Kaiser Permanente for Individuals and Families: Enrollment Guide, Oregon

Kaiser Permanente for Individuals and Families Kaiser Permanente for Individuals and Families

Healthy together Care and coverage that fits your life

buykp.orgHave questions? Call us at 1-800-494-5314. • Go to buykp.org/apply2020 Enrollment. • Or contact your producer.| Oregon

364999513 364999513 NW-OR 2020 Kaiser Permanente for Individuals and Families

Welcome to care that fits your life This Kaiser Permanente for Individuals and Families enrollment guide can help you choose the right health plan for your needs. Here’s a look at what you’ll get with all of our plans.

Get the care you need when you need it with routine, specialty, urgent, Right care, and emergency care. If you’re ever unsure where to go, call us for 24/7 right time care advice by phone.

Do more in less time. In most of our facilities, you can see your doctor, Many services get a lab test, and pick up prescriptions — all in a single trip. Find a under one roof location near you at kp.org/facilities.

Choose your doctor based on what’s important to you. Go to Your doctor, kp.org/searchdoctors for details about education, specialties, your choice languages spoken, and more. You can also change doctors at any time.

How you get care is up to you. Choose a phone appointment or video More care visit,* email your doctor’s office with nonurgent questions, or come see options us in person.†

Enjoy discounts on products and services that can help you stay Discounts for healthy — like gym memberships, massage therapy, and more. members Explore your options at kp.org/choosehealthy.

*When appropriate and available. †These features are available when you get care at Kaiser Permanente facilities.

Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.

364999513 NW-OR 2020 Kaiser Permanente for Individuals and Families

Choosing your health plan We offer a variety of plans to fit your needs and budget. All of them offer the same quality care, but the way they split the costs is different.

Copay plans — gold HSA-qualified deductible plans — silver

Copay plans are the simplest. You know in advance and bronze how much you’ll pay for care like doctor visits and HSA-qualified deductible health plans are prescriptions. This amount is called your copay. Your deductible plans that give you the option of setting monthly premium is higher, but you’ll pay much less up a health savings account (HSA) to pay for eligible when you get care. health care costs, including copays, coinsurance, and deductible payments. You won’t pay federal taxes on the money in this account. Deductible plans — gold, silver, bronze, You can use your HSA anytime to pay for care, and catastrophic including some services that may not be covered With a deductible plan, your monthly premium is by your plan, like eyeglasses, adult dental care, or lower, but you’ll need to pay the full charges for chiropractic services.* If you have money left in your most covered services until you reach a set amount, HSA at the end of the year, it will roll over for you to known as your deductible. Then you’ll start paying use the next year. less — a copay or coinsurance. Depending on your plan, some services, like office visits or prescriptions, may be available at a copay or coinsurance before you reach your deductible.

*For a complete list of services you can use your HSA to pay for, see Publication 502, Medical and Dental Expenses, at irs.gov.

Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.

364999513 NW-OR 2020 Kaiser Permanente for Individuals and Families

Example of your costs for care Let’s say you hurt your ankle. You visit your personal doctor, who orders an X-ray. It’s just a sprain, so the doctor prescribes a generic pain medication. Here’s an example of what you’d pay out of pocket for these services with each type of health plan.

Plan name Office visit X-ray Generic drug

KP OR Gold 0/20 $20 $40 $10 (no deductible)

KP OR Silver 2500/35 $87 or 30% if you’ve $35 $25 ($2,500 deductible) met your deductible

KP OR Bronze 5000/50 $87 or 35% if you’ve $49 or $30 if you've $50 ($5,000 deductible) met your deductible met your deductible

The cost estimates above are from kp.org/treatmentestimates. Visit this site anytime to get an idea of what the charges for common services might be before you reach your deductible.

Important open enrollment dates Do you qualify for financial help? for 2020 You may be eligible for federal or • The open enrollment period for 2020 state financial assistance to help coverage runs from November 1, 2019, you pay for care or coverage. through December 15, 2019. Visit healthcare.gov for details. • You can change or apply for coverage through Kaiser Foundation Health Plan of the Northwest, or we can help you apply through the Oregon Health Insurance Marketplace. • For coverage that starts on January 1, 2020, we must receive your Application for Health Coverage and first month’s premium no later than December 15, 2019.

Enrolling during a special enrollment period • Are you getting married, having a baby, or losing your health coverage? You can also enroll or change your coverage at other times throughout the year if you have a qualifying life event. • Visit kp.org/specialenrollment for a list of qualifying life events and instructions.

Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.

364999513 NW-OR 2020 Kaiser Permanente for Individuals and Families

Understanding the plans: benefit highlights The charts on the next few pages show you a sample of each plan’s benefits. Review the diagram below to help you understand how to read those charts.

Here’s a quick look at how to use the chart

KP Offered through Kaiser Foundation Health Plan of the KP M Northwest

KP OR Silver M Offered through the Oregon Health Insurance Marketplace 2500/35 Plan type Deductible Annual deductible Features You need to pay this amount before your plan starts helping Annual medical deductible $2,500/$5,000 you pay for most covered services. Under this sample plan, (individual/family) you’d pay the full charges for covered services until you reach Annual out-of-pocket maximum $8,150/$16,300 $2,500 for yourself or $5,000 for your family. Then you’d start (individual/family) paying copays or coinsurance. Benefits Preventive care Annual out-of-pocket maximum Routine physical exam, mammograms, etc. No charge This is the most you’ll pay for care during the calendar year Outpatient services (per visit or procedure) before your plan starts paying 100% for most covered services. Primary care office visit $35 In this example, you’d never pay more than $8,150 for yourself Specialty care office visit $65 and no more than $16,300 for your family for your copays, Most X-rays 30% after deductible coinsurance, and deductible in a calendar year. Most lab tests 30% after deductible MRI, CT, PET 30% after deductible Preventive care at no charge Outpatient surgery 30% after deductible Most preventive care services — including routine Mental health visit $35 physical exams and mammograms — are covered at no charge. Plus, they’re not subject to the deductible. Inpatient hospital care Room and board, surgery, anesthesia, X-rays, 30% after deductible lab tests, medications, mental health care Covered before you reach the deductible Maternity With some services, you’ll only pay a copay or coinsurance, Routine prenatal care and postpartum visits No charge regardless of whether you’ve reached your deductible. Under Delivery and inpatient well-baby care 30% after deductible this plan, primary care visits are covered at a $35 copay — even Emergency and urgent care before you meet your deductible. With our Silver deductible plans, primary care, specialty care, and urgent care visits all Emergency Department visit 30% after deductible are covered before you reach the deductible. Urgent care visit $50 Prescription drugs (up to a 30-day supply) Coinsurance Generic $25 After reaching your deductible, this is a percentage of Preferred brand $65 the charges that you may pay for covered services. Here, you’d Non-preferred brand 50% after deductible pay 30% of the cost per day for your inpatient hospital care after Specialty 50% after deductible you reach your deductible. Your plan would pay the rest for the Whole health remainder of the calendar year.

$25 per visit up to 3 visits for acupuncture and chiropractic Copay Healthy services services. $65 per visit up to 6 visits for naturopathic services. This is the set amount you pay for covered services, usually See chpgroup.com for details.† after you reach your deductible. In this example, you’d pay a $50 copay for urgent care visits, whether or not you have met your deductible.

