2016 enrollment book georgia together in good health · 2016 enrollment book georgia shbp state...
TRANSCRIPT
together in good health
see how easy healthy can be
2016 Enrollment BookGeorgia
SHBPState Health Benefit Plan
A Division of the Georgia Department of Community Health
Administered by
h : 0.9812maximum size
SHBPState Health Benefit Plan
A Division of the Georgia Department of Community Health
Administered by
30 years of a healthy partnership in Georgia!Kaiser Permanente is not just a health plan. We are also a team of health care providers—including doctors, nurses, pharmacists and specialists— all working together to provide the right care for you and your family. Choose your own personal doctor and work with a care team that puts you at the center of everything they do.
Highest Ranked. 6 Years Straight.Thanks to our members, J.D. Power has ranked us “Highest Member Satisfaction among Commercial Health Plans in the South Atlantic Region.”1
Our non-profit status works for GeorgiaAs Georgia’s largest non-profit health plan, Kaiser Permanente strives to build a healthier community for all Georgians. In fact, part of our mission is to improve the health of the communities we serve.
Get to know Kaiser Permanente
1
Enroll today! mySHBPga.adp.com
The experience… With other health plans… With Kaiser Permanente…*
Doctor choices
The insurance company simply contracts with doctors who accept their insurance. You often pick from only a list of names.
We carefully screen and hire our own doctors (over 450 of them), many from top schools like Emory and Harvard. You can review credentials on kp.org, choose your own doctor and can switch at any time, for any reason.
Getting care
You drive all around town to see doctors, take lab tests, get X-rays, or fill prescriptions.
You can see your doctor or specialist, plus get lab tests, X-rays and prescriptions all in the same building at most of our 25 locations. You can also see a doctor in another office whenever it’s more convenient.
Coordinating care
You’re on your own to work with unconnected doctors, specialists, pharmacies, hospitals and other providers. You could repeat the same tests, answer the same questions and just hope to avoid drug interactions.
Your personal doctor is your advocate and coordinates all your care. All of your providers — across all locations — see your electronic medical record, so you can quickly get the care that’s right for you.
Getting approval
Your doctor asks the insurance company to approve a test or procedure, which means you may wait days for an answer.
If your doctor thinks you need something, he/she simply orders it on the spot. And no referrals are needed to see any Kaiser Permanente specialist.
Out-of-pocket cost
You’re often surprised by the things your insurance doesn’t cover. Doctors are unconnected and paid for each service they provide, so you could pay for duplicate tests, X-rays, or other services you don’t need.
You’ll have coverage that’s designed to minimize surprise out-of-pocket costs. And because our providers are all connected, you pay for just the care you need to keep you healthy or get you better.
In between visits
It’s up to you to remember instructions, wait days or weeks for test results and play phone tag with your doctor to get questions answered.
Details of your visits and lab results are at your fingertips online or through our mobile app. Refill prescriptions, make appointments and even email your doctor with questions.
Discover the Kaiser Permanente differenceWhen you compare us to other health plans, you’ll see how the advantages of Kaiser Permanente quickly add up.
* When you get care at Kaiser Permanente facilities.3
Enroll today! mySHBPga.adp.com4
Deductible, Co-insurance & Out-of-Pocket Maximums
NOAnnual Deductible: Individual/Family
NOCo-insurance
Annual Out-of-Pocket Max: Individual/Family
Lifetime Benefit Maximum
$6,350 / $12,700 (Co-pays apply) None
Office Visits (Outpatient)Primary Care $35 co-pay
Specialty Care $45 co-pay
Scheduled Prenatal Visits and 1st Postpartum Visit Routine care covered at 100%
Vision Exam $0 co-pay, includes refractions
Physical, Occupational, Speech Therapy, Cardiac Rehab
$25 co-pay, up to 40 visits per calendar year for each therapy
Outpatient/Ambulatory Surgery $100 co-pay
Routine Preventive Care*Wellness Exams—Physical & Well Woman exams Covered at 100%
Mammography Screening• Mammography screening for breast cancer for women 50 to 74• Mammography screening for breast cancer in other age groups as jointly
determined by patient and physicianCovered at 100%
Pap Smear Covered at 100%Prostate Specific Antigen (PSA) TestProstate cancer screenings (PSA & digital rectal exams) Covered at 100%
Sigmoidoscopy/Colonoscopy Covered at 100%
Well Child Care Covered at 100%
Breast Cancer Medications (Tamoxifen & Raloxifene only) Covered at 100%
Lab & X-Ray
Laboratory X-Ray MRI/CT/PET/ Nuclear Medicine
Covered at 100% for services performed in a Kaiser Permanente Medical Center or a freestanding laboratory contracted with Kaiser Permanente; $100 co-pay for services performed in an outpatient hospital setting.
Covered at 100% for services performed in a Kaiser Permanente Medical Center or a freestanding imaging center contracted with Kaiser Permanente; $100 co-pay for services performed in an outpatient hospital setting.
$45 co-pay for services performed in a Kaiser Permanente Medical Center or a freestanding imaging center contracted with Kaiser Permanente; $100 co-pay when imaging is performed in outpatient hospital setting.
