Federal Employees and Annuitants 2016 Rates and Benefits Northwest Region

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together in good health see how easy healthy can be

Not a member yet?

For more information, visit kp.org/feds or call 1-855-366-9008 (TTY 711), Monday through Friday, 8 a.m. to 5 p.m. During open enrollment season, 6 a.m. to 8 p.m.

kp.org/feds 16MMC-15/10-15

All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest. 500 NE Multnomah St., Suite 100, Portland, OR 97232.

Making good health easier Experience the Kaiser Permanente difference The experience 

Without Kaiser Permanente

With Kaiser Permanente*

All you know is that your doctor accepts your insurance.

You can search our doctor profiles on kp.org and choose the one who’s right for you. You can even change your doctor anytime.

Getting care in your language

Some health plans have few multilingual doctors.

We have multilingual doctors and staff, and we offer interpretation services by phone in 140+ languages.

Choosing how you get care

Even for minor concerns, you usually make an appointment, drive to the doctor’s office, and sit in the waiting room.

For minor concerns, you can request a phone appointment or email your doctor’s office with routine questions.

Calling for advice

When your child has a latenight fever, there’s often no medical advice available.

Specially trained Kaiser Permanente nurses can offer medical advice by phone, 24/7.

Making an appointment

Calling and waiting to schedule an appointment can take forever.

You can schedule routine appointments from your computer or mobile device —  anytime, anywhere.

Seeing your doctor

Your doctor may need to flip through your files, hunting for details and looking for answers you’ve already given.

Your doctor has your medical history and prescriptions right at his or her fingertips through your electronic health record.

Remembering what your doctor said

Take lots of notes during your visit or trust your memory later.

You can view your past visit summaries and most lab test results online, whenever you want.

Choosing your doctor

*These features are available when you get care at Kaiser Permanente.

Kaiser Permanente Together in good health

The right choice for your health Get the great care and resources you need to live healthy — all together in one convenient package. Check out everything that comes with your health plan, and you’ll see why over 10 million people nationwide have chosen Kaiser Permanente.

Why KP?

Your 2016 FEHB Benefits

A healthy partnership. . . . . . . . . . . . . . . . . . . . . . . . . . 2

Benefit highlights. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Great care, great results. . . . . . . . . . . . . . . . . . . . . 3

Which option is right for you?. . . . . . . . . . . . . . . . 10

Care the way you want it. . . . . . . . . . . . . . . . . . . . 4

Your 2016 benefits summary. . . . . . . . . . . . . . . . . . 11

Healthy resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Ready to enroll with Kaiser Permanente?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Locations.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Extras for your well-being. . . . . . . . . . . . . . . . . . 8



Once you join

Visit kp.org/newmember for all you need to get started. It’s easy to choose your doctor, register for kp.org, and transition your prescriptions. If you have questions or need help making your first appointment, just give us a call.



Already a member?

Make sure you get the most out of your membership. If you haven’t already, register on kp.org, where you can manage your care online, schedule an appointment for a family member, get support for improving your health, and more.

1

Kaiser Permanente Together in good health

A healthy partnership Getting you connected with a doctor who suits your individual needs is our top priority. When you have a doctor you connect with, it’s easier to stay healthy.

 Choose your doctor  — and change anytime Browse our online doctor profiles at kp.org/ searchdoctors to see your options. You’ll find information on a wide range of highly skilled doctors, including their education, credentials, and specialties. Then choose the one who’s right for you. You can choose your doctor from: •  Adult medicine/internal medicine •  Family medicine •  Pediatrics/family medicine (for children up to 18) Choose 1 doctor for your whole family or a different doctor for each family member. You can also change your doctor anytime.

See specialists — often without a referral You don’t need a referral for obstetricsgynecology, optometry, psychiatry, chemical dependency, or addiction medicine. For other specialties, your doctor can easily refer you.

2

Great doctors working together as a team With Kaiser Permanente, you get the support of a team of doctors, nurses, and specialists focused on your health. Your entire care team works together — often under one roof — sharing information to give you the care you need. And with access to your electronic health record, they know your medical history, test results, medications, and allergies. This helps them tailor care for you.

