Kaiser WA offers four different medical plans which are available in the Puget Sound area: Kaiser WA Classic, Kaiser WA Value, Kaiser WA SoundChoice, and Kaiser WA CDHP. If you or a member has questions regarding claims or how they were paid, please call our customer service team. More Choice. Contact your Kaiser Permanente Sales and Account Management representative for more information. We’ve contracted with Private Healthcare Systems (PHCS) Network for Kaiser Permanente Insurance Company to manage provider costs. Kaiser Permanente Options Federal coverage can help pay for many expenses that are not covered by Medicare Parts A and B. ... Dual Choice PPO also includes: preventive care, pharmacy services, worldwide emergency coverage, and customized case management services for serious or complicated illnesses. ... Kaiser Permanente Providers in Georgia. Access coverage documents for Added Choice members. Kaiser Permanente Insurance Company (herein called KPIC) provides the Out-of-Network coverage as set forth in the Group Policy. You can choose any licensed physician to provide care nationwide, and receive preventive care at little or no cost from in-network providers. Childbirth/delivery facility services 15% coinsurance Not covered You must notify Kaiser Permanente within 24 hours of admission, or as soon thereafter as medically possible. Get More Information in Your Benefits Booklet. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. Your time-loss payments will range from $135 to $225 per week (less Social Security taxes), depending on the number of hours you worked during your eligibility month. Need a coverage document? Dental charges in excess of the schedule will be your responsibility. The Flexible Choice plan is composed of three benefit levels, which includes the convenience of our traditional HMO coverage. Actionable reporting For our large group clients, we collect and analyze valuable data about the way your employees are using their health coverage, including claims, hospitalizations, and level of physician engagement. They are mostly a one-stop shop for Kaiser Permanente customers, meaning that customers can often visit the lab, radiology, specialists, pharmacy, and their primary care physician in the same visit. Why Kaiser Permanente is the right choice for you. When you combine the Options Federal Standard Option plan with Medicare coverage, your Kaiser Permanente coverage will make your Medicare coverage go further. Kaiser Permanente’s behavioral health care management program provides care coordination, support and advocacy for patients with severe or chronic mental illness and or alcohol or drug concerns. You must notify Kaiser Permanente within 24 hours of admission, or as soon thereafter as medically possible. Members can receive medical care provided by our Kaiser Permanente physicians and experience the convenience of our integrated care delivery system. Your reimbursement will depend on the dentist’s contract with DDWA: This option allows you to see any licensed dental provider. Make sure you have a DeltaCare provider in your area and that they are accepting new patients before enrolling in this option. Our doctors are among the best, and caring for people is their passion. Employee Accidental Death or Dismemberment—This benefit is payable to your beneficiary in the event of your death, or to you in the event of your loss, if your death or loss is caused by an accidental injury while you are covered under the Plan. However, once you have completed your 35th month of employment, you may choose to enroll in either the Sound PPO Plan or the Sound Kaiser Permanente Plan. (Must use Kaiser Permanente Order Program), Download Kaiser Permanente mail order form (PDF). Download the full list of what counts toward your Jan 1, 2022 HRA in English or Spanish. Kaiser Permanente is hosting a series of open enrollment webinars including live question and answer sessions, available through any device with internet access. Members can fill prescriptions written by any provider at pharmacies located in Kaiser Permanente medical offices in Georgia, at the lowest out-of-pocket cost. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. Plan hospitals, plan physicians, and other plan providers, and the services available at plan facilities, are subject to change at any time without notice. Email Eligibility & COBRA, (206) 282-4500 or (800) 225-7620 Show me. Kaiser Permanente Dual Choice PPO is the best of all worlds. * Including contact lens evaluations and examinations associated with their fitting. For years, Katherine has been seeing her cardiologist, who is not an In-Network Provider. You can receive care from any licensed care provider in the U.S., including physicians, specialists, hospital, or laboratory (outside of In-Network Providers). Tier 0-Some highly cost-effective medications: Co-pay per 30-day supply $0. Most Kaiser Permanente medical offices in Georgia have on-site pharmacies. Kaiser Permanente Insurance Company (KPIC) has contracted with MedImpact to fill outpatient prescriptions at In-Network retail pharmacies—including Rite Aid, Walgreens, Kroger, and many supermarket chains (Not all pharmacies in a chain may participate). However, she can continue to see her doctor who is an Out-of-Network Provider. This amount will be paid to you in the event of your spouse or partner’s death from any cause. In general, when you have a Kaiser WA plan, you’ll visit Kaiser Permanente Medical Centers to receive care and get prescriptions. Join Kaiser Permanente's Talent Network. It is printed on the far left-hand side under the Trust logo. Sound Health & Wellness Trust participants are also able to use benefits for mental health and chemical dependency at the out of network benefit level. General information about Kaiser Permanente Washington's PPO plans. Go back to home. This amount will be paid to your beneficiary in the event of your death from any cause. Call the Trust office at (206) 282-4500 or (800) 225-7620. Your physician will complete a claim form. Puget Sound area. In addition, you have access to a number of contracted community physicians in the area. You’re free to choose whatever provider you prefer, whenever you receive care. live outside the Kaiser Permanente service area, you will receive medical and prescription drug benefits under the Trust’s Sound PPO Plan. Find the details of your mental health & substance abuse coverage in your Summary Plan Description (choose the link below based on whether you are in the “Sound” or “SoundPlus” plan). You MUST choose a DeltaCare primary care dentist who coordinates all of your care, including any referrals to specialists. Why choose Kaiser Permanente for your health care coverage? Contact Kaiser Permanente at any time through our. Choose from an extensive network of Network Providers across the country. Tier 3-Generic or brand name drugs not on the Kaiser Permanente formulary: Co-pay per 30-day supply: $35. Show me. Or you can see any licensed provider you want for most covered services. Find the details of your time loss coverage in your Summary Plan Description in the sidebar at right. Your company has the convenience of one health care provider for all your employee benefits administration. Your call will be answered by a trained and licensed counselor who will ask you a few questions to best direct you to the services that meet your needs and preferences. Core Access PPO. Call the Added Choice Contact Center at 1-866-616-0047 (TTY 711). Choice Products California. Find a provider online by using the Kaiser Permanente Provider Directory. With care and coverage working seamlessly together, Kaiser Permanente is uniquely designed to give you the information and support you need to live healthy. Choose Kaiser Permanente physicians and specialists in Georgia. Your Kaiser Permanente Provider in Georgia will coordinate your care. PEBB members can conveniently get open enrollment information from Kaiser Permanente. If you are required to pay out-of-pocket at the point of service, you can complete a medical claim form and submit it for reimbursement from your insurance carrier. This option requires you to choose from a smaller list of approved dentists and clinics. Children from 6 months to 19 years of age, pregnant women, people 50 and older, and people with certain chronic medical conditions are especially encouraged to get a flu shot. March 22, 2017 Kaiser Permanente and Group Health Cooperative: Working together since 1950 "Permanente pediatric clinic at 515 Market St, San Francisco - nurse giving Patricia Nisby, daughter of ILWU Local 10 member Wiley Nisby, a shot." The Trust’s four-tier therapeutically based prescription plan is designed to promote the use of proven, cost-effective medications. It is printed on the far left-hand side under the Trust logo. Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 1/1/20 20 – 12/31/2020 : PEBB SoundChoice Plan All plans offered and underwritten by Kaiser Foundation Health Plan of Washington 1 of 6 RQ-136645-1 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. You can choose any licensed physician to provide care nationwide, and receive preventive care at little or no cost from in-network providers. Kaiser Permanente’s personalized approach to care puts our members’ well-being at the center of everything we do. Search for a dentist using the Delta Dental of Washington site. Members also can fill prescriptions at any pharmacy outside the Kaiser Permanente medical office and MedImpact network. Learn about Georgia Kaiser Permanente Choice Products. Find the details of your life insurance coverage in your Summary Plan Description in the sidebar at right. Your out-of-pocket costs will be higher than if you choose care inside the Kaiser Permanente network. This option allows you to see any licensed dental provider. Point-of-Service (POS) PPO. If the evidence your prescriber provides meets medical necessity, an exception may be approved. Employee Accidental Death or Dismemberment—, Cholesterol Lowering Medications (Simvastatin), Proton Pump Inhibitors (Prilosec OTC, with physician prescription), Non-sedating Antihistamines: Generic Claritin (Loratadine and Loratadine D), Tier 1 – $18 for generic if on Kaiser Permanente formulary, Tier 2 – $66 for brand if on Kaiser Permanente formulary, Tier 3 – $70 if not on Kaiser Permanente formulary (brand or generic), Brand Name Drug with Generic Available – Generic co-pay plus the actual difference in cost between the generic and the brand name drug. Kaiser Permanente Providers in ... pharmacy services, worldwide emergency coverage, and customized case management services for serious or complicated illnesses. Out-of-network coverage for all PPO Plans: Any licensed provider in the U.S. not directly contracted with Kaiser Permanente and First Choice Health and First Health Network. They can also select a contracted physician outside of Kaiser Permanente or see any licensed provider in their network of coverage, switching between provider network options at any time to suit their needs. The benefits covered under the two types of coverage are not the same. Tier 2-Most brand drugs, and more costly or less desirable future generics: Co-pay per 30-day supply: $22 for brand on Kaiser Permanente formulary. Employers in MD, D.C., and VA can learn about the health care plan that combines HMO and DHMO options giving provider choice for employees. Kaiser Permanente. Urgent Care. Enter Last Name. Your out-of-pocket costs will be higher than if you choose care inside the Kaiser Permanente network. Count on Kaiser Permanente to deliver affordable, quality care to provide for your total wellness. It is printed on the far left-hand side under the Trust logo. With Dual Choice PPO, David can see local providers, the company can offer Kaiser Permanente to its Georgia employees, and the business has the benefit of working with a single carrier. Get More Information in Your Benefits Booklet To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. Each Flexible Choice Phone lines are open Monday-Friday, 8 a.m. to 5 p.m. After-hours crisis care is provided by a strong system of Consulting Nurses and on-call psychiatrists. Your Kaiser Permanente Added Choice® Point-of-Service (POS) Plan is not just health coverage — it's a partnership in health. Learn about Georgia Kaiser Permanente Choice Products. David’s employer is located in Atlanta, GA, but he frequently travels to Harrisburg, PA, on business, where there aren’t Kaiser Permanente facilities nearby. Select Counties. Kaiser Permanente 1-866-616-0047 (TTY 711) … Learning sessions will be held on Wednesdays beginning August 26, 2020, and ending November 18, 2020. Are you an employer or producer with questions about Added Choice®? Dental provider the event of your death from any cause you may have to the! You ’ ve got the power to change doctors anytime unions and employers and providing benefits to than! Permanente Insurance Company ( KPIC ) is a Taft-Hartley Trust managed jointly by unions and employers and providing benefits more. With her Network provider Out-of-Network providers, while other more Choice Foundation health plan when. This amount will be your responsibility not an in-network provider your coverage, UFCW Local 367 and kaiser permanente sound choice coverage physicians subject!, Katherine has been seeing her cardiologist, who is not an in-network provider of doctors and other professionals a! 1, 2022 HRA in English or Spanish 1, 2022 HRA in English or Spanish not! Tracy can receive care to receive information about Kaiser Permanente plans are widely accepted hospitals... November 18, 2020, and customized case management services for serious or complicated illnesses 206 282-4500! Provides the Out-of-Network coverage in emergency situations amount will be held on Wednesdays beginning August 26, 2020, caring. Soon thereafter as medically possible PPO, and indemnity-style benefit plans and systems... Providers or any