Helping you stay covered Options for continuing your membership for 2014 1014KPMCвЂ‘13/11вЂ‘13 All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest. 500 NE Multnomah St., Suite 100, Portland, OR 97232. Going through change can be stressful, so itвЂ™s nice to know that continuing your health care coverage doesnвЂ™t have to be. 2 Staying covered just got easier Right now you have more options than ever before for how you get and pay for coverage. And with the federal Affordable Care Act (ACA), also known as health care reform, you now have historic levels of choice and control. Health coverage is something you just canвЂ™t afford to be without. If you donвЂ™t have coverage, youвЂ™re putting your health and your finances at risk. And even if youвЂ™re healthy now, you need to protect your future. By staying with Kaiser Permanente, you can rest easy. You donвЂ™t have to worry about what to do or where to go if you get sick, injured, or pregnant. ThereвЂ™s no starting over with someone who doesnвЂ™t know you and your health needs. You can keep the doctors you know and trust, and if you have children they can have their same pediatrician. YouвЂ™re covered, with excellent care and convenient facilities that offer multiple services under one roof. We want to make it simple and stress-free for you to stay covered. WeвЂ™ll even help guide you through the process. If you have any questions about your plan options, please visit kp.org/continuecoverage or call Membership Services at 1-800-813-2000. 3 A few things to kno Health care reform and you The ACA has made the biggest change in the U.S. health care system since Medicare was established in 1965. It gives you more protections and easy access to high-quality health coverage. Visit kp.org/reform for more details. вЂў You can no longer be denied coverage, or dropped from your plan, if you have a medical condition or get sick. вЂў You donвЂ™t have to pass a medical exam to qualify for coverage. вЂў No annual or lifetime dollar limits on essential health benefits. вЂў You can apply for federal financial assistance that can help lower your health care costs. OregonвЂ™s and WashingtonвЂ™s state-run health insurance marketplaces, Cover Oregon (coveroregon.com) and Washington Healthplanfinder (wahealthplanfinder.org), let you shop, compare, and buy health care coverage. Or if youвЂ™d like, you can get your coverage directly from us. The ACA requires most U.S. citizens and those lawfully present in the U.S. to have minimum essential health coverage starting January 1, 2014. If you donвЂ™t have coverage or receive coverage from an employer, and go without it for three months or longer (or one month or longer if you had a previous coverage gap that same year), you may be charged a tax penalty by the government. Make sure you maintain your coverage before itвЂ™s too late. 4 ow beforeвЂ‚ you start Important dates to remember Special enrollment The loss of your employer-sponsored coverage means you are eligible for a special enrollment period. Your special enrollment period lasts 60 days after the date on which you lose (or would lose) coverage. For COBRA, State Continuation, and Temporary Continuation of Coverage (TCC) You have 60 days after receiving your COBRA election notice to choose whether or not to sign up. Contact your former employer to find out whether youвЂ™re eligible and how you can enroll. Open enrollment Other than special enrollments, the only time you can enroll through Cover Oregon, Washington Healthplanfinder, or directly from Kaiser Permanente is during the open enrollment period. Open enrollment for 2014 coverage is from October 1, 2013, through March 31, 2014. Open enrollment for 2015 coverage will begin in fall of 2014. Take the first step toward staying covered Find out all your options > > > Begin on page 6 You have so many new options at your fingertips, so let us give you a step-by-step guided tour. Step 1 > Choose how youвЂ™d like to continue your coverage Step 2 > Explore your options Step 3 > Stay covered You can also visit kp.org/continuecoverage to use our online tool. Just answer a few simple questions and you can get plan recommendations customized just for you. If you have any questions, please call Membership Services at 1-800-813-2000. 55 Step 1: Choose how youвЂ™d like to continue y DIRECTLY THROUGH KAISER PERMANENTE > See page 8 Kaiser Permanente for Individuals and Families вЂў Lots of plan types to choose from вЂў Coverage to fit your needs and budget вЂў A Kaiser Permanente health plan specialist to help you find the right plan Kaiser Permanente Senior Advantage (HMO) plan Are you eligible for Medicare? Kaiser Permanente coverage combined with original Medicare. Includes Medicare Part D prescription drug coverage. If youвЂ™re a Kaiser Permanente Senior Advantage member whose group coverage is ending, you may have already received information from us about our Kaiser Permanente Senior Advantage plan for individuals. If you want more information, please contact us to learn how you can continue your Kaiser Permanente membership. THROUGH THE HEALTH INSURANCE MARKETPLACE > See page 11 Kaiser Permanente for Individuals and Families plans at Cover Oregon & Washington Healthplanfinder вЂў Federal help with premiums and out-of-pocket expenses if you qualify вЂў Shop, compare, and