361334441 NW-OR 2020 Kaiser Permanente for Individuals and Families

KP Offered through Kaiser Foundation Health Financial assistance options with lower copays, coinsurance, and Plan of the Northwest deductibles are available for certain plans, and for Native Alaskans M Offered through the Oregon Health Insurance and American Indians on healthcare.gov. Marketplace

KP M KP M KP M KP M

KP OR Standard KP OR Bronze KP OR Bronze KP OR Standard Bronze Plan 6900/0% HSA 5000/50 Silver Plan Plan type Deductible HSA-qualified Deductible Deductible Features Annual medical deductible $7,900/$15,800 $6,900/$13,800 $5,000/$10,000 $3,550/$7,100 (individual/family) Annual out-of-pocket maximum $7,900/$15,800 $6,900/$13,800 $8,150/$16,300 $8,150/$16,300 (individual/family) Benefits Preventive care Routine physical exam, mammograms, etc. No charge No charge No charge No charge Outpatient services (per visit or procedure) Primary care office visit $45 No charge after deductible $50 $40 Specialty care office visit $90 No charge after deductible 35% after deductible $80 Most X-rays No charge after deductible No charge after deductible 35% after deductible 30% after deductible Most lab tests No charge after deductible No charge after deductible 35% after deductible 30% after deductible MRI, CT, PET No charge after deductible No charge after deductible 35% after deductible 30% after deductible Outpatient surgery No charge after deductible No charge after deductible 35% after deductible 30% after deductible Mental health visit $45 No charge after deductible $50 $40 Inpatient hospital care Room and board, surgery, anesthesia, X-rays, lab tests, medications, mental No charge after deductible No charge after deductible 35% after deductible 30% after deductible health care Maternity No charge Routine prenatal and postpartum visits No charge after deductible No charge 30% after deductible after deductible No charge Delivery and inpatient well-baby care No charge after deductible 35% after deductible 30% after deductible after deductible Emergency and urgent care Emergency Department visit No charge after deductible No charge after deductible 35% after deductible 30% after deductible Urgent care visit No charge after deductible No charge after deductible 35% after deductible $70 Prescription drugs (up to a 30-day supply) Generic $15* No charge after deductible $30* after deductible $15* Preferred brand No charge after deductible No charge after deductible 50% after deductible $60* Non-preferred brand No charge after deductible No charge after deductible 50% after deductible 50% Specialty No charge after deductible No charge after deductible 50% after deductible 50% Whole health CHP Active & Healthy up to $25 after deductible per visit up $25 per visit up to 3 visits for CHP Active & Healthy up to 20% discount on chiropractic, to 3 visits for acupuncture and acupuncture and chiropractic 20% discount on chiropractic, acupuncture, massage, naturopathy, chiropractic services. No charge after services. 35% after deductible acupuncture, massage, naturopathy, Healthy services gym memberships, and more. deductible per visit up to 6 visits per visit up to 6 visits gym memberships, and more. See chpactiveandhealthy.com for naturopathic services. for naturopathic services. See chpactiveandhealthy.com for details.† See chpgroup.com for details.† See chpgroup.com for details.† for details.† *Mail order: 90-day supply of qualified prescriptions for the cost of a 60-day supply. †Discount programs and other services shown may be provided by groups other than Kaiser Foundation Health Plan of the Northwest, and aren’t offered or guaranteed under your coverage. Additional fees you pay won’t count toward your deductible or out-of-pocket maximum. All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232 This plan summary is intended to highlight only some of the most frequently asked about benefits and their copays, coinsurance, and deductibles. For specific plan information, see the following forms: for HSA-qualified deductible plans: EOIDHDHP0120; for deductible plans: EOIDDEDSTD0120, EOIDDED0120; for traditional copay plans: EOIDTRAD0120; for the catastrophic plan: EOIDCAT0120. Please refer to the Evidence of Coverage for complete details on your plan or for specific limitations and exclusions. To request a copy of the Evidence of Coverage, please visit kp.org/plandocuments, call us at 1-800-813-2000 or contact your producer. For services subject to the deductible, you will have to pay health care expenses out-of-pocket until you meet your deductible. Most deductibles, copays, and coinsurance contribute to the out-of-pocket maximum.

361334441 NW-OR 2020 Kaiser Permanente for Individuals and Families

KP M KP KP M KP M

KP OR Silver KP OR Silver KP OR Silver KP OR Standard 3500/35 3000/20% HSA 2500/35 Gold Plan Plan type Deductible HSA-qualified Deductible Deductible Features Annual medical deductible $3,500/$7,000 $3,000/$6,000 $2,500/$5,000 $1,000/$2,000 (individual/family) Annual out-of-pocket maximum $8,150/$16,300 $6,900/$13,800 $8,150/$16,300 $7,300/$14,600 (individual/family) Benefits Preventive care Routine physical exam, mammograms, etc. No charge No charge No charge No charge Outpatient services (per visit or procedure) Primary care office visit $35 20% after deductible $35 $20 Specialty care office visit $65 20% after deductible $65 $40 Most X-rays 30% after deductible 20% after deductible 30% after deductible 20% after deductible Most lab tests 30% after deductible 20% after deductible 30% after deductible 20% after deductible MRI, CT, PET 30% after deductible 20% after deductible 30% after deductible 20% after deductible Outpatient surgery 30% after deductible 20% after deductible 30% after deductible 20% after deductible Mental health visit $35 20% after deductible $35 $20 Inpatient hospital care Room and board, surgery, anesthesia, X-rays, lab tests, medications, mental 30% after deductible 20% after deductible 30% after deductible 20% after deductible health care Maternity

Routine prenatal and postpartum visits No charge No charge No charge 20% after deductible

Delivery and inpatient well-baby care 30% after deductible 20% after deductible 30% after deductible 20% after deductible Emergency and urgent care

Emergency Department visit 30% after deductible 20% after deductible 30% after deductible 20% after deductible

Urgent care visit $50 20% after deductible $50 $60 Prescription drugs (up to a 30-day supply) Generic $25* $15* after deductible $25* $10* Preferred brand $65* $55* after deductible $65* $30* Non-preferred brand 50% after deductible 50% after deductible 50% after deductible 50% Specialty 50% after deductible 50% after deductible 50% after deductible 50% with a $500 per script maximum Whole health $25 after deductible per visit up CHP Active & Healthy up to $25 per visit up to 3 visits for $25 per visit up to 3 visits for to 3 visits for acupuncture and 20% discount on chiropractic, acupuncture and chiropractic acupuncture and chiropractic chiropractic services. 20% after acupuncture, massage, naturopathy, Healthy services services. $65 per visit up to 6 visits services. $65 per visit up to 6 visits deductible per visit up to 6 visits gym memberships, and more. for naturopathic services. for naturopathic services. for naturopathic services. See chpactiveandhealthy.com See chpgroup.com for details.† See chpgroup.com for details.† See chpgroup.com for details.† for details.† *Mail order: 90-day supply of qualified prescriptions for the cost of a 60-day supply. †Discount programs and other services shown may be provided by groups other than Kaiser Foundation Health Plan of the Northwest, and aren’t offered or guaranteed under your coverage. Additional fees you pay won’t count toward your deductible or out-of-pocket maximum. All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232 This plan summary is intended to highlight only some of the most frequently asked about benefits and their copays, coinsurance, and deductibles. For specific plan information, see the following forms: for HSA-qualified deductible plans: EOIDHDHP0120; for deductible plans: EOIDDEDSTD0120, EOIDDED0120; for traditional copay plans: EOIDTRAD0120; for the catastrophic plan: EOIDCAT0120. Please refer to the Evidence of Coverage for complete details on your plan or for specific limitations and exclusions. To request a copy of the Evidence of Coverage, please visit kp.org/plandocuments, call us at 1-800-813-2000 or contact your producer. For services subject to the deductible, you will have to pay health care expenses out-of-pocket until you meet your deductible. Most deductibles, copays, and coinsurance contribute to the out-of-pocket maximum.

