feds open enrollment brochure · 2019-10-03 · care and coverage that fits your life 3 new member...

Oregon and Southwest Washington (Clark and Cowlitz Counties)

The right plan for families — includes $0 maternity delivery and $0 primary care office visit copay for children

Federal employees and annuitants2020 rates and benefits

kp.org/feds

Healthy togetherCare and coverage that fits your life

All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest.500 NE Multnomah St., Suite 100, Portland, OR 97232.34

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Kaiser Permanente

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Welcome to care that fits your life

Many services under one roof

Do more in less time. In most of our facilities, you can see your doctor, get

a lab test, and pick up prescriptions — all in a

single trip.

Right care, right timeGet the care you need when you need it with

routine, specialty, urgent, and emergency care. If

you’re ever unsure where to go, call us for 24/7 care

advice by phone.

Convenient cost estimates

Get an idea of what you’ll pay before

you come in for care. For a personalized estimate based on

your plan details, visit kp.org/costestimates.

More care optionsHow you get care

is up to you. Choose a phone or video

appointment, email your doctor’s office

with routine questions, have an e-visit, or come

see us in person.1,2

Your doctor, your choiceChoose your doctor based on what’s important to you. Go to kp.org/searchdoctors for details about education,

specialties, languages spoken, and more.

We now serve the Eugene and Springfield areas!See the list of ZIP codes near the bottom of page 19 to see if Kaiser Permanente health plans are available where you live or work. Please note: Senior Advantage plans aren't currently available in the Eugene or Springfield area.

Care and coverage that fits your life

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Experience the Kaiser Permanente difference

To be healthy, you need quality care that’s simple, personalized, and

hassle-free. At Kaiser Permanente, care and coverage come together —

so you get everything you need to stay on top of your health in one

easy-to-use package.

Let’s get started

3 easy steps to get started 2

New member care transition 3

Quality care with you at the center 4

Great care, great results 5

Healthy resources 6

Getting care 7

Care when and where you need it 8

What you need to know for 2020

Benefit highlights 10

Your 2020 benefits at a glance 11

2020 Senior Advantage benefits 12

Which option is right for you? 14

Advantages of a Kaiser Permanente Medicare health plan 15

Ready to enroll with Kaiser Permanente? 16

Locations near you 17

Kaiser Permanente

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Step 1: Choose your doctor

Getting you connected with a doctor who suits your individual needs is the first priority. Choose from a wide range of doctors. Browse our online doctor profiles at kp.org/newmember and see how patients rate our doctors at kp.org/doctorreviews/nw.

Call us at 1-888-491-1124 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., if you want help choosing a doctor.

Step 2: Register on kp.org

Next, create your online account at kp.org. Once your coverage begins, you can register at kp.org/newmember and start using the many time-saving features to manage your health. You can email your doctor’s office with nonurgent questions, schedule routine appointments, refill most prescriptions, and even schedule a video visit from anywhere you are.2

Step 3: Get prescriptions

Finally, we’ll help you transition your prescriptions to Kaiser Permanente. Visit kp.org/newmember or give us a call at 1-888-491-1124 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m.

We’ve taken the hassle out of switching health plans. And once you join Kaiser Permanente, it’s easier than ever to get off to a healthy start.

Have your specialist info and a list of your current prescriptions ready when you contact our New Member Welcome Desk — we’ll be able to help you faster.

3 easy steps to get started


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New member care transition

When to call our New Member Welcome Desk:

Help is available at 1-888-491-1124 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m.• Are you working with a health care professional to manage your medical conditions

or achieve your health goals? • Have you recently had or are you scheduled for an upcoming surgery?• Are you currently taking any prescriptions or using any medical equipment?• Are you on a treatment plan that you would like to continue at Kaiser Permanente?• Are you currently pregnant?

If you have any other questions or want help getting started, give us a call. We’re here to help.

Our goal is to connect you with the right doctors, specialists, and prescription medications to effectively manage your care transition. This allows us to help manage the administrative tasks so your first interactions with our doctors are more useful.

Types of medical needs our New Member Welcome Desk can help with:

Common needs

• Choosing a doctor• Scheduling a routine appointment• Transferring prescriptions

Also available 24/7 for self-service at kp.org

Parent and child needs

• Selecting a pediatrician or family practice doctor• Transferring records and health history• Transferring prescriptions• Scheduling vaccinations

Specialty care needs

• Connecting with specialists such as oncologists, neurologists, and dermatologists

• Connecting with mental health professionals• Choosing an ob-gyn and pediatrician• Determining durable medical equipment needs

Complex medical needs

• Connecting with specialty care for conditions such as cancer, renal disease, pre-/post-surgery, and transplants

• Connecting with a pharmacy for specialty prescriptions

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Great care from great doctors

Our doctors come from top medical schools, and many of them taught at world-renowned universities. No matter which personal doctor you choose, you’ll be in highly skilled, experienced hands — and your health is their main concern.

As your biggest health advocate, your doctor will coordinate your care journey, and you‘ll work closely together to make decisions about your health.