Emergency CareAmbulance (Ground or Air) $100 co-pay (per trip)
Emergency Room $150 co-pay (per visit); waived if admitted
Urgent Care $35 co-pay; at designated facilities
Hospital Care (Inpatient)Inpatient $250 co-pay, per admission
Delivery and Inpatient Baby Care $250 co-pay, per admission
State Health Benefit Plan (SHBP)Effective Dates: January 1, 2016 – December 31, 2016
** Preventive Services are based on recommendations by the United States Preventive Services Task Force, the Health Resources and Service Administration and the Centers for Disease Control and Prevention. Additional services are mandated by the State of Georgia. We will cover all federal and state mandated benefits as required by law. Kaiser Permanente health professionals will determine if services are medically necessary for each member. A service is considered medically necessary if it’s medically required to prevent, diagnose or treat a member’s condition or clinical symptoms and it’s consistent with generally accepted professional standards of care in the community. (Preventive Services must be coded as preventive, state-mandated, a screening, age-appropriate, meet frequency guidelines and be delivered by a network provider).
Enroll today! mySHBPga.adp.com 5
Mental Health and Chemical DependencyMental Health Outpatient (Individual) $35 co-pay, unlimited visits per calendar year
Mental Health Outpatient (Group) $17 co-pay, unlimited visits per calendar year
Mental Health Inpatient $250 co-pay, unlimited days per calendar year
Chemical Dependency Outpatient (Individual) $35 co-pay, unlimited visits per calendar year
Chemical Dependency Outpatient (Group) $35 co-pay, unlimited visits per calendar year
Chemical Dependency Inpatient $250 co-pay, unlimited days per calendar year
Prescription DrugsGeneric Preferred $20 co-pay at KP Pharmacies & $30 co-pay at Network Pharmacies for 1x fill**
Brand Preferred $50 co-pay at KP Pharmacies & $60 co-pay at Network Pharmacies for 1x fill**
Non-Preferred $80 co-pay at KP Pharmacies & $90 co-pay at Network Pharmacies for 1x fill**
Day Supply 30-Day Supply
Mail Order – Generic Preferred $50 co-pay through Kaiser Permanente Pharmacies only
Mail Order – Brand Preferred $125 co-pay through Kaiser Permanente Pharmacies only
Mail Order – Non-Preferred $200 co-pay through Kaiser Permanente Pharmacies only
Mail Order – Day Supply 90-Day Supply
OtherSkilled Nursing Facility (SNF) Plan pays 100%, up to 120 days per calendar year
Hospice Care Covered at 100%
Home Health Care Plan pays 100%, unlimited. Private Duty Nursing is not covered.
Durable Medical Equipment (DME) Covered at 100%, unlimited
Chiropractic Care $45 co-pay, up to 20 visits per calendar year
Hearing (Non-routine Exams, Tests & Fittings) • Hearing Aids limited to $1,500 every 5 yrs for Adults• Hearing Aids limited to $3,000 every 5 yrs for Children
18 years & younger
Covered at 100%
Infertility Diagnosis Office VisitLimited to diagnostic services for the diagnosis of involuntary infertility only.
$45 co-pay
Infertility Diagnosis Only Laboratory, Radiology & Tests Limited to diagnostic services for the diagnosis of involuntary infertility. Tests covered under “Diagnosis Only” are those only to rule out underlying medical issues. Tests and treatment related to reproductive issues are not covered.
Covered at 100% for services performed in a Kaiser Permanente Medical Center or a freestanding laboratory contracted with Kaiser Permanente; $100 co-pay for services performed in an outpatient hospital setting.
** For immediate service after an emergency visit, prescriptions may be filled at Rite Aid or Walgreens at a co-pay $10 higher than those listed above. This is for a first fill ONLY per prescription. Subsequent refills must be filled through Kaiser Permanente Pharmacies, either at our facilities or through our mail order/home delivery option. Please note: Kaiser Permanente has extended pharmacy hours in the following Medical Centers: Southwood and TownPark Comprehensive Medical Centers—M–F 8:00 a.m.–11:00 p.m. and Sat–Sun 9:00 a.m.–6:00 p.m.; and Gwinnett Comprehensive Medical Center, M–F 8:30 a.m.–10:00 p.m. and Sat–Sun 10:00 a.m.–6:00 p.m.
This is a summary of your benefits and their co-pays. This is not a contract. A complete list, exclusions and limitations are contained in the Group Agreement we have with your State Health Benefit Plan and the Evidence of Coverage you will receive. In the case of a conflict between this benefit summary and the Evidence of Coverage, the Evidence of Coverage will prevail. For specific questions about coverage, please contact the SHBP Member Services Center at 800-610-1863 or contact Kaiser Permanente Member Services at 855-512-5997.
Work or Reside The State Health Benefit Plan members (and eligible dependents) are eligible to enroll in Kaiser Permanente if they work or live within the Service Area at the time of enrollment.
Enroll today! mySHBPga.adp.com
2016 Wellness ProgramEarn up to $480 and feel the benefits of taking care of your health!
Complete all four activities and earn a Visa® gift card worth $240. Simply sign up for the Kaiser Permanente Wellness Program at my.kp.org/shbp and make sure you are up-to-date on all four of the activities listed below. Each member and covered spouse who satisfies the Kaiser Permanente Wellness Program requirements will receive a $240 Visa® gift card - $480 per household!Getting your reward is easy and there is no specific order in which these four wellness activities must be completed! Just sign on to my.kp.org/shbp to accept your Wellness Program agreement, which is required for reward eligibility. For details or questions go to my.kp.org/shbp or call 866-300-9867.
What to Do
Step 1
Take Your Total Health AssessmentComplete your 2016 Kaiser Permanente on-line Total Health Assessment (THA). The questionnaire is confidential that takes about 20 minutes.
Step 2
Know Your NumbersComplete a Biometric Screening either at a Kaiser Permanente Medical Office, or by a Kaiser Permanente clinician at a worksite wellness event. ONLY those screenings performed by Kaiser Permanente are eligible for the reward.
Step 3
Get Yourself ScreenedComplete an age and gender appropriate preventive screening for breast, cervical, or colorectal cancer.
