Helping you stay covered - Kaiser Permanente · Helping you stay covered ... Contact Center at 1-800-464-4000, Monday through Friday, 8 a.m. to ... have to apply for health care coverage

Helping you stay coveredwith Kaiser Permanente

All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest. 500 NE Multnomah St., Suite 100, Portland, OR 97232.

60569409_NW_1/17DST 00190184

What’s inside

How do I stay covered? ....................................2

When do I need to enroll? .................................4

What are my options? .........................................6

Kaiser Permanente for Individuals and Families ............................8

Medicaid ...............................................................11

Oregon Health Plan .................................... 12

Apple Health ............................................... 13

Child Health Plus Program........................ 14

State Children’s Health Insurance Program (CHIP) .......................................... 15

Kaiser Permanente Senior Advantage (HMO) ............................. 16

COBRA and State ContinuationProgram ................................................................ 18

Federal Employees Health Benefits Program — Temporary Continuation of Coverage (TCC) ........................................... 19

2 Need help? kp.org/exploreoptions

How do I stay covered?

If a recent change is affecting your health coverage, we’re here to help. It’s important to act quickly, and in this guide we’ll show you how. If you want more help at any time, we’re just a click or call away (see below).

Rest assured, you may have several options for staying with Kaiser Permanente. Some of them might be newly available as a result of the Affordable Care Act (ACA). Other options might be available to you if you qualify for financial aid.

Connect with Kaiser Permanente

Go online for customized options Go to kp.org/exploreoptions,

where you’ll be guided through a few simple questions, then given options that fit your needs.

Talk to a representative If you’d like someone to personally

take you through your options, you can call our Member Service Contact Center at 1-800-464-4000, Monday through Friday, 8 a.m. to 6 p.m. For TTY, call 711.

Questions? 1-800-464-4000 3

By staying with Kaiser Permanente, you can:

• Keep the doctors you know and trust.

• Keep getting excellent care at nearby medical offices that offer many services under one roof.*

• Keep managing your health and prescriptions through our resources online, over the phone, and at our facilities.

We want to make this as simple as possible for you. We’ll help you figure out your deadline and find the right plan for your needs and budget. No matter what plan you choose, you’ll get the same great care and services from Kaiser Permanente.

* When receiving care at a Kaiser Permanente facility.


When do I need to enroll?

Act quickly to meet deadlinesDepending on your situation, you may have to apply for health care coverage very soon. Here are 3 enrollment options and their time frames for applying for coverage.

Special enrollment The loss of your employer-sponsored

coverage means you’re eligible for a special enrollment period. It can begin before you lose coverage and lasts 60 days after the date you lose (or would lose) coverage. If you sign up before your coverage ends, your new coverage may begin immediately and you won’t have any gap in coverage.

Open enrollment Unless you qualify for a special

enrollment, the only time you can enroll through the Oregon Health Insurance Marketplace or Washington Healthplanfinder or directly with Kaiser Permanente is during the open enrollment period. Open enrollment for 2017 coverage is from November 1, 2016, through January 31, 2017. If you qualify for Medicaid, you can sign up anytime during the year.

Questions? 1-800-464-4000 5

COBRA, State Continuation Program, and Federal Employees Health Benefits Program — Temporary Continuation of Coverage (TCC)

You can sign up within 60 days of when you get your COBRA or TCC election notice or the date you lose coverage, whichever is later. Contact your former employer to find out whether you’re eligible and how you can sign up.

How do I qualify for a special enrollment period?

Most people who are losing coverage through an employer will qualify for special enrollment. To find out if you qualify, visit kp.org/specialenrollment or call our Member Service Contact Center at 1-800-464-4000. For TTY, call 711).


What are my options?

Your options depend on your situation Do any of these sound like you? Find the statement that best fits your situation and continue on to read more about each option available to you.

