PEBB 2018 Frequently Asked Questions

PEBB Open Enrollment and Choosing Kaiser Permanente

Why should I choose Kaiser Foundation Health Plan of Washington?
Options, quality, and convenience — it's how Kaiser Permanente makes your health care better. You have the freedom to choose your own doctors, from the more than 1,000 providers at Kaiser Permanente Medical Group to the more than 9,000 community doctors and 46 hospitals statewide.* You also get the quality care you deserve, including more time with your doctor.

Better health care also means making it convenient for you. So nearly all Kaiser Permanente medical offices have lab, X-ray, and pharmacy services all under one roof. Get access anytime, anyplace with our personal online services on your computer or on your smartphone with our new mobile app. Either way, you can make appointments, email your doctors, see your test results, and more whenever you get care at Kaiser Permanente medical offices.

Doctors and Care

Note: For Classic, Value and SoundChoice plans only
How do I find out if my doctor is in Kaiser Permanente's network of providers?
You can use our Provider Directory to find available physicians in your area or to see if your current personal doctor is available through Kaiser Permanente Washington. In addition to the 1,000-plus doctors in the Washington Permanente Medical Group, our online Provider Directory also lists the names of over 9,000 contracted doctors.**

How do I choose a personal physician, and how can I change physicians?
To find a provider, check our website for the most current information, refer to our Provider Directory, or call Member Services at 1-888-901-4636. Our Member Services representatives can help you choose a doctor based on his or her location, special interests, gender, or other factors that are important to you. Also remember that each family member may choose a different provider. If for any reason you wish to change doctors, you can at any time.

How can I see a specialist?
With your Kaiser Foundation Health Plan of Washington plan, you can choose from 500 specialists in over 60 specialties* — most without a referral. These specialists are located at our Kaiser Permanente medical offices. To find out which specialists are available, please call Member Services at 1-888-901-4636 or speak to your personal physician. If you wish to see a specialist who does not practice at a Kaiser Permanente medical office, talk with your personal physician about a referral.

How do you cover services like acupuncture and naturopathy?
The PEBB plans cover a limited number of acupuncture, naturopathy, and chiropractic visits without requiring a referral from your personal physician or primary care provider. Massage therapy services require a prescription and care plan from your personal physician if he or she determines the services are medically necessary.

How do I access routine care?
Routine care is available at Kaiser Permanente medical offices or at facilities in our contracted network. Please refer to your Provider Directory on our website for specific phone numbers for the facility of your choice.

How do I access urgent care?
Five of our medical centers have Urgent Care Centers, most with evening, weekend, and holiday hours including Bellevue, Olympia, Seattle (Capitol Hill), Silverdale, and the Tacoma Medical Center. Urgent Care Centers at the Bellevue Medical Center, Capitol Hill Campus in Seattle, and Tacoma Medical Center are open 24 hours a day, seven days a week.

For urgent care during business hours, call your personal physician's office or the Consulting Nurse Service. For urgent care after business hours, on weekends, or on holidays, call the Consulting Nurse at 206-630-2244 for the Seattle area. For all other areas in Washington State, call 1-800-297-6877. The nurse will listen to your concerns and direct you to the most appropriate care.

How do I access emergency care?
In a life-threatening emergency, call 911 or your local emergency number. If you are unable to do so, ask someone to call for you or to take you to the nearest emergency care facility. You may go to any hospital in your area for emergency care. Remember that you may save money if you go to an emergency room at any of our contracted hospitals if possible. Please refer to your Provider Directory or our website for specific phone numbers for the facility of your choice. The Consulting Nurse Service can also direct you to the best place near you for your particular emergency.

How do I know if I need urgent or emergency care?
When you want care advice or need to know if you should get immediate medical attention, Kaiser Permanente Washington's Consulting Nurse Service can help 24 hours a day. In the Seattle area, call 206-630-2244. For all other areas in Washington State, call 1-800-297-6877.