buy health care coverage вЂў A health plan specialist to help guide you through coveroregon.com and wahealthplanfinder.org 6 your coverage THROUGH YOUR FORMER EMPLOYER > See page 13 COBRA, State Continuation, and TCC вЂў Easy way to temporarily keep your coverage вЂў Coverage is the same you had through your group THROUGH STATE AND CHARITABLE HEALTH PROGRAMS > See page 14 Medicaid вЂў Coverage for low-income Oregon and Washington residents who meet established income guidelines Child Health Program вЂў Coverage (including dental) for uninsured children in grades KвЂ“12 whose family income meets a certain qualifying level Find out all your options Visit kp.org/continuecoverage to use our online tool. Just answer a few simple questions and you can get plan recommendations customized just for you. If you have any questions, please call Membership Services at 1-800-813-2000. 7 DIRECTLY THROUGH KAISER PERMANENTE Step 2: Explore your options Kaiser Permanente for Individuals and Families plans Choose from a range of plans to fit your needs and budget. You can pick one plan for your entire family or separate plans for each person. Shopping for a Kaiser Permanente plan You can select from several levels of coverage. BRONZE вЂў вЂў вЂў вЂў SILVER GOLD MINIMUM COVERAGE All plan levels offer the same essential health benefits (such as doctor visits, hospital care, prescriptions, and maternity care) and include most preventive services for no charge. The categories donвЂ™t reflect the quality or amount of care the plans provide. YouвЂ™ll still receive the same Kaiser Permanente care that you are used to. The main difference is how you pay for coverage. Our Bronze plans generally offer lower premiums and higher out-of-pocket costs. Gold plans generally have higher premiums and lower out-of-pocket costs. To qualify for the minimum coverage plan, you must be under 30 when the plan goes into effect. If youвЂ™re 30 or older, you must prove financial hardship or lack of affordable coverage with a certificate from the health insurance marketplace. Conversion coverage (Washington state) If you are no longer eligible for health care benefits under your employerвЂ™s plan with Kaiser Foundation Health Plan of the Northwest (KFHPNW), and you are not eligible to enroll in a different group plan offered by your employer, you may enroll in one of our plans for individuals and families. To be eligible for this conversion coverage, you must live within the KFHPNW service area and must not have coverage under another health plan. For more information on our plans for individuals and families, please visit buykp.org. 8 Are you eligible for Medicare? Kaiser Permanente Senior Advantage (HMO) plan With Senior Advantage, you get all of the benefits of Kaiser Permanente membership, including Part D prescription drug coverage, combined with Original Medicare. Plus, you can keep seeing your Plan doctor and continue to receive the quality care youвЂ™ve come to expect as a Kaiser Permanente member. If you are a Kaiser Permanente Senior Advantage member whose group coverage is ending, you donвЂ™t need to do anything right now. WeвЂ™ll send you information about our individual plan coverage (which is different from your group coverage), and what you need to do to continue your membership. If you have any questions, call Membership 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. 9 DIRECTLY THROUGH KAISER PERMANENTE Kaiser Permanente is an HMO plan with a Medicare contract. You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. H9003_NWCOC1113 accepted Step 3: Pick a plan and stay covered Contact us now If youвЂ™d like to buy your new individual or family plan directly through Kaiser Permanente, call us at 1-800-494-5314 or visit us at buykp.org. WeвЂ™ll help you compare plans, get a quote, and find the plan thatвЂ™s right for you. 10 10 THROUGH THE HEALTH INSURANCE MARKETPLACE Step 2: Explore your options Kaiser Permanente for Individuals and Families plans through Cover Oregon & Washington Healthplanfinder Health insurance marketplaces, sometimes known as the health insurance вЂњexchanges,вЂќ are federal or state-run markets where you can buy health care coverage and apply for financial assistance from the federal government. In Oregon, itвЂ™s called Cover Oregon, and you can find it online at coveroregon.com. In Washington, the state exchange is Washington Healthplanfinder, online at wahealthplanfinder.org. You can buy your Kaiser Permanente plan directly from us, Cover Oregon, or Washington Healthplanfinder. We have tools and support that can help you find the Kaiser Permanente plan that works best for you, even if you buy through the marketplaces. Getting federal financial assistance To get federal financial help in paying for care and coverage, youвЂ™ll need to buy your plan through Cover Oregon or Washington Healthplanfinder. вЂў Help is available for premiums and out-ofpocket expenses. вЂў If you qualify, the federal government can pay Kaiser Permanente any financial assistance on your behalf. вЂў Assistance will be on a sliding scale, based on income and family size. This chart will give you an idea of whether you and your family may qualify: Number of people in household Annual family income level* 1 2 3 4 5 6 7 8 $45,960 or below $62,040 or below $78,120 or below $94,200 or below $110,280 or below $126,360 or below $142,440 or below $158,520 or below *2013 modified adjusted gross income levels; assistance will be based on your estimated 2014 modified adjusted gross income. 