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Enroll now for 2018
H1230_KPHI20170801 accepted
Advantage Plus
Kaiser Permanente Senior Advantage (HMO)
Hawaii
Get dental, hearing, and vision benefits
Be healthy. Be vibrant.Now you have the option to add dental, hearing, and vision benefits to your Kaiser Permanente Senior Advantage Individual Plan.
Member Services: 1-800-805-2739 (TTY 711) Seven days a week, 8 a.m. to 8 p.m. 3
Our Quick Start Guide below gives you a good overview of your Advantage Plus options. To learn more, turn to the table of contents on page 4.
Quick Start Guide
A Go to page 5 for a quick look at how Advantage Plus and Advantage Plus Complete make it easy to expand your health care coverage. For more detailed information about these benefits, go to page 10.
B Turn to “Benefits at a Glance” on page 6 for a summary of the two different Advantage Plus benefit packages that you can choose from. Both options offer dental, hearing, and vision benefits.
C Ready to sign up? Apply for coverage by filling out the simple enrollment form. Please see “How to Apply for Coverage” on page 19.
For more information or to enroll online, visit us at kp.org/advantageplus.
GET STARTED HERE.
4
TABLE OF CONTENTS
1 Benefits at a glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2 Dental coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Your dental benefits
3 Hearing coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Kaiser Permanente hearing aid participating provider locationsFrequently asked questionsHearing services exclusions
4 Vision coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Frequently asked questions
5 Enroll in Advantage Plus or Advantage Plus Complete . . . . . 19
6 Important information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Enrollment and disenrollment
Member Services: 1-800-805-2739 (TTY 711) Seven days a week, 8 a.m. to 8 p.m. 5
As a Kaiser Permanente Senior Advantage Individual Plan member, you enjoy the convenience of one plan that combines your Medicare coverage with Kaiser Permanente coverage. Now, with your choice of an Advantage Plus option, you get a bundle of valuable dental, hearing, and vision benefits added to your plan. So, all your health benefits can come in one convenient package.
Get more health coverage. More value. • Advantage Plus and Advantage Plus Complete work together with your Senior Advantage
Individual Plan to give you dental, hearing, and vision care, all through a convenient and trusted source — Kaiser Permanente and our health care partners.
• Save time and money by eliminating the need to shop around for dental, hearing, and vision benefits separately.
• One bill — for both your Senior Advantage Individual Plan and the Advantage Plus coverage you select — makes taking care of your health easier than ever. If you prefer, your entire Senior Advantage premium and your Advantage Plus premium can be made through a monthly electronic funds transfer.
You deserve the total health care that’s yours through Senior Advantage with Advantage Plus. It’s one more way we can help you live a more vibrant life.
Advantage Plus or Advantage Plus Complete
CHOOSE A BENEFITS PACKAGE FOR A HEALTHIER, MORE VIBRANT YOU.
Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. You must continue to pay your Medicare Part B premium and any other applicable Medicare premium(s), if not otherwise paid by Medicaid or another third party. You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll. The provider network may change at any time. You will receive notice when necessary.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.
6
The Advantage Plus package gives you the option of adding more benefits to your Senior Advantage Individual Plan. This chart shows the dental, hearing, and vision benefits you receive when you purchase an Advantage Plus package.
Select from one of the following Advantage Plus packages below.
BENEFITS AT A GLANCE
1 BENEFITS AT A GLANCE
Premiums and Benefits
Senior Advantage Individual Plan coverage only
Advantage Plus coverage combined with
Senior Advantage Individual Plan
Advantage Plus Complete coverage combined with
Senior Advantage Individual Plan
Monthly premium in addition to your monthly Senior Advantage Individual Plan premium.
$19 $43DENTALPlan Maximum per person per calendar year
Not Applicable Not Applicable HDS pays up to an annual benefit limit of $1,200 per calendar year. Once HDS has paid $1,200 calendar year benefit limit, you will pay 100% for services for the remainder of the year.
