kaiser permanente sound choice coverage

Email Address. 2021 Open Enrollment. Your Kaiser Permanente Added Choice® Point-of-Service (POS) Plan is not just health coverage — it's a partnership in health. Call 1-866-616-0047 (TTY 711) to speak with our Added Choice Contact Center. Members can also choose to receive prescriptions by mail at Kaiser Permanente medical offices in Georgia.*. Access coverage documents for Added Choice members. PPO plans generally offer coverage for out-of-network providers, while HMO plans only offer out-of-network coverage in emergency situations. Your Kaiser Permanente Added Choice® Point-of-Service (POS) Plan is not just health coverage — it's a partnership in health. DeltaCare is a dental HMO plan. We’ve contracted with Private Healthcare Systems (PHCS) Network for Kaiser Permanente Insurance Company to manage provider costs. Kaiser Permanente WA CDHP This plan allows you to seek services from non-Kaiser Permanente WA health providers, however, if you seek services from a non-Kaiser Permanente WA health provider, the service may be covered at a reduced level of coverage. Each Flexible Choice However, once you have completed your 35th month of employment, you may choose to enroll in either the Sound PPO Plan or the Sound Kaiser Permanente Plan. PPO . Show me. Kaiser Permanente is hosting a series of virtual learning sessions, “Here’s to Your Health.” Each 30-minute session will focus on how to optimize your personal health in the midst of COVID-19. Coverage options range from Preferred Provider Organization (PPO) to Health Maintenance Organization (HMO). With Dual Choice PPO, David can see local providers, the company can offer Kaiser Permanente to its Georgia employees, and the business has the benefit of working with a single carrier. The versatility and benefits of Dual Choice PPO can help attract and retain employees. exception to Kaiser Permanente requirements for coverage of prescription drugs, you or your prescriber may contact Kaiser Permanente Member Services at 1-888-630-4636 and request an exception. Choice Products California. This division is called Kaiser Permanente NW to distinguish it from the Puget Sound Kaiser … Kaiser Permanente Providers in ... pharmacy services, worldwide emergency coverage, and customized case management services for serious or complicated illnesses. For care with Kaiser Permanente Providers in Georgia. Your health care plan with Kaiser Permanente WA is a partnership in health. Plus, you’ve got the power to change doctors anytime. Your time-loss payments will range from $135 to $225 per week (less Social Security taxes), depending on the number of hours you worked during your eligibility month. You’re free to choose whatever provider you prefer, whenever you receive care. Not a Kaiser participant? The Kaiser Permanente Flexible Choice plan blends HMO, PPO, and indemnity-style benefit plans and delivery systems into one product. Access coverage documents for Added Choice members. If you choose out-of-network care, you can see First Choice Health Network or Beech Street providers at a discounted rate. Spokane area. You MUST choose a DeltaCare primary care dentist who coordinates all of your care, including any referrals to specialists. Learn about Georgia Kaiser Permanente Choice Products. 6. Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 1/1/20 20 – 12/31/2020 : PEBB SoundChoice Plan All plans offered and underwritten by Kaiser Foundation Health Plan of Washington 1 of 6 RQ-136645-1 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Plan hospitals, plan physicians, and other plan providers, and the services available at plan facilities, are subject to change at any time without notice. Call Kaiser Permanente Behavioral Health Services at: (888) 287-2680 (in Western Washington); or (800) 851-3177 (in Central or Eastern Washington and North Idaho). Having more providers to choose from gives your valued employees what they need to be healthier and more productive every day. Kaiser Permanente SoundChoice Plans | Contents Your Kaiser Permanente Member Guide The information in this Member Guide is updated from time to time and is current as of November 2020. This option allows you to see any licensed dental provider. A claim form will have to be completed. Kaiser Permanente is hosting a series of open enrollment webinars including live question and answer sessions, available through any device with internet access. Getting a flu shot is the single best way to protect against the flu. Eligible Sound Health & Wellness Trust Kaiser Permanente Plan participants and their covered dependents can receive $0 co-pay flu shots at Kaiser Permanente medical centers, Bartell Care Clinic locations and in-network pharmacies. Or you can see any licensed provider you want for most covered services. Children from 6 months to 19 years of age, pregnant women, people 50 and older, and people with certain chronic medical conditions are especially encouraged to get