KAISER PERMANENTE 2021-22 MEDICAL BENEFITS - Presented to the OEBB Insurance Committee May 2021
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KAISER PERMANENTE 2021-22 MEDICAL BENEFITS Presented to the OEBB Insurance Committee May 2021 1 | 2021-2022 OPEN ENROLLMENT
GETTING CARE
INTEGRATED CARE
FOR A MORE
CONVENIENT
EXPERIENCE
2 | 2021-2022 OPEN ENROLLMENT
GETTING CARE
Kaiser Permanente Northwest
Care Near You
• 31 medical offices • 2 hospitals
• 21 dental clinics • 2 Care Essentials® clinics
• 6 urgent care clinics • Affiliated hospitals and medical
offices
• 6 Vision Essentials clinics
Serving Oregon and Southwest Washington
• Healthgrades Top 100 Hospitals
• NCQA’s Best Health Plans
• DiversityInc Top 50 Hall of Fame
• Highest in customer loyalty 10 years in a row
Facility information current as of July 2020.
Visit kp.org/locations to find your nearest facility.
NCQA: No Plan Rated Higher for Private and Medicare Health Insurance Plan in Oregon and Washington. According to NCQA’s Medicare Health Insurance Plan Ratings 2011–2020 and NCQA’s Private Health Insurance Plan Ratings 2019–2020.
DiversityInc: Kaiser Permanente is recognized in DiversityInc Top 50 Hall of Fame for its ongoing commitment to diversity and inclusion. The criteria for the Hall of Fame is based on companies who have at one time ranked number one since the 2012 survey.
3 Satmetrix: For the 10th year in a row, Kaiser Permanente is number one in the health plan category for Customer Loyalty. Satmetrix, the co-developer of Net Promoter®, benchmarks leading brands according to their Net Promoter Score® (NPS).
Society of Thoracic Surgeons: Based on performance for adult heart bypass, aortic, and mitral valve replacement surgeries. Analysis of national data coveri ng the period from July 2017 through June 2019.
publicreporting.sts.org/search/cabg_report_card/surgery_group?title=&field_year_target_id=11&field_state_value=OR
GETTING CARE
Convenient ways to get care
You have flexible options to get care beyond the doctor’s office — and you can manage your care anytime
with the Kaiser Permanente app or at kp.org.1
Getting care Managing care3
• Talk with a Kaiser Permanente clinician by video or • Schedule or cancel routine appointments.
phone for the same high-quality care as an in-person • Order most prescription refills.
visit.2,3
• Check your medical record and pay bills.
• Get 24/7 medical advice by phone or online.
• Email your doctor’s office with nonurgent questions.3
• E-visits offer no-cost online care from a More than 80% of care visits during the COVID-19
Kaiser Permanente physician. outbreak have been phone appointments or video visits.4
1. To use the Kaiser Permanente app, you must be a member registered on kp.org. 2. When appropriate and available. 3. Available when you
get care from Kaiser Permanente facilities. 4. Kaiser Permanente internal data.
4 | 2021-2022 OPEN ENROLLMENT
OEBB MEDICAL PLANS
2021-2022
5 | 2021-2022 OPEN ENROLLMENTPLAN 2B 6 | 2021-2022 OPEN ENROLLMENT
PLAN BENEFITS PLAN 1 PLAN 2A PLAN 2B PLAN 3 (HSA Compatible)
Yearly deductible NONE $800 individual /$2,400 family $1,200 individual / $3,600 family $1,600 individual / $3,200 family
Maximum yearly out-of-pocket $1,500 individual / $3,000 family $4,000 individual / $12,000 family $4,500 individual / $13,500 family $6,550 individual / $13,100 family
costs
Preventive care $0 $0 $0 $0
Prenatal Care $0 $0 $0 $0
Well-baby Routine Visits $0 $0 $0 $0
Preventive Tests $0 $0 $0 $0
Office Visit Copay $20 $25 $30 20% after deductible
Specialist Copay $30 $35 $40 20% after deductible
Virtual Care $0 $0 $0 0% after deductible
Outpatient Surgery $75 20% after deductible 20% after deductible 20% after deductible
Emergency Room Copay $100 20% after deductible 20% after deductible 20% after deductible
Hospital Inpatient Care $100 per day, up to $500 per 20% after deductible 20% after deductible 20% after deductible
admission max
Bariatric Surgery $500 + hospital inpatient cost share $500 + 20% after deductible $500 + 20% after deductible $500 + 20% after deductible
Lab/X-ray/Diagnostics $20 $25 $30 20% after deductible
Prescription annual out-of-pocket $1,100 $1,100 $1,100 Subject to medical out of pocket
maximum per person maximum
Prescription Mail-order pharmacy $5 generic $5 generic $5 generic 20% after deductible
is available at 2 copays for a 90 -
$25 formulary brand $25 formulary brand $25 formulary brand
day supply
$45 non-formulary brand $45 non-formulary brand $45 non-formulary brand
25% up to $100 specialty 25% up to $100 specialty 25% up to $100 specialty
Self-referred alternative care: $20 $25 $30 20% after deductible
Chiropractic, naturopathy, and $2000 combined annual benefit $2000 combined annual benefit $2000 combined annual benefit $2000 combined annual benefit
acupuncture
maximum applies to alternative care maximum applies to alternative care maximum applies to alternative care maximum applies to alternative care
services services services servicesALTERNATIVE CARE
ALTERNATIVE CARE
OEBB Alternative Care Benefit:
• No referral required
• Up to $2,000 benefit maximum per
year
Find a provider:
• Chpgroup.com
Discounts available:
• CHPActiveandHealthy.com
8 | 2021-2022 OPEN ENROLLMENTBEHAVIORAL CARE
Mental health and addiction services — care for the whole you
Your thoughts and feelings can affect your overall well-being. We’re committed to helping you achieve and
maintain optimal health for your mind, body, and spirit.
Self Care Primary Care Specialty Care Emergency Care
• Visit kp.org • Advice Nurse • Mental Health • Crisis Line
• MyStrength • PCP • Addiction Medicine • Emergency Department
• Calm
• Health Coaching
Learn more at kp.org/mentalhealth for mental health and kp.org/addiction/nw for addiction medicine.
The first step to getting help is often the most difficult. So wherever the journey begins we are here to help.GETTING CARE:
ADDITIONAL RESOURCES
Added support to help you thrive1
ClassPass for reduced Wellness Coaching On-site health
rates on fitness classes by Phone education classes and
support groups2
Self-care apps Calm Online healthy lifestyle
and myStrength programs, videos,
podcasts, recipes, and
more
1. These services aren’t covered under your health plan benefits and aren’t subject to the terms set forth
in your Evidence of Coverage or other plan documents These services may be discontinued at any time
without notice. 2. Classes vary at each location and some may require a fee.
10 | 2021-2022 OPEN ENROLLMENTGETTING CARE:
GETTING STARTED
A positive experience from the start
We help guide you through each step of joining Kaiser Permanente, so you can start getting the care you need
from day one.
Onboarding support 3 easy steps toward a healthy change
Receive a personalized welcome book in the mail Register on kp.org.
and access our New Member Welcome Desk.
Transition your care and prescriptions.
Choose a care team and schedule your first
appointment.
Learn more at kp.org/newmember or call the New Member Welcome Desk at 1-888-491-1124.
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