Preventive Dental
Preventive Dental services are not covered
You pay:
• 10% of HDS allowed amount per examination (maximum of 2 per calendar year)
• 10% of HDS allowed amount for one bite-wing X-ray per calendar year
• 20% of HDS allowed amount for other X-rays
• 20% of HDS allowed amount for one full-mouth X-ray every five years
• 25% of HDS allowed amount per cleaning, up to a maximum of 2 per calendar year
• 25% of HDS allowed amount for adjunctive general services including palliative treatment for pain (but not to cure)
You pay:
• No charge per examination (maximum of 2 per calendar year)
• No charge for one bite-wing X-ray per calendar year
• 30% of HDS allowed amount for other X-rays
• 30% of HDS allowed amount for one full-mouth X-ray every five years
• No charge per cleaning, up to a maximum of 2 per calendar year
• 30% of HDS allowed amount for adjunctive general services including palliative treatment for pain (but not to cure)
Member Services: 1-800-805-2739 (TTY 711) Seven days a week, 8 a.m. to 8 p.m. 7
Premiums and Benefits
Senior Advantage Individual Plan coverage only
Advantage Plus coverage combined with
Senior Advantage Individual Plan
Advantage Plus Complete coverage combined with
Senior Advantage Individual Plan
Monthly premium in addition to your monthly Senior Advantage Individual Plan premium.
$19 $43DENTAL (continued)Comprehensive Dental
Covered services are limited to surgery of the jaw or related structures, setting fractures of the jaw or facial bones, extraction of teeth to prepare the jaw for radiation treatments of neoplastic cancer disease, or services that would be covered when provided by a physician.
Other comprehensive dental services are not covered.
Comprehensive Dental services are not covered.
You pay:
• 30% of HDS allowed amount for silver fillings
• 30% of HDS allowed amount for white-colored fillings — limited to front teeth
• 50% of HDS allowed amount for crowns and gold restorations — once every seven years
• 30% of HDS allowed amount for root canal therapy (Endodontics)
• 30% of HDS allowed amount for gum treatment (Periodontics)
• 50% of HDS allowed amount for fixed bridges and dentures (Prosthodontics) — once every seven years
• 50% of HDS allowed amount for implants
• 30% of HDS allowed amount for oral surgery (Oral and Maxillofacial Surgery)
BENEFITS AT A GLANCE
8
Premiums and
Benefits
Senior Advantage Individual Plan coverage only
Advantage Plus coverage combined with
Senior Advantage Individual Plan
Advantage Plus Complete coverage combined with
Senior Advantage Individual Plan
Monthly premium in addition to your monthly Senior Advantage Individual Plan premium.$19 $43
HEARING AIDSHearing aids and fitting services are not covered.
$500 is your maximum plan benefit coverage amount for purchase of up to two hearing aids every three years. If the hearing aid you purchase costs more than $500, you will pay the difference.
Visits for counseling, adjustment, cleaning, and inspection of hearing aids purchased at The Hearing Service Center by Kaiser Permanente within the manufacturer’s three-year warranty are at no charge.
$500 is your maximum plan benefit coverage amount for purchase of up to two hearing aids every three years. If the hearing aid you purchase costs more than $500, you will pay the difference.
Visits for counseling, adjustment, cleaning, and inspection of hearing aids purchased at The Hearing Service Center by Kaiser Permanente within the manufacturer’s three-year warranty are at no charge.
BENEFITS AT A GLANCE
Member Services: 1-800-805-2739 (TTY 711) Seven days a week, 8 a.m. to 8 p.m. 9
See your Kaiser Permanente Senior Advantage Evidence of Coverage for detailed information about dental, hearing, and vision services provided under your Senior Advantage Individual Plan.