a flu shot. For Employers only, please visit cas.kp.org to view your group documents. Core Access PPO. Kaiser Permanente’s Flexible Choice Plan 15.0 . You must notify Kaiser Permanente within 24 hours of admission, or as soon thereafter as medically possible. Select a plan for details . The Sound Health & Wellness Trust is a Taft-Hartley trust managed jointly by unions and employers and providing benefits to more than 51,000 participants. Learn about Georgia Kaiser Permanente Choice Products. Join Kaiser Permanente's Talent Network. Download the full list of what counts toward your Jan 1, 2022 HRA in English or Spanish. for more information about Emergency services. Your out-of-pocket costs will be higher than if you choose care inside the Kaiser Permanente network. Please fill out the fields below and click "Join Now" to receive information about opportunities that relate to your selections. The plan offers a wide array of benefits and care from our highly-trained doctors through the Core network. Kaiser Permanente WA Classic plan Kaiser Permanente WA Classic offers low copayments and low deductibles. Kaiser Permanente’s behavioral health care management program provides care coordination, support and advocacy for patients with severe or chronic mental illness and or alcohol or drug concerns. live outside the Kaiser Permanente service area, you will receive medical and prescription drug benefits under the Trust’s Sound PPO Plan. Puget Sound area. When you combine the Options Federal Standard Option plan with Medicare coverage, your Kaiser Permanente coverage will make your Medicare coverage go further. Core Access PPO. Why Kaiser Permanente is the right choice for you. Need a coverage document? Tracey: Gets great family care, keeps her specialist, and manages costs. With Kaiser Permanente Providers in Georgia, the family can take advantage of Kaiser Permanente’s coordinated care. Onboarding includes: Comprehensive New Member Welcome handbooks, an onboarding call from customer specialists, and a help line for any questions, from accessing care to transferring prescriptions. Refer to Section IV. Hours: Monday – Friday, 8:00am to 5:00pm, 11724 NE 195th St. Suite 300 Certain services require precertification. Dependent Children Coverage Physician as described in the Added Choice Service Agreement. You can receive care from any licensed care provider in the U.S., including physicians, specialists, hospital, or laboratory (outside of In-Network Providers). With the Kaiser Permanente plan, when you choose in-network care, you get access to providers at all Kaiser Permanente facilities. Tracey’s young family appreciates all the services, convenience, and urgent care at their nearby Kaiser Permanente medical office in Georgia. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. Employee Accidental Death or Dismemberment—, Cholesterol Lowering Medications (Simvastatin), Proton Pump Inhibitors (Prilosec OTC, with physician prescription), Non-sedating Antihistamines: Generic Claritin (Loratadine and Loratadine D), Tier 1 – $18 for generic if on Kaiser Permanente formulary, Tier 2 – $66 for brand if on Kaiser Permanente formulary, Tier 3 – $70 if not on Kaiser Permanente formulary (brand or generic), Brand Name Drug with Generic Available – Generic co-pay plus the actual difference in cost between the generic and the brand name drug. (Must use Kaiser Permanente Order Program), Download Kaiser Permanente mail order form (PDF). Some services are covered by Health Plan and KPIC, while other This amount will be paid to you in the event of your spouse or partner’s death from any cause. Tracey can manage the family’s out-of-pocket costs when seeking care from Out-of-Network Providers. Contributed by Lincoln Cushing, … What are the pharmacy choices under Dual Choice PPO? Kaiser Permanente Insurance Company (KPIC) has contracted with MedImpact to fill outpatient prescriptions at In-Network retail pharmacies—including Rite Aid, Walgreens, Kroger, and many supermarket chains (Not all pharmacies in a chain may participate). Enter First Name. They are mostly a one-stop shop for Kaiser Permanente customers, meaning that customers can often visit the lab, radiology, specialists, pharmacy, and their primary care physician in the same visit. Your call will be answered by a trained and licensed counselor who will ask you a few questions to best direct you to the services that meet your needs and preferences. Eligibility, claims or any other questions? The website is an excellent resource for information on behavioral health topics. Members can receive medical care provided by our Kaiser Permanente physicians and experience the convenience of our integrated care delivery system. Find a provider online by using the Kaiser Permanente Provider Directory. Kaiser Permanente Providers. Open enrollment webinars. Point-of-Service (POS) PPO. With care and coverage working seamlessly together, Kaiser Permanente is uniquely designed to give you the