Use emergency care for sudden, unexpected medical conditions that, in the reasonable judgment of a prudent lay person, would endanger a person's life or seriously harm the person's health if not treated immediately by a licensed medical professional. Emergency medical conditions include:

  • Suspected heart attack or stroke
  • Sudden or extreme difficulty breathing
  • Bleeding that will not stop or deep cuts
  • Major burns
  • Seizures
  • Sudden and severe headache or abdominal pain
  • Poisoning or suspected poisoning

If someone in my family gets a serious illness and needs hospitalization, where will they go if I am a Kaiser Permanente member?
Kaiser Permanente's priority is putting patients first — which always means giving you the best care possible. If you or anyone in your family has a serious illness and needs hospitalization, you can rest assured that Kaiser Permanente has amazing partners in care across our service area, including seven hospitals where we have physicians on the medical staff. Your personal physician will help coordinate your care to the place that best suits your needs.

How do I access routine care, urgent care and emergency care when I'm away from home?
You are covered for emergency and medically necessary urgent care worldwide. In the case of a life-threatening emergency, call 911 or the local emergency number where you are visiting. If you are admitted to the hospital, you or a family member must call the Emergency Notification Line at 1-888-457-9516 within 24 hours, or as soon as reasonably possible. For other care out-of-area, call the Consulting Nurse Service for advice on what to do for your particular health issue.

What services are offered at Kaiser Permanente medical offices?
You can get one-stop services at our 25 Kaiser Permanente medical offices where you'll find that, in addition to seeing your doctor, you usually can get lab tests, X-rays, and pharmacy services. Our Kaiser Permanente medical offices also provide specialty care services. See our Provider Directory for a list of Kaiser Permanente specialists and where they are located.

It seems Kaiser Permanente is very proactive about preventive care. What resources are available to me?
At Kaiser Permanente, we believe in getting healthy and staying that way. That's why we offer an array of wellness resources and put a priority on preventive care so you can avoid problems before they start. From your annual wellness visit and recommended screenings, to a proactive health risk assessment questionnaire, to access to health coaching 24/7 for additional support,  we provide you with a variety of clinical help so that you can be your healthiest self. We also have tobacco cessation programs, classes and support groups, and a whole lot more.

Prescriptions

How and where do I fill my medication prescriptions?
Your prescriptions can be filled at Kaiser Permanente medical offices or you can find additional contracted pharmacies in your Provider Directory. You can also conveniently refill your prescriptions online and have them delivered to your home with no shipping fees through our Mail Order service.

I am on a specific prescription. How is this transferred or handled?
If you are a new patient and are seeing a Kaiser Permanente physician for the first time, you may be taking medicine prescribed by a non-Kaiser Permanente doctor. Please make an appointment to review your medications with your new Kaiser Permanente personal physician. If you had an authorization for a drug from a previous insurer, you will need to get a new authorization from Kaiser Foundation Health Plan of Washington. Call Member Services for assistance.

I hear there is a Value Tier for the Prescription Drug benefit. Which drugs are included on this tier?

  • Diabetes: Metformin, glipizide, glimepiride, glyburide, insulin NPH
  • Hyperlipidemia: Simvastatin, lovastatin, pravastatin
  • Heart failure: Carvedilol, metoprolol XL, spironolactone
  • Hypertension: Hydrochlorothiazide, chlorthalidone, lisinopril, enalapril, captopril, ramipril, lisinopril/HCTZ, amlodipine, verapamil, diltiazem, metoprolol IR, atenolol

Transferring Care and Medical Records

If I have an ongoing medical condition, how will the transition of care be coordinated?
Members with transitional care needs are encouraged to contact a Member Services representative who will help in transitioning and coordinating the care of new members. Please call Member Services at 1-888-901-4636, Monday through Friday, between 8 a.m. and 5 p.m.

How do I get my medical records transferred?
You may request your personal medical record from your previous physician. Your previous physician may ask for proof of identification or a signature to release your medical records. You may bring your files to your newly selected physician or you can request that the files be sent directly to the facility of your choice.

Online Services and Mobile App

I've been hearing about time-saving online services that Kaiser Permanente provides. What's available?
Kaiser Permanente member website lets you refill prescriptions, create a health risk assessment report, and browse more than 5,000 health care topics. You can also better manage your health care costs by tracking your spending toward deductibles and out-of-pocket expenses. And, when you receive care at Kaiser Permanente medical offices, the secure member website allows you to securely email your doctor, view test results online, view your online medical record, check your child's medical record, and more. See our online tour for more information.