361334441 NW-OR 2020 Kaiser Permanente for Individuals and Families

KP M KP M KP M

KP OR Gold KP OR Gold KP OR Catastrophic 1000/20 0/20 8150/0 ‡ Plan type Deductible Copayment Deductible Features Annual medical deductible $1,000/$2,000 None/None $8,150/$16,300 (individual/family) Annual out-of-pocket maximum $7,500/$15,000 $7,500/$15,000 $8,150/$16,300 (individual/family) Benefits Preventive care Routine physical exam, mammograms, etc. No charge No charge No charge Outpatient services (per visit or procedure) First 3 office visits no charge;** Primary care office visit $20 $20 additional visits no charge after deductible. Specialty care office visit $40 $40 No charge after deductible Most X-rays 30% $40 No charge after deductible Most lab tests 30% $40 No charge after deductible MRI, CT, PET 30% after deductible $300 No charge after deductible Outpatient surgery 30% after deductible 30% No charge after deductible Mental health visit $20 $20 No charge after deductible Inpatient hospital care Room and board, surgery, anesthesia, X-rays, 30% after deductible 30% No charge after deductible lab tests, medications, mental health care Maternity Routine prenatal and postpartum visits No charge No charge No charge after deductible Delivery and inpatient well-baby care 30% after deductible 30% No charge after deductible Emergency and urgent care Emergency Department visit 30% after deductible $350 No charge after deductible Urgent care visit $40 $40 No charge after deductible Prescription drugs (up to a 30-day supply) Generic $10* $10* No charge after deductible Preferred brand $30* $30* No charge after deductible Non-preferred brand 50% 50% No charge after deductible Specialty 50% 50% No charge after deductible Whole health

$25 per visit up to 3 visits for acupuncture $25 per visit up to 3 visits for acupuncture CHP Active & Healthy up to 20% discount and chiropractic services. $40 per visit up to and chiropractic services. $40 per visit up to on chiropractic, acupuncture, massage, Healthy services 6 visits for naturopathic services. 6 visits for naturopathic services. naturopathy, gym memberships, and more. See chpgroup.com for details.† See chpgroup.com for details.† See chpactiveandhealthy.com for details.† *Mail order: 90-day supply of qualified prescriptions for the cost of a 60-day supply. † Discount programs and other services shown may be provided by groups other than Kaiser Foundation Health Plan of the Northwest, and aren’t offered or guaranteed under your coverage. Additional fees you pay won’t count toward your deductible or out-of-pocket maximum. ‡ Only applicants younger than age 30, or applicants age 30 and older who provide a certificate from the Health Insurance Marketplace demonstrating hardship or lack of affordable coverage, may purchase a KP OR Catastrophic 8150/0 plan. **The KP OR Catastrophic 8150/0 plan includes 3 office visits at no charge before you reach your deductible. Office visits include primary care. All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232 This plan summary is intended to highlight only some of the most frequently asked about benefits and their copays, coinsurance, and deductibles. For specific plan information, see the following forms: for HSA-qualified deductible plans: EOIDHDHP0120; for deductible plans: EOIDDEDSTD0120, EOIDDED0120; for traditional copay plans: EOIDTRAD0120; for the catastrophic plan: EOIDCAT0120. Please refer to the Evidence of Coverage for complete details on your plan or for specific limitations and exclusions. To request a copy of the Evidence of Coverage, please visit kp.org/plandocuments, call us at 1-800-813-2000 or contact your producer. For services subject to the deductible, you will have to pay health care expenses out-of-pocket until you meet your deductible. Most deductibles, copays, and coinsurance contribute to the out-of-pocket maximum.

361334441 NW-OR 2020 Kaiser Permanente for Individuals and Families

M Offered through the Oregon Health Insurance Cost Share Reduction (CSR) plans Marketplace You must qualify for and enroll in the CSR plans on this page through healthcare.gov.

M M M

KP OR Silver KP OR Silver KP OR Silver 2500/35 73% CSR 2500/35 87% CSR 2500/35 94% CSR Plan type Deductible Deductible Copayment Features Annual medical deductible $2,350/$4,700 $250/$500 None/None (individual/family) Annual out-of-pocket maximum $6,500/$13,000 $2,700/$5,400 $2,700/$5,400 (individual/family) Benefits Preventive care Routine physical exam, mammograms, etc. No charge No charge No charge Outpatient services (per visit or procedure) Primary care office visit $35 $20 $5 Specialty care office visit $60 $30 $10 Most X-rays 30% after deductible 30% after deductible 10% Most lab tests 30% after deductible 30% after deductible 10% MRI, CT, PET 30% after deductible 30% after deductible 10% Outpatient surgery 30% after deductible 30% after deductible 10% Mental health visit $35 $20 $5 Inpatient hospital care Room and board, surgery, anesthesia, X-rays, 30% after deductible 30% after deductible 10% lab tests, medications, mental health care Maternity Routine prenatal and postpartum visits No charge No charge No charge Delivery and inpatient well-baby care 30% after deductible 30% after deductible 10% Emergency and urgent care Emergency Department visit 30% after deductible 30% after deductible 10% Urgent care visit $50 $35 $25 Prescription drugs (up to a 30-day supply) Generic $25* $15* $5* Preferred brand $65* $45* $10* Non-preferred brand 50% after deductible 50% after deductible 50% Specialty 50% after deductible 50% after deductible 50% Whole health

$25 per visit up to 3 visits for acupuncture $25 per visit up to 3 visits for acupuncture $25 per visit up to 3 visits for acupuncture and chiropractic services. $60 per visit up to and chiropractic services. $30 per visit up to and chiropractic services. $10 per visit up to Healthy services 6 visits for naturopathic services. 6 visits for naturopathic services. 6 visits for naturopathic services. See chpgroup.com for details.† See chpgroup.com for details.† See chpgroup.com for details.†

*Mail order: 90-day supply of qualified prescriptions for the cost of a 60-day supply. †Discount programs and other services shown may be provided by groups other than Kaiser Foundation Health Plan of the Northwest, and aren’t offered or guaranteed under your coverage. Additional fees you pay won’t count toward your deductible or out-of-pocket maximum. All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232 This plan summary is intended to highlight only some of the most frequently asked about benefits and their copays, coinsurance, and deductibles. For specific plan information, see the following forms: for HSA-qualified deductible plans: EOIDHDHP0120; for deductible plans: EOIDDEDSTD0120, EOIDDED0120; for traditional copay plans: EOIDTRAD0120; for the catastrophic plan: EOIDCAT0120. Please refer to the Evidence of Coverage for complete details on your plan or for specific limitations and exclusions. To request a copy of the Evidence of Coverage, please visit kp.org/plandocuments, call us at 1-800-813-2000 or contact your producer. For services subject to the deductible, you will have to pay health care expenses out-of-pocket until you meet your deductible. Most deductibles, copays, and coinsurance contribute to the out-of-pocket maximum.

361334441 NW-OR 2020 Kaiser Permanente for Individuals and Families

M Offered through the Oregon Health Insurance Cost Share Reduction (CSR) plans Marketplace You must qualify for and enroll in the CSR plans on this page through healthcare.gov.