Care for diverse and cultural needs Great care isn’t one-size-fits-all. That’s why we have programs that focus on tailoring care for our diverse membership. We’re one of the only care providers with an institute dedicated to culturally competent care, where we do research to help improve health outcomes for all our members. We’ve already reduced health disparities among different ethnicities for conditions like high blood pressure, diabetes, and colon cancer.

Great care, great results Get the care you need to stay your healthiest. From preventive screenings to care for serious conditions, we’ve got you covered. And it’s all backed by the latest medical technology and research. Preventive care that keeps you healthy We help you protect your health, even when you’re healthy. To catch problems early, before they get serious, we offer preventive screenings, routine appointments, and more. Through your electronic health record, your care team knows what you’re due for and can keep you up-to-date. With this focus on prevention, our members can rely on impressive results.

Leading the way in prevention •  We have the highest rating for breast and colon cancer screenings.* •  We’re in the top 10% for cervical cancer screenings.* •  89% of members diagnosed with high blood pressure now have it under control, compared to 63% nationally.†

Comprehensive care when you need it Along with our commitment to prevention, we’re here for you if you get sick. You get great doctors, state-of-the-art facilities, and the latest technology — all combined to help you get healthy quickly.

Cutting-edge research and care Kaiser Permanente research centers make up one of the largest nonacademic research programs in the country. We have about 2,000 studies happening at any given time. And our clinical trials program drives cutting-edge cancer research, which leads to better care for members. Through our innovative electronic health record system, your care team stays up-to-date — not only about each patient’s needs but also about the latest medical research and the safest, most effective treatments. *Ratings based on Breast Cancer Screening, Colorectal Cancer Screening, and Controlling High Blood Pressure 2013 performance results and Cervical Cancer Screening 2012 performance results for commercial and Medicare plans from the Healthcare Effectiveness Data and Information Set (HEDIS®) published by the National Committee for Quality Assurance. For more information, visit ncqa.org. † Kaiser Permanente program average is the weighted average of each regional health plan’s screening data and its eligible population.

Manage ongoing conditions If you have a condition like diabetes or heart disease, you’re automatically enrolled in a disease management program to help you get it under control. And we start managing your condition right away with care supported by proven best practices and advanced technology.

3

Kaiser Permanente Together in good health

Care the way you want it Get the choices you need to stay on top of your care. Whether you want to schedule an appointment online or you’d like to talk to your doctor by phone or email, you have many convenient options. Choose how you get and manage your care

4

In person

You can always make an appointment to see your doctor in person. And because most of our locations offer many services under one roof, you can see your doctor, get lab services and X-rays, and pick up your prescriptions — all in one trip.

By phone

Save a trip to the doctor’s office. Where telephone appointments are available, you can schedule one to talk to your doctor by phone. If you’re not sure what kind of care you need, you can also call our advice nurses 24/7.

By email

Connect with your doctor anytime. You can email your doctor’s office with nonurgent questions and get a reply within 48 hours, often sooner.

By video

Save time and a copayment with a video appointment. For certain conditions or symptoms, you may be able to see your doctor using your computer or mobile device.

Online

Stay on top of your care 24/7. Once you’ve registered on kp.org, you can use our website to choose your doctor, schedule routine appointments, view most lab test results, refill most prescriptions, print vaccination records, and manage a family member’s health.

On the go

After registering on kp.org, you can go to your smartphone, download the Kaiser Permanente app, and start using our secure online features — anytime, anywhere. Learn more at kp.org/mobile.

Healthy resources Good health goes beyond the doctor’s office. Take a look at all the healthy tools and resources available online, by phone, and at our facilities — and choose the ones that are right for you. Get the most out of your health plan Online wellness tools

Visit kp.org/healthyliving for helpful articles, wellness information, health calculators, fitness videos, music channels, podcasts, and recipes from world-class chefs.

Health classes

Choose from more than 3,800 classes and support groups at our facilities and get help improving your health.* Find classes near you at kp.org/classes.