Better care with a connected team

Your doctor, nurses, and other specialists are all connected to each other, and to you, through your electronic health record. So they know important things about you and your health, and can help you get the care you need.

Personalized care for all members

Care at Kaiser Permanente isn’t one-size-fits-all. 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 train our care teams to connect with and care for people of all backgrounds. We also offer high-quality LGBTQ health care services that are recognized for adopting LGBTQ-inclusive policies and practices.3

Tener una buena comunicación con su medico es importante para su salud y bienestar. En nuestros 7 consultorios médicos que aparecen a continuación, usted encontrará medicos certificados que hablan español e inglés de manera fluida: Cascade Park Medical Office, Interstate Medical Office East, Mt. Scott Medical Office, North Lancaster Medical Office, Orchards Medical Office, Rockwood Medical Office, y Sunset Medical Office.

Our physician-led care teams work together to keep you healthy by delivering high-quality, personalized care.

Through our culturally responsive care programs, we’ve improved health outcomes among diverse populations for conditions like high blood pressure, diabetes, and colon cancer.4

Quality care with you at the center


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Hear care stories from real Kaiser Permanente members at kp.org/carestories.

Preventive care to keep you healthy

Preventive care is key to how we practice medicine. It can help you avoid some health issues and catch others before they become serious.

You can get preventive care services at no cost — including age-appropriate preventive medical exams, blood pressure screenings, routine physical exams, depression screenings, and pediatric immunizations. Visit kp.org/prevention to learn more.

Specialty care to meet your needs

We‘re also here for you if you get sick or need specialty care. With one of the largest multispecialty medical groups in the country, we can conveniently connect you with the right specialist.2 And you don’t need referrals for certain specialties, like obstetrics-gynecology, psychiatry, and drug dependency services.

From high-quality maternity care to treatment for cancer, heart problems, and more, you get great doctors, the latest technology, and evidence-based care — all combined to help you recover quickly.

Support for ongoing conditions

If you have a condition like diabetes or heart disease, you’re automatically enrolled in a disease management program for personal coaching and support.2 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 leader in clinical quality

In 2018, Kaiser Permanente led the nation as the top performer in 30 effectiveness-of-care measures — the most of any health plan.5 These measures include:

• Prevention and screening

• Cardiovascular care

• Comprehensive diabetes care

• Medication monitoring

From preventive screenings that keep you healthy to world-class care if you get sick, we’ve got you covered.

Great care, great results

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Get the most out of your health plan

Help to quit smoking

If you use cigarettes, e-cigarettes, or other tobacco products, let us help you quit. You pay nothing for classes, telephone coaching, online programs, and prescriptions, including prescribed over-the-counter tobacco-cessation drugs. For more information, ask your doctor or visit kp.org/quitsmoking.

Prescription costs at your fingertips

Use our prescription drug pricing tool to find out how much you'll pay for different medications as a Kaiser Permanente member. Learn more at kp.org/feds.

Healthy rewards

Take simple steps to improve your well-being and earn up to $150 per family for the Standard Option and up to $300 per family for the High Option to pay for qualified medical expenses.6

An FEHB subscriber and their enrolled spouse (18 and over) are eligible for the following rewards:

• Standard Option: $50 for taking the online Total Health Assessment and $25 for completing an online healthy lifestyle program

• High Option: $100 for taking the online Total Health Assessment and $50 for completing an online healthy lifestyle program

Online wellness toolsConnect to better health with online programs to help you lose weight, quit smoking, reduce stress, and more — all at no cost. Learn more at kp.org/healthylifestyles.

Health classesSign up for health classes and support groups at many of our facilities. See what’s available near you at kp.org/classes — some may require a fee.

Personal wellness coaching

Get help reaching your health goals. Work one-on-one with a wellness coach by phone at no cost. Find out more at kp.org/wellnesscoach.

Special rates for members

Enjoy reduced rates on services that can help you stay healthy — like gym memberships, massage therapy, and more. Explore your options at kp.org/choosehealthy.

Good health goes beyond the doctor’s office. Explore all the convenient resources available to members and choose the ones that fit your life.

Healthy resources


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Get care where, when, and how you want it. With many options below, you can even skip the trip to your doctor’s office.

Getting care

Visit kp.org/telehealth/nw to learn more about online and phone options.

Online

• E-visits — Get treatment, including prescriptions, in less than one hour.

• Secure email — Message your care team with nonurgent questions.2

• Video visits — Meet face-to-face with a Kaiser Permanente doctor on your computer, smartphone, or tablet.1,2

• Online resources — Visit kp.org to manage your health, find nearby locations, and take advantage of health guides and other resources.

By phone

• Phone appointments — Save yourself a trip to the medical office for minor conditions or follow-up care.1,2

• 24/7 advice — Call for medical advice and care guidance. We’ll help you find out what care is right for you, schedule appointments, and more.

In person

• Primary and specialty care — Schedule a primary or specialty care visit with a member of your care team. If you don’t need to see your regular doctor, schedule a visit with an available doctor at any of our medical offices. You may need a referral to see certain specialists.

