CCC Workbook 2013 - FINAL.pdf - Cherry Creek School District

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ENROLLMENT FREQUENTLY ASKED QUESTIONS (continued) WHAT ARE THE MAJOR DIFFERENCES BETWEEN THE HEALTH PLANS? Kaiser Catastrophic DHMO & Kaiser DHMO vs. Added Choice Triple Option • Kaiser physicians are employed by Colorado Medical Group. • Members must seek care at Kaiser facilities for DHMO benefits and for Option 1 of the Added Choice Triple Option in-network benefits. Other facilities/hospitals may be used in life threatening urgent and emergency situations. • In Kaiser’s Added Choice Triple Option you may choose from three provider “tier options”. Option 1: The Kaiser DHMO facilities/providers offer the least amount of out-of-pocket expense. Option 2: PHCS facilities/providers are available with an even higher out-ofpocket expense. Option 3: You may see any provider anywhere with a higher out-of-pocket expenses. At each point of service you are free to choose any of the provider options listed. The member is responsible for satisfying the deductible for benefits with a coinsurance for all other services. (See Summary of Benefits & Coverage form for more details). • St. Joseph’s and Good Samaritan are the primary hospitals contracted with Kaiser Permanente DHMO in the Denver/Boulder areas. After hours emergency care can be obtained at any licensed facility. After hours urgent care are at Lutheran or Swedish. There are other Kaiser Permanente facilities that provide after hours care, you can find these facilities on their website at www.kp.org. • With the exception of the out-of-area student benefit, Kaiser’s DHMO has no coverage outside the DHMO service area unless it is urgent or emergency care. HOW DO I ACCESS MENTAL HEALTH AND SUBSTANCE ABUSE SER- VICES? As a member of any Kaiser medical plan you have access to four Mental Health Facilities and two Substance Abuse Facilities in Kaiser’s network for most of your mental health / substance abuse needs. To obtain services you do not need a referral. Simply call one of the facilities listed below: Baseline Mental Health 580 Mohawk Drive Boulder, CO 80302 303-554-5200 Execuve Center Mental Health 4851 Independence St., Suite 270 Wheat Ridge, CO 80033 303-467-5850 Highline Center Mental Health and Chemical Dependency 10350 E. Dakota Avenue Denver, CO 80231 303-367-2800 Hidden Lake Mental Health and Chemical Dependency 7701 Sheridan Blvd. Westminster, CO 80003 303-650-3900 18
ENROLLMENT FREQUENTLY ASKED QUESTIONS (continued) DO I HAVE TO USE KAISER FACILITIES FOR MENTAL HEALTH / SUBSTANCE ABUSE EVEN IF I AM ON THE ADDED CHOICE TRIPLE OPTION? As a member of the Kaiser Added Choice Triple Option plan you can access the facilities listed above for the lowest cost. You can use any licensed facility for inpatient and outpatient care, but benefits will be paid according to lower out-of-network or PHCS benefits. HOW DO I ACCESS ALTERNATIVE CARE SERVICES? For other services such as acupuncture or chiropractic care please contact Kaiser for participating providers. These services are not covered under the schedule of benefits, but may be available at a reduced fee. HOW DO I ACCESS THE EYE EXAMINATION BENEFIT? You can have an annual eye exam with applicable co-pay as a part of your Kaiser Permanente benefit package. The eye examination benefit does not include the cost of eyeglasses, contact lenses or contact lens fittings. Contact lens exams are available at an additional charge. A referral from a primary care physician is not required. Simply call the Kaiser Permanente optical department of your choice and make an appointment. DOES KAISER OFFER ANY OTHER SERVICES? Kaiser Permanente offers a variety of courses, webinars for everything from weight loss, smoking cessation, yoga classes, parenting classes and more for all Kaiser members and nonmembers. Health Education Webinars Kaiser Permanente Webinars offer "live" interactive learning with a professional health expert and coach. View the presentation through your computer's web browser and listen through your phone or computer headset. Most Webinars are free to Kaiser Permanente members and non-members. Below is a link to view upcoming and pre-recorded classes and to register: https://www.signup4.net/Public/ap.aspx?EID=20113952E%20 Can I attend these Webinars with my Smartphone? Yes, if you have a 4G phone (Examples: I-Phone, I-Pad, or Android) * You will be alerted to download the WebEx application Health Education Courses (On-site courses offered at Kaiser facilities and hospitals) Kaiser Permanente offers many health education courses at several of their facilities for a cost for all members and non-members. For a listing of their courses please visit their website at: https://healthy.kaiserpermanente.org/health/care/consumer/health-wellness/programs-classes/ classes you will be directed to select your region and city to find the course closest to you. 19
Page 1: CHERRY CREEK BENEFITS July 1, 2013
Page 4 and 5: TABLE OF CONTENTS AN INTRODUCTION W
Page 6 and 7: DHMO Catastrophic DHMO Added Choice
Page 8 and 9: NEW EMPLOYEE ENROLLMENT ENROLLMENT
Page 10 and 11: WHO IS ELIGIBLE? Eligible Employees
Page 12: Medical Plan Designs 12
Page 16 and 17: ALL MEDICAL PLANS (continued) ARBIT
Page 20 and 21: IMPORTANT KAISER PHONE NUMBERS Kais
Page 22: KAISER PERMANENTE CATASTROPHIC DHMO
Page 34: KAISER PERMANENTE DHMO The Kaiser P
Page 46 and 47: Kaiser Permanente Added Choice Trip
Page 48 and 49: Hospitalization Kaiser Permanente A
Page 62 and 63: Limitaons for In-Plan Benefits The
Page 64 and 65: in physical funcon · Sex transform
Page 71:
Vision Plan Design 71
Page 92:
Kaiser Permanente Added Choice Trip
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CCC Workbook 2013 - FINAL.pdf - Cherry Creek School District

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