Premiums and
Benefits
Senior Advantage Individual Plan coverage only
Advantage Plus coverage combined with
Senior Advantage Individual Plan
Advantage Plus Complete coverage combined with
Senior Advantage Individual Plan
Monthly premium in addition to your monthly Senior Advantage Individual Plan premium.$19 $43
EYEWEARYou pay 20% for Medicare Allowable eyewear after each cataract surgery.
Medicare Allowable eyewear after cataract surgery is only covered for the cost of basic eyeglass frames and lenses. You must pay charges above the Medicare Allowable amount for premium lenses, premium eyeglass frames, anti-reflective coatings/tints, polarized or Transitions® photochromic lenses, or other premium options.
$200 maximum benefit coverage amount for purchase of one pair of basic or premium prescription eyeglasses or one order of contact lenses every year.
and
You pay 20% for Medicare Allowable eyewear after cataract surgery.
You may combine your Advantage Plus eyewear $200 benefit with your Medicare Allowable cataract eyewear benefit or the $200 Advantage Plus eyewear benefit may be used for a separate prescription eyewear purchase.
Once the Advantage Plus eyewear $200 benefit is used toward any purchase, the benefit will not become available until January 1st of the next calendar year.
$200 maximum benefit coverage amount for purchase of one pair of basic or premium prescription eyeglasses or one order of contact lenses every year.
and
You pay 20% for Medicare Allowable eyewear after cataract surgery.
You may combine your Advantage Plus eyewear $200 benefit with your Medicare Allowable cataract eyewear benefit or the $200 Advantage Plus eyewear benefit may be used for a separate prescription eyewear purchase.
Once the Advantage Plus eyewear $200 benefit is used toward any purchase, the benefit will not become available until January 1st of the next calendar year.
BENEFITS AT A GLANCE
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Your dental health is key to your overall health. Healthy teeth and gums allow you to eat better and feel better.
Preventing and treating dental problems are important at any stage of life. You may feel more tooth sensitivity or have dental problems as a result of certain medications or health conditions. Regular oral exams not only keep your mouth healthy, they can also help spot medical problems.
Advantage Plus or Advantage Plus Complete makes it easy to get the dental care you need.
Brushing and flossing are important for healthy teeth. They also help reduce the risk of infection. Bacteria can travel from the mouth to other parts of the body, causing infection. This is a major cause of joint replacements failing. With proper oral health, including brushing, flossing, and regular check-ups and cleanings, you can help keep your whole body healthy.
REDUCE YOUR RISK OF INFECTION.
Health Tip:
DENTAL COVERAGE
2 ENJOY THE POWER OF A HEALTHY SMILE
Member Services: 1-800-805-2739 (TTY 711) Seven days a week, 8 a.m. to 8 p.m. 11
YOUR DENTAL BENEFITSAdvantage Plus and Advantage Plus Complete dental benefits are provided through Hawaii Dental Services (HDS).
Visit HDS Online to access your online account today:
1. Log on to the HDS website at www.HawaiiDentalService.com.
2. Click on “New User.”
3. Complete the “Member Registration” form.
4. Select “yes” to “Request electronic Explanation of Benefits.”
5. Click on “Register User” button.
6. An email will be sent to you with a link. Click on the link to activate your account.
Access to HDS Information 24/7
CHECK
• whether you and/or your dependents are eligible for HDS benefits
• what services are covered by your plan
• what the limits are of each type of covered service and how much you have used
SEARCH
• for an HDS participating dentist by specialty, location, handicap accessibility, weekend hours, and more
• for a Delta Dental participating dentist in the Mainland, Guam, or Saipan
VIEW
• your own tooth chart — see what services have been performed on each tooth
• your Explanation of Benefits (EOB) statements (and print them out)
• a list of frequently asked questions
• HDS contact information
REQUEST
• to receive an email when your claim is processed
• to receive EOB statements through email
• an HDS membership card to be mailed to you
DOWNLOAD & PRINT
• a summary of your benefits for tax purposes
• blank claim forms
• an HDS identification card
• HDS Notice of Privacy Practices
DENTAL COVERAGE
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How to Contact HDSCUSTOMER SERVICE REPRESENTATIVES
Phone . . . . . . . . . . . . . . . . . . . . 808-529-9248
Toll-free . . . . . . . . . . . . . . . . . .1-844-379-4325
Fax . . . . . . . . . . . . . . . . . . . . . . . 808-529-9366
Toll-free fax . . . . . . . . . . . . . . .1-866-590-7988
Monday through Friday, 7:30 a.m.–4:30 p.m. Hawaii Standard Time
SEND WRITTEN CORRESPONDENCE TO:
Hawaii Dental ServiceAttn: Customer Service700 Bishop St., #700Honolulu, HI 96813-4196
DENTAL COVERAGE
Member Services: 1-800-805-2739 (TTY 711) Seven days a week, 8 a.m. to 8 p.m. 13
Good hearing allows you to fully enjoy life. You’re more confident, more secure, and more connected to your world.
Millions of Americans experience some degree of hearing loss. But now, more than ever, hearing loss doesn’t mean that your quality of life has to change. Today’s hearing products are smaller, more effective, and more comfortable.
Hearing benefits from Advantage Plus or Advantage Plus Complete can help make sure you’re not missing the sounds and conversations that make life more fulfilling.
Below are our participating providers:
OAHU
The Hearing Service Center by Kaiser Permanente Kaiser Permanente Honolulu Medical Office 1010 Pensacola St., 1st Fl. Honolulu, HI 96814 Phone: 808-432-2155 TTY: 711
The Hearing Service Center by Kaiser Permanente Kaiser Permanente Kailua Medical Office 201 Hamakua Dr., Bldg. B Kailua, HI 96734 Phone: 808-432-2155 TTY: 711
The Hearing Service Center by Kaiser Permanente Kaiser Permanente Waipio Medical Office 94-1480 Moaniani St. Waipahu, HI 96797 Phone: 808-432-2155 TTY: 711
MAUI
The Hearing Service Center by Kaiser Permanente Kaiser Permanente Wailuku Medical Office 80 Mahalani St. Wailuku, HI 96793 Phone: 808-243-6191 TTY: 711
HAWAII ISLAND
June Uyehara-Isono, AuD, FAAA 101 Aupuni St., #113 Hilo, HI 96720
Queen’s Specialty Care at: June Uyehara-Isono, AuD, FAAA 75-5653 Kuakini Hwy., #100 Kailua-Kona, HI 96740 1-877-524-1432
Island Audiology 73-5618 Maiau St., #A203 Kailua-Kona, HI 96740 808-217-8568
3 HEAR WELL, LIVE WELL
HEARING COVERAGE
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FREQUENTLY ASKED QUESTIONSHearing services for Kaiser Permanente members are provided by Kaiser Permanente and participating providers to provide comprehensive hearing care products and services.
Be sure to have your hearing checked by a plan provider. In the meantime, use these questions for a simple self-check of your hearing health:
• Do you often ask people to speak up or repeat themselves?
• Do you have trouble following conversations in a noisy room or understanding speech on the phone?
• Do you have trouble hearing the sound of your telephone, alarm clock, or doorbell?
• Do others complain that your TV or stereo is too loud?
QUICK HEARING SELF-CHECK.
Q: Are hearing tests covered?A: Your current Kaiser Permanente Senior Advantage Individual Plan covers hearing tests
that determine the need for hearing correction. These tests are provided at your Kaiser Permanente Senior Advantage Individual Plan office visit co-payment. Hearing aid consultations for evaluations to determine the appropriate hearing aid are offered at no charge at The Hearing Service Center by Kaiser Permanente. If you suspect you have hearing loss, call Kaiser Permanente Audiology Department for an appointment at 808-432-8000.