11 THROUGH THE HEALTH INSURANCE MARKETPLACE Shopping for a Kaiser Permanente plan You can select from several levels of coverage. BRONZE вЂў вЂў вЂў вЂў SILVER GOLD MINIMUM COVERAGE All plan levels offer the same essential health benefits (such as doctor visits, hospital care, prescriptions, and maternity care) and include many preventive services for no charge. The categories donвЂ™t reflect the quality or amount of care the plans provide. The main difference is how you pay for coverage. Our Bronze plans generally offer lower premiums and higher out-of-pocket costs. Gold plans generally have higher premiums and lower out-ofpocket costs. To qualify for the minimum coverage plan, you must be under 30 when the plan goes into effect. If youвЂ™re 30 or older, you must prove financial hardship or lack of affordable coverage. Federal financial assistance is not available with this plan. What if you donвЂ™t qualify for federal financial assistance? Even if you canвЂ™t get assistance from the federal government, you can still buy a Kaiser Permanente plan directly from us or through the marketplaces. We have lots of plan options. Step 3: Contact us and stay covered Contact us now For help with Cover Oregon or Washington Healthplanfinder and finding the Kaiser Permanente plan that works best for you, please visit kp.org/continuecoverage or call Membership Services at 1-800-813-2000. Explore plans and rates 12 12 Buykp.org lets you compare individual or family plans, get a quote, and see if you might be eligible for financial assistance. ThereвЂ™s even an easy-to-use online tool to give you an estimate of how much federal assistance you may receive to help pay your premium. THROUGH YOUR FORMER EMPLOYER Step 2: Explore your options COBRA, State Continuation, and TCC If you lose your group coverage, you may be eligible for temporary continuation of the same coverage through COBRA, State Continuation, or TCC (TCC is for eligible Federal Employees Health Benefits Program (FEHBP) members only). COBRA Most employers with at least 20 employees must offer COBRA coverage. All eligible family members who were covered under your original group plan may apply. State Continuation If you are not eligible for COBRA, Medicare or other group coverage, and your coverage was through an employer with fewer than 20 employees, you may be eligible for State Continuation coverage. To be eligible, you must have been covered by your group plan for at least three consecutive months. In Oregon, the employer is required to offer state continuation coverage. In Washington, the employer may opt out of State Continuation coverage or offer KFHPNW conversion coverage. Temporary Continuation of Coverage (TCC) If you were covered under the FEHBP, you may be eligible for TCC. You must notify your employing office within 60 days of a qualifying event in order to obtain TCC for a child who loses FEHBP coverage. Step 3: Call your employer and stay covered Act now For COBRA, State Continuation, and TCC plans, youвЂ™ll need to contact your former employer to find out whether youвЂ™re eligible, what the premiums are, and how you can enroll. If you have any questions, please visit kp.org/continuecoverage or call Membership Services at 1-800-813-2000. 1313 THROUGH STATE AND CHARITABLE HEALTH PROGRAMS Step 2: Explore your options State and charitable health programs For people with unique needs and circumstances, there are several different types of programs available. HereвЂ™s a look at some options and how to find out if you qualify. Medicaid Who may be eligible? Oregon and Washington residents who meet established income guidelines and certain qualifying conditions. For more information on eligibility and how to apply: вЂў Call your county social services office, ask for a Medicaid eligibility worker. вЂў Visit your county website. вЂў Visit the Oregon Health Authority website at oregon.gov/oha or the Washington State Health Care Authority website at hca.wa.gov. Child Health Program (Oregon) Children who do not qualify for federal financial assistance in the marketplace (Cover Oregon) may qualify for the Child Health Program. Who may be eligible? Children who: вЂў are enrolled in grades K-12 вЂў are not eligible for health care coverage вЂў are in families with income в‰¤ 300 percent of the Federal Income Guidelines For more information: вЂў Call Membership Services at 1-800-813-2000, 8 a.m.вЂ“6 p.m., Monday through Friday. TTY users, call 711. вЂў Visit us at info.kp.org/childhealthplan. Step 3: Contact us and stay covered Contact us now 14 14 For help understanding your options and finding the right fit for you and your family, visit kp.org/continuecoverage or call Membership Services at 1-800-813-2000. 1515 Losing your health coverage? Look inside ... kp.org/continuecoverage Kaiser Permanente Membership Services MondayвЂ“Friday, 8 a.m. to 6 p.m. 1-800-813-2000 711 (TTY) Language interpretation services: 1-800-324-8010 1014KPMCвЂ‘13/11вЂ‘13 Please recycle. This material was produced from eco-responsible resources. В©2013 Kaiser Foundation Health Plan of the Northwest