Step 4
Take an Online CourseComplete one online Healthy Lifestyle Program (HLP)
How will you and your covered spouse use your $480 Wellness Incentive reward?
Pay toward medical expenses
Relieve stress with quarterly massages
Take a nice weekend hiking trip in the mountains
Splurge on new work-out clothes or walking shoes
Stock up on healthy foods at the grocery store
Treat yourself to something you enjoy
EARN UP TO480$
6
Enroll today! mySHBPga.adp.com
Membership has its benefits!At Kaiser Permanente, we’re more than just a provider of health plans. As your partner in health, we’re committed to keeping you healthy. That’s why we offer a wealth of tools and programs at no additional cost that empower you to take an active role in your own health.
Preventive care to keep you healthy To catch problems early, many of our plans cover services like well visits, flu shots and more, with no co-pays, coinsurance or deductible required.
In fact, we lead the way in prevention:• We’re #1 in colon and breast cancer screenings2
• We’re in the top 10% for cervical cancer screenings2
• 89% of our members diagnosed with high blood pressure now have it under control, compared to 63% nationally3
Appointments with a physician without leaving your homeYou can email your doctor’s office when you have questions, or you can call us to schedule a telephone appointment with certain doctors.
Telephone coaching for chronic conditionsIf you’re dealing with a chronic situation or ongoing health condition, you’re not alone. You can access our award-winning Complete Care program to help you manage conditions like asthma, diabetes, hypertension, depression and more.
24/7 nurse adviceRegistered nurses who can access your medical record are available to you 24/7 to answer your questions and offer advice.
Wellness coaching by phoneA busy schedule may make it hard to live your healthiest. That’s why we offer telephone support to help you stay focused on healthy habits, create a customized plan, or guide you to better health choices.
Healthy Living ClassesWe offer health classes at our medical centers, including courses in fitness and exercise, healthy cooking, prenatal care, cholesterol care and much more. Learn more at kp.org/classes.
Discounts to stretch your health care dollarsTo help you make total health more affordable, we offer discounts on a variety of services— including fitness clubs, chiropractic care, massage therapy, acupressure and acupuncture, vision care, vitamins and more. Learn more at kp.org/choosehealthy.
More online resourcesFor more valuable health care insight, take advantage of the tools in the health and wellness section of kp.org:• kp.org/symptoms
Interactive Symptom Checker• kp.org/health and kp.org/medications
Health and drug encyclopedias• kp.org/watch and kp.org/listen
Videos and guided-imagery audio programs• kp.org/foodforhealth
Healthy recipes
7
Enroll today! mySHBPga.adp.com
Managing your care onlineWith Kaiser Permanente’s exclusive My Health Manager on kp.org, you are connected 24/7 to your health records and health care providers. With My Health Manager, you can manage your health care right from your computer or through our mobile app.
You can easily: • schedule and cancel
routine appointments• order prescription refills• view lab test results and
immunization records• review benefits information
and eligibility• get estimates of out-of-pocket
costs for services• email your doctor’s office
Pharmacies: even more convenientAfter you see your doctor, just walk down the hall to the pharmacy at most of our locations. You have several options for getting refills:• order online at kp.org• order on your mobile device with the Kaiser Permanente app• call our 24-hour Refill Line at 770-434-2008• refills can be picked up at any Kaiser Permanente pharmacy• most prescriptions can be mailed directly to your home with
no cost for shipping (in some instances you can save even more with a 90 day supply for the cost of 60 days!)
Once you become a member, call 855-512-5997, option 2, ask for a Pharmacy Consult and we will help you transfer prescriptions from another doctor.
8
Enroll today! mySHBPga.adp.com
Specialty Care*• Acute Care• Adult Medicine• Audiology• Behavioral Health• Breast Care Center• Cardiology• Colorectal Surgery• Cosmetic
Dermatology**• Dermatology• Elder Care• Endocrinology• Family Medicine
• Gastroenterology• General Surgery• Geriatrics• Hematology• Infectious Disease• Maternal Fetal
Medicine• Nephrology• Neurology• Obstetrics/
Gynecology• Oncology and
Infusion• Ophthalmology• Optometry
• Orthopedics• Otolaryngology (ENT)• Pain Management• Pediatrics/Adolescent
Medicine• Podiatry• Plastic Surgery**• Psychiatry• Pulmonology• Radiation Oncology• Radiology• Rheumatology• Sleep Medicine• Sports Medicine• Urgent Care
• Urogynecology• Urology• Vascular Surgery• Wound Care
Specialists vary by location
* At our medical offices. Other specialties available through our network of affiliated specialists.
** Plastic Surgery and Cosmetic Dermatology are covered when deemed medically necessary and/or meets state/federal mandates.
Right care, right time: quality care and specialties Specialty Care You can feel confident you and your family have access to expert care. You can schedule an appointment without a referral for any specialist at a Kaiser Permanente medical facility. (Some specialists may require a clinical evaluation or additional information before they see you.) In certain cases, you might be referred to an affiliated specialist.
24/7 Nurse Advice If you have an illness or injury and you’re not sure what kind of care you need, call our registered nurses 24/7 at 404-365-0966. They’ll have access to your electronic health record and can help you handle the problem at home or direct you to the appropriate location for care.
Inpatient Hospital Care You’ll have access to inpatient care at several of Atlanta’s most well-respected hospitals, such as Northside, Piedmont and Children’s Healthcare of Atlanta. At many of these locations, you’ll get care from a Kaiser Permanente doctor who has access to your medical record.