Health Tip:
HEARING COVERAGE
Member Services: 1-800-805-2739 (TTY 711) Seven days a week, 8 a.m. to 8 p.m. 15
Q: If I have a hearing loss, are hearing aids covered?
A: As a Kaiser Permanente member with the Advantage Plus or Advantage Plus Complete benefit package, you will receive a $500 maximum plan benefit coverage amount toward the purchase of hearing aids. This maximum plan benefit coverage amount is available once every three years. If your hearing aids cost more than $500, you will be responsible for the difference. If you do not use all of the $500 at the initial point of sale, you cannot use it later.
Q: Where can I obtain my hearing aids?A: You may use your hearing aid benefit at
The Hearing Service Center by Kaiser Permanente or a participating provider. The Hearing Service Center by Kaiser Permanente services are offered at our Honolulu, Kailua, Waipio, and Wailuku medical facilities. To find a location near you, call Member Services at 1-800-805-2739 (TTY 711) seven days a week, 8 a.m. to 8 p.m.
Q: Are referrals or special claim forms required to use my hearing aid benefit?
A: Referrals or claim forms are not required for hearing aid purchase from The Hearing Service Center by Kaiser Permanente, however, forms are required for hearing aid purchases from participating providers.
Q: Are there any limitations to the type or style of hearing aid that is covered?
A: The Hearing Service Center by Kaiser Permanente or participating provider audiologist will assist you in selecting a hearing aid that best meets your needs. You will receive a thorough explanation of your test results and recommended treatment options. There is a wide range of technology and variety of styles from which to choose. Coverage is limited to the types and models of hearing aids furnished by the provider.
Q: What if I have a medical problem with my hearing?
A: If a medical problem is identified during the hearing examination, the audiologist can assist you in obtaining the appropriate medical follow-up.
Q: What if I need service or repairs on my hearing aids?
A: If you purchased your hearing aid in Hawaii at The Hearing Service Center by Kaiser Permanente you have an applicable warranty for up to a 3-year period. If you purchased your hearing aid from a contracted Hawaii provider, you should check with that contracted Hawaii provider for warranty information on your specific hearing aid. Batteries, accessories, and damaged hearing aid repairs are not part of your hearing aid package and are an out-of-pocket expense. If you purchased your hearing aid from any provider outside Hawaii or from a provider who is not contracted by the Kaiser Permanente Hawaii region, your hearing aid will not be covered for service or repairs under your Kaiser Permanente Advantage Plus benefit package.
HEARING AID BENEFIT EXCLUSIONS
The following Services are not covered under this “Hearing Coverage” section:
• Internally implanted hearing aids such as cochlear implants and osseointegrated external hearing devices (instead, refer to “Prosthetic or orthotic devices and related supplies” benefit description in the Senior Advantage Individual Plans Evidence of Coverage)
• Replacement parts, batteries, and hearing aid accessories, repair of hearing aids, and replacement of lost or broken hearing aids
• Service packages which include adjustment, cleaning, and inspection of hearing aids after manufacturer’s warranty
HEARING COVERAGE
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Want to enhance your life? Improve your vision. It’s possible that your vision has changed — but you haven’t noticed. An eye exam can show you what you’ve been missing. When you see clearly, your daily activities, such as driving and reading, become noticeably easier.
It’s important to have your eyes checked regularly to identify minor as well as more serious eye problems. Advantage Plus or Advantage Plus Complete adds to your Senior Advantage vision benefits, giving you more to spend on your glasses or contacts. So you’ll have more choices to help you see a brighter, more vibrant world.
PROTECT YOUR VISION.
Health Tip:
To protect your eyes from our year round Hawaiian sunshine, you should consider using your optical benefit toward a pair of prescription sunglasses. Your sunglass lenses can be manufactured to the optical prescription specifications provided by your doctor.