• Care Essentials by Kaiser Permanente — Visit a primary care clinician at our Hawthorne or Pearl District locations. Evening and weekend appointments available. Walk-ins welcome. Visit careessentials.org to learn more.

• Urgent care — Visit a walk-in clinic if you have a condition that requires prompt medical attention (usually within 1 or 2 days) but is not an emergency.7 Open 7 days a week, including evenings, weekends, and holidays. Visit kp.org/urgentcare/nw to find a facility near you. You’re also covered for urgent care while traveling anywhere in the world.

• Emergency care — If you ever need emergency care, you’re covered — anywhere, anytime.8 You can get care at any Kaiser Permanente hospital or any other hospital emergency department.

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It’s easy for you and your family to get the care you need, when you need it. There are many Kaiser Permanente facilities in your area, offering convenient hours and a wide range of care and services.

Care when and where you need it

Convenient care near you With multiple locations to choose from, it’s easy to find one near home or work. We offer same-day or next-day appointments. You can also see different doctors at different locations — whatever works best for you.

Many services under one roof2

Most of our facilities offer a variety of care and services, so you can take care of several health care needs in one visit. You can see your doctor or specialist, get a lab test or an X-ray, and pick up your medications — all without leaving the building.

Guidance and convenience for families

As a parent, you’ll get helpful reminders for well-child checkups, immunizations, and other important services for your child.

The convenience of our medical-dental integration, telephone appointments, video visits, and advice by phone can help you spend less time in traffic going to and from your doctor’s office.

Finding the right location Choosing a convenient place to get care can be simple — just hop online or grab your smartphone.

• Visit kp.org/facilities to search by ZIP code, keyword, or the type of service you need.

• Search on your smartphone with the location finder on the Kaiser Permanente app.9

For a list of locations, please see the facilities map on page 17.


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Care away from home Care while travelingIf you get hurt or sick while traveling, we’ll help you get care. We can also help you before you leave town by checking to see if you need a vaccination, a prescription refill, and more. Just call our 24/7 Away from Home Travel Line10 at 951-268-3900 or visit kp.org/travel.

Visiting member careYou can get care in all or parts of California, Colorado, Georgia, Hawaii, Maryland, Virginia, Washington, and Washington, D.C. as a visiting member. Call our Away from Home Travel Line

at 951-268-3900 and let them know you plan to visit another Kaiser Permanente service area for care.

Dependent children are covered for routine, continuing, and follow-up care when they‘re residing outside the service area. We also cover urgent and emergency care.7,8

PeaceHealth Through our collaboration with PeaceHealth, if you work or live in Eugene or Springfield, you have access to 4 more medical offices throughout Lane County (High and Standard Options only). Costs are the same for covered services whether you seek care from Kaiser Permanente or PeaceHealth.11

The Portland Clinic

Through our collaboration with The Portland Clinic, you also have access to 6 additional medical offices throughout the Portland metro area. Costs are the same for covered services whether you seek care from Kaiser Permanente or The Portland Clinic,11 and services not offered by The Portland Clinic can be performed at Kaiser Permanente facilities. To make an appointment, call The Portland Clinic at 503-223-3113.

Care Essentials® by Kaiser Permanente

You also have the option to visit one of our Care Essentials clinics for treatment of minor illnesses and injuries, routine care, sports physicals, and checkups. With evening and weekend hours, it’s care that fits your schedule. Call 1-855-235-0491 to schedule an appointment and visit careessentials.org for more information.

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Benefit highlights

2020 changes — see what’s new

These are some of the key changes to High and Standard Options:

• Added Standard Option Senior Advantage 2 plan

• Enhanced e-visits, with treatment plan and prescriptions available in less than an hour

• Expanded list of preventive care services available at no cost to include perinatal depression counseling and interventions for pregnant and postpartum individuals at increased risk of perinatal depression

• Changed provision of primary care services at home to be based on medical criteria and need

For a full list of 2020 benefit changes, please refer to the FEHB Plan brochure, 73-004.

Preventive care at no cost

Health screenings and routine appointments can help you stay healthy and avoid serious health problems. No matter which plan you choose, you pay nothing for most preventive care services.

$0 primary care copay for children

There’s no charge for primary care office visits to a pediatrician or other physician for children through age 17. This includes checkups, as well as when your children get sick.

Alternative care services

Visit any CHP Group participating provider without a referral, and get up to $1,000 per year in chiropractic services, acupuncture, naturopathic care, and massage therapy (High Option) and (Standard Option). To find a participating provider, visit chpgroup.com or call 1-800-449-9479 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m.

Save on prescription drugs

• If the cost of your prescription is less than your copay, you pay only the cost of your prescription.

• Kaiser Permanente offers lower-cost prescriptions to treat some ongoing conditions like asthma, high blood pressure, diabetes, or depression, which can make managing these conditions more affordable.

• Save time and money by ordering prescription refills online or by phone. We can mail most prescription drugs to you within 10 days with no cost for shipping. Get a 90-day supply for the cost of a 60-day supply when we mail your prescription. Visit kp.org/refill or call 1-800-548-9809.