Urgent and Emergency Care Our Urgent Care Centers are open on evenings and weekends and offer an alternative to the emergency room when your injury or illness needs immediate medical attention but is not a medical emergency. At our Advanced Care Centers, we offer care for urgent medical needs 24 hours a day, 7 days a week, staffed by our own physicians. For medical emergencies, you have access to any hospital emergency room, even if it’s not affiliated with Kaiser Permanente.4
Care when you travel You can get visiting member benefits when you’re temporarily visiting another Kaiser Permanente region and you’re covered for emergency care wherever you go.
TelemedicineTelemedicine is one of the new ways we are making healthcare easier, faster and more convenient. Members have access to specialists in Dermatology, Gastroenterology, and Pulmonary Medicine. We also use Telemedicine in our Acute Care Centers to give the physician the ability to consult with a variety of specialists—right away—in real time.
9
Enroll today! mySHBPga.adp.com
“ Care close to work, care close to home.”
10
Enroll today! mySHBPga.adp.com
Loca
tions
Convenience you can’t beat: 25 locations in Metro AtlantaWith 25 Kaiser Permanente offices and over 450 doctors throughout Metro Atlanta—plus pharmacy, lab and X-ray usually right in the same building—you’ll enjoy convenience you won’t find with other plans.
Cherokee County
HOLLY SPRINGS MEDICAL OFFICE684 Sixes Road, Suite 275, Holly Springs, GA 30115Phone: 770-852-2440 Services: Adult Medicine, Lab Services, Pediatrics/ Adolescent Medicine and Pharmacy
Clayton County
SOUTHWOOD COMPREHENSIVE MEDICAL CENTER2400 Mt. Zion Parkway, Jonesboro, GA 30236Phone: 770-603-3649Services: Adult Medicine, Advanced Care (24/7), Behavioral Health and Chemical Dependency, Cardiology, Endocrinology, Geriatrics, Health Education, Infectious Diseases, Lab Services, Maternal Child Health/Lactation, Neurology, Nutrition, Obstetrics-Gynecology, Oncology and Infusion, Ophthalmology, Optometry, Orthopedics, Pain Management, Palliative Care, Pediatrics/Adolescent Medicine, Pharmacy, Podiatry, Pulmonology, Rheumatology, Surgery, Urgent Care, Urogynecology, Urology, Vascular Surgery and X-raySouthwood is one of Kaiser Permanente’s Diagnostic Centers of Excellence, providing mammography, ultrasound, general radiology and high-end imaging.
KAISER PERMANENTE SOUTHWOOD SPECIALTY CENTER 2470 Mt. Zion Parkway, Jonesboro, GA 30236Phone: 770-603-3679Services: Audiology, Dermatology, Ear, Nose and Throat, Gastroenterology, Geriatrics, Nephrology and Orthopedics
Note: services subject to change
24/7 URGENT CARE
11
Enroll today! mySHBPga.adp.com
Loca
tions
Cobb County
CUMBERLAND MEDICAL CENTER 2525 Cumberland Parkway SE, Atlanta, GA 30339Phone: 770-431-4235Services: Adult Medicine, Behavioral Health, Endocrinology, Geriatrics, Health Education, Infectious Diseases, Lab Services, Mammography, Maternal Child Health/Lactation, Nephrology, Nutrition, Obstetrics-Gynecology, Palliative Care, Pediatrics/Adolescent Medicine, Pharmacy, Rheumatology and X-ray
TOWNPARK COMPREHENSIVE MEDICAL CENTER 750 Townpark Lane, Kennesaw, GA 30144Phone: 770-514-5401Services: Advanced Care (24/7), Adult Medicine, Behavioral Health, Cardiology, Dermatology, Gastroenterology, Health Education, Lab Services, Maternal Child Health/Lactation, Neurology, Nutrition, Obstetrics-Gynecology, Oncology and Infusion, Ophthalmology, Optometry, Orthopedics, Pediatrics/Adolescent Medicine, Pharmacy, Podiatry, Pulmonology, Surgery, Urgent Care and X-ray TownPark is one of Kaiser Permanente’s Diagnostic Centers of Excellence, providing mammography, ultrasound, general radiology and high-end imaging.