Polarized lenses can protect your eyes from blinding glare and block out harmful ultraviolet (UV-A and UV-B) rays from the sun. Prolonged UV exposure increases the risk of developing cataracts, pterygium, corneal sunburn, skin cancer (eyelids), and aged-macular degeneration, a leading cause of vision loss for the elderly.
VISION COVERAGE
4 FOCUS ON A HEALTHIER YOU
Member Services: 1-800-805-2739 (TTY 711) Seven days a week, 8 a.m. to 8 p.m. 17
The vision benefits covered by Advantage Plus or Advantage Plus Complete are provided at Vision Essentials by Kaiser Permanente locations. For information about vision benefits (including limitations and exclusions) covered under your Senior Advantage plan, please refer to your Senior Advantage Individual Plan Evidence of Coverage Benefits Chart under “Vision care.”
Q: What is my coverage for eyeglass frames, lenses, and contact lenses?
A: As a Kaiser Permanente Senior Advantage Individual Plan member with the Advantage Plus or Advantage Plus Complete benefit package, you will receive a maximum plan benefit coverage amount of $200 every year to use toward the purchase of eyeglass frames, lenses, and/or contact lenses. If the eyewear you purchase costs more than $200, you pay the difference. If you do not use all of the $200 at the initial point of sale, you cannot use it later.
Q: Where can I obtain my eyeglasses and contact lenses?
A: You may use your vision benefit at any of our eight Vision Essentials by Kaiser Permanente locations. These optical centers are conveniently located in our medical offices, and carry a large selection of eyeglass frames, lenses, and contact lenses priced to fit every budget. To find a Vision Essentials location near you, call Member Services at 1-800-805-2739 (TTY 711) seven days a week, 8 a.m. to 8 p.m. or visit kp2020.org for more information.
Q: When will I be eligible to use my Advantage Plus or Advantage Plus Complete vision benefit for the first time?
A: Once you receive confirmation of your enrollment in Advantage Plus or Advantage Plus Complete, you can begin using your vision benefits on your effective date.
Q: After I use my Advantage Plus or Advantage Plus Complete vision benefit, when can I use it again?
A: You are eligible to use your Advantage Plus or Advantage Plus Complete vision benefit on January 1st of the next calendar year.
Q: Can I combine my Advantage Plus or Advantage Plus Complete vision $200 benefit with other optical discounts offered by Kaiser Permanente?
A: No. Depending on the total price of your eyewear (frame and lenses), you may use either your $200 vision benefit or the member discount, whichever option provides the best savings for you.
Q: Can I combine my Advantage Plus or Advantage Plus Complete vision benefit with my Senior Advantage Individual Plan vision benefits listed in the Evidence of Coverage?
A: Yes. Under your Senior Advantage Individual Plan cataract vision benefit, you pay 20% of the Medicare Allowable eyeglass frame and lens charges and any remaining balance resulting from purchase of premium products/options, calculated as follows:
You may combine your Advantage Plus or Advantage Plus Complete vision benefit with your Senior Advantage Individual Plan cataract benefit to decrease your out-of-pocket Member Obligation amount. However, once the Advantage Plus or Advantage Plus Complete vision benefit is used towards purchase, the benefit will not become available for one year from order date.
Premium eyeglass and lens
products/options*
Member Obligation
Medicare Allowable Amounts for frame and lens
=—
*Premium eyeglass and lens products/options include premium lenses, premium eyeglass frames, anti-reflective coatings/tints, polarized or Transitions® photochromic lenses.
VISION COVERAGE
FREQUENTLY ASKED QUESTIONS
18
ENROLL IN ADVANTAGE PLUS
Member Services: 1-800-805-2739 (TTY 711) Seven days a week, 8 a.m. to 8 p.m. 19
1. Choose one of our Advantage Plus benefit packages:
• Advantage Plus offers preventive dental, hearing, and vision benefits for $19 per month. The $19 monthly premium is in addition to your monthly Senior Advantage premium, and you must also continue to pay your Medicare Part B premium.