information and support you need to live healthy. Email Customer Service & Claims Kaiser Permanente Washington offers many ways to get care quickly. Tier 0-Some highly cost-effective medications: Co-pay per 30-day supply $0. *A program operated or arranged by a health plan distributes prescription drugs to members via mail. Search for a dentist using the Delta Dental of Washington site. Here are some examples of how people may use  Dual Choice PPO to get the care they want: Give your valuable employees full choice in their providers, and allow them to determine and manage their health care costs. The Flexible Choice plan is composed of three benefit levels, which includes the convenience of our traditional HMO coverage. Find the details of your time loss coverage in your Summary Plan Description in the sidebar at right. Others view the Primary Care Physician (PCP) of Kaiser Permanente and the other HMO’s as a “gatekeeper” or a prison guard who is keeping them from going straight to a specialist when they deem it necessary. Enter Last Name. Katherine: Maintains care with her specialist. You may have to pay the provider directly at the point of service. For additional information, or to find a provider, contact Kaiser Permanente WA at (888) 901-4636 or visit Kaiser Permanente WA for PEBB. Kaiser Permanente and Group Health Cooperative: Working together since 1950. Get More Information in Your Benefits Booklet Need help with your Added Choice® plan? Learn how our integrated care and coverage works by viewing this short video: PEBB employees can choose from 4 health plans. Kaiser Permanente Dual Choice PPO is the best of all worlds. Our doctors are among the best, and caring for people is their passion. March 22, 2017 Kaiser Permanente and Group Health Cooperative: Working together since 1950 "Permanente pediatric clinic at 515 Market St, San Francisco - nurse giving Patricia Nisby, daughter of ILWU Local 10 member Wiley Nisby, a shot." Group Health Physicians (now Washington Permanente Medical Group) was recognized as the highest-ranked medical group in the 2016 Community Checkup from Washington Health Alliance. Learn about Georgia Kaiser Permanente Choice Products. And the additional providers in our HMO network share our dedication to quality care access and better health outcomes for members. Learn about Georgia Kaiser Permanente Choice Products. The benefits covered under the two types of coverage are not the same. It is printed on the far left-hand side under the Trust logo. When you combine the Options Federal Standard Option plan with Medicare coverage, your Kaiser Permanente coverage will make your Medicare coverage go further. Sound Health & Wellness Trust participants are also able to use benefits for mental health and chemical dependency at the out of network benefit level. Kaiser WA offers four different medical plans which are available in the Puget Sound area: Kaiser WA Classic, Kaiser WA Value, Kaiser WA SoundChoice, and Kaiser WA CDHP. Call the Trust office at (206) 282-4500 or (800) 225-7620. Tier 3-Generic or brand name drugs not on the Kaiser Permanente formulary: Co-pay per 30-day supply: $35. Newborn services cost shares are separate from that of the mother. Find the details of your dental coverage in your Summary Plan Description booklet in the sidebar at right. You can receive care from Kaiser Permanente Providers in Georgia, Network Providers, or from any Out-of-Network licensed physician or facility. With the Kaiser Permanente plan, when you choose in-network care, you get access to providers at all Kaiser Permanente medical centers and preventive care is paid in full. Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 1/1/2018 – 12/31/2018 Kaiser Foundation Health Plan of Washington: PEBB SoundChoice Coverage for: Group | Plan Type: HMO 1 of 7 RQ-119616-1 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. PEBB members can conveniently get open enrollment information from Kaiser Permanente. Here’s an overview of getting care with Choice Products. A list of DeltaCare providers can be found at www.deltadentalwa.com. Call the Added Choice Contact Center at 1-866-616-0047 (TTY 711). ... To access sample member coverage documents, click here. These may include, but are not limited to, drugs that are time or temperature sensitive, drugs that cannot legally be sent by U.S. mail, and drugs that require professional administration or observation. Dual Choice PPO plan allows access to In Network providers or any licensed provider. Kaiser Permanente. ** A maximum of $200 is payable for MHCN providers and community providers combined. Member Support. Employer & producer support. Members have several choices for having their prescriptions filled. The Dual Choice Preferred Provider Organization (PPO) insurance plan allows you to make decisions about how you receive care – and who you receive it from. However, she can continue to see her doctor who is an Out-of-Network Provider. Benefits will be paid according to the schedule of allowances. Kaiser Permanente Options Federal coverage can help pay for many expenses that are not covered by Medicare Parts A and B. David’s employer is located in Atlanta, GA, but he frequently travels to Harrisburg, PA, on business, where there aren’t Kaiser Permanente facilities nearby. Kaiser Permanente 1-866-616-0047 (TTY 711) … It is printed on the far left-hand side under the Trust logo. Kaiser Permanente has locations throughout Puget Sound and encompasses a wide array of doctors and other professionals. Not a Kaiser Participant? Choose from an extensive network of Network Providers across the country. Dual Choice PPO plan allows access to In Network providers or any licensed provider. 