Personal wellness coaching

Work one-on-one by phone with a personal wellness coach — at no cost. You can get help and inspiration for reaching a variety of health goals. Find out more at kp.org/wellnesscoach.

Special rates for members

Our members get reduced rates on a variety of products and services — like gym memberships, massage therapy, and more. See your options at kp.org/choosehealthy.

*Classes vary at each care facility and some may require a fee. 5

Kaiser Permanente Together in good health

Locations MEDICAL FACILITIES Cowlitz

5

62 45

Portland-area medical centers

N

Longview

1 Kaiser Permanente Sunnyside

Medical Center 10180 SE Sunnyside Road Clackamas, OR 97015

Skamania

2 Kaiser Permanente Westside

Medical Center 2875 NW Stucki Ave. Hillsboro, OR 97124

Columbia

3 OHSU Doernbecher Children’s Hospital

30

3181 SW Sam Jackson Park Road Portland, OR 97239 (For children 17 and younger)

Clark

Portland-area medical offices

Vancouver

26

4 Beaverton Medical Office

4855 SW Western Ave. Beaverton, OR 97005

205

Washington

5 Brookside Center

84

Portland

10180 SE Sunnyside Road Clackamas, OR 97015

Multnomah

6 Center for Health Research

3800 N. Interstate Ave. Portland, OR 97227

Clackamas

7 Clackamas Eye Care

39 59

12100 SE Stevens Court, Suite 106 Portland, OR 97086

35

Vancouver

Yamhill

5

Salem Polk

44

53 6 15 11 14 12 13

60 42

Hillsboro 26

56 32 10

25 2

46 27 28 20

6

30

17

Beaverton

Please note: Facility locations are approximate. Facility location numbers on this map correspond with our larger location map for Kaiser Permanente Northwest.

1550 NW Eastman Parkway, Suite 100 Gresham, OR 97030

205

41

40 43 61

8 Eastman Parkway Office

38

5

3 4

47

217

34

Tigard Tualatin

57

36

9 Gateway Medical Office

37 58

1700 NE 102nd Ave. Portland, OR 97220

51

84

9

31

55

50

22

Hillsboro Medical Office 5373 W. Baseline Road Hillsboro, OR 97123

11

Interstate Medical Office Central 3600 N. Interstate Ave. Portland, OR 97227

12

Interstate Medical Office East 3550 N. Interstate Ave. Portland, OR 97227

13

Interstate Medical Office South 3500 N. Interstate Ave. Portland, OR 97227

14

Interstate Medical Office West 3325 N. Interstate Ave. Portland, OR 97227

15

Interstate Radiation Oncology Center 3620 N. Interstate Ave. Portland, OR 97227

16

Lake Road Nephrology Center 6902 SE Lake Road, Suite 100 Milwaukie, OR 97267

17

Mother Joseph Plaza 9427 SW Barnes Road Portland, OR 97225

52

Portland 5

10 29

49

Milwaukie

48 7 21 18 19 24 23 5 1

16

33

26

205

54

8

Oregon City

18

Mt. Scott Medical Office 9800 SE Sunnyside Road Clackamas, OR 97015

19

Mt. Talbert Medical Office 10100 SE Sunnyside Road Clackamas, OR 97015

20

Murrayhill Medical Office 11200 SW Murray Scholls Place, Suite 100 Beaverton, OR 97007

21

One Town Center 10163 SE Sunnyside Road, Suite 490 Clackamas, OR 97015

22

Rockwood Medical Office 19500 SE Stark St. Portland, OR 97233

23

Sunnybrook Medical Office 9900 SE Sunnyside Road Clackamas, OR 97015

24

Sunnyside Medical Office 10180 SE Sunnyside Road Clackamas, OR 97015

25

26

27

2211 NE 139th St. Vancouver, WA 98686 (24-hour, emergency, low-risk childbirth, and selected services only)

29

The Portland Clinic — Columbia 5847 NE 122nd Ave. Portland, OR 97230

30

The Portland Clinic — Downtown 800 SW 13th Ave. Portland, OR 97205

31

The Portland Clinic — East 541 NE 20th Ave., Suite 210 Portland, OR 97232

32

The Portland Clinic — Hillsboro 256 SE Second Ave. Hillsboro, OR 97123

46

47

37

Mill Plain One Medical Office 203 SE Park Plaza Drive, Suite 140 Vancouver, WA 98684