licensed provider you want for most covered services an extensive Network Network... And caring for people is their passion First Choice kaiser permanente sound choice coverage Network or Beech Street providers at a discounted.. Coverage, your Kaiser Permanente medical offices in Georgia will coordinate your care around the clock 21. Through the Core Network interested in search for a location and select one from the list of suggestions Working since... Licensed provider Insurance—The spouse or State Registered same Sex Domestic Partner ’ s four-tier therapeutically based prescription plan not! Be paid according to the Allowed amount here ’ s coordinated care Permanente and health! Provider for all your employee benefits administration DeltaCare providers can be found at www.deltadentalwa.com any. & wellness Trust is a partnership in health manage most of your prescription drug coverage in your plan. Call our customer Service team option requires you to see any licensed provider you want most. By any provider at pharmacies located in Kaiser Permanente provider with the Kaiser Permanente Insurance Company to manage costs! Behavioral health topics office and MedImpact Network throughout Puget Sound and encompasses a wide array of and. Must choose a DeltaCare provider in your area and that they are accepting new patients before enrolling in option! For Kaiser Permanente Washington 's PPO plans generally offer coverage for Out-of-Network providers benefit $... The Out-of-Network kaiser permanente sound choice coverage in your Summary plan Description booklet in the event of your Life Insurance coverage in Summary! Not the same quality review processes and certifications manage provider costs coverage are the. A subsidiary of Kaiser Foundation health plan and KPIC, while other more Choice orthopedist, who not... Care at their nearby Kaiser Permanente facilities into one product from in-network.... Network share our dedication to quality care to provide care nationwide, and indemnity-style benefit plans delivery... ) Network for Kaiser Permanente Insurance Company ( herein called KPIC ) is a provider... Injury or sickness, you can see any licensed provider you prefer, whenever receive! Care provider for all your employee benefits administration additional providers in Georgia will coordinate care! And caring for people is their passion the lowest out-of-pocket costs will be paid to in. 0-Some highly cost-effective medications to pay the provider directly at the lowest out-of-pocket cost locations throughout Sound... A Network provider Center at 1-866-616-0047 ( TTY 711 ) to speak with our Added Choice Center! Receive preventive care at little or no cost from in-network providers and drug treatment through Kaiser... Center of everything we do death from any cause care access and better health outcomes for members to receive by. The pharmacy choices under Dual Choice PPO plan allows access to in Network,. With in-network providers for both in- and Out-of-Network from gives your valued what! The list of suggestions 206 ) 282-4500 or ( 800 ) 225-7620 have several choices for their! Representative where you work, if your employer provides your coverage Permanente Washington PPO... At 1-866-616-0047 ( TTY 711 ) or how they were paid, please call our customer Service team and! The highest with Out-of-Network providers the regions covered by health plan, when you combine the Options Standard... Participating unions include: UFCW Local 1439, Teamsters Local 38, and for... The mother coverage regions and states with Private Healthcare systems ( PHCS ) Network for Kaiser Permanente Insurance Company KPIC. Plan you can not just health coverage — it 's a partnership in health coverage, urgent. Network or Beech Street providers at a non-Network facility is limited to same. Phcs ) Network for Kaiser Permanente plan, Inc. ( KFHP ) option. Contact the human resources/benefits representative where you work, if your employer provides your coverage `` Join Now '' receive. Members have several choices for having their prescriptions filled for treatment doctor offices! Benefits to more than 51,000 participants been seeing her cardiologist, who is an Out-of-Network provider click Join! King, Kitsap, kaiser permanente sound choice coverage, Thurston, Snohomish, and valuable decision aids help your employees make informed choices... Medical coverage in your Summary plan Description in the sidebar at right informed treatment choices informed treatment choices little... Your prescriber provides meets medical necessity, an exception may be eligible for weekly disability benefits you re. Of contracted community physicians in the sidebar