Member Guide - Medicare Advantage HMO Kaiser Permanente .
Member GuideKaiser Permanente Medicare Advantage HMOkp.org/wa/medicareH5050 MA0001442 57 20 C
1Important phone numbersMember ServicesMental Health Access Center1-888-901-4600206-630-4600711 (TTY)8 a.m. to 8 p.m., 7 days a week1-888-287-1680206-901-6300Get information about: Getting care. Choosing or switchingdoctors, where to go for care, referrals forspecialists, and on-the-job injuries.Coverage. What your health plan does anddoesn’t cover, and coverage while traveling.Billing. Statements, payments, andreimbursements.Language services. If your primarylanguage is not English.New Member Welcome Team1-888-844-4607206-630-0029Get help transferring your care orprescriptions to Kaiser Permanente.Consulting Nurse Service1-888-297-6877206-630-2244Get health care advice 24 hours a day,7 days a week.Schedule first-time appointments for mentalhealth care, including addiction and recovery.Care Management services1-888-901-4600206-630-4600711 (TTY)8 a.m. to 8 p.m., 7 days a weekGet help managing chronic health conditions.Hospital Notification Line1-888-457-9516Call if you’ve been hospitalized for anemergency.Prescription refills1-800-245-7979Sign in at kp.org/wa/pharmacy or call us toorder refills or transfer prescriptions.Resource Line1-800-992-2279Get information on health topics, communityresources, services for seniors, and supportgroups in your area.Delta Dental of Washingtondeltadentalwa.com1-800-554-1907Monday through Friday, 8 a.m. to 5 p.m.Find links to providers, pharmacies, and the Medicare Part D formulary atkp.org/wa/medicare. Register for personal online services and you’ll beable to check your health coverage and benefits, order prescription refills,complete a health risk assessment, and more.
2Kaiser Permanente Medicare Advantage HMO ContentsYour Kaiser Permanente Member GuideWelcome to your go-to source for understanding your care options,finding health resources, and more. Getting and staying healthy startswith taking advantage of all that Kaiser Permanente has to offer.ContentsYour member ID card . 3Your careChoose your doctor . 4Staying wellResources for healthy living . 14Preventive care . 15Care locations near you . 5Be informedRoutine care and care advice . 6Protecting your privacy and security . 16Specialty care . 7Your medical treatment . 17Urgent and emergency care . 8Coverage decisions . 19Getting prescriptions filled . 9Your rights and responsibilities . 21Supportive care services . 10Definitions you should know . 24Managing your health online . 11Nondiscrimination notice andlanguage access services . 26Care away from home . 12Paying for your care . 13The information in this Member Guide (current as of November 2020) is subject to changewithout notice. If you have questions, or to get the latest information, call Member Services orvisit kp.org/wa/medicare.
3Kaiser Permanente Medicare Advantage HMO Your member ID cardYour member ID cardYour Kaiser Permanente member ID card willbe mailed to you. You need your member IDcard or ID number to: Get care at our facilities and with other plannetwork providers Fill prescriptions Sign in at kp.org/wa to use personalonline services Get assistance from Member ServicesKaiser Foundation Health Plan of WashingtonID 12345678John SampleMedicare Advantage HMOCMS# H5050 XXXRxBIN 610011RxPCN IRXMedical RxGrpadvice: GCOCOMMCall 7.Life-threateningemergency: Call 911 or localemergency number.Admitted to a hospital:Call 1-888-457-9516 within24 hours or as soon as possibleafter admission.Reimbursement for claims:Claims ProcessingPO Box 34585Seattle, WA 98124Member Services:206-630-4600 or1-888-901-4600(WA TTY Relay1-800-833-6388 or 711)Electronic Payer ID: 91051kp.org/wa/medicareMA0001902-50-17Digital ID card lets you manageyour care on the goYou can also access your membershipinformation anytime, anywhere, with theKaiser Permanente digital membership card —an electronic version of your membershipcard. Just register for online services,sign in, and find the link on your securehomepage. The digital card lets you check infor appointments, pick up prescriptions, andprovide your membership information —right from your smartphone.Helpful tipsCheck out the back of your card. You’ll finduseful numbers such as the Consulting NurseService, Member Services, and the number tocall if you’re admitted to a hospital.Call Member Services immediately if your IDcard is lost, stolen, or needs to be replaced.Write down your member ID numberand keep it in a safe place separate fromyour card.Download the Kaiser PermanenteWashington app. It’s as easy as 1, 2, 31. Register for online services at kp.org/wa/getstarted.2. Download the Kaiser Permanente Washington app from the app store onyour mobile device. Make sure the app you download has WA on the icon.3. Sign in with your member ID and manage your health careanytime, anywhere.