M M M

KP OR Silver KP OR Silver KP OR Silver 3500/35 73% CSR 3500/35 87% CSR 3500/35 94% CSR Plan type Deductible Deductible Deductible Features Annual medical deductible $2,750/$5,500 $500/$1,000 $100/$200 (individual/family) Annual out-of-pocket maximum $6,500/$13,000 $2,700/$5,400 $2,000/$4,000 (individual/family) Benefits Preventive care Routine physical exam, mammograms, etc. No charge No charge No charge Outpatient services (per visit or procedure) Primary care office visit $35 $20 $5 Specialty care office visit $60 $30 $10 Most X-rays 30% after deductible 30% after deductible 10% after deductible Most lab tests 30% after deductible 30% after deductible 10% after deductible MRI, CT, PET 30% after deductible 30% after deductible 10% after deductible Outpatient surgery 30% after deductible 30% after deductible 10% after deductible Mental health visit $35 $20 $5 Inpatient hospital care Room and board, surgery, anesthesia, X-rays, 30% after deductible 30% after deductible 10% after deductible lab tests, medications, mental health care Maternity Routine prenatal and postpartum visits No charge No charge No charge Delivery and inpatient well-baby care 30% after deductible 30% after deductible 10% after deductible Emergency and urgent care Emergency Department visit 30% after deductible 30% after deductible 10% after deductible Urgent care visit $50 $45 $25 Prescription drugs (up to a 30-day supply) Generic $25* $15* $5* Preferred brand $65* $45* $10* Non-preferred brand 50% after deductible 50% after deductible 50% after deductible Specialty 50% after deductible 50% after deductible 50% after deductible Whole health $25 per visit up to 3 visits for acupuncture $25 per visit up to 3 visits for acupuncture $25 per visit up to 3 visits for acupuncture and chiropractic services. $60 per visit and chiropractic services. $30 per visit and chiropractic services. $10 per visit Healthy services up to 6 visits for naturopathic services. up to 6 visits for naturopathic services. up to 6 visits for naturopathic services. See chpgroup.com for details.† See chpgroup.com for details.† See chpgroup.com for details.† *Mail order: 90-day supply of qualified prescriptions for the cost of a 60-day supply. †Discount programs and other services shown may be provided by groups other than Kaiser Foundation Health Plan of the Northwest, and aren’t offered or guaranteed under your coverage. Additional fees you pay won’t count toward your deductible or out-of-pocket maximum. All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232 This plan summary is intended to highlight only some of the most frequently asked about benefits and their copays, coinsurance, and deductibles. For specific plan information, see the following forms: for HSA-qualified deductible plans: EOIDHDHP0120; for deductible plans: EOIDDEDSTD0120, EOIDDED0120; for traditional copay plans: EOIDTRAD0120; for the catastrophic plan: EOIDCAT0120. Please refer to the Evidence of Coverage for complete details on your plan or for specific limitations and exclusions. To request a copy of the Evidence of Coverage, please visit kp.org/plandocuments, call us at 1-800-813-2000 or contact your producer. For services subject to the deductible, you will have to pay health care expenses out-of-pocket until you meet your deductible. Most deductibles, copays, and coinsurance contribute to the out-of-pocket maximum.

361334441 NW-OR 2020 Kaiser Permanente for Individuals and Families

M Offered through the Oregon Health Insurance Cost Share Reduction (CSR) plans Marketplace You must qualify for and enroll in the CSR plans on this page through healthcare.gov.

M M M

KP OR Standard Silver KP OR Standard Silver KP OR Standard Silver Plan 73% CSR Plan 87% CSR Plan 94% CSR Plan type Deductible Deductible Deductible Features Annual medical deductible $3,550/$7,100 $900/$1,800 $100/$200 (individual/family) Annual out-of-pocket maximum $6,500/$13,000 $2,700/$5,400 $1,000/$2,000 (individual/family) Benefits Preventive care Routine physical exam, mammograms, etc. No charge No charge No charge Outpatient services (per visit or procedure) Primary care office visit $40 $15 $10 Specialty care office visit $70 $30 $20 Most X-rays 30% after deductible 10% after deductible 10% after deductible Most lab tests 30% after deductible 10% after deductible 10% after deductible MRI, CT, PET 30% after deductible 10% after deductible 10% after deductible Outpatient surgery 30% after deductible 10% after deductible 10% after deductible Mental health visit $40 $15 $10 Inpatient hospital care Room and board, surgery, anesthesia, X-rays, 30% after deductible 10% after deductible 10% after deductible lab tests, medications, mental health care Maternity Routine prenatal and postpartum visits 30% after deductible 10% after deductible 10% after deductible Delivery and inpatient well-baby care 30% after deductible 10% after deductible 10% after deductible Emergency and urgent care Emergency Department visit 30% after deductible 10% after deductible 10% after deductible Urgent care visit $70 $40 $30 Prescription drugs (up to a 30-day supply) Generic $15* $10* $5* Preferred brand $55* $25* $10* Non-preferred brand 50% 50% 25% Specialty 50% 50% 25% Whole health

CHP Active & Healthy up to 20% discount CHP Active & Healthy up to 20% discount CHP Active & Healthy up to 20% discount on chiropractic, acupuncture, massage, on chiropractic, acupuncture, massage, on chiropractic, acupuncture, massage, Healthy services naturopathy, gym memberships, and more. naturopathy, gym memberships, and more. naturopathy, gym memberships, and more. See chpactiveandhealthy.com for details.† See chpactiveandhealthy.com for details.† See chpactiveandhealthy.com for details.† *Mail order: 90-day supply of qualified prescriptions for the cost of a 60-day supply. †Discount programs and other services shown may be provided by groups other than Kaiser Foundation Health Plan of the Northwest, and aren’t offered or guaranteed under your coverage. Additional fees you pay won’t count toward your deductible or out-of-pocket maximum. All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232 This plan summary is intended to highlight only some of the most frequently asked about benefits and their copays, coinsurance, and deductibles. For specific plan information, see the following forms: for HSA-qualified deductible plans: EOIDHDHP0120; for deductible plans: EOIDDEDSTD0120, EOIDDED0120; for traditional copay plans: EOIDTRAD0120; for the catastrophic plan: EOIDCAT0120. Please refer to the Evidence of Coverage for complete details on your plan or for specific limitations and exclusions. To request a copy of the Evidence of Coverage, please visit kp.org/plandocuments, call us at 1-800-813-2000 or contact your producer. For services subject to the deductible, you will have to pay health care expenses out-of-pocket until you meet your deductible. Most deductibles, copays, and coinsurance contribute to the out-of-pocket maximum.

361334441 NW-OR 2020 Kaiser Permanente for Individuals and Families

Find your rate Use the monthly rates chart on the following pages or apply on buykp.org/apply to have your rate calculated automatically. Along with your monthly rate, consider what you’ll need to pay when you get care.

The rates in the monthly rates chart apply to these How is your rate determined? ZIP codes. Please check that your ZIP code is listed Your rate is based on: below. If it isn’t, call us at 1-800-494-5314 for • The plan you choose information on other rate areas.