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Benefits and Services High Option Standard OptionDeductible (2x per family maximum) None $250These benefits and services are NOT subject to plan deductibles.

Outpatient services (per visit or procedure)*

Preventive care $0 $0

Primary care $20 $0 through age 17$25

$0 through age 17

Specialty care $30 $35

Routine prenatal care visit, delivery, and first postpartum visit $0 $0

Most X-rays $15 $30

Most lab tests $10 $25

Chiropractic, naturopathic, acupuncture, and massage services (up to 12 massage visits per year)

$20 ($25 massage) ($1,000 annual benefit

maximum)

$25 ($1,000 annual benefit maximum)

Prescription drugs (up to a 30-day supply at plan pharmacies, or up to a 90-day supply for 2 copays through mail order)†

Generic $15 $15

Preferred brand $40 $50

Non-preferred brand $60 $70

Specialty $100 $150

Eyeglasses and contacts (every calendar year for children through age 18 and every 2 calendar years age 19 and over)

$0 for children $150 credit for adults


Out-of-pocket maximum (2x per family maximum) $4,250 $5,500

Subject to deductible

Emergency and urgent care (per visit or trip)*

Urgent care $35 $40

Emergency care $150 $125‡

Ambulance $100 $125‡

Hospital and facility*

Outpatient surgery $100 $150‡

Inpatient hospital care $250 per admission$0 for maternity

$300‡ per admission

$0 for maternity

*You pay 10% of the cost (High) and 20% of the cost after the deductible (Standard) for drugs administered while receiving care. †Plan providers determine the drug that is medically necessary. If you request another drug, you must pay prices charged to

members for non-covered drugs. For certain drugs, you can get prescription refills mailed to you through our Kaiser Permanente mail-order pharmacy. You should receive them within 10 business days. If not, please call 1-888-572-7231 (TTY 711).

‡You pay the deductible, then your share of the cost.

Your 2020 benefits at a glance

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High Option Standard OptionBenefits and Services Senior Advantage 1 Senior Advantage 2 Benefits and Services Senior Advantage 1 Senior Advantage 2

Deductible (2x per family maximum) None None Deductible (2x per family maximum) None NoneOutpatient services (per visit or procedure) Outpatient services (per visit or procedure)Preventive care $0 $0 Preventive care $0 $0

Primary care $0 $15 $0 through age 17 Primary care$5

$0 through age 17$20

$0 through age 17

Specialty care $0 $15 Specialty care $5 $20 Routine prenatal care visit, delivery, and first postpartum visit $0 $0 Routine prenatal care visit, delivery, and first postpartum visit $0 $0 Most X-rays $0 $0 Most X-rays $0 $15 Most lab tests $0 $0 Most lab tests $0 $15


$20 ($25 massage)($1,000 annual benefit

maximum)


maximum)


$25 ($1,000 annualbenefit maximum)


Prescription drugs (up to a 30-day supply at plan pharmacies, or up to a 90-day supply for 2 copays through mail order)* Prescription drugs (up to a 30-day supply at plan pharmacies, or up to a 90-day supply for 2 copays through mail order)* Generic $15 $15 Generic $15 $15 Preferred brand $30 $40 Preferred brand $40 $40

Non-preferred brand $50 $60 Non-preferred brand $60 $60 Specialty $100 $100 Specialty $150 $150 Eyeglasses and contacts (every calendar year for children through age 18 and every 2 calendar years age 19 and over)






Out-of-pocket maximum (2x per family maximum) $600 $1,000 Out-of-pocket maximum (2x per family maximum) $750 $2,000 Silver&Fit® fitness program $0 $0 Silver&Fit® fitness program $0 $0 Medicare Part B Premium Reimbursement† $0 Up to $150 monthly Medicare Part B Premium Reimbursement† $0 Up to $150 monthlyEmergency and urgent care (per visit or trip) Emergency and urgent care (per visit or trip)Urgent care $0 $30 Urgent care $10 $35 Emergency care $60 $75 Emergency care $60 $120 Ambulance $75 $100 Ambulance $75 $125 Hospital and facility Hospital and facility Outpatient surgery $0 $50 Outpatient surgery $50 $100

Inpatient hospital care $0 $200 $0 for maternity Inpatient hospital care$100

$0 for maternity$225

$0 for maternity

*Plan providers determine the drug that is medically necessary. If you request another drug, you must pay prices charged to members for non-covered drugs. For certain drugs, you can get prescription refills mailed to you through our Kaiser Permanente mail-order pharmacy. You should receive them within 10 business days. If not, please call 1-888-572-7231 (TTY 711).

†We will not reimburse you for any extra charges added to your standard Part B premium, such as the Part B Late-Enrollment Penalty or Income-Related Monthly Adjustment Amount.