Kaiser Permanente Medicare Advantage HMO Your care Choose your doctor4Choose your doctor andchange anytimeEven if you don’t need to see a doctor right away, having apersonal physician is an important part of taking care of your health.Your personal physician coordinates your overall health care andmakes sure you’re connected with the resources you need.Choose the right doctorTo find a personal doctor who’s right for you,you can call Member Services or go online tokp.org/wa/medicare and choose “Providers.”You can then search for doctor profilesonline, or you can view our Medicare ProviderDirectory. For your personal physician, choosefrom these specialties: Family medicine Adult medicine/internal medicineBe sure to check that the doctor you’reconsidering is accepting new patients. If yourchoice doesn’t feel right after a few visits, youcan change personal doctors at any time, forany reason.If you don’t choose a doctor when you firstbecome a Kaiser Permanente member, we willmatch you with a physician to make sure youhave a doctor assigned to you if you get sickor injured.What to consider when youchoose a doctorMake a list of what’s important to you in adoctor. Here are some things to consider:gender, clinic location, medical interests,languages spoken, years of experience,cultural or personal background.Make an appointmentCall the doctor’s office to schedule anappointment. At the appointment, talk withyour doctor about your medical history,including any current conditions, knownhealth risks, and medications you’re taking.Review our preventive care schedules atkp.org/wa/wellcare and schedule anyimmunizations, tests, or screenings you’redue for.If you’ve chosen a personal physician at aKaiser Permanente facility, you can schedulean appointment online once you’ve registeredfor our secure member website.Help for new membersAre you in the middle of treatment? If you need help transferring your care orprescriptions from other providers and pharmacies to Kaiser Permanente, callour New Member Welcome Team at 206-630-0029 or 1-888-844-4607.
Kaiser Permanente Medicare Advantage HMO Your care Care locations near youCare locations near youOur Medicare Advantage HMO network includes doctors and hospitalsin every community we serve. You can switch to a different networkdoctor at any time.In addition to providers at Kaiser Permanente care facilities, there are thousands ofadditional in-network community providers who meet our high standards for care.The network includes both individuals and institutions, clinicians to cover virtuallyevery medical need, and at least one major hospital in every community. To becovered, you must use network providers except for emergencies and specialcircumstances such as out-of-area urgent care and dialysis. Some services requireprior authorization.Locations where you’ll find community doctors who are part of our MedicareAdvantage HMO network:AnacortesEverettMount VernonArlingtonEversonNine Mile FallsBellinghamFerndaleOak HarborBlaineFreelandPoulsboBurlingtonGig HarborSammamishCamano IslandGranite FallsSedro WoolleyCentraliaLa ConnerSheltonCheneyLiberty LakeSpokaneCoupevilleLyndenSpokane ValleyDarringtonLynnwoodStanwoodDeer ParkMedical LakeVashonFor the most up-to-date list of our providers, visit kp.org/wa/medicare/providers.5
Kaiser Permanente Medicare Advantage HMO Your care Routine care and care advice6Routine care and care adviceWe want it to be easy for you to get the care you need, so we offeronline, phone, and face-to-face options.OnlineE-visit*Go to kp.org/wa/onlinevisit and get apersonalized care plan and prescriptions forcommon health conditions. If your symptomscan’t be diagnosed online, we’ll quicklyconnect you to the appropriate care.Care Chat*Sign in to your secure account at kp.org/waand chat online with a Kaiser Permanenteprovider to get immediate care, treatment,and prescriptions, if necessaryVideo visit*Meet face-to-face with a Kaiser Permanenteclinician by video for high-quality,personalized care. Same-day or next-dayappointments are often available.Phone appointment*Doctors who practice at Kaiser Permanenteoften