48

38

Orchards Medical Office 7101 NE 137th Ave. Vancouver, WA 98682

49

39

Salmon Creek Medical Office 14406 NE 20th Ave. Vancouver, WA 98686

50

Salem-area medical center and offices

51

40 Salem Hospital

890 Oak St. SE Salem, OR 97301

42

The Portland Clinic — Beaverton 15950 SW Millikan Way Beaverton, OR 97006

Portland-area dental offices

Cascade Park Medical Office 12607 SE Mill Plain Blvd. Vancouver, WA 98684

Tualatin Medical Office 19185 SW 90th Ave. Tualatin, OR 97062 Westside Medical Office 2875 NW Stucki Ave. Hillsboro Oregon, 97124 (located inside Kaiser Permanente Westside Medical Center)

DENTAL FACILITIES

36

41

28

34

35 Legacy Salmon Creek Medical Center

Sunset Medical Office 19400 NW Evergreen Parkway Hillsboro, OR 97124

The Portland Clinic facilities*

33

Vancouver-area medical center and offices

43

44

Keizer Station Medical Office 5940 Ulali Drive Keizer, OR 97303 North Lancaster Medical Office 2400 Lancaster Drive NE Salem, OR 97305 Skyline Medical Office 5125 Skyline Road S. Salem, OR 97306 West Salem Medical Office 1160 Wallace Road NW Salem, OR 97304

Longview-area medical office 45

Longview-Kelso Medical Office 1230 Seventh Ave. Longview, WA 98632

52

53

54

55

56

57

Aloha Dental Office 17675 SW Tualatin Valley Hwy. Beaverton, OR 97006 Beaverton Dental Office 4855 SW Western Ave. Beaverton, OR 97005

Clackamas Dental Office 10209 SE Sunnyside Road Clackamas, OR 97015

Eastmoreland Dental Office 5025 SE 28th Ave. Portland, OR 97202 Glisan Dental Office 10102 NE Glisan St. Portland, OR 97220

Grand Avenue Dental Office 1314 NE Grand Ave. Portland, OR 97232 Gresham Dental Office 360 NW Burnside St. Gresham, OR 97030

North Interstate Dental Office 7201 N. Interstate Ave. Portland, OR 97217

Oregon City Dental Office 1900 McLoughlin Blvd., Suite 68 Oregon City, OR 97045 Rockwood Dental Office 822 NE 181st Ave. Portland, OR 97230

Sunset Dental Office 19075 NW Tanasbourne Drive Hillsboro, OR 97124 Tigard Dental Office 7105 SW Hampton St. Tigard, OR 97223

Vancouver-area dental offices 58

59

Cascade Park Dental Office 12711 SE Mill Plain Blvd. Vancouver, WA 98684

Salmon Creek Dental Office 14406 NE 20th Ave. Vancouver, WA 98686

Salem-area dental offices 60

North Lancaster Dental Office 2300 Lancaster Drive NE Salem, OR 97305

The Portland Clinic — South 6640 SW Redwood Lane Portland, OR 97224

61

The Portland Clinic — Tigard 9250 SW Hall Blvd. Tigard, OR 97223

Longview-area dental office 62

Skyline Dental Office 5135 Skyline Road S. Salem, OR 97306

Longview-Kelso Dental Office 1230 Seventh Ave. Longview, WA 98632

*Available to all Kaiser Permanente members except those on Medicaid, receiving full financial assistance, or visiting from another Kaiser Permanente region.