• Advantage Plus Complete offers preventive and comprehensive dental, hearing, and vision benefits for $43 per month. The $43 monthly premium is in addition to your monthly Senior Advantage premium, and you must also continue to pay your Medicare Part B premium.
2. Complete the enrollment form. Fill in every item, and sign and date the form. (If you need an enrollment form, please call Member Services at 1-800-805-2739 (TTY 711) seven days a week, 8 a.m. to 8 p.m.)
3. Return your enrollment form to:
Kaiser PermanenteMedicare DepartmentP.O. Box 232407San Diego, CA 92193-9914
4. We’ll notify you when your enrollment form has been approved and give you more details about your coverage and start date.
Thank you for taking this step toward better dental, hearing, and vision health.
For more information, visit us online at kp.org/advantageplus.
Applying is easy
5 ENROLL IN ADVANTAGE PLUS OR ADVANTAGE PLUS COMPLETE
ENROLL IN ADVANTAGE PLUS
20
IMPORTANT INFORMATION
Member Services: 1-800-805-2739 (TTY 711) Seven days a week, 8 a.m. to 8 p.m. 21
ENROLLMENT AND DISENROLLMENT
Enrollment
Other important information about applying for Advantage Plus or Advantage Plus Complete:
• You must be a Kaiser Permanente Senior Advantage Individual Plan member to enroll in one of the Advantage Plus options. (If your Senior Advantage Plan is provided to you by an employer group or trust fund, you are not eligible to enroll in an Advantage Plus option.)
• If you are currently a Kaiser Permanente Senior Advantage Individual Plan member, you can enroll in one of the Advantage Plus options during the annual election period from October 15 to December 7 to begin your Advantage Plus plan year on January 1, 2018. You may also enroll during our Advantage Plus enrollment period from January 1 through March 31, 2018 to begin your Advantage Plus benefit coverage period on the first day of the month after your application is received by Kaiser Foundation Health Plan, Inc.
• If you recently applied for Kaiser Permanente Senior Advantage membership and your Senior Advantage membership effective date is within the past 30 days, you can enroll in one of the Advantage Plus options by using the Short Enrollment Form. Your Advantage Plus or Advantage Plus Complete benefit coverage period will begin on the first day of the month after your completed Short Enrollment Form is received by Kaiser Foundation Health Plan, Inc. (Please note that if you do not enroll in an Advantage Plus option within the first 30 days of your Kaiser Permanente Senior Advantage effective date, then you cannot apply for Advantage Plus until the annual enrollment period of October 15 to December 7 for an effective date of January 1. You may also enroll during our Advantage Plus enrollment period from January 1 through March 31 for an effective date on the first day of the month after your completed Short Enrollment Form is received by Kaiser Foundation Health Plan, Inc.)
6 IMPORTANT INFORMATION
IMPORTANT INFORMATION
22
Disenrollment
You can terminate your Advantage Plus or Advantage Plus Complete coverage anytime by sending us a completed disenrollment form. Your disenrollment will be effective the first of the month following the date we receive your completed disenrollment form. For more information regarding disenrollment, please call Member Services at 1-800-805-2739 (TTY 711) seven days a week, 8 a.m. to 8 p.m.
If you disenroll, you will not be eligible to re-enroll until the next annual election period of October 15 to December 7 for coverage to be effective January 1. You can also enroll during January 1 through March 31 for Advantage Plus or Advantage Plus Complete coverage effective the first of the month following the date we receive your completed enrollment form.
If you disenrolled after you used your vision benefits, and subsequently re-enrolled, you won’t be able to get covered eyewear until 12 months after you last used your vision benefit. If you disenrolled after you used your hearing aid benefits, and subsequently re-enrolled, you won’t be able to get covered hearing aids until 36 months after you last used your hearing aid benefit.
