Kaiser Permanente Integrated Health Model Plan
State of Maryland Employee and Retiree Health and Welfare Benefits Program
2016 Enrollment
Your partner in good health a wide range of specialists
video appointments
convenient facilities near you
I can choose and change my doctor anytime
better care for healthier tomorrows
I can email my doctor
free to focus on you
Statements above relate to Kaiser Permanente physicians and services only.
I’m part of the decision
State of Maryland:
Discover the Kaiser Permanente difference
With health care and coverage working seamlessly together, Kaiser Permanente is uniquely designed to be your partner in health so you can feel your best — in mind, body, and spirit.
your choice of top doctors
online access anytime, anywhere
everything under one roof
You can choose and change your doctor anytime, for any reason. Our doctors are among the best. They love caring for people and aren’t weighed down by a lot of paperwork, so they can focus on you.
It’s easy to stay involved in your care. Use your computer or mobile device to email your doctor’s office, schedule routine appointments, view most lab test results, refill most prescriptions, and more.
You can do more and drive less because most of our locations include pharmacy, lab, X-ray services, and more.
see your doctor from home Welcome to care on your terms. Video appointments with your primary care doctor save time and money. There’s no extra cost, and from your tablet, smartphone, or computer, you can talk with your doctor wherever you are.3
healthier tomorrows personalized care and attention You’re at the center of your care. Your doctors, nurses, and specialists, all connected by your electronic health record, work together to help you manage your health.
Every decision starts with what’s best for you. That’s why our highquality care for conditions like cancer, heart disease, and diabetes leads to better outcomes and healthier tomorrows.
my.kp.org/maryland
Note: Many features discussed in this book are available only to members receiving care at Kaiser Permanente medical facilities. Video appointments with PCPs available only with Permanente physicians when members are physically present in Maryland, Virginia, or Washington, D.C.
Kaiser Permanente A better choice for good health
Your partner in good health Nationwide, more than 10 million people turn to us as their trusted partner in total health. Take a look, and you’ll see why Kaiser Permanente is a better choice for State of Maryland employees.
The power to choose ..............................................................2
Excellent care .........................................................................3
Your health. Your way. ............................................................4
Healthy extras ........................................................................5
Experience the Kaiser Permanente difference........................6
Our locations ..........................................................................7
Footnotes ...............................................................................8
Prefer to see this information online? Go to my.kp.org/maryland.
New medical center!
Kaiser Permanente Baltimore Harbor Medical Center Opens November 2015 Our City Plaza Medical Center is moving to 815 East Pratt St. in Baltimore. Expanded services include internal medicine/family practice, Ob/Gyn, pediatrics, laboratory, pharmacy, and general radiology, including mammography.
For more information on rates and benefits, visit www.dbm.maryland.gov/benefits. 1
The power to choose Stay in charge of your health. It’s simple to make smart choices when you have great doctors and convenient facilities.
Your choice of top doctors1,2
Under-one-roof access
You have a wide selection of skilled doctors that you can choose from and change anytime, for any reason.
Save time and avoid driving all over town for care. You’ll have many locations to choose from, and most of them offer multiple services under one roof. You can see your doctor, get a lab test or an X-ray, and pick up medications (for members enrolled in the State of Maryland Express Scripts pharmacy plan), all without leaving the building.
Our doctors: Are named “top doctors” by many publications in the Mid-Atlantic Work hand in hand with your entire care team, who are all connected by your electronic health record Don’t have excessive paperwork, so they can focus on delivering the care you need Care about their patients and love what they do g
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Urgent care services are located in 10 Mid-Atlantic Kaiser Permanente medical centers. Six have 24/7 urgent care, along with pharmacy,4 lab, and advanced imaging.
Extra conveniences g
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Email your doctor’s office with routine questions. Get same-day, after-hours, and weekend services at multiple locations. It’s easy to find doctors who speak more than one language. For members enrolled in the State of Maryland Express Scripts pharmacy plan, you can refill prescriptions online, by telephone, or by mobile app. Call our 24/7 medical advice line to talk with a nurse 24/7 or video chat with a doctor.3 Travel freely; you’re covered for emergency care worldwide.
Our members say it best. Hear their stories at kp.org/carestories.
Your electronic health record brings it all together.