• Where you live, based on your county Our service area and ZIP code Benton County 97330–31, 97333, 97339, 97370, 97448, 97456 • Your age on your plan start date (effective date) Clackamas County All ZIP codes • If you add a pediatric dental plan for children 18 Columbia County All ZIP codes and younger Hood River County 97014 Lane County 97401–5, 97408–9, 97419, 97424, 97426, 97431, • If you qualify for federal financial assistance. Visit 97437–8, 97440, 97446, 97448, 97451–2, 97454–6, buykp.org/apply or call us at 1-800-494-5314 97461, 97475, 97477–8, 97487, 97489 Linn County 97321–22, 97335, 97348, 97355, 97358, 97360, (TTY 711) to see if you may qualify. 97374, 97377, 97389, 97446 • If you use tobacco Marion County All ZIP codes Multnomah County All ZIP codes Interested in a family plan? Polk County All ZIP codes Find the rate for each family member, based on his Washington County All ZIP codes or her age on the start date. Yamhill County All ZIP codes Family members include: • You • Your spouse/domestic partner • All adult children 21 through 25 • Your 3 oldest children under 21

If you have more than 3 children under 21, you only need to pay for the 3 oldest. The other children under 21 will be covered at no charge.

Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.

361335157 NW-OR 2020 Kaiser Permanente for Individuals and Families

2020 Monthly rates Please note: These rates do not include the federal financial assistance you Benton, Linn, and Lane counties may be eligible to receive through the Oregon Health Insurance Marketplace.

Non-Tobacco User Rates KP Oregon KP OR Silver KP OR Silver Age on KP Oregon Standard Silver 3500/35 KP OR Silver 2500/35 KP Oregon KP OR 2020 KP OR Bronze KP OR Bronze KP OR Gold KP OR Gold Standard Plan (includes (includes 3000/20% (includes Standard Gold Catastrophic effective 6900/0% HSA 5000/50 1000/20 0/20 Bronze Plan all CSR plan all CSR plan HSA all CSR plan Plan 8150/0 date variations) variations) variations) 0–20 $174 $153 $169 $230 $229 $211 $238 $242 $234 $242 $153 21–24 274 241 267 362 360 332 374 382 368 381 241 25 275 242 268 364 362 333 376 383 370 383 242 26 281 247 273 371 369 340 383 391 377 390 247 27 287 253 279 379 377 348 392 400 386 400 252 28 298 262 290 394 391 361 407 415 400 415 262 29 307 270 298 405 403 372 419 427 412 427 270 30 311 274 303 411 409 377 425 433 418 433 273 31 318 280 309 420 417 385 434 442 427 442 279 32 324 285 315 428 426 393 443 451 436 451 285 33 328 289 319 434 431 398 449 457 441 457 289 34 333 293 324 440 437 403 455 463 447 463 292 35 335 295 326 442 440 406 458 466 450 466 294 36 337 297 328 445 443 408 460 469 453 469 296 37 339 299 330 448 446 411 463 472 456 472 298 38 341 301 332 451 449 414 466 475 459 475 300 39 346 305 337 457 454 419 472 482 465 481 304 40 350 308 341 463 460 424 478 488 471 487 308 41 357 314 347 471 469 432 487 497 480 497 314 42 363 320 353 480 477 440 496 506 488 505 319 43 372 327 362 491 489 451 508 518 500 517 327 44 383 337 373 506 503 464 523 533 515 533 337 45 396 348 385 523 520 480 541 551 532 551 348 46 411 362 400 543 540 498 562 572 553 572 361 47 428 377 417 566 563 519 585 596 576 596 377 48 448 395 436 592 589 543 612 624 602 623 394 49 467 412 455 618 614 567 639 651 628 651 411 50 489 431 476 647 643 593 669 681 658 681 430 51 511 450 497 675 672 619 698 712 687 711 449 52 535 471 521 707 703 648 731 745 719 744 470 53 559 492 544 739 735 677 764 778 752 778 491 54 585 515 569 773 769 709 799 815 787 814 514 55 611 538 595 807 803 741 835 851 822 850 537 56 639 563 622 845 840 775 873 890 859 890 562 57 668 588 650 882 878 809 912 930 898 929 587 58 698 615 679 923 918 846 954 972 939 972 614 59 713 628 694 943 937 864 975 993 959 993 627 60 743 655 724 983 977 901 1,016 1,036 1,000 1,035 654 61 770 678 749 1,018 1,012 933 1,052 1,072 1,035 1,072 677 62 787 693 766 1,040 1,035 954 1,076 1,096 1,058 1,096 692 63 809 712 787 1,069 1,063 980 1,105 1,126 1,087 1,126 711 64+ 822 723 801 1,086 1,080 996 1,122 1,146 1,104 1,143 723

Rates are effective January 1, 2020, through December 31, 2020. 361335157 NW-OR 2020 Kaiser Permanente for Individuals and Families

Tobacco User Rates KP Oregon KP OR Silver KP OR Silver Age on KP Oregon Standard Silver 3500/35 KP OR Silver 2500/35 KP Oregon KP OR 2020 KP OR Bronze KP OR Bronze KP OR Gold KP OR Gold Standard Plan (includes (includes 3000/20% (includes Standard Gold Catastrophic effective 6900/0% HSA 5000/50 1000/20 0/20 Bronze Plan all CSR plan all CSR plan HSA all CSR plan Plan 8150/0 date variations) variations) variations) 0–20 $174 $153 $169 $230 $229 $211 $238 $242 $234 $242 $153 21–24 329 290 320 435 432 398 449 458 442 458 289 25 330 291 321 436 434 400 451 460 444 459 290 26 337 297 328 445 442 408 460 469 453 469 296 27 345 303 335 455 453 418 471 480 463 480 303 28 357 315 348 472 470 433 488 498 481 497 314 29 368 324 358 486 484 446 503 512 495 512 324 30 373 329 363 493 490 452 510 520 502 519 328 31 381 336 371 504 501 462 521 531 512 530 335 32 389 343 379 514 511 471 531 542 523 541 342 33 394 347 383 521 518 477 538 549 530 548 346 34 399 352 388 528 525 484 545 556 537 556 351 35 402 354 391 531 528 487 549 560 540 559 353 36 404 356 394 534 532 490 553 563 544 563 356 37 407 359 396 538 535 493 556 567 547 567 358 38 410 361 399 541 538 497 560 571 551 570 360 39 415 365 404 548 545 503 567 578 558 577 365 40 420 370 409 555 552 509 574 585 565 585 369 41 428 377 417 566 563 519 585 596 576 596 376 42 436 384 424 576 573 528 595 607 586 606 383 43 446 393 434 590 586 541 610 621 600 621 392 44 459 405 447 607 604 557 628 640 618 639 404 45 475 418 462 627 624 575 649 661 638 661 417 46 493 434 480 652 648 598 674 687 663 686 434 47 514 453 500 679 675 623 702 716 691 715 452 48 537 473 523 710 707 652 735 749 723 748 473 49 561 494 546 741 737 680 766 781 754 781 493 50 587 517 572 776 772 712 802 818 790 817 516 51 613 540 597 810 806 743 838 854 824 853 539 52 642 565 625 848 843 778 877 894 863 893 564 53 671 591 653 886 882 813 917 934 902 934 590 54 702 618 683 928 923 851 959 978 944 977 617 55 733 646 714 969 964 889 1,002 1,021 986 1,020 645 56 767 676 747 1,014 1,008 930 1,048 1,068 1,031 1,068 674 57 801 706 780 1,059 1,053 971 1,095 1,116 1,077 1,115 705 58 838 738 815 1,107 1,101 1,015 1,145 1,167 1,126 1,166 737 59 856 754 833 1,131 1,125 1,037 1,169 1,192 1,151 1,191 753 60 892 786 868 1,179 1,173 1,081 1,219 1,243 1,200 1,242 785 61 924 814 899 1,221 1,214 1,120 1,262 1,287 1,242 1,286 812 62 944 832 919 1,248 1,241 1,145 1,291 1,316 1,270 1,315 831 63 970 855 945 1,283 1,276 1,176 1,326 1,352 1,305 1,351 853 64+ 987 870 960 1,305 1,296 1,194 1,347 1,374 1,326 1,374 867

Rates are effective January 1, 2020, through December 31, 2020. 361335157 NW-OR 2020 Kaiser Permanente for Individuals and Families

2020 Monthly rates Please note: These rates do not include the federal financial assistance you All other service area counties may be eligible to receive through the Oregon Health Insurance Marketplace.