2020 Senior Advantage benefits


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High Option Standard OptionBenefits and Services Senior Advantage 1 Senior Advantage 2 Benefits and Services Senior Advantage 1 Senior Advantage 2

Deductible (2x per family maximum) None None Deductible (2x per family maximum) None NoneOutpatient services (per visit or procedure) Outpatient services (per visit or procedure)Preventive care $0 $0 Preventive care $0 $0

Primary care $0 $15 $0 through age 17 Primary care$5

$0 through age 17$20

$0 through age 17

Specialty care $0 $15 Specialty care $5 $20 Routine prenatal care visit, delivery, and first postpartum visit $0 $0 Routine prenatal care visit, delivery, and first postpartum visit $0 $0 Most X-rays $0 $0 Most X-rays $0 $15 Most lab tests $0 $0 Most lab tests $0 $15



maximum)


maximum)




Prescription drugs (up to a 30-day supply at plan pharmacies, or up to a 90-day supply for 2 copays through mail order)* Prescription drugs (up to a 30-day supply at plan pharmacies, or up to a 90-day supply for 2 copays through mail order)* Generic $15 $15 Generic $15 $15 Preferred brand $30 $40 Preferred brand $40 $40

Non-preferred brand $50 $60 Non-preferred brand $60 $60 Specialty $100 $100 Specialty $150 $150 Eyeglasses and contacts (every calendar year for children through age 18 and every 2 calendar years age 19 and over)






Out-of-pocket maximum (2x per family maximum) $600 $1,000 Out-of-pocket maximum (2x per family maximum) $750 $2,000 Silver&Fit® fitness program $0 $0 Silver&Fit® fitness program $0 $0 Medicare Part B Premium Reimbursement† $0 Up to $150 monthly Medicare Part B Premium Reimbursement† $0 Up to $150 monthlyEmergency and urgent care (per visit or trip) Emergency and urgent care (per visit or trip)Urgent care $0 $30 Urgent care $10 $35 Emergency care $60 $75 Emergency care $60 $120 Ambulance $75 $100 Ambulance $75 $125 Hospital and facility Hospital and facility Outpatient surgery $0 $50 Outpatient surgery $50 $100

Inpatient hospital care $0 $200 $0 for maternity Inpatient hospital care$100

$0 for maternity$225

$0 for maternity

*Plan providers determine the drug that is medically necessary. If you request another drug, you must pay prices charged to members for non-covered drugs. For certain drugs, you can get prescription refills mailed to you through our Kaiser Permanente mail-order pharmacy. You should receive them within 10 business days. If not, please call 1-888-572-7231 (TTY 711).

†We will not reimburse you for any extra charges added to your standard Part B premium, such as the Part B Late-Enrollment Penalty or Income-Related Monthly Adjustment Amount.

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High Option Standard Option Included with both

• No deductible

• Higher premiums, but lower copays for most services and prescription drugs

• Up to $300 available when you and your spouse take the Total Health Assessment and complete a healthy lifestyle program (learn more at kp.org/feds)

If you want low out-of-pocket costs, this may be the right choice.

• $250 deductible (doesn‘t apply to office visits, prescription drugs, lab services, X-rays, urgent care, and many other services).

• Lower premiums, but higher copays or coinsurance after you reach your deductible

If you want predictable copays at a lower premium, this may be the right choice.

• No copays for primary care for children through age 17

• No copays for maternity care outpatient visits or delivery

• No copays when you email your doctor’s office, call the 24/7 medical advice line, or video chat with a doctor

• Vision coverage (see below for details)

• No paperwork to fill out when you get services from Kaiser Permanente providers

If you have a family, either choice may be right for you with $0 maternity care outpatient visits and delivery.

Dental coverage for Federal enrollees

Dental care is more than just a bright smile. Your Kaiser Permanente dentist is connected to your electronic health record, giving your entire care team a more complete view of your health.

Choose from more than 160 Kaiser Permanente providers at 21 convenient locations, including many inside or near our medical offices.

For more details or to enroll in our dental plans, visit kp.org/feds/nwdental.

Vision services for better health

As a Kaiser Permanente member, your eye health information becomes part of your electronic health record, giving your care team a more complete picture of your health.

Plans include eye exams ($20 to $25 copay) and a $150 hardware allowance every 2 years for adults 19 and older. For members 18 and younger, there’s no charge for frames when you choose from a specified collection (limited to 1 pair per year).

For more information, including our 10 optical locations, visit kp2020.org.

Which option is right for you?


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When you join Kaiser Permanente Senior Advantage (HMO) for Federal Members, you get better benefits without increasing your FEHB premium:

• New for 2020: Added Standard Option Senior Advantage Part B monthly premium reimbursement of $150 and increased High Option Part B monthly reimbursement from $125 to $150

• No copays or lower copays for most other services, such as inpatient hospital, outpatient surgery, urgent and emergency care, lab, X-ray, and specialty scans

• Lower out-of-pocket maximums

• Membership in Silver&Fit® Fitness Program12 at no extra cost

High and Standard Option members have 2 great choices

If you‘re enrolled in the Kaiser Permanente FEHB High Option or Standard Option plan, you have 2 great choices:

• Senior Advantage 1— No copays for most office visits (High Option), plus extras like the Silver&Fit® fitness program

• Senior Advantage 2 — Get lower copays than with your FEHB plan and reimbursement of your Medicare Part B premium — up to $150 each month13

Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. To join a Kaiser Permanente Medicare Health Plan, you must reside in the Kaiser Permanente Senior Advantage service area in which you enroll. This information is not a complete description of benefits. Call 1-888-572-7231 (TTY 711), 8 a.m. to 8 p.m., 7 days a week. Enrolling in Senior Advantage for Federal Members will not affect the benefits you receive through the Federal Employees Health Benefits (FEHB) Program, although the network and other rules of Medicare may apply.