schedule phone appointments withestablished patients for health concernsor follow-ups that don’t require anin-person visit.Walk-in clinicsFind hours for walk-in clinics at a number ofour medical facilities (Everett, Olympia,Puyallup, Tacoma, and Riverfront in Spokane)at kp.org/wa. No appointment is needed.Office visitsEmail your care teamIf you get your care at Kaiser Permanentemedical facilities, you can sign in at kp.org/wa,email your care team’s office with nonurgentmedical questions and get a response within2 business days.See your doctorCall your personal physician’s office toschedule routine visits for preventive careor to discuss symptoms or health issues. AtKaiser Permanente, we’ll make every effort toget you an appointment with your personalphysician at a convenient time. You canalso sign in at kp.org/wa and schedule anappointment at our medical facilities.PhoneWomen’s health careConsulting Nurse ServiceIf you have an injury or troubling symptomswhen our offices aren’t open, you can call ourConsulting Nurse Service at 1-888-297-6877or 206-630-2244. The nurses are available24 hours a day, 7 days a week. They willassess your situation and help you decideon next steps — whether that’s self-care, anappointment with a provider, or a trip to thenearest urgent care or emergency facility.In addition to having a personal physician,women can refer themselves to women’shealth care providers for routine reproductivehealth care and gynecological care.Women’s health care providers includespecialty doctors such as gynecologistsand obstetricians, and physician assistantsor nurse practitioners specializing inwomen’s health.*When appropriate and available. If you travel out of state, virtual care could be limited due tostate laws that may prevent doctors from providing care across state lines. Laws differ by state.
Kaiser Permanente Medicare Advantage HMO Your care Specialty care7Specialty careWhen you need specialty care, your primary care doctor can recommenda specialist in your plan, or you choose one yourself from some of thenetwork specialists who practice at Kaiser Permanente.ReferralsYou can self-refer to some specialists atKaiser Permanente medical facilities. Onceyou’ve found a specialist you’d like to see orone your personal physician has suggested toyou, just call the specialist’s office and ask foran appointment.Visit kp.org/wa to find telephone numbersfor specialty departments at our medicalfacilities. For specialties at Kaiser Permanentethat don’t accept self-referrals, our staff will letyou know that you’ll need to first get a formalauthorization or referral from your primarycare doctor.For specialists in the Medicare AdvantageHMO network who don’t practice atKaiser Permanente, you’ll need to ask therecommending physician to submit a referralto get authorization from Kaiser Permanente.Once you’re under a specialist’s care, youcan contact the specialist’s office directly tomake appointments.Mental health carereferral from your personal doctor toaccess these services. You can call MentalHealth Access Center at 1-888-287-2680.They coordinate and authorize all mentalhealth care, including addiction and recovery,for plan members.Vision careRoutine eye exams and vision hardware arecovered by our plans. Many of our medicalfacilities have an optical center where youcan fill your prescription for contact lensesor eyeglasses. Visit kp.org/wa/eyecare forlocations, hours, and frame selections. Orfind an optician in your area in the providerdirectory at kp.org/wa/medicare.Hearing careYou can self-refer for a hearing evaluationfrom a Kaiser Permanente Audiology/HearCenter or ask your personal physician fora referral to another network audiologist.Some of our plans include coverage forhearing hardware.Mental health services, including addictionand recovery, are available in the MedicareAdvantage HMO network. You don’t need aIn-patient care for surgery or a planned procedure is covered at a networkfacility when ordered by a Kaiser Permanente or other network physician.Your physician will request any needed preauthorization from the health plan.