Non-Tobacco User Rates KP Oregon KP OR Silver KP OR Silver Age on KP Oregon Standard Silver 3500/35 KP OR Silver 2500/35 KP Oregon KP OR 2020 KP OR Bronze KP OR Bronze KP OR Gold KP OR Gold Standard Plan (includes (includes 3000/20% (includes Standard Gold Catastrophic effective 6900/0% HSA 5000/50 1000/20 0/20 Bronze Plan all CSR plan all CSR plan HSA all CSR plan Plan 8150/0 date variations) variations) variations) 0–20 $166 $146 $161 $219 $218 $201 $226 $231 $223 $231 $146 21–24 261 230 254 345 343 316 357 363 351 363 229 25 262 231 255 346 344 318 358 365 352 365 230 26 267 235 260 353 351 324 365 372 359 372 235 27 273 241 266 361 359 331 374 381 368 381 240 28 284 250 276 375 373 344 388 395 381 395 249 29 292 257 284 386 384 354 399 407 393 406 257 30 296 261 288 391 389 359 405 412 398 412 260 31 302 266 294 400 397 367 413 421 407 421 266 32 309 272 300 408 406 374 422 430 415 430 271 33 313 275 304 413 411 379 427 435 420 435 275 34 317 279 308 419 416 384 433 441 426 441 279 35 319 281 310 421 419 386 436 444 429 444 280 36 321 283 312 424 422 389 439 447 432 447 282 37 323 285 314 427 425 392 441 450 434 450 284 38 325 286 316 430 427 394 444 453 437 453 286 39 329 290 320 435 433 399 450 459 443 458 290 40 333 294 325 441 438 404 456 464 448 464 293 41 340 299 331 449 447 412 464 473 457 473 299 42 346 305 336 457 454 419 472 482 465 481 304 43 354 312 345 468 465 429 484 493 476 493 311 44 364 321 355 482 479 442 498 508 490 507 321 45 377 332 367 498 495 457 515 525 507 524 331 46 391 345 381 517 514 474 535 545 526 545 344 47 408 359 397 539 536 494 557 568 548 568 359 48 427 376 415 564 561 517 583 594 574 594 375 49 445 392 433 588 585 540 608 620 599 620 391 50 466 410 454 616 613 565 637 649 627 649 410 51 487 429 474 643 640 590 665 678 654 677 428 52 509 449 496 673 669 617 696 709 685 709 448 53 532 469 518 704 700 645 727 741 716 741 468 54 557 491 542 736 732 675 761 776 749 775 490 55 582 513 566 769 765 705 795 810 782 810 512 56 609 536 592 805 800 738 832 848 819 847 535 57 636 560 619 840 836 771 869 886 855 885 559 58 665 586 647 879 874 806 909 926 894 925 585 59 679 598 661 898 893 823 928 946 913 945 597 60 708 624 689 936 931 858 968 986 952 986 623 61 733 646 714 969 964 889 1,002 1,021 986 1,021 645 62 750 660 730 991 985 909 1,024 1,044 1,008 1,043 659 63 770 678 750 1,018 1,012 934 1,053 1,073 1,036 1,072 677 64+ 783 690 762 1,035 1,029 948 1,071 1,089 1,053 1,089 687

Rates are effective January 1, 2020, through December 31, 2020. 361335157 NW-OR 2020 Kaiser Permanente for Individuals and Families

Tobacco User Rates KP Oregon KP OR Silver KP OR Silver Age on KP Oregon Standard Silver 3500/35 KP OR Silver 2500/35 KP Oregon KP OR 2020 KP OR Bronze KP OR Bronze KP OR Gold KP OR Gold Standard Plan (includes (includes 3000/20% (includes Standard Gold Catastrophic effective 6900/0% HSA 5000/50 1000/20 0/20 Bronze Plan all CSR plan all CSR plan HSA all CSR plan Plan 8150/0 date variations) variations) variations) 0–20 $166 $146 $161 $219 $218 $201 $226 $231 $223 $231 $146 21–24 313 276 305 414 412 380 428 436 421 436 275 25 314 277 306 415 413 381 430 438 423 438 276 26 321 282 312 424 421 389 438 447 431 446 282 27 328 289 319 434 431 398 448 457 441 457 289 28 340 300 331 450 447 413 465 474 458 474 299 29 350 309 341 463 461 425 479 488 471 488 308 30 355 313 346 470 467 431 486 495 478 495 313 31 363 320 353 480 477 440 496 505 488 505 319 32 370 326 361 490 487 449 506 516 498 516 326 33 375 330 365 496 493 455 513 522 504 522 330 34 380 335 370 502 500 461 519 529 511 529 334 35 383 337 372 506 503 464 523 533 514 533 336 36 385 339 375 509 506 467 526 536 518 536 339 37 388 341 377 512 509 470 530 540 521 540 341 38 390 344 380 516 513 473 533 543 525 543 343 39 395 348 385 522 519 479 540 550 531 550 347 40 400 352 389 529 526 485 547 557 538 557 352 41 408 359 397 539 536 494 557 568 548 567 358 42 415 365 404 548 545 503 567 578 558 577 365 43 425 374 414 562 558 515 581 592 571 591 374 44 437 385 426 578 575 530 598 609 588 609 385 45 452 398 440 598 594 548 618 630 608 629 398 46 470 414 457 621 617 569 642 654 632 654 413 47 489 431 476 647 643 593 669 682 658 681 430 48 512 451 498 677 673 621 700 713 688 713 450 49 534 471 520 706 702 647 730 744 718 744 470 50 559 493 544 739 735 678 764 779 752 778 492 51 584 514 568 772 768 708 798 813 785 813 514 52 611 538 595 808 803 741 835 851 822 851 537 53 639 563 622 844 840 774 873 890 859 889 562 54 668 589 651 884 879 810 914 931 899 930 588 55 698 615 680 923 918 846 954 972 939 972 614 56 730 643 711 965 960 885 998 1,017 982 1,017 642 57 763 672 743 1,009 1,003 925 1,043 1,063 1,026 1,062 671 58 798 703 777 1,054 1,049 967 1,090 1,111 1,073 1,110 702 59 815 718 793 1,077 1,071 988 1,114 1,135 1,096 1,134 717 60 850 749 827 1,123 1,117 1,030 1,161 1,184 1,143 1,183 747 61 880 775 856 1,163 1,156 1,066 1,202 1,225 1,183 1,225 774 62 899 792 876 1,189 1,182 1,090 1,229 1,253 1,210 1,252 791 63 924 814 900 1,222 1,215 1,120 1,263 1,287 1,243 1,287 813 64+ 939 828 915 1,242 1,236 1,140 1,284 1,308 1,263 1,308 825

Rates are effective January 1, 2020, through December 31, 2020. 361335157 NW-OR 2020 Kaiser Permanente for Individuals and Families

Dental and vision coverage With our Kaiser Permanente Individuals and Families dental plans and vision coverage, you get the benefits you need and the high quality of care you’ve come to expect. There is no waiting period — you’ll be eligible to start receiving covered services the minute your coverage takes effect.