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Your doctor’s office
Pharmacy,4 lab, X-ray
Your personal electronic medical record gets updated with each visit to a Kaiser Permanente facility, so it’s current.
No need for paperwork when you get services at our facilities — your doctor’s orders are already there.
Excellent care At Kaiser Permanente, you have access to the region’s number one ranked health plan. It includes some of the Mid-Atlantic’s top specialists in cardiology, oncology, Ob/Gyn, and more.2,8
Personalized care and attention
Easy access to top specialty care
Leaders in prevention and chronic disease
Your care is personalized and designed to fit your life. Kaiser Permanente’s care teams are connected to you and to one another, and have access to your medical records. Your team works together to provide care that leads to better health. And it doesn’t stop there. You have access to no-cost online and mobile wellness tools, telephone coaching on stress management and smoking cessation, and much more.
Seeing specialists who are experts in their fields just got easier.
We’re committed to preventive care and your overall wellness. We are among the best in treatments for those with chronic diseases.
At Kaiser Permanente, your primary care doctor can book an appointment for you to see a specialist, sometimes on the same day. You get the care you need faster and easier. Because your doctors are connected electronically, your records and other information are instantly available to the specialists.
We keep our members healthy with easy access to wellness tools, routine appointments, and preventive care screenings. In fact, Kaiser Permanente is ranked first in the nation in breast cancer screenings. We are first in the MidAtlantic region in cholesterol management of patients with cardiovascular conditions, in cervical cancer screenings, and in childhood immunizations.5
Learn more about the doctors available in your area at kp.org/doctorsandlocations.
Specialty care
Your specialist sees the same information as your primary care doctor, pharmacist, and other members of your care team — so they’re up to speed and ready to take care of you.
At home or on the go Get your health information on your computer or mobile device to stay informed and in charge.
Connect with doctors on video
Go ahead, make a video appointment with your primary care doctor — with no extra cost. It’s just one way you’re in control of your care. And when you call for medical advice anytime, 24/7, you could also have a video chat with a doctor who is connected to your personal care team.3
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Your health. Your way. We’re always here when you need us, however you need us. You can get many services under one roof at most of our locations. Medical advice is 24/7 and for some conditions, you can get video advice from a doctor. You can manage your family’s health needs anytime, anywhere, online or through mobile. And you can make video appointments with your personal doctor, for no copay.3
It’s easy to stay connected
A website full of healthy ideas
Good health on the go
Members registered on kp.org have secure access to My Health Manager, the online tool that helps you manage your family’s health care anytime, anywhere with more than 20 features, including: Email your doctor’s office with routine questions. Refill most prescriptions for members enrolled in the State of Maryland Express Scripts pharmacy plan. View most lab test results. Make, change, or cancel routine appointments.
Get informed and inspired on our award-winning website, kp.org. Take charge of your health with articles, wellness topics, and health calculators. Our music channels, podcasts, fitness videos, and recipes from world-class chefs can help you find new and interesting ways to live well and thrive.
Manage your care from home, work, or on the go with our mobile app, which puts all the convenient features of My Health Manager right in the palm of your hand. You can download the free Kaiser Permanente app from the App StoreSM or Google Play ®.
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App Store is a service mark of Apple, Inc., and Google Play is a trademark of Google, Inc.
For a guided tour of My Health Manager, visit kp.org/experience.
Top reasons to join Kaiser Permanente
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You can choose
Excellent care,
and change your doctor anytime, for any reason.
for conditions like cancer, heart disease, and diabetes, leads to healthier tomorrows.
Healthy extras Good health starts with helpful information and resources. That’s why you get lots of healthy extras as a Kaiser Permanente member.
Boost your health IQ
Fresh food in the parking lot
Maximize your health
There’s always something new to learn about how to be your healthiest. With the many health classes we offer, there’s something for everyone. Try classes for eating well, baby care, ongoing health conditions, and much more. Classes vary by location and some require a fee.
Eating well is easier when you bring home fresh food from our farmers markets. They’re conveniently located at many of our facilities, so you can pick up fresh fruits and delicious vegetables when you’re in the neighborhood.
Our personalized online wellness programs can help you lose weight, stay active, reduce stress, sleep better, and much more.5 You can also download the free Every Body Walk! app for your smartphone or mobile device from the App Store or Google Play. It’s a fun, interactive tool to help you create and maintain a daily walking routine. App Store is a service mark of Apple, Inc., and Google Play is a trademark of Google, Inc.