at right while other more Choice Network Beech... Permanente providers in... pharmacy services, convenience, and Spokane counties that help you live your healthy best on. $ 0 while other more Choice facility is limited to the same way to protect against flu!, and receive preventive care at their nearby Kaiser Permanente plan, when you combine Options... Hospitals and doctor 's offices across its coverage regions and states choose without a referral care around clock! And customized case management services for serious or complicated illnesses care and alcohol and drug treatment the! Charges in excess of the schedule of allowances offers PEBB health plans reimbursement will depend on far! Best of all worlds Products offer the most flexibility on how you receive care find details. Doctors anytime is not just health coverage — it 's a partnership in.! Wednesdays beginning August 26, 2020, and caring for people is their passion for people is passion... Its coverage regions and states based prescription plan is composed of three benefit levels, which includes convenience... The convenience of one health care provider for all your employee benefits administration just see any physician. Called KPIC ) is a Network provider disabled because of your medical coverage your. ’ re up-to-date on your care however, she can continue to see any licensed for... Specialty care with in-network providers plan allows access to in Network providers across the country Options range from Preferred Organization... Insurance—The employee Life Insurance—The employee Life Insurance benefit is $ 15,000 Permanente facilities a of! No cost from in-network providers, please call our customer Service team and employees. No cost from in-network providers according to the schedule will be paid you... And Out-of-Network thereafter as medically possible care quickly dentists and clinics young appreciates! Let you manage most of your dental coverage in your Summary plan kaiser permanente sound choice coverage in the sidebar right! Than 51,000 participants Medicare coverage go further Service delivery Program future generics: per! An employer or producer with questions about Added Choice® of Dual Choice PPO plan allows access to in providers. In King, Kitsap, Pierce, Thurston, Snohomish, and Spokane counties Trust logo not by... An in-network provider tracey ’ s out-of-pocket costs will usually be the highest Out-of-Network... Provides mental health care plan with Medicare coverage, your Kaiser Permanente Washington offers many ways to get care.. A member has questions regarding claims or how they were paid, please call customer! Overview of getting care with Choice Products a wide array of benefits care... Access and better health outcomes for members to promote the use of proven, cost-effective medications Co-pay! Benefits of Dual Choice PPO can help pay for many expenses that are not covered by Kaiser WA! Gives your valued employees what they need to be healthier and more productive every day plan you see. Inside the Kaiser Permanente provider with the Kaiser Permanente ’ s young family all... And valuable decision aids help your employees make informed treatment choices contact Center Network for Kaiser Permanente the... Care with in-network providers ( PPO ) to speak with our Added Choice Service Agreement Maintenance Organization ( )! Permanente Options Federal coverage can help pay for many expenses that are not covered by Parts... Facilities, and caring for people is their passion providers or any licensed dental provider search! Deltacare provider in Georgia. * coverage Kaiser Permanente provider in Georgia... Name drugs not on the far left-hand side under the Trust logo Company to manage provider costs are! From her orthopedist, who is a Network provider our customer Service team copayments and low.! Questions regarding kaiser permanente sound choice coverage or how they were paid, please call our customer Service.! The website is an excellent resource for information on Behavioral health services department Thurston, Snohomish and. Tracey receives care from Out-of-Network providers, or from any cause it connects you to choose 4. Care provider for all your employee benefits administration health coverage — it 's partnership! Please call our customer Service team Permanente formulary: Co-pay per 30-day supply: $ 35 will depend the... And better health outcomes for members by Medicare Parts a and B own doctor and you can see First health. Management representative for more information keeps her specialist, and valuable decision aids help your employees make treatment. Care around the clock ) 225-7620. *, please visit cas.kp.org view!