WEST COBB MEDICAL CENTER 3640 Tramore Pointe Parkway, Austell, GA 30106Phone: 770-439-4700Services: Adult Medicine, Behavioral Health, Lab Services, Pediatrics/Adolescent Medicine, Pharmacy and X-ray
Coweta County
NEWNAN MEDICAL OFFICE 203 Newnan Crossing Bypass, Newnan, GA 30263Phone: 770-304-4400 Services: Adult Medicine, Health Education, Lab Services, Nutrition (limited), Pediatrics/Adolescent Medicine, Pharmacy and X-ray
24/7 URGENT CARE
12
Enroll today! mySHBPga.adp.com
Loca
tions
DeKalb County
CRESCENT MEDICAL CENTER 200 Crescent Centre Parkway, Tucker, GA 30084Phone: 770-496-3414Services: Adult Medicine, Behavioral Health, Dermatology, Health Education, Lab Services, Mammography, Maternal Child Health/Lactation, Nephrology, Nutrition, Obstetrics-Gynecology, Pediatrics/Adolescent Medicine, Pharmacy and X-ray
DOWNTOWN DECATUR MEDICAL OFFICE 201 W. Ponce de Leon Ave., Suite A, Decatur, GA 30030Phone: 404-687-7700Services: Adult Medicine, Gynecology, Lab Services, Maternal Child Health/Lactation, Pediatrics/Adolescent Medicine and Pharmacy
PANOLA MEDICAL CENTER 5440 Hillandale Drive, Lithonia, GA 30058Phone: 770-322-2777Services: Adult Medicine, Health Education, Lab Services, Mammography, Maternal Child Health/Lactation, Nephrology, Nutrition, Obstetrics-Gynecology, Pediatrics/Adolescent Medicine, Pharmacy and X-ray
STONECREST MEDICAL CENTER 8011 Mall Parkway, Lithonia, GA 30038Phone: 678-323-7500Services: Adult Medicine, Gynecology, Lab Services, Pediatrics/Adolescent Medicine, Pharmacy and X-ray
Note: services subject to change 13
Enroll today! mySHBPga.adp.com
Loca
tions
Douglas County
DOUGLASVILLE MEDICAL OFFICE 6875 Douglas Blvd., Suite A, Douglasville, GA 30135Phone: 678-838-2225 Services: Adult Medicine, Gynecology, Lab Services, Pediatrics/Adolescent Medicine, Pharmacy and X-ray
Fayette County
FAYETTE MEDICAL OFFICE 101 Banks Road, Fayetteville, GA 30214Phone: 678-610-3700Services: Adult Medicine, Lab Services, Pediatrics/Adolescent Medicine and Pharmacy
Forsyth County
FORSYTH MEDICAL OFFICE 1400 Northside Forsyth Drive, Suite 350 Cumming, GA 30041Phone: 678-455-1407Services: Adult Medicine, Lab Services, Pediatrics/Adolescent Medicine and Pharmacy
Fulton County
ALPHARETTA MEDICAL CENTER 3550 Preston Ridge Road, Alpharetta, GA 30005Phone: 770-663-3110Services: Adult Medicine, Behavioral Health, Health Education, Lab Services, Mammography, Maternal Child Health/ Lactation, Nutrition, Obstetrics-Gynecology, Pediatrics/Adolescent Medicine, Pharmacy and X-ray
BROOKWOOD AT PEACHTREE MEDICAL OFFICE 1745 Peachtree Road, Suite U, Atlanta, GA 30309Phone: 404-888-7688Services: Adult Medicine, Behavioral Health, Dermatology, Infectious Disease, Lab Services, Maternal Fetal Medicine (Perinatology), Plastic Surgery, Pharmacy and Pulmonology
14
Enroll today! mySHBPga.adp.com
Loca
tionsCASCADE MEDICAL CENTER
1175 Cascade Parkway, Atlanta, GA 30311Phone: 404-505-4006 Services: Adult Medicine, Health Education, Lab Services, Mammography, Maternal Child Health/Lactation, Nephrology, Nutrition, Obstetrics-Gynecology, Pediatrics/Adolescent Medicine, Pharmacy and X-ray
GLENLAKE COMPREHENSIVE SPECIALTY CENTER 20 Glenlake Parkway, Sandy Springs, GA 30328Phone: 770-677-6075 Services: Audiology (Hearing Aids), Breast Care Center, Cardiology, Diagnostic Imaging (CT, MRI), Ear, Nose and Throat, Gastroenterology, General Surgery, Health Education, Lab Services, Mammography, Maternal Child Health/ Lactation, Maternal Fetal Medicine (Perinatology), Neurology, Nuclear Medicine, Nutrition, Obstetrics-Gynecology, Ophthalmology, Optometry, Orthopedics, Pain Management, Pharmacy, Plastic Surgery, Podiatry, Pulmonology, Urodynamics, Urogynecology, Urology, Vascular Surgery, Wound Care and X-ray Glenlake is one of Kaiser Permanente’s Diagnostic Centers of Excellence, providing mammography, ultrasound, general radiology and high-end imaging.
SANDY SPRINGS MEDICAL OFFICE 1100 Lake Hearn Drive NE, Suites 250 & 500 Sandy Springs, GA 30342Phone: 404-845-4500Services: Adult Medicine, Behavioral Health and Chemical Dependency, Dermatology, Lab Services, Maternal Child Health/Lactation, Pediatrics/Adolescent Medicine, Pharmacy and X-ray
Note: services subject to change 15
Enroll today! mySHBPga.adp.com
Loca
tions Gwinnett
CountyLAWRENCEVILLE MEDICAL OFFICE 455 Philip Blvd., Suite 130, Lawrenceville, GA 30046Phone: 678-985-5000Services: Adult Medicine, Gynecology, Lab Services and Pharmacy
GWINNETT COMPREHENSIVE MEDICAL CENTER 3650 Steve Reynolds Blvd., Duluth, GA 30096Phone: 770-931-6012Services: Audiology, Adult Medicine, Behavioral Health, Cardiology, Dermatology, Ear, Nose and Throat, Endocrinology, Gastroenterology, General Surgery, Health Education, Infectious Disease, Lab Services, Maternal Child Health/Lactation, Nephrology, Neurology, Nutrition, Obstetrics-Gynecology, Oncology, Ophthalmology, Optometry, Orthopedics, Pain Management, Palliative Care, Pediatrics/Adolescent Medicine, Pharmacy, Podiatry, Pulmonology, Rheumatology, Sports Medicine, Urgent Care, Urology and X-rayGwinnett is one of Kaiser Permanente’s Diagnostic Centers of Excellence, providing mammography, ultrasound, general radiology and high-end imaging.