Quality dental care How to make appointments Our dental offices are open Monday through Friday, Combining dental coverage with our medical with Saturday hours for hygienist services and coverage is a great way to experience Kaiser emergencies at most locations. To schedule a visit, Permanente's uniquely coordinated approach to care. call our Appointment Center at 1-800-813-2000 Save a trip — and often a copay — by taking care of (TTY 711) from 8 a.m. to 6 p.m., Monday through Friday minor medical needs, like flu shots or vaccinations, (closed major holidays). during your dental appointment.* Plus, your dentist For more information, visit kp.org/dental/nw. can view your electronic health record to see if you're due for a screening, lab test, or follow-up appointment. Our dental and medical teams work together to Vision Essentials support your total health, giving you another reason We offer eye care services to help keep your world in to smile. focus. Plus, when you’re a Kaiser Foundation Health Choice Plan of the Northwest member, your eye health You’ll have your first appointment with a dentist information becomes part of your overall medical and dental hygienist at the location that works best record, giving your care team a complete picture of for you. After that, you can choose to keep them as your health. your providers, or request to be transferred. You can Adult vision exams are included in our Gold plans change your dentist or dental hygienist at any time. (except Oregon Standard) and the KP OR Silver Convenience 2500/35 plan. All plans include medically necessary We have 21 dental offices in the Portland metro eye exams, pediatric vision exams for children 18 and area, southwest Washington, Longview, Salem, and younger, as well as glasses or contact lenses for Eugene, so there’s sure to be one near you. Our dental children, usually at no additional cost.‡ For more group includes pediatric dentists, orthodontists, information, including our 10 optical locations, visit periodontists, oral surgeons, endodontists, and kp2020.org. prosthodontists. Quality Our dental professionals exceed national standards. Since 1990, we’ve received accreditation from the Accreditation Association for Ambulatory Health Care (AAAHC). Right now, we’re the only dental practice in the Pacific Northwest with AAAHC accreditation.†

* Medical services aren't available at all dental locations. You must be a Kaiser Permanente medical member to get medical care. † Source: https://eweb.aaahc.org/eweb/dynamicpage.aspx?site=aaahc_site&webcode=find_orgs ‡ Vision hardware must be prescribed and purchased at a Kaiser Permanente Optical Center, and is no additional charge when selected from a list of standard frames.

361341999 NW-OR 2020 Kaiser Permanente for Individuals and Families

KP OR Dental 100 KP OR Dental 80H KP OR Dental 80L

Child Adult Child Adult Child Adult Dental plans (18 or younger) (19 or older) (18 or younger) (19 or older) (18 or younger) (19 or older) Features Benefit maximum Does not apply $1,000 Does not apply $1,000 Does not apply No maximum Out-of-pocket maximum (individual/family) $350/$700 Does not apply $350/$700 Does not apply $350/$700 Does not apply Deductible (individual/family) $50/$150 $50/$150 $0 $0 $100/$300 $100/$300 Benefits(subject to deductible unless otherwise noted) Preventive and diagnostic services No charge 20% coinsurance (not subject to deductible) 20% coinsurance (not subject to deductible) Basic restorative services 20% coinsurance 75% coinsurance 50% coinsurance Oral surgery, endodontics, and periodontics 20% coinsurance 75% coinsurance 50% coinsurance Major restorative services 50% coinsurance 75% coinsurance 50% coinsurance

Monthly rates Age on 2020 KP OR Dental 100 KP OR Dental 80H KP OR Dental 80L effective date To calculate the rate of your dental plan for you and your entire family, add the rate for each family <18 $33.64 $21.71 $25.78 member based on their age. For children who are 19–29 37.29 25.28 33.09 under 21 and covered under the same dental plan, 30–34 39.21 26.59 34.80 include a rate for no more than the 3 oldest children. 35–39 40.96 27.77 36.35 Note: All family members must enroll in a 40–44 45.33 30.73 40.23 pediatric dental plan unless you confirm on your application that you and your family members 45–49 50.40 34.17 44.73 are enrolled in another Oregon Health Insurance 50–54 54.15 36.71 48.06 Marketplace–certified pediatric dental plan. 55–59 58.75 39.83 52.14 60+ 60.50 41.02 53.69

This brochure provides summaries of various plans and is not a contract. Dental plan details are provided in your Evidence of Coverage. For specific plan information about dental plans, see the following forms:EOIDFAMILYDNT0120, EOIDDEDFAMILYDNT0120–Evidence of Coverage; BOIDFAMILYDNT0120, BOIDDEDFAMILYDNT0120–Benefit Summaries; FSOIDFAMILYDNT0120—Face Sheet.

361341999 NW-OR 2020 Kaiser Permanente for Individuals and Families

Find a facility near you Having a wide selection of health care providers in convenient locations is important. That’s why we have medical facilities and dental offices in 5 areas: southwest Washington, Salem, Longview, Eugene-Springfield, and the Portland metropolitan area.

Locate a medical provider Our locations Just visit kp.org/newmember, select your region and It’s easy to find a location near you. Our service area is click on “Choose a personal physician” under “Getting made up of 36 medical offices, 6 urgent care clinics, and Started.” Next, choose a physician, physician’s assistant, 2 hospitals. You can access Care Essentials by Kaiser or nurse practitioner as your primary care participating Permanente, convenient care clinics for nonemergency provider in these departments: and preventive health services, located in Portland. We g also have a network of affiliated providers, including Family Medicine for children and adults The Portland Clinic. g Internal Medicine for members 18 and older In the Eugene-Springfield area, in addition to the g Ob-Gyn for female members (certified nurse- Eugene Medical Office and Valley River Dental Office, midwives also available) we have expanded our network to partner with 4 g Pediatrics for members under age 18 affiliate medical offices, 4 hospitals, 12 urgent care Our medical staff directory lists both primary care clinics, 6 pharmacies, and many specialists to offer more and specialty care providers, and shows their options for care where you need it. education, gender, languages spoken, and more. For more information on our medical facilities, visit You can download the directory from the “Forms kp.org/facilities. and Publications” section of the website. Or, to have one sent to you, contact Member Services at 1-800-813-2000 (TTY 711) from 8 a.m. to 6 p.m., Dental care Monday through Friday (closed major holidays). For With 21 dental offices to choose from, it's easy to find a language interpretation services, call 1-800-324-8010. location that's convenient for you. For more information about our dental plans and the wide range of services Talk to a new member specialist available, please visit kp.org/dental/nw. Call our dedicated New Member Welcome Desk at 1-888-491-1124 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., and talk with a specialist who can help you get the most out of your benefits quickly and easily. They can assist you with selecting a provider, transferring medical records and prescriptions, setting appointments, and more.

Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.