Advantages of a Kaiser Permanente Medicare health plan

How do I sign up for Senior Advantage for Federal Members?

To enroll in Senior Advantage for Federal Members, you must first enroll in the Kaiser Permanente FEHB plan (either the High or Standard Option), plus Medicare Parts A and B. After that, you can apply for Senior Advantage for Federal Members.

Be sure to choose the right enrollment code on page 16.

When you become eligible for Medicare, you may be able to change your current plan or option outside of Open Season. To learn more, visit opm.gov or contact your employing agency or retirement office.

We can help you make an easy transition. For more information, download our brochure, Your Guide to Choosing a Kaiser Permanente Medicare Health Plan, at kp.org/feds. Annuitants can contact the Retirement Information Center at 1-888-767-6738 (TTY 1-855-887-4957), or [email protected].

If you have questions, need help with the enrollment process, or want information sent to you, please call Member Services at 1-877-221-8221 (TTY 711), Monday through Friday, 8 a.m. to 8 p.m.

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1. Choose an option.2. Select the type of

enrollment you want.3. Sign up online or call.

• High Option• Standard Option

Find brief descriptions of these options on page 11. More details about benefits are on pages 12 and 13.

• Self Only covers you.• Self Plus One covers

you and one eligible family member.

• Self and Family covers you and all eligible family members.

Find your enrollment code in the chart below. Then, visit opm.gov to enroll online or contact your employing agency or retirement office for next steps and other information.

Annuitants can contact the Retirement Information Center at 1-888-767-6738 or (TTY 1-855-887-4957), or [email protected].

If you qualify for Medicare, or will soon, see page 15 for more information.

Your Premium Share† High Option Standard Option

Self Only

Biweekly Non-Postal $101.12 $74.76 Biweekly Postal Category 1 $97.84 $71.77 Biweekly Postal Category 2 $88.02 $62.05 Monthly Non-Postal $219.09 $161.99

Self Plus One


Self and Family


Enrollees covering themselves and one other eligible family member may choose either the “Self Plus One” or ”Self and Family“ enrollment type. However, you’ll save money if you enroll in Self and Family.

Choose the right enrollment code

Enrollment Code High Option Standard OptionSelf Only 571 574Self Plus One 573 576Self and Family 572 575

* These are highlights of the FEHB enrollment process. Please refer directly to opm.gov and your employing agency or retirement office for FEHB coverage effective dates, enrollment procedures and deadlines, and other information. To add an eligible family member to your Kaiser Permanente Self and Family enrollment, complete and return an Enrollment Change Form to us. These forms can be obtained at kp.org/feds or by calling Member Services.

† These rates do not apply to all enrollees. If you are in a special enrollment category, please contact the agency or Tribal Employer that maintains your health benefits enrollment.

Ready to enroll with Kaiser Permanente?*


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Locations near you

Map to scale

We provide quality care to more than 600,000 members in Oregon and Southwest Washington. Our service area is made up of Kaiser Permanente facilities, including 36 medical offices, 21 dental offices, 6 urgent care clinics, 2 hospitals, and 2 Care Essentials by Kaiser Permanente clinics. We also have a network of affiliated providers if you need routine, urgent, or emergency care.

For quick and easy care, including prescriptions, try a phone appointment, video visit, or an e-visit.1,2 Learn more at kp.org/telehealth/nw.

Facility information is current as of July 2019.

Go to kp.org/locations to see all our current locations and to find the facility closest to you. Or call Member Services at 1-800-813-2000 (TTY 711).

Hillsboro

TigardMilwaukie

Tualatin

Beaverton

Oregon City

Portland

217

5

5

205

205

8426

Vancouver

Kaiser Permanente medical office

Kaiser Permanente dental office

Affiliate location

Kaiser Permanente hospital

Care Essentials® by Kaiser Permanente

Longview

5

Salem5

Eugene

13

Oakridge

Florence

Kaiser Permanente

18

For the latest hours, go to kp.org/urgentcare/nw. Urgent care hours are subject to change.