7

Kaiser Permanente Together in good health

Extras for your well-being We care for the whole you. From emergencies to personal wellness goals, you get the support you need to thrive. And to sweeten the deal, we’ll even throw in Visa reward cards just for taking healthy steps. Get coverage, no matter where life takes you As a Kaiser Permanente FEHB member, your benefits go further than your home service area. Wherever you go, you’re covered for: •  Emergency room and urgent care visits — anywhere in the world •  Care at any Kaiser Permanente location in another region •  Coverage for certain outpatient follow-up care and outpatient care outside of Kaiser Permanente service areas through the FEHB travel benefit •  Certain coverage for dependent children who are temporarily outside your home area

Earn up to $150 in Visa reward cards for taking healthy steps* You and your enrolled spouse can each get up to $75 in Visa reward cards per year: •  $50 for taking the Total Health Assessment, an online questionnaire that gives you a wellness action plan •  $25 for completing a healthy lifestyle program, an online class to help you reach your health goals Go to kp.org/feds to learn more and get started.

Help to quit smoking Let us help you succeed in quitting. You pay nothing for classes, telephone coaching, online programs, and prescriptions, including prescribed over-the-counter tobacco-cessation drugs. Ask your doctor about your treatment options.

*The rewards program runs from January 1 through December 31, 2016, and is open to all Kaiser Permanente FEHB subscribers and their enrolled spouses 18 and older. You can take the Total Health Assessment as often as you would like and as many healthy lifestyle programs as you want, but you can only earn rewards for them once during the reward period. Visa reward cards expire 12 months from date issued. 8

Benefit highlights 2016 benefit changes — what’s new?

Coverage away from home for children

Key benefit changes to High and Standard Options include:

We provide coverage for enrolled children under age 26 who are temporarily outside our service area and within the United States. Coverage up to 10 office visits, 10 laboratory tests and diagnostic X-rays, and 10 prescription drug fills per calendar year. There are no deductibles. You pay 20% of our allowance, except for prescription drugs, you pay the same cost sharing you would pay at Kaiser Permanente pharmacies.

•  Increased preferred brand-name prescription drug copayments (Standard Option), and non-preferred brand-name prescription drug and specialty drug cost-sharing (High and Standard Options). You can use Kaiser Permanente’s FEHB drug formulary to find which tier your drug is in.* •  Added 10% coinsurance for drugs administered during an office visit or other facility (High Option only). Standard Option plan remains at 20% coinsurance after deductible. •  Increased the copayments for lab and X-ray visits (High and Standard Options), and increased the specialty scan copayment (Standard Option only). •  You no longer have to meet the deductible before receiving physical, occupational, and speech therapy (Standard Option only). •  Payments made toward the deductible in the last 3 months of the year will no longer count towards the deductible for the following calendar year (Standard Option). •  Increased the frequency for eyeglasses and contacts from every 24 months to every 12 months for members through age 18.

Enjoy chiropractic services, acupuncture, and other alternative care You can visit any CHP Group participating provider, without a referral, and receive chiropractic services, acupuncture, naturopathic care, and massage therapy up to $1,000 per year on the High Option or $500 on the Standard Option. To find a participating provider, visit chpgroup.com or call 1-800-813-2000, (TTY 711), Monday through Friday, 8 a.m. to 6 p.m.

*To learn more, see the 2016 benefits summary on page 11; download our FEHB brochure (see Section 2 “Changes for 2016”), FEHB Drug Formulary, and other material at kp.org/feds; or call us at 1-800-813-2000 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m. You can also fill out the reply card at the back of this brochure to get material.

9

Kaiser Permanente Together in good health

Which option is right for you? High Option

Standard Option

Included with Both

•  Higher premiums, but lower copays for most services and prescription drugs •  No deductible

•  L  ower premiums, but higher copays or coinsurance after you meet your deductible

If you want low out-of-pocket costs, this may be the right choice.

If you want predictable copays at a lower premium, this may be the right choice.