SNELLVILLE MEDICAL OFFICE 2240 Fountain Drive, Snellville, GA 30078Phone: 770-978-5400Services: Adult Medicine, Lab Services, Maternal Child Health/Lactation, Obstetrics-Gynecology, Pediatrics/Adolescent Medicine and Pharmacy
URGENT CARE
16
Enroll today! mySHBPga.adp.com
Loca
tionsSUGAR HILL–BUFORD MEDICAL CENTER
1435 Broadmoor Blvd., Sugar Hill, GA 30518Phone: 678-765-5700Services: Adult Medicine, Gynecology, Health Education, Lab Services, Maternal Child Health/Lactation, Nutrition (limited), Pediatrics/Adolescent Medicine, Pharmacy and X-ray
Henry County
HENRY TOWNE CENTRE MEDICAL CENTER 1125 Towne Centre Village Drive, McDonough, GA 30253Phone: 678-583-6000Services: Adult Medicine, Gynecology, Health Education, Lab Services, Mammography, Maternal Child Health/ Lactation, Nutrition (limited), Pediatrics/Adolescent Medicine, Pharmacy and X-ray
Rockdale County
CONYERS MEDICAL OFFICE1478 Dogwood Drive, Conyers, GA 30013Phone: 678-413-4320 Services: Adult Medicine, Lab Services, Pediatrics/ Adolescent Medicine and Pharmacy
Note: services subject to change 17
Enroll today! mySHBPga.adp.com
“ It’s good knowing Kaiser Permanente is part of a bigger network, if we need it.”
18
Enroll today! mySHBPga.adp.com
More care options when you need themKaiser Permanente has partnered with several leading hospitals and many urgent care facilities. In fact, our own doctors practice at some of Atlanta’s top hospitals. For medical emergencies, you have access to any hospital emergency room, even if it’s not affiliated with Kaiser Permanente.4
Our hospital partners include:5
Metro Atlanta Children’s Healthcare
of Atlanta at Egleston 1405 Clifton Road, NE Atlanta, GA 30322 404-785-6000
Children’s Healthcare of Atlanta at Scottish Rite 1001 Johnson Ferry Road, NE Atlanta, GA 30342 404-785-5252
Gwinnett Medical Center – Duluth 3620 Howell Ferry Road Duluth, GA 30045 678-312-6800
Gwinnett Medical Center– Lawrenceville 1000 Medical Center Boulevard Lawrenceville, GA 30045 678-312-4321
Northside Hospital 1000 Johnson Ferry Road, NE Atlanta, GA 30342 404-851-8000
Northside Hospital Cherokee 201 Hospital Road Canton, GA 30114 770-720-5100
Northside Hospital Forsyth 1200 Northside Drive Cumming, GA 30041 770-844-3200
Piedmont Hospital 1968 Peachtree Road, NW Atlanta, GA 30309 404-605-5000
Piedmont Fayette Hospital 1255 Highway 54 West Fayetteville, GA 30214 770-719-7000
Piedmont Henry Hospital 1133 Eagle's Landing Parkway Stockbridge, GA 30281 770-389-2200
Piedmont Mountainside Hospital 1266 Highway 515 South Jasper, GA 30143 706-692-2441
Piedmont Newnan Hospital 745 Poplar Road Newnan, GA 30265 770-400-1000
19
Enroll today! mySHBPga.adp.com
“ From specialists to urgent care, Kaiser Permanente has it all.”
20
Enroll today! mySHBPga.adp.com
Urg
ent C
are
Kaiser Permanente Urgent Care
Gwinnett Comprehensive Medical Center 3650 Steve Reynolds Blvd Duluth, GA 30096 Monday – Friday Noon to 10 p.m. Saturday and Sunday, 10 a.m. to 6 p.m.
Southwood Comprehensive Medical Center 2470 Mt. Zion Parkway Jonesboro, GA 30236 24 hours a day, 7 days a week
TownPark Comprehensive Medical Center 750 Townpark Lane Kennesaw, GA 30144 24 hours a day, 7 days a week
Plus additional affiliated community urgent care locations throughout Metro Atlanta:
Affiliated Community Urgent Care Locations
Barrow CountyRegional First Care340 Exchange Blvd. Bethlehem, GA 30620 678-963-7171
Cherokee CountyMedPost Urgent Care 12201 Hwy. 92 Suite D Woodstock, GA 30188 770-517-4621
Northside Urgent Care 684 Sixes Road Suite 125 Canton, GA 30115 678-426-5450
Clayton CountyConcentra Urgent Care 4223 Moreland Ave. Hwy. 42 Conley, GA 30288 404-366-2900
Concentra Urgent Care 1368 Southlake Professional Plaza Dr. Morrow, GA 30260 678-422-8824
Cobb CountyChildren’s Healthcare of Atlanta 625 Big Shanty Rd. NW Kennesaw, GA 30144 404-785-8010
Concentra Urgent Care 220 N. Cobb Pkwy. Suite 400 Marietta, GA 30062 770-424-7125
East Cobb Urgent Care 1401 Johnson Ferry Rd. Suite 390 Marietta, GA 30062 770-971-5494
Northside Urgent Care 1121 Johnson Ferry Rd. Suite 100 Marietta, GA 30068 770-509-1025
21
Enroll today! mySHBPga.adp.com
Urg
ent C
are Cobb County (cont.)