Same-day and next-day care

Kaiser Permanente urgent care locations1

Beaverton Medical and Dental Office4855 SW Western Ave.Beaverton, OR 97005

Interstate Medical Office South3500 N. Interstate Ave.Portland, OR 97227

Mt. Talbert Medical Office10100 SE Sunnyside Rd. Clackamas, OR 97015

Cascade Park Medical Office12607 SE Mill Plain Blvd.Vancouver, WA 98684

Longview-Kelso Medical Office1230 7th Ave.Longview, WA 98632

North Lancaster Medical Office2400 Lancaster Dr. NESalem, OR 97305

Affiliate locations

McMinnville Immediate Care207 NE 19th St. McMinnville, OR 97128

Newberg Urgent Care and Medical Center2880 Hayes St.Newberg, OR 97132


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1When appropriate and available.2These features are available when you get care at Kaiser Permanente facilities.3 Kaiser Permanente Northwest hospitals were among the 38 Kaiser Permanente hospitals recognized as a leader in LGBTQ healthcare

quality by the Human Rights Campaign Foundation. “Healthcare Equality Index 2018,” Human Rights Campaign Foundation: www.hrc.org/hei/leaders-in-lgbt-healthcare-equality.

4 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.

5 Kaiser Permanente 2018 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 2018 and is used with the permission of NCQA. Quality Compass 2018 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.

6 As a Kaiser Permanente member, you and your enrolled spouse (age 18 and over) are eligible to earn up to $75 each in rewards. We will send you a Kaiser Permanente health payment card 4 to 6 weeks after you complete your first activity, then load additional rewards when you complete your second activity. You must keep your card for use throughout the year and use rewards to pay qualified medical expenses by March 31 of the next calendar year. Go to kp.org/feds to learn more and get started.

7 An urgent care need is one that requires prompt medical attention, usually within 24 or 48 hours, but is not an emergency medical condition. This can include minor injuries, backaches, earaches, sore throats, coughs, upper-respiratory symptoms, and frequent urination or a burning sensation when urinating.

8 If you reasonably believe you have an emergency medical condition, which is a medical or psychiatric condition that requires immediate medical attention to prevent serious jeopardy to your health, call 911 or go to the nearest emergency department. For the complete definition of an emergency medical condition, please refer to your Plan brochure, 73-004.

9To use the Kaiser Permanente app, you must be a Kaiser Permanente member registered on kp.org.10 This number can be dialed from inside and outside the United States. Outside, you must dial the U.S. country code “001” for landlines

and “+1” for mobile before the phone number. Long-distance charges may apply and we cannot accept collect calls. This phone line is closed on major holidays (New Year’s Day, Easter, Memorial Day, July Fourth, Labor Day, Thanksgiving, and Christmas). It closes early the day before a holiday at 10 p.m. Pacific time (PT), and it reopens the day after a holiday at 4 a.m. PT.

11Exceptions include members on Medicaid, receiving full financial assistance, or visiting from another Kaiser Permanente region.12Silver&Fit® is a federally registered trademark of American Specialty Health, Inc.13 We will not reimburse you for any extra charges added to your standard Part B premium, such as the Part B late enrollment penalty or

Income Related Monthly Adjustment Amount.

Kaiser Foundation Health Plan of the Northwest coverage is available in the Eugene-Springfield area. You may be eligible for a Kaiser Permanente plan if you work or live in one of the following ZIP codes: 97401, 97402, 97403, 97404, 97405, 97408, 97409, 97419, 97424, 97426, 97431, 97437, 97438, 97440, 97446, 97448, 97451, 97452, 97454, 97455, 97456, 97461, 97475, 97477, 97478, 97487, 97489. If you have questions about your eligibility, please contact your benefits coordinator or human resources manager.This is a summary of the features of the Kaiser Permanente health plan, including Kaiser Permanente Senior Advantage for Federal Members. Before making a final decision, please read the Federal Employees Health Benefits (FEHB) brochure, 73-004. All benefits are subject to the definitions, limitations, and exclusions set forth in the FEHB brochure. The services listed on page 6 (“Get the most out of your health plan,” except “Health classes”), page 10 (CHP Group complementary care), and page 14 (Dental coverage) are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees and family members who become members of Kaiser Permanente.Notice of Summary of Benefits and Coverage (SBC): Availability of Summary Health Information The Federal Employees Health Benefits (FEHB) Program offers numerous health benefits plans and coverage options. Choosing a health plan and coverage option is an important decision. To help you make an informed choice, each FEHB plan makes available a Summary of Benefits and Coverage (SBC) about each of its health coverage options, online and in paper. The SBC summarizes important information in a standard format to help you compare plans and options. This plan’s SBC is available on the internet at kp.org/feds. A paper copy is also available, at no charge, by calling 1-800-464-4000, 24 hours a day, 7 days a week. For TTY, call 711. To find out more information about plans available under the FEHB Program, including SBCs for other FEHB plans, please visit opm.gov/insure.

Kaiser Permanente

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NONDISCRIMINATION NOTICE Kaiser Foundation Health Plan of the Northwest (Kaiser Health Plan) complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Kaiser Health Plan 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 communicateeffectively 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 notEnglish, such as:• Qualified interpreters• Information written in other languages

If you need these services, call 1-800-813-2000 (TTY: 711)

If you believe that Kaiser Health Plan 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 by mail or phone at: Member Relations, Attention: Kaiser Civil Rights Coordinator, 500 NE Multnomah St. Ste 100, Portland, OR 97232, telephone number: 1-800-813-2000.

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, 1-800-537-7697 (TDD). Complaint forms are available athttp://www.hhs.gov/ocr/office/file/index.html.