I also heard Kaiser Permanente Washington has a smartphone app. What services are available through my phone?
If you are registered with Kaiser Permanente member website and receive your care at Kaiser Permanente medical offices, you can now do many things that you can via Kaiser Permanente member website anytime, anywhere — with our smartphone app. For added convenience, this app includes a host of innovative features to easily connect you to the Consulting Nurse, check lab and pharmacy wait times at your nearest Kaiser Permanente medical office, map directions to our medical facilities, or connect to your care team if you get care with Kaiser Permanente..

Benefit Changes and Enrollment

In 2018, Kaiser Permanente will:

Kaiser Permanente WA CDHP

  • Switch the network from Access PPO to Core HMO; Beyond access to 10,000 providers in the Core network, members can call the Consulting Nurse helpline for advice 24/7, use CareClinics at Bartell Drugs at select Seattle-area locations, or get diagnosis and treatment for routine issues with a Kaiser Permanente online visit

Kaiser Permanente WA Sound Choice

  • Reduce out-of-pocket limit of $2000/person, $4000/family
  • Addition of a $100/person, $300 family prescription drug deductible
  • Prescription drug deductible waived on value and tier 1
  • Addition of $2000/person prescription drug out-of-pocket limit
  • Reduce coinsurance of 15%

Kaiser Permanente WA Classic

  • Lower medical deductible of $175/person, $525/family
  • Addition of a $100/person, $300 family prescription drug deductible
  • Prescription drug deductible waived on value and tier 1
  • Addition of $2000/person prescription drug out-of-pocket limit

Kaiser Permanente WA Value

  • Addition of a $100/person, $300 family prescription drug deductible
  • Prescription drug deductible waived on value and tier 1
  • Addition of $2000/person prescription drug out-of-pocket limit

PEBB 2018 Rates and Benefits
In 2018, Kaiser Permanente Washington is offering the SoundChoice plan, which offers the lowest monthly premium available for non-CDHP plans. This plan is available to members living in Snohomish, King, Pierce and Thurston Counties. Our Value plan, with its predictable copayments continues to be an economical option for PEBB members and the Classic Plan offers the same comprehensive services with lower copays. We also offer a consumer-directed health plan (CDHP) with an even lower premium than our other plans, balanced with a higher deductible and out-of-pocket maximum.
See rates and benefits.

What doesn't count toward the annual out-of-pocket maximum?
The annual out-of-pocket maximum is the most you pay in a calendar year. Once you have paid this amount, the plans pay 100 percent of allowed charges for most covered benefits for the rest of the calendar year.

These costs do not apply toward your annual out-of-pocket maximum:

  • Monthly premiums
  • Charges above what the plan pays for a benefit
  • Charges above the plan's allowed amount paid to a provider
  • Charges for noncovered services or treatments
  • Coinsurance for non-network providers

See our website for all of your 2018 plan details.

 

How do I enroll in a Kaiser Permanente plan?
Visit the PEBB website where you can select "Sign On to My Account" (under the My PEBB header) to make a plan change online during the PEBB Program's open enrollment period (Nov. 1 – 30, 2017). Or you can download and print a form from PEBB's Get a Form page.

Medicare

I'm going to be eligible for Medicare soon. What do I need to do?
For retirees, COBRA, and PEBB Extension of Coverage members only: When you receive your Medicare card, send a copy of it to the Public Employees Benefits Board (PEBB) Program indicating the effective dates of your Medicare Parts A & B coverage. You will also need to send a Medicare Advantage election form to Kaiser Foundation Health Plan of Washington or the PEBB Program. You won't need to enroll in Part D of Medicare, since your PEBB plan provides comparable prescription drug benefits.

Dependent Children and Student Dependents

What's the coverage for out-of-area student dependents?
Dependent students who live outside the Kaiser Permanente Washington service area in the Puget Sound and Spokane have the same coverage as any out-of-area member, which is emergency/urgent care only. Other services will be covered when they are obtained within our service area. If your student dependent lives in Kaiser Permanente Washington's service area, they can get routine care at Kaiser Permanente medical offices.