Physicians Immediate Med3540 North Cobb Pkwy. Acworth, GA 30101 770-974-3911
Physicians Immediate Med 2481 George Busbee Pkwy. Kennesaw, GA 30144 770-423-0000
Dawson County Northside Family Medicine and Urgent Care of Dawson 81 Northside Dawson Dr. Suite 100-A Dawsonville, GA 30534 706-216-6000
DeKalb CountyMedPost Urgent Care 3979 Buford Hwy. NE Atlanta, GA 30345 404- 679-0337
MedPost Urgent Care 1234 South Hairston Rd. Suite 28 Stone Mountain, GA 30088 404-292-9034
North Atlanta Urgent Care 2700 Clairmont Rd. NE Atlanta, GA 30329 404-327-8744
Physicians Immediate Med 1834 Clairmont Rd. Decatur, GA 30033404-634-4443
Douglas CountyPhysicians Immediate Med9390 The Landings Dr. Douglasville, GA 30135770-947-1112
Fayette CountyPeachtree City Urgent Care8 Eastbrook Bend Suite B Peachtree City, GA 30269 770-487-2273
Forsyth CountyChildren’s Healthcare of Atlanta410 Peachtree Pkwy. Suite 300 Cumming, GA 30041404-785-3100
Northside Urgent Care5610 Bethelview Rd. Suite 500 Cumming, GA 30040770-205-2804
Physicians Immediate Med2575 Peachtree Pkwy. Cumming, GA 30041770-888-8777
Fulton CountyBethany Bend Urgent Care13081 Highway 9 N Milton, GA 30004 770-521-6690
Children’s Healthcare of Atlanta3795 Mansell Rd. Alpharetta, GA 30022404-785-8540
Concentra Urgent Care3580 Atlanta Ave. Hapeville, GA 30354404-768-3351
Concentra Urgent Care5044 Clark Howell Hwy.Atlanta, GA 30349404-765-2400
Concentra Urgent Care5670 Fulton Industrial Blvd. Atlanta, GA 30336 404-344-3930
Concentra Urgent Care 688 Spring St. NW Atlanta, GA 30308 404-881-1155
Concentra Urgent Care 6334 Roswell Rd. NE Suite C Sandy Springs, GA 30328 678-812-2277
Concentra Urgent Care 10820 Abbotts Bridge Rd. Suite 3000 Johns Creek, GA 30097 770-441-0444
MedPost Urgent Care 5655 Atlanta Hwy. Suite A Alpharetta, GA 30004 770-343-6364
MedPost Urgent Care 12460 Crabapple Rd. Suite 901 Alpharetta, GA 30004 678- 762-0574
22
Enroll today! mySHBPga.adp.com
Urg
ent C
areNorth Atlanta Urgent Care
2701 Holcomb Bridge Rd. Alpharetta, GA 30022 770-998-7611
Physicians Immediate Med 10905 Haynes Bridge Rd. Alpharetta, GA 30022
770-505-3000
Gwinnett CountyChildren’s Healthcare of Atlanta2660 Satellite Blvd.Duluth, GA 30096404-785-8330
Concentra Urgent Care6475 Jimmy Carter Blvd. Suite 200 Norcross, GA 30071770-242-7744
Concentra Urgent Care755 Lawrenceville Suwanee Rd, Suite 1600 Lawrenceville, GA 30043770-995-1500
Gwinnett Urgent Care1300 Peachtree Industrial Blvd, Suite 4101 Suwanee, GA 30024770-831-5525
Physicians Immediate Med3425 Buford Dr. Buford, GA 30519678-546-0200
Physicians Immediate Med3720 Holcomb Bridge Rd. Norcross, GA 30092770-263-1000
Physicians Immediate Med3551 Satellite Blvd. Duluth, GA 30096770-476-3000
Premier Immediate Care289 Grayson Hwy. Lawrenceville, GA 30046 678-376-1300
Premier Immediate Care2696 Lawrenceville Suwanee Rd.Suwanee, GA 30024678-376-1300
Henry CountyChildren’s Healthcare of Atlanta 1510 Hudson Bridge Rd.Stockbridge, GA 30281404-785-8660
Oconee CountyRegional First Care1010 Village Dr. Watkinsville, GA 30677706-769-0000
Paulding County Physicians Immediate Med3827 Jimmy Lee Smith Pkwy. Hiram, GA 30141770-222-8900
Rockdale CountyConcentra Urgent Care1680 GA Hwy. 138 Suites E and F Conyers, GA 30013770-760-0066
23
Enroll today! mySHBPga.adp.com
“ Managing my health is important. Accessing Kaiser Permanente is easy.”
24
Enroll today! mySHBPga.adp.com
What can I expect when I join?Getting started is simple. Within 2 weeks of your start date, you should receive your ID Card with your Health Record Number and tips for getting started. If you need care before then, just call Member Services at 855-512-5997.
Call us or visit kp.org/newmember to:
Register on kp.org so you can take advantage of timesaving online features like scheduling appointments, ordering refills and emailing your doctor.And, with the new digital membership card on our Kaiser Permanente app, you can access your membership information on your smartphone.
Choose your own personal doctor online or by calling us at 855-512-5997.
If you have existing prescrip-tions, we’ll help you get them re-prescribed by a Kaiser Permanente physician online or when you call 855-512-5997 option 2, ask for a Pharmacy Consultation.
25
Enroll today! mySHBPga.adp.com26
Care where you want it at Kaiser Permanente medical facilitiesWith your choice of great doctors and convenient locations throughout Metro Atlanta, it’s easy to get the care you need. Most locations offer multiple services under one roof — so you can see your doctor, get a lab test or X-ray and pick up your medications, all without leaving the building.
CUMBERLAND DOWNTOWN DECATUR DOUGLASVILLE
CRESCENTALPHARETTA BROOKWOOD AT PEACHTREE CASCADE CONYERS
WEST COBBSUGAR HILL-BUFORD
SNELLVILLESANDY SPRINGS
STONECREST
HOLLY SPRINGS LAWRENCEVILLE
PANOLANEWNAN
HENRY TOWNE CENTRE
FORSYTH
GLENLAKE
FAYETTE
GWINNETT
URGENT CARE
SOUTHWOOD
24/7 URGENT CARE
TOWNPARK
24/7 URGENT CARE
Learn more about the Kaiser Permanente Difference
Call Member Services at 855-512-5997, 7 a.m. to 7 p.m. EST Monday through Friday.