I‘m going through employment changes.Whether you’re losing your job or your employer no longer offers coverage, there are several ways to stay with Kaiser Permanente, including:

• Kaiser Permanente for Individuals and Families

• Oregon Health Plan

• COBRA or State Continuation Program

• Temporary Continuation of Coverage

I’m no longer on my parent’s plan.If you’re 26, you can’t stay on your parent’s plan, but you have options to get your own Kaiser Permanente plan or continue your previous coverage, including:



• Temporary Continuation of Coverage

Questions? 1-800-464-4000 7

I’m interested in financial aid.No matter your employment status or age, there are a number of ways to get help (if you qualify), including:



• Child Health Plus Program

I’m over 65 years of age.With Kaiser Permanente Senior Advantage, you get all the benefits of a Kaiser Permanente membership, along with the convenience of having your Medicare services covered under one plan. Plus, you can keep seeing your Kaiser Permanente doctor and continue to receive the quality care you’ve come to expect as a Kaiser Permanente member.

Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.

You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll.

Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Limitations, copayments, and restrictions may apply.


Kaiser Permanente for Individuals and Families

What is it?A range of Kaiser Permanente plans to fit your needs and budget. You can pick one plan for your entire family or separate plans for each person.

You can select from several levels of coverage. Gold plans offer higher levels of coverage, usually with higher premiums and lower out-of-pocket costs. Silver and Bronze plans usually have lower premiums and higher out-of-pocket costs.

All plan levels offer most of the same health benefits (such as doctor visits, hospital care, prescriptions, and maternity care). They also include most preventive services for no charge.

Who is it for?• Anyone can get a Gold, Silver, or

Bronze plan.

• We also offer Catastrophic plans for people under 30, as well as people who have a certificate from the Oregon Health Insurance Marketplace or Washington Healthplanfinder proving financial hardship or a lack of affordable coverage.

How do I get a plan?*

* You must reside or work in the Kaiser Permanente health plan service area in which you enroll.

Questions? 1-800-464-4000 9

• You can shop for a plan by calling us at 1-800-245-3181 or visiting us at buykp.org. We’ll help you compare plans, get a quote, and find the plan that’s right for you. You can also shop for a plan through your Health Insurance Marketplace (also known as Exchanges), the Oregon Health Insurance Marketplace or Washington Healthplanfinder.

• However, to get federal financial help, you must buy your plan through the Oregon Health Insurance Marketplace or Washington Healthplanfinder.

How do I know if I qualify for federal financial help?You can get a plan with or without financial help. The chart on the next page shows the estimated family income lev-els that can help you figure out if you may qualify for help paying premiums.

A few things to know about federal financial help, if you qualify:

• Help is available for a portion of premiums and out-of-pocket expenses.

• The federal government will pay Kaiser Permanente any financial help on your behalf.

• Help will be on a sliding scale, based on income and family size.

• Help paying premiums is also based on the cost of the second lowest Silver Plan offered through your Exchange.


Do you qualify for financial aid?The numbers change slightly every year, so it’s important to contact us to check the amounts.

Number of people in household

Annual family income level*

1 $47,520 or below

2 $64,080 or below

3 $80,640 or below

4 $97,200 or below

5 $113,760 or below

6 $130,320 or below

7 $146,920 or below

8 $163,560 or below

*These amounts are effective as of January 1, 2017.

What if I don’t qualify for financial help?Even if you can’t get help from the federal government, you can buy a Kaiser Permanente plan directly from us by calling us at 1-800-245-3181 or visiting us at buykp.org, or through the Oregon Health Insurance Marketplace or Washington Healthplanfinder. You may also qualify for Medicaid.

Where can I find more information?To compare individual or family plans, get a quote, and see if you’re eligible for federal financial help, go to buykp.org.

Questions? 1-800-464-4000 11

Medicaid

What is it?Medicaid is a federal and state health coverage program available to people who have low incomes and limited resources. If you lose your job or have a life-changing event, you may be eligible for Medicaid.

Who is it for?To qualify, individuals must meet certain requirements. For instance, you must be a U.S. citizen or legal permanent resident and have a certain income level based on the Federal Poverty Level Guidelines.

Where can I find more information?

• Call our Medicaid Assistance Center at 1-800-239-4393, Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 8 a.m. to 5 p.m. For TTY, call 711.

• Visit the Oregon Health Insurance Marketplace website at oregonhealthcare.gov, the Washington Healthplanfinder website at wahealthplanfinder.org, or kp.org/medicaid.

• Contact your county Social Services office.


Oregon Health Plan

Oregon’s Medicaid program is called the Oregon Health Plan (OHP). OHP is a state health insurance program for low-income individuals.