IMPORTANT INFORMATION
Member Services: 1-800-805-2739 (TTY 711) Seven days a week, 8 a.m. to 8 p.m. 23
Notice of nondiscrimination
Kaiser Permanente complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Kaiser Permanente does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. We also:
• Provide no cost aids and services to people with disabilities to communicate effectively with us, such as:
– Qualified sign language interpreters.
– Written information in other formats, such as large print, audio, and accessible electronic formats.
• Provide no cost language services to people whose primary language is not English, such as:
• Qualified interpreters.
• Information written in other languages.
If you need these services, call Member Services at 1-800-805-2739 (TTY 711), 8 a.m. to 8 p.m., seven days a week.
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, or sex, you can file a grievance with our Civil Rights Coordinator by writing to 711 Kapiolani Blvd, Honolulu, HI 96813 or calling Member Services at the number listed above. You can file a grievance by mail or phone. 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.
24
Multi-language Interpreter Services
Multi-language Interpreter Services
EnglishATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-800-805-2739 (TTY: 711).
SpanishATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-805-2739 (TTY: 711).
Chinese注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800-805-2739（TTY：711）。
VietnameseCHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-805-2739 (TTY: 711).
TagalogPAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-800-805-2739 (TTY: 711).
Korean
주의: 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다.
1-800-805-2739 (TTY: 711)번으로전화해주십시오.
Japanese注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-800-805-2739（TTY:711）まで、お電話にてご連絡ください。
Lao
ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົ ້ າພາສາ ລາວ, ການບໍ ລິ ການຊ່ວຍເຫືຼອດ້ານພາສາ, ໂດຍບໍ່ ເສັຽຄ່າ, ແມ່ນມີ ພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-800-805-2739 (TTY: 711).
IlocanoPAKDAAR: Nu saritaem ti Ilocano, ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan para kenyam. Awagan ti 1-800-805-2739 (TTY: 711).
SamoanMO LOU SILAFIA: Afai e te tautala Gagana fa'a Sāmoa, o loo iai auaunaga fesoasoan, e fai fua e leai se totogi, mo oe, Telefoni mai: 1-800-805-2739 (TTY: 711).
Member Services: 1-800-805-2739 (TTY 711) Seven days a week, 8 a.m. to 8 p.m. 25
MarshalleseLALE: Ñe kwōj kōnono Kajin Ṃajōḷ, kwomaroñ bōk jerbal in jipañ ilo kajin ṇe aṃ ejjeḷọk wōṇāān. Kaalọk 1-800-805-2739 (TTY: 711)
TrukeseMEI AUCHEA: Ika iei foosun fonuomw: Foosun Chuuk, iwe en mei tongeni omw kopwe angei aninisin chiakku, ese kamo. Kori 1-800-805-2739 (TTY: 711).
Hawaiian E NĀNĀ MAI: Inā hoʻopuka ʻoe i ka ʻōlelo hoʻokomo ʻōlelo, loaʻa ke kōkua manuahi iā ʻoe.E kelepona iā 1-800-805-2739 (TTY: 711).
PohnpeianNi songen mwohmw ohte, komw pahn sohte anahne kawehwe mesen nting me koatoantoal kan ahpw wasa me ntingie Lokaiahn Pohnpei komw kalangan oh ntingidieng ni lokaiahn Pohnpei. Call 1-800-805-2739 (TTY: 711).
BisayanATENSYON: Kung nagsulti ka og Cebuano, aduna kay magamit nga mga serbisyo sa tabang sa lengguwahe, nga walay bayad. Tawag sa 1-800-805-2739 (TTY: 711).
TonganFAKATOKANGA’I: Kapau ‘oku ke Lea-Fakatonga, ko e kau tokoni fakatonu lea ‘oku nau fai atu ha tokoni ta’etotongi, pea teke lava ‘o ma’u ia. Telefoni mai 1-800-805-2739 (TTY: 711).
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