•  No copays for most preventive care services •  No copays when you email your doctor’s office, call the 24/7 medical advice line, or video chat with a doctor •  No paperwork to fill out when you get services from Kaiser Permanente providers

Medicare members get better benefits

Dental coverage for Federal enrollees

If you have Medicare and decide to enroll in Kaiser Permanente Senior Advantage (HMO) for Federal Members, you’ll get richer benefits than with your FEHB coverage alone. Learn all about the different parts of Medicare and how they work together in Your Guide to Choosing a Kaiser Permanente Medicare Health Plan. Download our brochure at kp.org/feds/Medicare, or to have one sent to you, please call Member Services at 1-877-221-8221 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.

Kaiser Permanente is uniquely designed to be your partner in total health, as our medical and dental plans provide care and coverage that work seamlessly together. All Federal employees and retirees are now eligible for Kaiser Permanente dental coverage. You may choose between 2 great dental plans, both with comprehensive benefits and a wide range of providers:

Save on prescription drugs Save time and money by ordering prescription refills online or by phone. We can mail most prescription drugs to you within 10 days. You don’t pay for standard U.S. postage. You get a 90-day supply for only twice the 30-day supply copay when we mail your prescription.

•  Dental Preferred: Choose from more than 140 Kaiser Permanente providers in 17 convenient locations, including many inside or near our medical offices. •  Dental Select: Choose from more than 4,500 Oregon and Washington dentists who are outside the Kaiser Permanente network. For more details or to enroll in our dental plans, visit kp.org/feds/nwdental.

You pay the deductible, then cost-sharing. Plan providers determine the drug that is medically necessary. If you request another drug, you must pay prices charged to members for non-covered drugs. ‡ These rates do not apply to all enrollees. If you are in a special enrollment category, please contact the agency or Tribal Employer which maintains your health benefits enrollment.

* †

10

Your 2016 benefits summary Benefits and Services Deductible (2x per family maximum) Outpatient services (per visit or procedure) Preventive care Primary care Specialty care Most X-rays Most lab tests Chiropractic, naturopathic, acupuncture, and massage services (up to 12 massage visits per year)

High Option None

Standard Option $250 per person

$0 $20 $30 $15 $10 $20 ($25 massage) ($1,000 per year annual benefit maximum)

$0 $25 $35 $30 $25 $25 ($500 per year annual benefit maximum)

Hospital and facility Outpatient surgery $100 $150* Inpatient hospital care (per admission) $250 $200 per day up to $600* Maternity Routine prenatal care visit, first postpartum visit $0 $0 Delivery (per admission) $250 $200 per day up to $600* Emergency and urgent care (per visit or trip) Emergency care $150 $125* Urgent care $35 $45 Ambulance $100 $125* Prescription drugs (up to a 30-day supply at plan pharmacies, or up to a 90-day supply for 2 copays through mail order) † Generic $15 $20 Preferred brand $40 $50 Non-preferred brand $60 $70 Specialty 20% up to $100 30% up to $150 Eyeglasses and contacts (every 12 months for children through $0 for children; $0 for children; age 18 and every 24 months age 19 and over) $150 credit for adults $150 credit for adults Out-of-pocket maximum (2x per family maximum) $3,000 per person $3,500 per person ‡ Your Premium Share High Option Standard Option Biweekly Non-Postal and Biweekly Postal Category 2 $85.57 $65.30 Self Only Biweekly Postal Category 1 $73.71 $54.20 Monthly Non-Postal $185.40 $141.49 Biweekly Non-Postal and Biweekly Postal Category 2 $214.19 $150.02 NEW Self Biweekly Postal Category 1 $188.58 $124.52 Plus One Monthly Non-Postal $464.08 $325.05 Biweekly Non-Postal and Biweekly Postal Category 2 $186.71 $150.02 Self and Biweekly Postal Category 1 $159.57 $124.52 Family Monthly Non-Postal $404.54 $325.05 11

Kaiser Permanente Together in good health

Ready to enroll with Kaiser Permanente? 1. Choose an option.

2. Select the type of enrollment you want.

3. Sign up online or call.

•  High Option •  Standard Option Find brief descriptions of these options on page 10. More details about benefits and rates are on page 11.