Kaiser Permanente Medicare Advantage HMO Your care Urgent and emergency care8Urgent and emergency careYou are covered for emergency care and medically necessary urgent careanywhere in the world. If you think you are experiencing an emergency,go immediately to the nearest emergency care facility or call 911.When to use urgent care centers Go to the closest network urgent care centerfor an illness or injury that requires promptmedical attention but is not an emergency.Examples include:Olympia Medical Center, Monday throughFriday, 8 a.m. to 9 p.m.; Saturday andSunday, 9 a.m. to 5 p.m. Silverdale Medical Center, Monday throughFriday, 8 a.m. to 9 p.m.; Saturday andSunday, 9 a.m. to 5 p.m. Tacoma Medical Center, 24 hours a day,7 days a week Minor injuries, wounds, and cutsneeding stitches Minor breathing issues Minor stomach painWhen to use emergency care*If you’re unsure whether urgent care isyour best option, call the Consulting NurseService for advice at 1-800-297-6877 or206-630-2244.Seek emergency care for a medical orpsychiatric condition that requires immediatemedical attention to prevent serious risk toyour health. Examples include:Where to go for urgent care Chest pain or pressure that may move out tothe arm, neck, back, shoulder, jaw, or wristFor urgent care during office hours, you cancall your personal doctor’s office first tosee if you can get a same-day appointment.If a doctor isn’t available or it’s after officehours, check kp.org/wa/medicare/providersor call Member Services to find the nearesturgent care facility in your network.Kaiser Permanente has urgent carecenters at 5 locations: Severe stomach pain that comes onsuddenly A sudden decrease in or loss ofconsciousness Severe shortness of breath Bellevue Medical Center, 24 hours a day,7 days a week Capitol Hill Campus, Seattle, Main Building,24 hours a day, 7 days a weekOur plans provide coverage for emergencyservices, including ambulance transportationused for a medical or psychiatric emergency.If your particular plan has a copayment,coinsurance, or deductible for these services,you will receive a bill. You can review coveragefor emergency services in your Evidenceof Coverage.* If you need emergency care and are admitted to a non-network hospital, you or a familymember must let us know within 48 hours after care begins, or as soon as is reasonablypossible. Call the notification number listed on the back of your Kaiser Permanente memberID card to help make sure your claim is accepted.
Kaiser Permanente Medicare Advantage HMO Your care Getting prescriptions filled9Getting prescriptions filledIf your plan includes prescription drug coverage, you can fill prescriptionsat any network pharmacy, including those located at Kaiser Permanentemedical facilities, or through our mail-order service.Covered drugsTransfer your prescriptionsOur plans that include prescription drugcoverage have an approved list of drugsto help make sure that the safest, mostappropriate, and most effective prescriptionmedications are available to you. This list —called a formulary — typically divides groupsof medications into tiers. Our plans with PartD have 6 tiers in 2021, ranging from preferredgeneric drugs to injectable Part D vaccines.The tier your medication is in determines yourportion of the drug cost.Make sure your refills are ready when youneed them. Sign in at kp.org/wa/getstartedto transfer your prescriptions or call our NewMember Welcome Team at 206-630-0029 or1-888-844-4607.Requirements for some drugsA formulary usually includes some restrictions.Here’s what you should know: Step therapy (ST). If two drugs have beenshown to be equally effective at treatinga condition, we ask that you try the lesscostly drug first before we’ll cover theother medication. Quantity limit (QL). Based on a drug’ssafety, toxicity, and potential misuse, we maylimit the amount of the drug you can haveeach time you fill the prescription. Prior authorization (PA). This process isto confirm medical criteria have been metthat will help ensure your safety. If you’reon a drug that requires prior authorizationand you got it while on another company‘shealth plan, you will still need to completethe process with Kaiser Permanente.To search our Medicare Drug Formulary, go tokp.org/wa/medicare/formulary.What’s not coveredMost plans do not include: Nonprescription or over-the-countermedicines Drugs for cosmetic uses Drugs for weight loss or sexual dysfunction Drugs that Medicare will not coverIf it’s determined that a drug that’s not onyour plan formulary is medically necessary foryour treatment, your doctor can request thatKaiser Permanente review the circumstancesand cover the medication. Copay orcoinsurance will apply.Go to kp.org/wa/directory to find pharmacies in our Medicare AdvantageHMO network. Choose ”Pharmacy” under the Explore menu. Then refinedistance to 5 miles to see the closest options.
