guide to HMO plans

Kaiser Permanente has the “Highest Member Satisfaction among Commercial Health Plans in the South Atlantic Region, Three Years in a Row.”¹ Fast Facts

• 29 convenient Kaiser Permanente medical facilities across metro and Athens. • Primary care, specialists, lab, X-ray, and pharmacy services available under one roof at most medical facilities. • All caregivers in our medical facilities—primary care, specialists, nurses, pharmacists, lab technicians —share access to members’ health records through our electronic medical records system. • Four of our medical facilities also provide after-hours urgent care, which includes primary care, lab, X-ray, and pharmacy services.2 • Access to approximately 30 affiliated community After-hours Urgent Care Centers across metro Atlanta. • No additional charge for home delivery on mail-order prescription refills— available online or by phone.2 • Members can email their doctor’s office. • No claims to file when receiving care at any of our medical facilities. • No referral needed to see specialists at our medical facilities. • Special rates on chiropractic, accupressure, accupuncture, and massage therapy services, fitness club memberships, vision care, vitamins, and more.

Affiliated Metro Atlanta and Athens Hospitals3

• Athens Regional Medical Center • Northside —Forsyth • Children’s Healthcare of Atlanta at Scottish Rite •  • Children’s Healthcare of Atlanta—Egleston • Piedmont Fayette Hospital • —Duluth •  • Gwinnett Medical Center—Lawrenceville • Piedmont Mountainside Hospital •  •  • Northside Hospital—Cherokee • St. Joseph’s Hospital—Atlanta

1 Kaiser Foundation Health Plan of Georgia, Inc. received the highest numerical 2 If you have an emergency, call 911 or go to the nearest emergency room. score among commercial health plans in the South Atlantic Region (GA, NC, SC) in the proprietary J.D. Power and Associates 2010 - 2012 U.S. Member Health 3 The hospital you are admitted to is determined by the primary care physician Plan StudiesSM. Study based on 32,868 total member responses, measuring you select. Some locations are available only in specific cases. In an emergency, nine plans in the South Atlantic Region (excludes Medicare and Medicaid). you have access to any hospital emergency room. Proprietary study results are based on experiences and perceptions of members surveyed December 2011-January 2012. Your experiences may vary. Visit jdpower.com. Q: If a member has children away at school, Frequently Asked are they covered? Questions A: Yes. Members who are temporarily outside of our service area, such as students, are covered. If a member’s children are attending school in another Kaiser Permanente service area, they can receive visiting member benefits. If their children are not Q: Do members have to choose a personal physician? in a Kaiser Permanente service area, they’re still A: Yes. Upon enrollment in Kaiser Permanente, the first covered for emergency and urgent care. step to receiving care is for members to choose their own personal physician. Having a personal physician They can go to any emergency room or urgent care (also referred to as a Primary Care Physician) helps provider, but if they are admitted to the hospital, they ensure our members get the coordinated care they should notify us within 24 hours of their admission, or need and deserve. as soon as reasonably possible.

Our industry-leading electronic health record system, Q: Will members have to get approval to receive care? used exclusively in Kaiser Permanente medical A: Some services require prior notification and/or facilities, puts us ahead of our competitors and allows preauthorization by the Utilization Management us to offer a level of online consumer engagement Program. If a member fails to obtain preauthorization, tools the vast majority of other health plans don’t it may result in penalties against their benefit offer. Our system connects our members, doctors, payment, or we may deny all or part of their claims. pharmacists, and lab technicians together to improve In the event we deny any service because it does not the quality, efficiency, and effectiveness of care our meet criteria, they may request an appeal. members receive. Utilization Management Department Q: Who can be selected as a personal physician? 404-364-7320 A: With Kaiser Permanente, members can select 1-800-221-2412 their personal physician from The Southeast Monday through Friday from 8 a.m.-5 p.m. (EST) Permanente Medical Group physicians (TSPMG) who practice in our medical facilities. Q: What if a member needs to be admitted to Our physicians are well-qualified and adhere to a the hospital? high standard of care. Many come from some of the A: Kaiser Permanente is affiliated with the Gwinnett, top medical schools and training programs in the Piedmont, Northside, and Children’s Healthcare of country, including Duke University, Emory University, Atlanta hospital systems. The member’s personal Harvard University, Johns Hopkins University, and physician choice will determine the hospital to Yale University; 100 percent are required to be which they will be admitted. Board Certified; and all focus on caring for Kaiser Permanente members. Q: Where can members get Kaiser Permanente prescriptions filled? Q: Are there some services members can receive without a referral from a personal physician? A: If the member’s plan has a prescription drug benefit, they can get prescriptions filled at any A: Yes. To make it easy to get the care they need, Kaiser Permanente medical facility pharmacy. Please members have direct access to all specialty remember that under most benefit plans, drugs must departments in our medical facilities—no referral be prescribed by a Kaiser Permanente physician, necessary. referral specialist, or any dentist.

Q: How much will appointments cost? Q: Can members access their health record online? A: The amount members pay for appointments will be A: Yes. With My Health Manager on kp.org, the determined by their plan. If the plan has a copayment member portion of our electronic medical records or coinsurance, the copayment or a percentage of system, members being treated in our medical the costs is due at the time of each visit. For more facilities can view their health record online. Some of information about specific copayments, co-insurance, the secure features available online allow members or benefits, please contact our Member Services to view lab results, view after-visit summaries, email Department at 404-261-2590 locally or their doctor’s office, order prescription refills, and 1-888-865-5813 long distance. much more. My Health Manager makes it easier for members to stay healthy and productive. How to Reach Us

Health Line Medical Claims For information, nurse advice, appointment cancellations, Answers questions about medical bills and provides or to schedule an appointment in Pediatrics/Adolescent medical claims for HMO plans. Medicine or Adult Medicine, call the HEALTH LINE Monday-Friday: 8:30 a.m. to 5 p.m. 24 hours a day, seven days a week. To schedule all other appointments, call Monday through Friday between 404-261-2825 locally 7 a.m. and 7 p.m. 1-888-865-5813 long distance

404-365-0966 locally Kaiser Permanente Online 1-800-611-1811 long distance On kp.org/myhealth, members can:4 TTY: 1-800-255-0056 (Disponible en Español) • Email their doctor’s office • Schedule, view, and cancel routine appointments Member Services • Review after-visit summaries Offers assistance selecting a personal physician; explaining how your health plan works; and questions • View lab test results about eligibility, and coverage verification. • Order prescription refills Monday-Friday: 7 a.m. to 7 p.m. • Act for a family member 404-261-2590 locally • View eligibility and benefits5 1-888-865-5813 long distance (Disponible en Español) • View claims and claims status5 • Monitor ongoing health conditions Pharmacy • Order replacement ID cards Members with a prescription drug benefit can have prescriptions filled at any Kaiser Permanente medical •­ And much more facility pharmacy. In addition, two great time-saving options are available when refilling prescriptions 4 Available to members receiving care/filling prescriptions previously filled at a Kaiser Permanente medical facility at a Kaiser Permanente medical facility. pharmacy: Order online at kp.org/rxrefill, or call the 5 Available to any member registered on kp.org. 24-hour Refill Line at770-434-2008.

brokernet.kp.org/ga

Kaiser Foundation Health Plan of Georgia Nine Piedmont Center 3495 Piedmont Road, NE Atlanta, GA 30305 404-364-7000

At the time of production, the information contained in this publication was accurate. Please contact Member Services at 404-261-2590 locally or 1-888-865-5813 for the latest information.

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©2012 Kaiser Foundation Health Plan of Georgia, Inc.