with applicable Federal and Washington state civil rights laws and do not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or any other basis protected by applicable federal, state, or local law. We also:

• Provide free aids and services to people with disabilities to communicate effectively with us, such as:
  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats, and other formats)
  • Assistive devices (magnifiers, Pocket Talkers, and other aids)
• Provide free language services to people whose primary language is not English, such as:
  • Qualified interpreters
  • Information written in other languages

If you need these services, contact Member Services at 1-888-901-4636 (TTY 711). If you believe that Kaiser Permanente has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, sex, sexual orientation, or gender identity, you can file a grievance with our Civil Rights Coordinator by writing to P.O. Box 35191, Mail Stop: RCR-A3S-03, Seattle, WA 98124-5191 or calling Member Services at the number listed above. You can file a grievance by mail, phone, or online at kp.org/wa/feedback. If you need help filing a grievance, our Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with:

• The U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at
  https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 800-537-7697 (TDD)
  Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

• The Washington State Office of the Insurance Commissioner, electronically through the Office of the Insurance Commissioner Complaint portal available at
  https://www.insurance.wa.gov/file-complaint-or-check-your-complaint-status, or by phone at 800-562-6900, 360-586-0241 (TDD). Complaint forms are available at
  https://fortress.wa.gov/oic/onlineservices/cc/pub/complaintinformation.aspx

Multi-language Interpreter Services

ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-888-901-4636 (TTY 711).

Let us help you find your healthy place

Having a good health plan is important for peace of mind. So is getting quality care. With Kaiser Permanente, you get both.
Want to learn more?
Talk to an enrollment specialist today about specialty care, extra features, and more. Call 1-800-494-5314 (TTY 711). Visit kp.org/myhealthyplace to see how we can make your care experience better, no matter what stage of life you’re in. Current members with questions can call our Member Service Contact Center.

• 1-800-290-8900
• 711 (TTY)

In Washington (except Clark, Cowlitz, and certain other counties), all plans are offered and underwritten by Kaiser Foundation Health Plan of Washington, 1300 SW 27th Street, Renton, WA 98057.

37214229 2022. ©2022 Kaiser Foundation Health Plan, Inc

References

• Individuals & Family Medical Plans - Kaiser Permanente
• Custom Care & Coverage Just For You | Kaiser Permanente
• Learn about health care
• Custom Care & Coverage Just For You | Kaiser Permanente
• KP Special Enrollment
• High-quality health care for all | Kaiser Permanente
• Email Member Services | Kaiser Permanente Washington
• Check a complaint | Washington State Office of the Insurance Commissioner
• File a complaint or check your complaint status | Washington state Office of the Insurance Commissioner

Read User Manual Online (PDF format)

Read User Manual Online (PDF format)  >>

Download This Manual (PDF format)

Download this manual  >>