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

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Hospitalization Kaiser Permanente Added Choice Triple Option (Continued) • You may be admitted to any hospital your provider chooses. PHCS hospitals will be less expensive than nonaffiliated hospitals. Pre-certification is required. • For pre-certification, your doctor must call 1-800-448-9776. • If a Kaiser Permanente provider admits you to a Kaiser Permanente hospital, your in-plan DHMO hospital benefits will apply. Pre-certification for PHCS and Out-of-Network Procedures Pre-certification is required for: • Hospital admission, including pre-admission testing • Any procedure performed at a non-Kaiser Permanente outpatient surgery facility (colonoscopy, sigmoidoscopy and other diagnostic tests included) • Prenatal care (call within the first trimester, if possible) • MRIs. The test cannot be performed at Kaiser Permanente until a pre-certification is obtained. • Skilled nursing facility admission Your benefit will be reduced by an additional 20%, after the deductible, if pre-certification is not obtained. Other information Certain services are covered only in Option 1/Tier 1 (inside Kaiser Permanente). These include: • With the exception of prosthetic arms and legs, Durable Medical Equipment, including oxygen. Your provider may manage your care, but you must obtain your durable medical supplies (including oxygen) from Kaiser’s contracted vendors. For information call Customer Service at 303-338-3800. • Dialysis is performed at Presbyterian-St. Luke’s. • Skilled nursing facility care must be arranged through Kaiser Permanente. • All Emergency claims are paid by Kaiser Permanente. Claims You or your provider should mail claims to: Kaiser Permanente Added Choice Claims, P.O. Box 370897, Denver, CO 80237-0897 Emergencies • In the event of a life threatening emergency, call 911. • Regardless of where an emergency occurs, it is always covered under DHMO benefits. Check your Summary of Benefits & Coverage (SBC) for DHMO emergency room co-payments, ambulance co-payments, and hospital co-payments. Your emergency room co-payment is waived if you are admitted as an inpatient. • Kaiser Permanente contracts with several hospitals in the Denver/Boulder area. • If time permits, please go to the nearest contracted hospitals: Exempla St. Joseph Hospital, Exempla Good Samaritan, Lutheran Medical Center, or Swedish Medical Center. 48
Kaiser Permanente Added Choice Triple Option (Continued) Important telephone numbers for Added Choice Triple Option members: Emergency 911 To check on a claim 1-800-382-4661 Kaiser Permanente Customer Service 303-338-3800 (TTY 303-338-3820) Clinical Pharmacy Call Center 303-338-4503 Use this number for questions about formulary medications and to transition prescriptions to Kaiser Permanente. Please tell them when you call that you are an Added Choice Triple Option member. 49
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 18 and 19: ENROLLMENT FREQUENTLY ASKED QUESTIO
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 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

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

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