Or get location details at kp.org/facilities.
SOUTHWOOD SPECIALTY
COWETA
SPALDING
HENRY
FAYETTE
CLAYTON
FULTON
DOUGLAS
BUTTS
NEWTON
ROCKDALE
DEKALB
WALTON
BARROWFULTON
CHEROKEEBARTOW
PAULDING
CARROLL
PICKENS DAWSON
COBB
FORSYTH
GWINNETT
HARALSON
HEARD
MERIWETHER
PIKELAMAR
75
75
985
575
285
285
285
20
20
67575
85
85
8578
78
316
400
400
166
75
10
316
78
U
U
U
UU
U
U
U
U
U
U
U
UU U
UU
U
UU
U
U
U
UU
U
U
U
U
U
U
U
U
UU
U
UU
U
UU
HH
H
H
H
H
H
HH
H
H
H
KP
KP
KP
KP KP
KP
KP
KPKP
KP
KP
KP
KP
KP
KPKP
KP
KP
KP
KP
KP
KP
KP
KPKP
KP Kaiser Permanente Medical OfficesAffiliated Community Urgent Care Centers Affiliated Hospitals
Enroll today! mySHBPga.adp.com
25 locations in Metro Atlanta
27
COWETA
SPALDING
HENRY
FAYETTE
CLAYTON
FULTON
DOUGLAS
BUTTS
NEWTON
ROCKDALE
DEKALB
WALTON
BARROWFULTON
CHEROKEEBARTOW
PAULDING
CARROLL
PICKENS DAWSON
COBB
FORSYTH
GWINNETT
HARALSON
HEARD
MERIWETHER
PIKELAMAR
75
75
985
575
285
285
285
20
20
67575
85
85
8578
78
316
400
400
166
75
10
316
78
U
U
U
UU
U
U
U
U
U
U
U
UU U
UU
U
UU
U
U
U
UU
U
U
U
U
U
U
U
U
UU
U
UU
U
UU
HH
H
H
H
H
H
HH
H
H
H
KP
KP
KP
KP KP
KP
KP
KPKP
KP
KP
KP
KP
KP
KPKP
KP
KP
KP
KP
KP
KP
KP
KPKP
KP Kaiser Permanente Medical OfficesAffiliated Community Urgent Care Centers Affiliated Hospitals
Enroll today! mySHBPga.adp.com
Want to learn more? Call us at 855-512-5997, or visit kp.org/thrive.
kp.org/myhealth View your personal health record, email your doctor’s office, view your lab results, make routine appointments and much more.
kp.org/medicalstaff A listing of our physicians and medical staff.
kp.org/facilities An online directory of our medical office locations.
kp.org/healthylifestyles Learn how to make healthy choices and manage your condition on your time, in the privacy of your home.
At Kaiser Permanente facilities, you’re entitled to free language services that include access to an interpreter and translation of key documents. If you would like to have an interpreter (usually via telephone) during your doctor visit, please request that at the time you schedule your appointment.
1 Kaiser Foundation Health Plan of Georgia, Inc., received the highest numerical score among commercial health plans in South Atlantic Region (GA, NC, SC) in the Proprietary J.D. Power 2010-2015 U.S. Member Health Plan StudiesSM. 2015 study based on 31,543 total member responses, measuring eight plans in the south atlantic 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.
2 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. HEDIS is a registered trademark of the NCQA.
3 Kaiser Permanente program average is the weighted average of each regional health plan’s screening date and its eligible population.
4 If you think you have an emergency—a medical or psychiatric condition that may put your life, health, limbs, or bodily functions in serious jeopardy—call 911 or go to the nearest emergency room.
5 The hospital you will be admitted to for inpatient care is determined by the primary care physician you select. Some locations are available only in specific cases. In an emergency, you have access to any hospital emergency room.
Locations and services are correct at time of print and are subject change.
For information about doctor availability; utilization management procedures; potential network, service or benefit restrictions; privacy practices; pharmacy management procedures; and the Consumer Choice Option (CCO), visit kp.org/formsandpubs. Click on the “Plan services and information” link and view the Annual Notices brochure (under “Coverage information”), along with the New Member Guide (under “Directories”) specific to your plan.
To be eligible for membership in the Kaiser Permanente health plan, all members and their eligible dependents must live within the state-approved Kaiser Permanente Georgia service areas. All of the zip codes in the following counties are included in the service area: Barrow, Bartow, Butts, Carroll, Cherokee, Clayton, Cobb, Coweta, Dawson, DeKalb, Douglas, Fayette, Forsyth, Fulton, Gwinnett, Hall, Haralson, Heard, Henry, Lamar, Meriwether, Newton, Paulding, Pickens, Pike, Rockdale, Spalding and Walton.
facebook.com/kpthrive
twitter.com/kpgeorgia
youtube.com/kpganews
pinterest.com/kpgeorgia
kp.org/georgia
28
Kaiser Foundation Health Plan of Georgia, Inc. Nine Piedmont Center3495 Piedmont Road, NEAtlanta, Georgia 30305404-364-7000 kp.org/thrive
Please recycle. 60352212 08/15 © 2015 Kaiser Foundation Health Plan of Georgia, Inc.
Enroll today! mySHBPga.adp.com
Contact informationMicrosite my.kp.org/SHBP
Dedicated Member Services 855-512-5997 (Eligibility, Coverage Verification & General Questions)
Health Line Local: 404-365-0966; Toll-free: 800-611-1811• Appointment Scheduling or Prescription Help
Monday – Friday, 7 a.m. to 7 p.m. • Nurse Advice
24 Hours a day, 7 days a week