Kaiser Permanente Medicare Advantage HMO Your care Supportive care services10Supportive care servicesSome medical diagnoses and conditions can be stressful and create manyquestions for you. These support services — all available to plan membersat no additional cost — can help.Chronic conditionsIf you’d like more help managing chronicasthma, diabetes, high blood pressure,cholesterol, or heart disease, call1-866‑656‑4183, Monday through Friday,8 a.m. to 5 p.m. Registered nurses certified incase management offer phone-based supportto help you navigate the health system andmake positive changes in your health.Complex case managementwith advanced illnesses. Your doctorcan refer you to these services whenappropriate. In the 4 countiesmentioned, call 1-800-332-5735for details. In other areas, look fora network agency in the MedicareProvider Directory atkp.org/wa/medicare/providers.Specialty pharmacy programThis program assists plan members who arefinding it difficult to manage because they havemultiple chronic conditions, medications, andproviders. A specially trained nurse — inpartnership with your primary care doctor— will help you explore next steps for takingbetter care of yourself. Call 1-866-656-4183to see if this program is right for you or afamily member.This phone-based service offers ongoingsupport to members taking specialty drugsfor a wide range of conditi
Seattle, WA 98124 Member Services: 206-630-4600 or 1-888-901-4600 (WA TTY Relay 1-800-833-6388 or 711) Electronic Payer ID: 91051 Medical advice: Call 24/7 Consulting Nurse Service 1-800-297-6877. Life-threatening emergency: Call 911 or local emergency number. Admitted to a hospital: Call 1-888-457-9516 within 24 hours or as soon as possible
Health Net Dental Plans CIGNA Dental Delta Dental HMO Non-Medicare Signature Value HMO HMO Non-Medicare DHMO Preferred PPO Senior Advantage Group Medicare Advantage HMO Medicare Senior Supplement Seniority Plus Persons to be enrolled Member Member and Spouse /Partner Member and Child Family (Date) (Member Signature) .
Provider Manual Kansas Health Advantage (HMO I-SNP) I. Introducing Kansas Health Advantage Welcome to the Kansas Health Advantage HMO Institutional Special Needs Plan (HMO I-SNP) Plan, offered by Kansas Superior Select, Inc., Kansas Health Advantage is a Health Maintenance Organization (HMO) with a Medicare contract. We are pleased
Medical-Only HMO and Keystone 65 Preferred Rx HMO cover and what you pay. Keystone 65 Preferred Medical-Only HMO and Keystone 65 Preferred Rx HMO are Medicare Advantage HMO (Health Maintenance Organization) plans. With an HMO plan, members choose a family doctor, called a primary c
Para afiliados a Health Net Seniority Plus (HMO)*, Health Net Healthy Heart (HMO), Health Net Ruby Select (HMO), Health Net Gold Select (HMO), Health Net Jade (HMO SNP) y Health Net Seniority Plus (Employer HMO). Su examen de la vista de rutina está cubierto como un beneficio médico básico a través de su plan médico.
Health Net Dental Plans CIGNA Dental Delta Dental HMO Non-Medicare HMO Non-Medicare DHMO Preferred PPO Senior Advantage Group Medicare Advantage HMO Medicare Senior Supplement Seniority Plus Persons to be enrolled Member Member and Spouse /Partner Member and Child Family (Date) (Member Signature) Please complete all sections of this form. .
Medical-Only HMO, Keystone 65 Select Medical-Only HMO, and Keystone 65 Select Rx HMO have networks of doctors, hospitals, pharmacies, and other providers. Keystone 65 Basic Rx HMO, Keystone 65 Liberty Medical-Only HMO, Keystone 65 Select Medical-Only HMO, and Keystone 65 Select Rx HMO: If you use providers that are not in
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Open Enrollment 2021 Miami-Dade County HMO Advantage/ POS Advantage PROVIDER DIRECTORY Miami-Dade County HMO/POS Advantage Network 3 6,&, 1 1' 263,7 / ',5(&725 1' 27 (5 3529,'(56 . The HMO/POS Advantage Network is comprised of AvMed contracted physicians and providers, including those with the University of Miami and Jackson Memorial .