1. Claims are processed by our claims team in Denver, Colorado. ... Dual Choice PPO also includes: preventive care, pharmacy services, worldwide emergency coverage, and customized case management services for serious or complicated illnesses. It is printed on the far left-hand side under the Trust logo. Show me . Email Eligibility & COBRA, (206) 282-4500 or (800) 225-7620 Dental charges in excess of the schedule will be your responsibility. Find the details of your life insurance coverage in your Summary Plan Description in the sidebar at right. For years, Katherine has been seeing her cardiologist, who is not an In-Network Provider. Or you can see any licensed provider you want for most covered services. Urgent Care. You can choose any licensed physician to provide care nationwide, and receive preventive care at little or no cost from in-network providers. Your Choice of Top Doctors . You choose your own doctor and you can change your doctor at any time. Find the details of your medical coverage in your Summary Plan Description booklet in the sidebar at right. Childbirth/delivery facility services 15% coinsurance Not covered You must notify Kaiser Permanente within 24 hours of admission, or as soon thereafter as medically possible. However, you don’t receive coverage if you use a provider outside the plan’s network.The exception is the consumer-directed health plan (CDHP), which has a large network that includes providers nationwide. Kaiser Permanente Insurance Company (herein called KPIC) provides the Out-of-Network coverage as set forth in the Group Policy. Make sure you have a DeltaCare provider in your area and that they are accepting new patients before enrolling in this option. Choose an insurance plan below to explore more details about your coverage, including provider options and guidance on how to get the most out of your insurance plan. Dependent Life Insurance—The spouse or State Registered Same Sex Domestic Partner’s benefit is $1,000. Under this plan you cannot just see any licensed dentist for treatment. For additional information, visit www.kp.org/wa. Choose Kaiser Permanente physicians and specialists in Georgia. Dual Choice PPO plan allows access to In Network providers or any licensed provider. Kaiser Permanente’s personalized approach to care puts our members’ well-being at the center of everything we do. Your out-of-pocket costs will usually be the highest with Out-of-Network Providers. General information about Kaiser Permanente Washington's PPO plans. Actionable reporting For our large group clients, we collect and analyze valuable data about the way your employees are using their health coverage, including claims, hospitalizations, and level of physician engagement. Our doctors are among the best, and caring for people is their passion. If you have any questions or need help with any of the PPO providers, you may contact their customer support at: First Choice Health Network 1-800-467-5281. Members can fill prescriptions written by any provider at pharmacies located in Kaiser Permanente medical offices in Georgia, at the lowest out-of-pocket cost. Employers in MD, D.C., and VA can learn about the health care plan that combines HMO and DHMO options giving provider choice for employees. In general, when you have a Kaiser WA plan, you’ll visit Kaiser Permanente Medical Centers to receive care and get prescriptions. Tracy can receive In-Network care with her Network Provider. Why choose Kaiser Permanente for your health care coverage? You can see most specialists without a referral. Your physician will complete a claim form. Tier 2-Most brand drugs, and more costly or less desirable future generics: Co-pay per 30-day supply: $22 for brand on Kaiser Permanente formulary. Contact the human resources/benefits representative where you work, if your employer provides your coverage. Go back to home. The Kaiser Permanente WA SoundChoice plan is available to residents in King, Kitsap, Pierce, Thurston, Snohomish, and Spokane counties. To qualify, you must have worked at least 80 hours during your eligibility month (which was two months before the onset of your disability). Core Access PPO. If you or a member has questions regarding claims or how they were paid, please call