364999513 NW-OR 2020 Kaiser Permanente for Individuals and Families

Northwest locations NONDISCRIMINATION NOTICE Kaiser Foundation Health Plan of the Northwest (Kaiser Health Plan) complies with Visit kp.org/locations to see all our current locations and find the one closest to you. applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Kaiser Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, Kaiser Permanente or sex. We also: Medical Office 5 Kaiser Permanente • Provide no cost aids and services to people with disabilities to communicate Hospital effectively with us, such as: Vancouver Affiliate Location • Qualified sign language interpreters • Written information in other formats, such as large print, audio, and Kaiser Permanente accessible electronic formats 5 Dental Office Longview 205 Care Essentials by • Provide no cost language services to people whose primary language is not Kaiser Permanente English, such as: • Qualified interpreters • Information written in other languages

If you need these services, call 1-800-813-2000 (TTY: 711)

If you believe that Kaiser Health Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by mail or phone at: Member Relations, Attention: Kaiser Civil Rights Coordinator, 500 NE Multnomah St. Ste 100, Portland, OR 97232, telephone number: 1-800-813-2000. 84 26 Hillsboro You can also file a civil rights complaint with the U.S. Department of Health and Portland Human Services, Office for Civil Rights electronically through the Office for Civil 13 Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, Beaverton or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 1-800-537-7697 (TDD). Complaint forms are available at 217 5 http://www.hhs.gov/ocr/office/file/index.html.

Milwaukie ______Tigard HELP IN YOUR LANGUAGE Tualatin 205 ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-800-813-2000 (TTY: 711). Oregon City አማርኛ (Amharic) ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት 5 ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-800-813-2000 (TTY: 711). العربية (Arabic) ملحوظة: إذا كنت تتحدث العربية، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان . Salem اتصل برقم TTY( 1-800-813-2000: 711(. Florence Eugene 中文 (Chinese) 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電（TTY：）。 Oakridge 1-800-813-2000 711 فارسی (Farsi) توجه: اگر به زبان فارسی گفتگو می کنيد، تسهيالت زبانی بصورت رايگان برای شما فراهم می باشد. با TTY) 1-800-813-2000: 711) تماس بگيريد. Cottage Grove

Maps not to scale

Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer. 60576526_ACA_1557_MarCom_NW_2017_Taglines

364999513 NW-OR 2020 NONDISCRIMINATION NOTICE Kaiser Foundation Health Plan of the Northwest (Kaiser Health Plan) complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Kaiser Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. We also:

• Provide no cost aids and services to people with disabilities to communicate effectively with us, such as: • Qualified sign language interpreters • Written information in other formats, such as large print, audio, and accessible electronic formats

• Provide no cost language services to people whose primary language is not English, such as: • Qualified interpreters • Information written in other languages

If you need these services, call 1-800-813-2000 (TTY: 711)

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 1-800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. ______HELP IN YOUR LANGUAGE ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-800-813-2000 (TTY: 711). አማርኛ (Amharic) ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-800-813-2000 (TTY: 711). العربية (Arabic) ملحوظة: إذا كنت تتحدث العربية، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم TTY( 1-800-813-2000: 711(. 中文 (Chinese) 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800-813-2000（TTY：711）。 فارسی (Farsi) توجه: اگر به زبان فارسی گفتگو می کنيد، تسهيالت زبانی بصورت رايگان برای شما فراهم می باشد. با TTY) 1-800-813-2000: 711) تماس بگيريد.

60576526_ACA_1557_MarCom_NW_2017_Taglines

Français (French) ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-800-813-2000 (TTY: 711). Deutsch (German) ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-800-813-2000 (TTY: 711). 日本語 (Japanese) 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-800-813-2000（TTY: 711）まで、お電話にてご連絡ください。 ខ្មែរ (Khmer) ប្រយ័㿒ន៖ បរើសិនᾶ诒នកនិ架យ 徶羶ខ្មែរ, បស玶ជំនួយខ្ននក徶羶 បោយមិន គិ㿒⏒ន ួល គឺ讶ច掶នសំ殶រ់រំបរ ើ诒នក។ ចូរ ទូរស័寒ទ 1-800-813-2000 (TTY: 711)។ 한국어 (Korean) 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-800-813-2000 (TTY: 711) 번으로 전화해 주십시오. ລາວ (Laotian) ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວ້ າພາສາ ລາວ, ການບໍລິການຊ່ວຍເຫ ອດ້ານພາສາ, ໂດຍບໍ່ ເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-800-813-2000 (TTY: 711). Naabeehó (Navajo) Díí baa akó nínízin: Díí saad bee yáníłti’go Diné Bizaad, saad bee áká’ánída’áwo’dé̖ é̖ ’, t’áá jiik’eh, éí ná hóló̖ , koji̖ ’ hódíílnih 1-800-813-2000 (TTY: 711). Afaan Oromoo (Oromo) XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-800-813-2000 (TTY: 711).

ਚ ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇ ਲਈﹱਪੰਜਾਬੀ (Punjabi) ਧਿਆਨ ਧਿਓ: ਜੇ ਤੁਸੀਂ ਪੰਜਾਬੀ ਬੋਲਿੇ ਹੋ, ਤਾਂ ਭਾਸ਼ਾ ਧਵ ਮੁਫਤ ਉਪਲਬਿ ਹੈ। 1-800-813-2000 (TTY: 711) 'ਤੇ ਕਾਲ ਕਰੋ। Română (Romanian) ATENȚIE: Dacă vorbiți limba română, vă stau la dispoziție servicii de asistență lingvistică, gratuit. Sunați la 1-800-813-2000 (TTY: 711). Pусский (Russian) ВНИМАНИЕ: если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-800-813-2000 (TTY: 711). Español (Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-813-2000 (TTY: 711). Tagalog (Tagalog) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-800-813-2000 (TTY: 711). ไทย (Thai) เรียน: ถ ้าคุณพูดภาษาไทย คุณสามารถใชบริการช้ วยเหลือทางภาษาได่ ้ฟรี โทร 1-800-813-2000 (TTY: 711). Українська (Ukrainian) УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером 1-800-813-2000 (TTY: 711). Tiếng Việt (Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-813-2000 (TTY: 711).

60576526_ACA_1557_MarCom_NW_2017_Taglines Kaiser Permanente for Individuals and Families

Helpful websites and phone numbers Have questions about enrolling or getting started with Kaiser Permanente? Want to learn more about our services? Use this information to explore the resources available to members, or to get answers to any questions you have.

Kaiser Permanente Discover Kaiser Permanente...... kp.org/thrive

Enrollment resources Apply online...... buykp.org/apply Get started if you’re a new member...... kp.org/newmember Enroll during a special enrollment period...... kp.org/specialenrollment

Member resources Manage your care...... kp.org Find a location near you...... kp.org/facilities Choose your doctor...... kp.org/searchdoctors Create your online account...... kp.org/registernow Get an idea of what your care will cost...... kp.org/treatmentestimates Get an estimate of what you’ll pay for your care...... kp.org/costestimates Get a copy of your Evidence of Coverage...... kp.org/plandocuments

Additional resources Find resources for healthier living...... kp.org/healthyliving Learn about vision care...... kp2020.org Learn about dental care...... kp.org/dental/nw

Get in touch with us by phone Get general information about Kaiser Permanente...... 1-800-494-5314 New Member Welcome Desk...... 1-800-813-2000

Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.

364999513 NW-OR 2020 The right choice for a healthier you Having a good health plan is important. So is getting quality care. With Kaiser Permanente, you get both.

Want to learn more? Visit kp.org or call us at 1-800-494-5314 (TTY 711).

Stay connected to good health

facebook.com/kpthrive

youtube.com/kaiserpermanenteorg

@kpnorthwest, @kpthrive, @aboutkp, @kptotalhealth

Kaiser Foundation Health Plan of the Northwest 500 NE Multnomah St., Suite 100 Portland, OR 97232