OHP provides health care coverage for adults within the State of Oregon with a federal poverty level (FPL) of up to 138% and children in families with incomes up to 300% FPL.

To qualify, applicants must meet the eligibility, income, and state citizenship requirements and must be residents of Oregon.

For more information on eligibility and how to apply, please call the Oregon Health Insurance Marketplace at 1-855-268-3767 or visit oregonhealthcare.gov.

Questions? 1-800-464-4000 13

Apple Health

Washington’s Medicaid program is called Apple Health. Apple Health is a state health insurance program for low-income individuals.

Apple Health provides health care coverage for Washingtonians under the age of 65 with income below 138% of the federal poverty level.

To qualify, applicants must meet the eligibility, income, and state citizenship requirements and must be residents of Washington.

Kaiser Foundation Health Plan of the Northwest is contracted as a health plan under Molina. Individuals may select Kaiser upon enrollment with Molina.

For more information on eligibility and how to apply, please call Washington Apple Health at 1-855-923-4633 or visit wahealthplanfinder.org.


Child Health Plus Program

What is it?This program offers a Kaiser Permanente subsidy to help pay the premiums for one of our Individual and Family plans. It also offers medical financial aid to help pay out-of-pocket costs for services at Kaiser Permanente locations.

Who may be eligible?*Children who:

• Are enrolled in grades K–12

• Do not have access to any other public or private health coverage

• Are not eligible for reduced premiums and reduced cost-sharing assistance from the federal government

• Live in a household with incomes up to 300% of the federal poverty level

Enrollment into this charitable, subsidized program is limited and subject to availability.

For more information:• Call our Member Service Contact

Center at 1-800-813-2000, Monday through Friday, 8 a.m. to 6 p.m. For TTY, call 711.

• Visit us at info.kp.org/childhealthprogram.

* You must reside or work in the Kaiser Permanente health plan service area in which you enroll.

Questions? 1-800-464-4000 15

State Children’s Health Insurance Program (CHIP)

What is it?CHIP offers benefits for pregnant women and children under 19 years old whose families earn too much to qualify for Medicaid but cannot afford private health insurance.

Covers pregnant women and children up to 300% of the federal poverty level.

Must meet the income requirements and be a resident of Oregon.

Where can I find more information?Please call the Kaiser Permanente Medicaid Assistance Center at 1-800-239-4393 or visit kp.org/medicaid.


Kaiser Permanente Senior Advantage Plan

With Senior Advantage, you get all the benefits of a Kaiser Permanente membership, along with the convenience of having your Medicare services covered under one plan. Plus, you can keep seeing your Kaiser Permanente doctor and continue to receive the quality care you’ve come to expect as a Kaiser Permanente member.

Questions? 1-800-464-4000 17

Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. The provider network may change at any time. You will receive notice when necessary.

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Connect with Kaiser Permanente

If you are a Kaiser Permanente Senior Advantage member whose group coverage is ending, we’ll send you information about our individual plan coverage (which is different from your group coverage). If you have any questions about what you need to do to continue your membership, call our Member 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.


COBRA and State Continuation Program

If you lose your group coverage, you may be eligible for temporary continuation of the same coverage through COBRA or State Continuation Program.

COBRAMost employers with at least 20 full-time employees must offer COBRA coverage.

State Continuation ProgramIf your coverage was through an employer with fewer than 20 employees, you may be eligible for State Continuation Program coverage.

Call your employer and stay coveredYou’ll need to contact your former employer to find out whether you’re eligible, what the premiums are, and how you can enroll.

Questions? 1-800-464-4000 19

Federal Employees Health Benefits Program — Temporary Continuation of Coverage (TCC)

TCC is for eligible Federal Employees Health Benefits (FEHB) Program members only.

If you were covered under the FEHB, you may be eligible for TCC. You must notify your employing office within 60 days of a qualifying event in order to get TCC for a child who loses FEHB coverage. TCC enrollments and premiums always begin 32 days after regular coverage ends.

Call your employer and stay coveredFor 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.

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kp.org/exploreoptions

©2017 Kaiser Foundation Health Plan of the Northwest60569409_NW_1/17

DST 00190184

Documents

Helping you stay covered - Kaiser Permanente · Helping you stay covered ... Contact Center at 1-800-464-4000, Monday through Friday, 8 a.m. to ... have to apply for health care coverage