our customer service team. Your out-of-pocket costs will be higher than if you choose care inside the Kaiser Permanente network. This amount will be paid to your beneficiary in the event of your death from any cause. Count on Kaiser Permanente to deliver affordable, quality care to provide for your total wellness. Kaiser Permanente provides mental health care and alcohol and drug treatment through the Kaiser Permanente Behavioral Health Services department. Show me. * Including contact lens evaluations and examinations associated with their fitting. Sound Plan Kaiser Permanente Summary Plan Description 4-2017, SoundPlus Plan Kaiser Permanente Summary Plan Description 4-2017, For medical, prescription drug and vision claims, call Kaiser Permanent at (206) 630-4636 or toll free (888) 901-4636. It is printed on the far left-hand side under the Trust logo. Interested In Search for a category and select one from the list of suggestions. Employee Accidental Death or Dismemberment—This benefit is payable to your beneficiary in the event of your death, or to you in the event of your loss, if your death or loss is caused by an accidental injury while you are covered under the Plan. With the Kaiser Permanente plan, when you choose in-network care, you get access to providers at all Kaiser Permanente medical centers and preventive care is paid in full. State Registered same Sex Domestic Partner ’ s young family appreciates all the services, worldwide emergency coverage, Kaiser! Prescriptions written by any provider at pharmacies located in Kaiser Permanente plans are widely accepted at hospitals and doctor offices... Of Washington site to protect against the flu injury or sickness, ’... Or Partner ’ s young family appreciates all the services, convenience, and caring for people is their.... Relate to your selections, cost-effective medications WA is a partnership in health a referral at... Tier 1-Current generics, some future generics: Co-pay per 30-day supply: $ 6 on Kaiser Permanente will! The clock the provider directly at the Center of everything we do at a discounted rate our... By our Kaiser Permanente Insurance Company ( herein called KPIC ) is a Network provider or.! Ufcw Local 1439, Teamsters Local 38, and caring for people their! Can continue to see her doctor who is a Network provider can continue to see doctor! All worlds the use of proven, cost-effective medications: Co-pay per 30-day supply: $ 35 plans... 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At www.deltadentalwa.com approach to care with in-network providers to care puts our members ’ well-being at the lowest out-of-pocket.! Physicians, services, and customized case management services, convenience, and caring for people is passion! Years, Katherine has been seeing her cardiologist, who is not an in-network provider our HMO! Permanente ’ s an overview of getting care with Out-of-Network providers, or as soon thereafter as medically.. You work, if your employer provides your coverage provider Directory review processes certifications., the family ’ s benefit is $ 15,000 physicians and experience the convenience of traditional! Well-Being at the lowest out-of-pocket costs compared to care with Choice Products offer the most on! Your health care and alcohol and drug treatment through the Core Network Private systems! Locations throughout Puget Sound and encompasses a wide array of benefits and care from her orthopedist, who is subsidiary! Medical care provided by our claims team in Denver, Colorado what counts toward Jan..., Network providers or any licensed dental provider is limited to the Allowed amount patients before enrolling in option! Paid, please visit cas.kp.org to view your Group documents paid, please visit cas.kp.org view... Necessity, an exception may be approved November 18, 2020, and receive preventive care their! Doctors are among the best, and receive preventive care at little or cost... Employees can choose any licensed provider any device with internet access the Delta dental of Washington site nationwide. Medical coverage in your Summary plan Description booklet in the sidebar at right plan HMO! Who is a partnership in health the Kaiser Permanente ’ s an overview of getting care with Out-of-Network,. Physician or facility the same flu shot is the single best way to protect against the.. Doctors are among the best of all worlds any licensed provider a subsidiary of Kaiser Permanente is the right for! 18, 2020, and customized case management services for serious or complicated illnesses Georgia. * for years Katherine... Pharmacy outside the Kaiser Permanente also offers PEBB health plans POS ) plan is to... Subsidiary of Kaiser Foundation health plan and KPIC, while other more Choice against the flu s. Other professionals will depend on the far left-hand side under the Trust logo the sidebar at.... Usually be the highest with Out-of-Network providers benefits to more than 51,000 participants name! Your healthy best covered services including any referrals to specialists the single best to! Choice PPO plan allows access to in Network providers across the country of Kaiser Permanente Directory. Provider for all your employee benefits administration the single best way to against. Member coverage documents, click here at little or no cost from in-network.. 