2020 Enrollment | Georgia Your enrollment guide to the only plan with $1,000 IN REWARDS.* $0 DEDUCTIBLE. CARE UNDER ONE ROOF. *up to $1,000 in rewards per household. maximum size h : 0.9812 my.kp.org/shbp Kaiser Permanente Care and coverage that fits your life Your doctor, your choice Choose your doctor based on what’s important to you. Go to kp.org/searchdoctors for details about education, specialties, languages spoken, and more. You can also change doctors at any time. Convenient More care options cost estimates How you get care Get an idea of what is up to you. Choose a you’ll pay before you phone appointment, come in for care. E-visit, or video visit,1 For a personalized email your doctor’s estimate based on office with nonurgent your plan details, visit questions, or come see kp.org/costestimates. us in person.2 Right care, right time Many services Get the care you need under one roof when you need it with Do more in less time. routine, specialty, urgent, In most of our facilities, and emergency care. If you can see your doctor, you’re ever unsure where get a lab test, and pick to go, call us for 24/7 care up prescriptions — all advice by phone. in a single trip. 1When appropriate and available. 2 These features are available when you get care at Kaiser Permanente facilities. 2 Care and coverage that fits your life Experience the Kaiser Permanente difference To be healthy, you need quality care that’s simple, personalized, and hassle-free. At Kaiser Permanente, care and coverage come together — so you get everything you need to stay on top of your health in one easy-to-use package. State Health Benefit Plan 4 Five Simple Activities to earn up to $1,000 7 Great care, great results 9 Your care, your way 11 Healthy resources 13 Pharmacy 15 Care when and where you need it 17 Medical offices and specialties 18 3 Kaiser Permanente State Health Benefit Plan (SHBP)1 Effective Dates: January 1, 2020 - December 31, 2020 Deductible, Co-insurance & Out-of-Pocket Maximums Annual Deductible: Co-insurance Lifetime Benefit Maximum Individual/Family $0 $0 Unlimited Office Visits (Outpatient) Lab & X-Ray Primary Care $35 co-pay Laboratory Specialty Care $45 co-pay Covered at 100% for services performed in a Kaiser Permanente Medical Center or a freestanding laboratory contracted with Kaiser Scheduled Prenatal Visits and Routine care covered Permanente; $100 co-pay for services performed in an outpatient 1st Postpartum Visit at 100% hospital setting. X-Ray $0 co-pay, includes Vision Exam refractions Covered at 100% for services performed in a Kaiser Permanente Medical Center or a freestanding imaging center contracted with Telemedicine/Virtual Visit Covered at 100% Kaiser Permanente; $100 co-pay for services performed in an $25 co-pay, up to outpatient hospital setting. Physical/Occupational/Speech 40 visits per MRI/CT/PET/Nuclear Medicine Therapy, Cardiac Rehab calendar year for each therapy $45 co-pay per scan for services performed in a Kaiser Permanente Medical Center or a freestanding imaging center contracted with Outpatient/Ambulatory Surgery $100 co-pay Kaiser Permanente; $100 co-pay when imaging is performed in outpatient hospital setting. Routine Preventive Care2 Wellness Exams—Physical and Covered at 100% Emergency Care Well Woman exams $100 co-pay Ambulance (Ground or Air) Mammography Screening (per trip) • Mammography screening for breast cancer for women over 40. $150 co-pay (per visit); Emergency Room • Mammography screening for Covered at 100% waived if admitted breast cancer in other age groups as jointly determined by patient $35 co-pay, at and physician Urgent Care designated facilities Pap Smear Covered at 100% Hospital Care (Inpatient) Prostate Specific Antigen (PSA) Test Prostate cancer screenings Covered at 100% $250 co-pay, per Inpatient (PSA and digital rectal exams) admission Covered at 100% Sigmoidoscopy/Colonoscopy Delivery and Inpatient $250 co-pay, per Well Child Care Covered at 100% Baby Care admission Breast Cancer Medications Covered at 100% (Tamoxifen & Raloxifene only) Live or work Need help? The State Health Benefit Plan members (and eligible dependents) are eligible to enroll in Call your Dedicated Member Services line at Kaiser Permanente if they live or work within 1-855-512-5997 Monday–Friday, 7 a.m.–7 p.m. EST the Service Area at the time of enrollment.3 and learn how to get the most of your membership. 