•  S  elf Only covers you. •  Self Plus One covers you and 1 eligible family member. •  Self and Family covers you and all eligible family members.

Find your enrollment code in the chart below. Then, visit opm.gov to enroll online or contact your employing agency or retirement office for next steps and other information. Annuitants can contact the Retirement Information Center at 1-888-767-6738 or 1-855-887-4957 (TTY), or [email protected].

If you qualify for Medicare, or will soon, see page 10 for more information.

Important information for families Self Plus One is a new enrollment type for 2016. Enrollees who cover themselves and 1 eligible dependent may choose to enroll in Self Plus One or Self and Family. You decide which enrollment type is best for you. Refer to the benefits summary on page 11 to pick the lowest premium share based on your situation.

Choose the right enrollment code Enrollment Code Self Only NEW Self Plus One Self and Family

High Option 571 573 572

Standard Option 574 576 575

Need help? Call us at 1-800-813-2000 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m.

These are highlights of the FEHB enrollment process. Please refer directly to opm.gov and your employing agency or retirement office for FEHB coverage effective dates, enrollment procedures and deadlines, and other information. To add an eligible family member to your Kaiser Permanente Self and Family or Self Plus One enrollment, complete and return an Enrollment Change Form to us. These forms can be obtained at kp.org/feds or by calling Member Services. 12

This is a summary of the features of the Kaiser Permanente health plan. Before making a final decision, please read the plan’s Federal brochure (RI 73-004). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure. The benefits on page 6 and the dental plans listed on page 13 under “Dental Coverage for Federal Enrollees” are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees and family members who become members of Kaiser Permanente.

Kaiser Permanente Senior Advantage for Federal Members Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. To join a Kaiser Permanente Medicare health plan, you must reside in the Kaiser Permanente Senior Advantage service area in which you enroll. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year and at other times in accord with your group’s contract with us. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. You must pay the Medicare Part B premium to join a Kaiser Permanente Medicare health plan. Enrolling in Senior Advantage for Federal Members will not affect the benefits you receive through the Federal Employees Health Benefits (FEHB) Program, although the network and other rules of Medicare may apply.

Notice of Summary of Benefits and Coverage (SBC): Availability of Summary Health Information The Federal Employees Health Benefits (FEHB) Program offers numerous health benefits plans and coverage options. Choosing a health plan and coverage option is an important decision. To help you make an informed choice, each FEHB plan makes available a Summary of Benefits and Coverage (SBC) about each of its health coverage options, online and in paper. The SBC summarizes important information in a standard format to help you compare plans and options. This plan’s SBC is available on the Internet at kp.org/feds. A paper copy is also available, free of charge, by calling Member Services at 1-800-813-2000 (toll free). For TTY for the deaf, hard of hearing, or speech impaired, call 711. To find out more information about plans available under the FEHB Program, including SBCs for other FEHB plans, please visit opm.gov.

Produced by DAZzle, Version 9.0.05 (c) 1993-2009, Endicia, www.Endicia.com U.S. Postal Service, Serial #

Kaiser Foundation Health Plan of the Northwest 500 NE Multnomah St., Suite 100 Portland OR, 97232

An exceptional choice for good health Kaiser Foundation Health Plan of the Northwest has “Highest Member Satisfaction among Commercial Health Plans in the Northwest Region, Two Years in a Row,” according to the J.D. Power 2014 and 2015 U.S. Member Health Plan StudySM.*

Artwork for User Defined (3.5" x 5.5") Layout: BRM IMB 3.5 X 5.5.LYT September 17, 2012

*Kaiser Foundation Health Plan of the Northwest received the highest numerical score among commercial health plans in the Northwest region (OR, WA) in the proprietary J.D. Power 2014 and 2015 U.S. Member Health Plan StudySM. Study based on 31,543 total member responses, measuring eight plans in the northwest region (excludes Medicare and Medicaid). Proprietary study results are based on experiences and perceptions of members surveyed November-December 2014. Your experiences may vary. Visit jdpower.com.

16MMC-15/10-15

©2015 Kaiser Foundation Health Plan of the Northwest