©2018 Kaiser Foundation Health Plan, Inc. 61089010 09/18

HEALTHIER FAMILY. HEALTHIER BUDGET. HEALTHIER YOU.

CHOOSEHEALTHIER CARE

2019 RATES AND BENEFITS | FEDERAL EMPLOYEES AND ANNUITANTSkp.org/feds

Inside, check out everything that comes with your health plan, and see why more than 11 million people nationwide choose Kaiser Permanente. Get great care and the resources you need to live healthier—all in one convenient package.

Need more information to make a decision?Call 855–315–1006 (TTY 711) Monday through Friday:10 a.m. to 8 p.m.

During open enrollment season: Monday through Friday: 9 a.m. to 10 p.m.

Visit kp.org/feds anytime.

» Premiums as low as $60.71

» $0 Inpatient Maternity copays for High Options plans, $250 for Standard Options plans,

and a $0 pediatric copay through age 17

» Healthy Rewards increased up to $400depending on the option and enrollment you choose

» Decreased copays for preferred generic drugs by $5

NEWFOR 2019

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One of the many things that I really appreciate about Kaiser is the fact that I DON’T HAVE TO FILL OUT ENDLESS PAPERWORK every time I go to the doctor. Rarely do I EVER have to complete a form for additional information. Also, no paperwork for insurance claims. This eliminates time and energy spent with claiming and trying to be reimbursed.

Kathleen, Federal employee

KAISER PERMANENTE IS EASY

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Traditional Health CareCOMPLICATED & EXPENSIVE

Kaiser PermanenteHASSLE-FREE & AFFORDABLE

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It’s outdated and doesn’t acknowledge the way people

live today.

Waiting for appointments and getting bounced around between

doctors, labs, X-rays, specialists, and pharmacies means it takes

longer to get care.

And extra expenses for transportation, babysitters, and

parking can add up, too.

Isn’t it time for a change?

Our members can connect to doctors, lab, X-ray, and pharmacy

under one roof—in person or online.

Our health care professionals are all connected by one of the largest commercial electronic

medical records systems in the country.

That means less traveling for you, less time waiting, and better

coordination of your care.

VS.

SEE THE KAISER PERMANENTE DIFFERENCE

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SIMPLER, SMARTER, HEALTHIER CARE DESIGNED FOR YOU

MAKING HEALTH CARE EASIER

Our award-winning1 health plan and our top-notch medical care are fully integrated.

When your doctors, health plan, pharmacy, and hospitals are connected, health care works better for you, becoming more affordable and hassle-free.

Kaiser Permanente provides both your coverage and your care. Most health plans can’t do that.

WHAT YOU NEED, ALL TOGETHER

When you get care in our facilities, your doctors, nurses, and other caregivers all work together to keep you healthy. They’re connected to each other, and to you, through your electronic health record. So they know important things about you and your health —like when you’re due for a screening

and what medications you’re taking. That way, you get personalized care that’s right for you.

CONVENIENT CARE THAT SAVES YOU TIME

Having so many services under one roof with your doctor makes getting care easier. And when your personal doctor and any specialists you need are all part of the same

medical group and connected by the same system, consultations, diagnoses, and treatments come together smoothly.

In the end, all of this coordinated care means you’re saving time, saving money on unnecessary tests and trips to the doctor, and getting peace of mind.

Learn more at kp.org/feds

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STAYING HEALTHY

Preventive care is key to how we practice medicine at Kaiser Permanente. It can help you avoid some health issues and catch others before they become serious. To catch problems early, we offer preventive screenings at no cost, routine appointments with low copays, and more. Your electronic health record plays a

vital role—the system tracks your preventive care services and triggers automatic reminders when you’re due for your next screening. We’ll let you know when to come in, so you’re free to focus on living your life. And because good health goes beyond the doctor’s office, we have classes, wellness coaching, and programs to help you thrive.

WHEN YOU’RE SICK

We’re here for you. Our commitment to prevention is matched by our drive to get you to your healthy best. Great doctors, state-of-the-art facilities, and the latest technology all combine to help you recover.

If you have a chronic condition such as asthma, diabetes, or

heart disease, we’ll work with you to manage it using proven best practices and advanced technology. Our well-rounded approach supports you physically and emotionally to help you continue living life to the fullest.

SIMPLER, SMARTER, HEALTHIER CARE DESIGNED FOR YOU

Learn more at kp.org/feds

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IN-PERSON VISIT WITH YOUR PERSONAL DOCTOR OR SPECIALIST

Most of our locations have many services under one roof,* so you can see your doctor, get lab services or X-rays, and pick up a prescription—all in the same trip. We also offer same-day and next-day appointments for many services at several of our locations.

24/7 NURSE ADVICE

Have questions? Not sure what kind of care you need? You can call our local, specially trained Kaiser Permanente nurses anytime at 404-365-0966. If you receive care in our facilities, the nurses are connected to your doctor, can see your health record and help determine what type of care you may need, and can even schedule a routine or Urgent Care appointment for you.

AT HOME, WORK, OR ON THE GO

Stay on top of your care 24/7 through kp.org or from any mobile device through the KP app. If you receive care in Kaiser Permanente facilities, you can view your medical record, refill most prescriptions, schedule and cancel routine appointments, get vaccination records, see most lab results, and more. Visit kp.org/newmember to see how it works. To learn more about the KP app, visit kp.org/mobile.

When and where do you want to receive care? How do you want to manage your health? With Kaiser Permanente, you get care that fits your life.

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*When you get care at Kaiser Permanente facilities.

