Kaiser Permanente
v
Kaiser Permanente Northwest Region
Enrollment Service Area
Kaiser Permanente
Senior Advantage Medicare Plan
The Value of Kaiser Permanente Sr. Advantage
Medicare Plan and PHIP Partnership
Enhanced Medicare Part D prescription coverage
• Broad list of coverage prescriptions
Enhanced Medicare plan
• Low copays for: office visits, inpatient hospitalization,
outpatient surgery, MRI/CT/PET scans, and ambulance
• Low out-of-pocket maximum
• Vision hardware benefit
• International travel benefit
Kaiser Permanente Sr. Advantage Medicare
Plan
How Our Plan Works
Providers
• Exclusive access to Kaiser Permanente doctors and facilities
• Choose your Kaiser Permanente provider and change at any time
Locations
• 36 medical offices from Longview to Salem, plus access to 7
additional locations at The Portland Clinic
• 17 dental offices
• Kaiser Sunnyside Medical Center in Clackamas, and Kaiser
Westside Medical Center in Hillsboro
• Contracted hospitals: Legacy Salmon Creek Medical Center,
Salem Hospital and OHSU Doernbecher Children’s Hospital
Kaiser Permanente Sr. Advantage Medicare
Plan
How Our Plan Works
Copays for most services, no deductible
• Predictable costs without surprises
Convenience and Quality
• Medicare’s highest possible rating in Oregon and Washington in
2016*
• Care where and when you want it:
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Phone appointment
Video appointments
24/7 Nurse advice
• Services under one roof
• Local mail-order pharmacy
*Rated by Centers for Medicare & Medicaid Services Health Plan Management System, Plan Ratings 2012-2016. Kaiser
Permanente contract #H9003. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each
year and may change from one year to the next.
Kaiser Permanente Sr. Advantage Medicare
Plan
Emergency and Travel Benefits
Service
Kaiser Permanente Sr. Advantage
Urgent Care
$15 copay
(Worldwide coverage)
Emergency Room
$50 copay
(Worldwide coverage)
Ambulance
$50 copay
(Worldwide, air or ground)
Out of Area Travel:
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Within the U.S.
Out of Area Travel:
Outside the U.S.
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Visiting Member – If you travel to another Kaiser or
Group Health region (90 day limit for Group Health)
Additional travel benefit – covers routine, preventive,
& follow-up care outside Kaiser network at 20%
coinsurance, up to $1,000 annual plan-paid benefit
maximum.
Kaiser Permanente Sr. Advantage Medicare
Plan
Special Benefits and Services
KP HealthConnect
• Advanced electronic medical record system
securely connects your entire Kaiser
Permanente medical team to each other—and
to you.
• Outpatient
• Inpatient
• Lab and X-ray
• Dental
Care In The Palm Of Your Hand (kp.org)
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Make an appointment
Email your doctor
Check test results
Prescriptions by mail
Kaiser Permanente Sr. Advantage Medicare
Plan
Special Benefits and Services
Silver &Fit ® Program
• Free membership at participating fitness clubs
or a home fitness kit for those who prefer not to
go to a club
• Hundreds of fitness clubs/exercise facilities,
including Curves® , 24 Hour Fitness® , community
centers and more
Kaiser Permanente
Non-Medicare Plans
Kaiser Permanente Non-Medicare Plans
Features
Kaiser Permanente
Core Value Plan
Type of Plan
Deductible
Kaiser Permanente
Select Value Plan
HMO
None
$1,000
Primary Care Physician
Required
Referral Requirement
Required
Network
Alternative Care
Kaiser Permanente and The Portland Clinic
Included
Kaiser Permanente Non-Medicare Plans
• CHP Active & Healthy discounts - bring healthy balance to
your life
• Save money on hundreds of fitness, wellness and entertainment
activities
www.chpactiveandhealthy.com
Kaiser Permanente
Prescription Drug Plan
Prescription Drug Plan
• Pharmacies located in most medical offices
• Comprehensive list of covered medications
• Prescription formulary at: www.kp.org/formulary
• Local mail-order pharmacy
• Up to a 90 day supply available through mail-order has $300
maximum for mail-order maintenance drugs
• Order online or by phone
• Most prescriptions are delivered within a few days at no
additional cost
• More pharmacy resources at www.kp.org/pharmacy
Kaiser Permanente
Dental Plan
Available for all PHIP Health Plans
For Kaiser Permanente dental, you must reside in the
Kaiser Permanente dental plan service area
Kaiser Permanente Dental Plan
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17 dental locations
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Integrated with Kaiser Permanente medical plans
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No deductible
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$1,500 annual benefit maximum
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(Preventive charges do not apply.)
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$10 office visit copay; includes preventive care
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Additional coinsurance for basic and major services