Find tools, tips, and information for living well at kp.org/livehealthy.
Under one roof
Healthy extras
You get care your way with PCP
are your doctors and other caregivers, along with the lab, pharmacy, X-ray, and many other services. What could be more convenient?
like onsite classes* and farmers markets help you stay well.
video appointments, video advice with doctors, our 24/7 nurse medical advice telephone line, emailing your doctor’s office, online lab results, and even more — all connected to your electronic health record. That’s online, too.3
*Some classes require a fee.
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Our locations and hospital partners* Care is convenient and connected, with 29 locations in the Mid-Atlantic region. Ten locations provide urgent care services, and six provide 24/7 services including urgent care, pharmacy, lab, and advanced imaging. Why drive around town for all your health care needs when what you need is in the same building?
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Visit us at my.kp.org/maryland to connect to a facility, review physician profiles or directories, and learn more about Kaiser Permanente services. 6
2016 State of Maryland Kaiser Permanente IHM Benefit Highlights6 Benefits and services Preventive care Routine physical exam
$0
Outpatient services (per visit or procedure) Primary care office visit (copay waived for children under age 5)
$15
Specialty care office visit
$15
Most X-rays and lab tests
$0
MRI, CT, PET scans
$0
Outpatient surgery
$0
Chiropractic and acupuncture services
$15
Inpatient hospital care Room and board, surgery, anesthesia, X-rays, lab tests, medications
$0 per admission
Maternity Routine prenatal care visits and first postpartum visit
$0 $0 per admission
Delivery Telemedicine In office e-consult with specialist Video chat with a doctor
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$0 $0
Emergency and urgent care (per visit or trip) 7
Emergency care
$150
Urgent care
$15
Ambulance
$0
Prescription drugs Prescription drug coverage
Generic/brand Not covered under medical plan
Maximum out-of-pocket Per person
$1,500
Maximum per family
$3,000
For more information on rates and benefits, visit www.dbm.maryland.gov/benefits. Need to talk to a live person? Call Member Services, 7 days a week, 7 a.m. to 11 p.m., at 855-839-5763 or 711 TTY for hearing impaired. 7
Footnotes To nominate a physician to join the Mid-Atlantic Permanente Medical group, please call the State of Maryland dedicated member services line at 855-839-5763, 7 days a week, 7 a.m. to 11 p.m.
1
Kaiser Permanente top doctors named in Northern Virginia Magazine, April 2015 and February 2015; Baltimore magazine, November 2014; Washingtonian MOM magazine, Spring 2014; Washingtonian magazine, March 2014.
2
Video advice with a doctor is for certain medical conditions and for members 18 years and older (12 and older starting winter 2015). Video appointments with PCPs available only with Permanente physicians. Both available only when member is physically present in Maryland, Virginia, or Washington, D.C.
3
Only members who are enrolled in the State of Maryland Express Scripts pharmacy plan can use Kaiser Permanente pharmacies to fill and refill prescriptions.
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Kaiser Permanente is first in the nation for breast cancer screening and many childhood immunizations. We are in the top 10 nationally for many aspects of diabetes care, and care and management of patients with cardiovascular conditions. 2015 Healthcare Effectiveness Data and Information Set (HEDIS) published by the National Committee for Quality Assurance. For more information, visit ncqa.org.
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This is a summary of the benefits of the Kaiser Permanente Integrated Health Model plan. Before making a final decision, please read the State of Maryland Summary of Benefits and Coverage, as additional exclusions and limitations may apply. This document can be downloaded by visiting the plans and benefits section of my.kp.org/maryland or by calling 855-839-5763.
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The emergency copay is waived if admitted to the hospital within 24 hours for the same condition or if admitted directly to the hospital as an inpatient.
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In NCQA’s Health Insurance Plan Rankings 2014–2015, Kaiser Permanente of the Mid-Atlantic States, Inc., ranked first in Maryland, Virginia, and Washington, D.C., and ranked 13th out of 507 commercial health plans in the country.
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my.kp.org/maryland For training purposes only
Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
2101 East Jefferson Street, Rockville, MD 20852
60348708_MAS
9/1/15–8/30/16