CDHP and HSAs

Can you tell me more about CDHP plans?
The CDHPs offer a low monthly premium, balanced with a higher deductible and out-of-pocket maximum. However, members can use funds in their Health Savings Account (HSA) to pay for many out-of-pocket costs (including deductibles), or allow HSA savings to grow for future medical expenses. When you enroll in a CDHP, your employer or the PEBB Program contributes money into your HSA on a prorated basis. This will add up to $700.08 annually for a single subscriber, or $1400.04 annually for a subscriber and one or more covered dependents. The entire amount is not deposited in the HSA on Jan. 1. If you are a single subscriber, your employer will contribute $58.34 each month in your HSA as long as you remain eligible for enrollment in a consumer-directed health plan and health savings account. Members may also choose to make tax-free contributions to their own health savings accounts, up to IRS annual limits. Learn more about the Kaiser Foundation Health Plan of Washington's HealthPays HSA (CDHP) plan rates and benefits or call Member Services at HealthEquity, the trustee for your HSA, at 1-877-873-8823.

Can I invest the money in my HSA?
Yes, similar to an IRA, many HSAs let you choose to invest a portion of your account balance in stocks, bonds, mutual funds, CDs and/or other annuities. With your Kaiser Permanente Washington's HSA, you can invest in pre-selected mutual funds after you reach a $2,000 balance in your account.

Can I roll the money from my IRA into my HSA?
Yes, you can make a one-time rollover from your IRA into your HSA. You can't however roll money into your IRA from your HSA. Note that a rollover will count against annual contribution limits.

How much money can I contribute to my HSA?
In 2018, the maximum annual contribution limits set by the IRS for an individual account is $3,450 and the maximum contribution for family coverage is $6,900. People ages 55 and older may contribute up to $1,000 more annually in addition to the limits above.

What happens to my HSA if I leave my job or retire?
You may take that money with you wherever you go — it's your money and your account. If you're on Medicare or go to another employer that doesn't have a qualified CDHP, you can still use your HSA money to pay for co-pays and qualified medical expenses, but won't be able to make contributions to your HSA.

Does the money I have in my HSA rollover from year to year or do I lose that money at the end of the year?
The money rolls over from year to year. You don't lose the money left in your HSA or the interest it's earned.

Can I take the money out of my HSA any time I want?
Yes, you can take the money out anytime tax-free and without penalty as long as it's to pay for qualified medical expenses. If you take money out for other purposes, however, you'll have to pay income taxes on the withdrawal plus a 20 percent penalty.

If I get an HSA, but don't cover my children under that plan - can I still use the money in my HSA to pay for my children's medical expenses?
Yes, the money in your HSA can be used to pay for qualified medical expenses of any family member who qualifies as a dependent on your tax return. However, if the dependent isn't covered under your plan, his/her expenses won't be applied toward your deductible.

With a HSA plan, do I pay for the full doctor's office visit when I go to the doctor?
You're responsible to pay the amount your insurance has contracted to pay your doctor, typically a discounted rate, until your deductible is met. You can use your HSA for this expense. It's best to have your doctor's office put the charge through to your insurance so that you can receive credit toward your deductible and know exactly what to pay. Some doctors may require that you pay up front, but most bill your insurance and then bill you only once the claim has been processed.

Can I use the money in my HSA for non-medical expenses?
Yes, but if you do (and you are under age 65) you'll be taxed on the money you use and assessed a 20 percent penalty. Once you are 65, you'll be taxed for moneys used for nonmedical expenses, but won't pay the penalty.

Contacting Kaiser Permanente

If I have more questions about Kaiser Foundation Health Plan of Washington, who should I ask?
You may contact Kaiser Permanente's Member Services directly at 1-888-901-4636, TTY 1-800-833-6388 or 711, Monday through Friday, between 8 a.m. and 5 p.m.

*OIC Provider Form A
**According to a study published in Health Affairs in May 2010

 

 

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