____________________________________________________________________

HELP IN YOUR LANGUAGE ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-800-813-2000 (TTY: 711).

አማርኛ (Amharic) ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎትተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-800-813-2000 (TTY: 711).

.، فإن خدمات المساعدة اللغوية تتوافر لك بالمجانالعربيةإذا كنت تتحدث :ملحوظة(Arabic)العربية(.TTY :711) 2000-813-800-1 اتصل برقم

中文 (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1-800-813-2000（TTY：711）。

اگر به زبان فارسی گفتگو می کنيد، تسهيالت زبانی بصورت رايگان برای توجه: (Farsi)فارسی711)شما فراهم می باشد. با :TTY) تماس بگيريد.1-800-813-2000

60576526_ACA_1557_MarCom_NW_2017_Taglines

Français (French) ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-800-813-2000 (TTY: 711).

Deutsch (German) ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-800-813-2000 (TTY: 711).

日本語 (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。1-800-813-2000（TTY: 711）まで、お電話にてご連絡ください。

ខ្មែ រ (Khmer) ប្រយត័្ន៖ បរើសិនជាអ្នកនិយាយ ភាសាខ្មែរ, បសវាជំនួយខ្ននកភាសា បោយមិនគិត្ឈ្ន លួ គអឺាចមានសំរារ់រំបរ ើអ្នក។ ចូរ ទូរស័ព្ទ 1-800-813-2000 (TTY: 711)។

한국어 (Korean)주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-800-813-2000 (TTY: 711)번으로 전화해 주십시오.

ລາວ (Laotian) ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວ ້ າພາສາ ລາວ, ການບໍລິການຊ່ວຍເຫ ຼື ອດ້ານພາສາ, ໂດຍບ່ໍເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-800-813-2000 (TTY: 711).

Naabeehó (Navajo) Díí baa akó nínízin: Díí saad bee yáníłti’go Diné Bizaad, saad bee áká’ánída’áwo’dé̖é̖’, t’áá jiik’eh, éí ná hóló̖, koji̖’ hódíílnih 1-800-813-2000 (TTY: 711).

Afaan Oromoo (Oromo) XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-800-813-2000 (TTY: 711).

ਪੰਜਾਬੀ (Punjabi) ਧਿਆਨ ਧਿਓ: ਜੇ ਤੁਸੀਂ ਪੰਜਾਬੀ ਬੋਲਿੇ ਹੋ, ਤਾਂ ਭਾਸ਼ਾ ਧਵਿੱ ਚ ਸਹਾਇਤਾ ਸਵੇਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਿ ਹੈ। 1-800-813-2000 (TTY: 711) 'ਤੇ ਕਾਲ ਕਰੋ। Română (Romanian) ATENȚIE: Dacă vorbiți limba română, vă stau la dispoziție servicii de asistență lingvistică, gratuit. Sunați la 1-800-813-2000 (TTY: 711).

Pусский (Russian) ВНИМАНИЕ: если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-800-813-2000 (TTY: 711).

Español (Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-813-2000 (TTY: 711).

Tagalog (Tagalog) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-800-813-2000 (TTY: 711).

ไทย (Thai) เรยีน: ถา้คณุพดูภาษาไทย คณุสามารถใชบ้รกิารชว่ยเหลอืทางภาษาไดฟ้ร ีโทร 1-800-813-2000 (TTY: 711).

Українська (Ukrainian) УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером 1-800-813-2000 (TTY: 711).

Tiếng Việt (Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-813-2000 (TTY: 711).

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©2019 Kaiser Foundation Health Plan, Inc., of the Northwest

Are you considering Kaiser Permanente and want to learn more? Visit kp.org/feds or call 1-855-315-1007, Monday through Friday, 7 a.m. to 5 p.m. Open Season hours: Monday through Friday, 6 a.m. to 7 p.m.

Kaiser Foundation Health Plan of the Northwest 500 NE Multnomah St., Suite 100

Portland, OR 97232

Are you a new or current Kaiser Permanente member with a question?New Member Welcome Desk ....................................................................................................1-888-491-1124 Monday through Friday, 8 a.m. to 6 p.m.

New Member Pharmacy Services ...........................................................................................1-888-572-7231 Monday through Friday, 8 a.m. to 6 p.m.

For more information about Kaiser Permanente benefits, availability, and restrictions, go to kp.org/disclosures. (Click on “Forms” and then “Related links.”)

Member ServicesEnglish ............................................................................................................................................................1-800-813-2000 Language interpretation services ...........................................................................................1-800-324-8010 TTY (Monday through Friday, 8 a.m. to 6 p.m.) ............................................................................................ 711

Structure BookmarksWelcome to care that fits your lifeExperience the Kaiser Permanente difference3 easy steps to get startedNew member care transitionHealthy resourcesBenefit highlightsYour 2020 benefits at a glance2020 Senior Advantage benefitsWhich option is right for you?Advantages of a Kaiser Permanente Medicare health planReady to enroll with Kaiser Permanente?Locations near you

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