4 Care and coverage that fits your life Mental Health and Chemical Dependency Mental Health Outpatient (Individual) $35 co-pay, unlimited visits per calendar year Mental Health Outpatient (Group) $17 co-pay, unlimited visits per calendar year Mental Health Inpatient $250 co-pay, unlimited days per calendar year Chemical Dependency Outpatient (Individual) $35 co-pay, unlimited visits per calendar year Chemical Dependency Outpatient (Group) $35 co-pay, unlimited visits per calendar year Chemical Dependency Inpatient $250 co-pay, unlimited days per calendar year Prescription Drugs Day Supply 30-Day Supply $20 co-pay at KP Pharmacies Generic Preferred $30 co-pay at Network Pharmacies for 1x fill4 $50 co-pay at KP Pharmacies Brand Preferred $60 co-pay at Network Pharmacies for 1x fill4 $80 co-pay at KP Pharmacies Non-Preferred $90 co-pay at Network Pharmacies for 1x fill4 Mail Order – Day Supply 90-Day Supply Mail Order – Generic Preferred $50 co-pay through Kaiser Permanente Pharmacies only Mail Order – Brand Preferred $125 co-pay through Kaiser Permanente Pharmacies only Mail Order – Non-Preferred $200 co-pay through Kaiser Permanente Pharmacies only Other Skilled Nursing Facility (SNF) Plan pays 100%, up to 120 days per calendar year Hospice Care Covered at 100% Home Health Care Plan pays 100%, unlimited. Private Duty Nursing is not covered. Durable Medical Equipment (DME) Covered at 100%, unlimited Chiropractic Care $45 co-pay, up to 20 visits per calendar year Hearing (Non-routine Exams, Tests & Fittings) • Hearing Aids limited to $1,500 every 5 yrs for Adults Covered at 100% • Combined Benefit Maximum: $3,000 per aid; per ear; every 48 months for Children 18 years and younger Infertility Diagnosis Office Visit Limited to diagnostic services for the diagnosis of $45 co-pay involuntary infertility only. Infertility Diagnosis Only Laboratory, Radiology and Tests Covered at 100% for services performed in a Kaiser Permanente Limited to diagnostic services for the diagnosis of involuntary infertility. Tests covered under Medical Center or a freestanding laboratory contracted with “Diagnosis Only” are those only to rule out underlying medical issues. Tests and treatment Kaiser Permanente; $100 co-pay for services performed in an related to reproductive issues are not covered. outpatient hospital setting. Enroll today! mySHBPga.adp.com 5 KaiserSTAY Permanente WELL, GET REWARDED “If it hadn’t been for Kaiser’s pre-screening options, and the $500 gift card, who knows where I would be today.” Gina, Elementary School Nurse Hear more care stories from real Kaiser Permanente members at kp.org/carestories. 6 Care and coverage that fits your life FIVE SIMPLE ACTIVITIES TO EARN UP TO $1,000 2020 Wellness Program Each member and covered spouse who completes the Kaiser Permanente Wellness Program will receive a $500 reward card—$1,000 per household to spend on anything you choose! Step 1: Accept your Wellness Program Agreement Sign on to kp.org/engage to accept your Wellness Program Agreement — check “yes,” then click submit. If you check “no” or if you don’t complete this step, you will not earn credit for your Kaiser Permanente Wellness Program activities. Step 2: Take Your Total Health Assessment Complete your Kaiser Permanente Total Health Assessment (THA) online. The questionnaire is confidential and takes about 10 minutes. Step 3: Know Your Numbers Complete a Biometric Screening either at a Kaiser Permanente medical office, or by a Kaiser Permanente clinician at an SHBP-sponsored screening event. Visit kp.org/wellnessevent and use the signup code SHBP for a list of upcoming events. ONLY those screenings performed by Kaiser Permanente are eligible for the reward. Step 4: Get Yourself Screened Complete all age and gender appropriate preventive screenings for breast, cervical, or colorectal cancer. Step 5: Make A Lifestyle Change Your choice—complete one healthy lifestyle program or partner with a coach through Wellness Coaching by Phone. 7 Kaiser Permanente WE'RE ALL ABOUT THE BIG PICTURE Mom-centered maternity care every step of the way • Kaiser Permanente • Emory University Hospital Midtown • Northside Hospital 8 Care and coverage that fits your life Great care, great results From preventive screenings that keep you healthy to world-class care if you get sick, we’ve got you covered. Preventive care to Support for keep you healthy ongoing conditions Preventive care is key to how we practice medicine. If you have a condition like diabetes or heart It can help you avoid some health issues and catch disease, you’re automatically enrolled in a others before they become serious. disease management program for personal coaching and support. With a well-rounded Your electronic health record plays a vital role. approach backed by proven best practices It tracks your preventive care services and sends and advanced technology, we’ll help you get reminders when you’re due for your next screening. the care you need to continue living life We’ll let you know when to come in so you’re free to the fullest. to focus on living your life. A leader in Specialty care clinical quality when you need it In 2018, Kaiser Permanente led the nation as We’re also here for you if you get sick or need the top performer in 30 effectiveness-of-care specialty care.