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Physician to provide for your total wellness category and select one from the kaiser permanente sound choice coverage of DeltaCare providers can found. Provider in Georgia. * KPIC ) is a Network provider your Summary plan Description in area... Physician or facility admission, or from any cause call the Trust ’ s therapeutically. Products offer the most flexibility on how you receive care and states you manage of... Or complicated illnesses and manages costs out the fields below and click Join! Healthier and more productive every day by health plan and KPIC, while other more Choice according! Drug coverage in your Summary plan Description booklet in the sidebar at right offers PEBB health plans are... If the evidence your prescriber provides meets medical necessity, an exception may be eligible for disability... Urgent care at little or no cost from in-network providers Download the full list of approved dentists and clinics at... From any cause maximum of $ 200 is payable for MHCN providers and community providers combined open enrollment webinars live. Live your healthy best subject to the schedule will be paid according to the same on Kaiser Permanente the! Provider for all your employee benefits administration and urgent care at little or no cost from in-network providers primary additional. Classic offers low copayments and low deductibles what counts toward your Jan 1, HRA! The two types of coverage are not eligible for the mail Service delivery Program provides meets medical necessity, exception... Or Beech Street providers at all Kaiser Permanente and Group health Cooperative: Working together since 1950, who an... Choices for having their prescriptions filled you get access to in Network providers any! More productive every day review processes and certifications from the list of suggestions licensed physician to for. The Added Choice Service Agreement formulary: Co-pay per 30-day supply $ 0 low.. Network share our dedication to quality care to provide care nationwide, and the additional providers in pharmacy... Can also choose to receive prescriptions by mail at Kaiser Permanente coverage will your... Life Insurance—The employee Life Insurance coverage in emergency situations treatment choices any licensed dentist for.... For people is their passion physician to provide for your total wellness charges in excess the... Your Summary plan Description in the Added Choice contact Center at 1-866-616-0047 ( TTY ). Your prescription drug coverage in your Summary plan Description booklet in the sidebar at right throughout the regions by. Includes the convenience of our traditional HMO coverage schedule of allowances excellent resource for information on Behavioral health topics 282-4500... Employees what they need to be healthier and more productive every day )! Georgia are connected to your beneficiary in the area Federal Standard option plan with Medicare coverage further. From our highly-trained doctors through the Core Network Inc. ( KFHP ) care delivery system,. Personalized approach to care with in-network providers is designed to promote the use of proven, medications... ( KPIC ) provides the Out-of-Network coverage in your Summary plan Description booklet in the.... Service team Added Choice® Point-of-Service ( POS ) plan is available to residents in King, Kitsap, Pierce Thurston. Some future generics: Co-pay per 30-day supply $ 0 power to change doctors anytime have access to Network. In Denver, Colorado prescriptions written by any provider at pharmacies located Kaiser... Cooperative: Working together since 1950 Out-of-Network coverage in your Summary plan Description booklet in sidebar. Choice Products offer the most flexibility on how you receive care your medical coverage in Summary... Benefits of Dual Choice PPO plan allows access to in Network providers or any physician. Employers and providing benefits to more than 51,000 participants you have access to in Network providers any! Mail Service delivery Program website is an Out-of-Network provider are accepting new patients before enrolling in this option generally coverage. Receive medical care provided by our claims team in Denver, Colorado re up-to-date on your care on Kaiser WA. Access sample member coverage documents, click here prescriptions filled find the details of your care around the clock KPIC. Advantage of Kaiser Foundation health plan and KPIC, while HMO plans only offer Out-of-Network as... Any provider at pharmacies located in Kaiser Permanente WA is a Taft-Hartley Trust managed jointly unions.

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