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EMAIL — $0 COPAY

Email your doctor’s office anytime with non-urgent questions. You’ll usually get a response within 2 business days, if not sooner.*

PHONE APPOINTMENTS — $0 COPAY

You may be able to save a trip to the doctor’s office by having a phone appointment with a physician to discuss your progress, talk about a new concern, or ask a question about your care.*

VIDEO APPOINTMENTS2 — $0 COPAY

For some conditions, you can meet virtually face-to-face with your doctor* on your computer, smartphone, or tablet. Video visits are available for primary care, as well as a growing number of specialties, for members who are registered on kp.org and have seen their doctor in the past year. For certain minor issues, same-day video appointments are also available.

CARE ANYWHERE

*When you get care at Kaiser Permanente facilities.

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SPECIALTY CARE

Need to see a specialist? You get great care from Kaiser Permanente experts in more than 40 specialties—most without a referral. If needed, you also have access to certain affiliated specialists associated with Kaiser Permanente.

INPATIENT HOSPITAL CARE3

If you need inpatient care or are having a baby, you’ll have access to several of Atlanta’s most well-respected hospitals including Emory, Northside, and Children’s Healthcare of Atlanta. At some of our partner locations, you’ll get top-notch care from a Kaiser Permanente doctor who has direct access to your medical record, which means you’ll get the right care in the right place.

URGENT/SAME-DAY CARE If you need care quickly, we're here for you. For less serious symptoms, you can schedule a same-day telephone or video appointment, or visit one of our offices offering same-day appointments. Three of our Kaiser Permanente medical centers offer 24/7 Urgent Care, where you'll also find lab, X-ray, and pharmacy under the same roof. You also have access to our affiliated Urgent Care locations, found on page 41 - 42.

EMERGENCY CARE If you ever need emergency care, you’re covered worldwide—anytime, anywhere.4 You can get care at any hospital emergency room, even if it's not affiliated with Kaiser Permanente.

CARE AWAY FROM HOME If you travel for vacation or work, or have a student going to school outside the area, we’ll help with getting care. We can also help you before you leave town by checking to see if you need a vaccination, prescriptions refills, and more. Once you register at kp.org and download our app, you can see your health information online.

WHEN YOU TRAVEL4 Enjoy peace of mind when you travel, knowing that you’re covered for emergency care anywhere in the world at emergency rooms and urgent care centers. And once you’re registered at kp.org and download our app, you can see your health information online.

IN A DIFFERENT KAISER PERMANENTE SERVICE AREA You’re covered for certain routine and specialty care, including care for an ongoing health condition, at any of our Kaiser Permanente or affiliated facilities in a different Kaiser Permanente service area.

OUTSIDE A KAISER PERMANENTE SERVICE AREAIn addition to emergency care, you can also get certain follow-up care when Kaiser Permanente facilities aren’t near. When you’re temporarily outside your home service area by more than 100 miles and outside any other Kaiser Permanente service area, you're covered for the following:

• Outpatient follow-up care to complete a course of treatment after a covered emergency

• Outpatient continuing care for covered services related to conditions diagnosed and treated within the previous 12 months by a Kaiser Permanente practitioner or affiliated practitioner

You pay $25 for each follow-up or continuing care office visit. Kaiser Permanente pays up to $1,200 each calendar year for this follow-up or continuing care travel benefit.

STUDENT COVERAGE OUTSIDE THE SERVICE AREA Students taking at least 12 credit hours per semester at an accredited institution outside of a Kaiser Permanente service area and within the United States are covered for routine, continuing, and follow-up medical care. You pay 20% of the usual and customary charges with an annual benefit limit of $1,200.

CARE ANYWHERE CONTINUED

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TOP-RATED DOCTORS

You have exclusive access to a broad network of physicians. With over 500 hand-picked doctors and specialists trained at top schools like Emory, Duke, and Harvard, you can rest easy knowing you’ll have plenty of amazing physicians to choose from. And if you decide to switch to a new doctor—no problem. It’s your call. No matter which personal doctor you choose, you’ll be in highly skilled, experienced hands—with your health and your best life as the priority.

CHOOSE YOUR DOCTOR — AND CHANGE ANY TIME

At kp.org/searchdoctors, you can learn all about our physicians, including their education, credentials, and what makes them thrive, so you can connect with a doctor that's right for you.

You can choose your personal doctor from:

• Adult medicine/internal medicine • Family medicine • Pediatrics/family medicine

(for children up to 18)

We pioneered how an integrated care delivery system, with its own specialists and multidisciplinary care teams, can prevent disease and provide high-quality care. Every day, we make a commitment to early detection, cutting-edge research, and superior individualized and evidence-based medical care delivered with compassion.

Watch members talk about their care experiences at kp.org/carestories.

“Kaiser Permanente’s integrated system is a better place to get health care. I had previously resisted going to an HMO, wanting to choose my own doctors, but Kaiser’s are better than the ones I chose before.”

–Scott, Federal Employee

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TECHNOLOGY TURBOCHARGES OUR CARE

Every Kaiser Permanente physician is connected to one another—and to a wide range of caregivers, including nurses, lab technicians, and pharmacists—through the world’s largest civilian electronic health records system, allowing each of them to be up to date about information on their patients’ care. This connectivity means faster, better-informed decisions from physicians and sound treatment paths for you.

Our physicians are empowered to:

• Discuss patient issues, diagnoses, andtreatment options with one another inreal time.

• Analyze data from more than9 million records to detect signs ofemerging chronic conditions andidentify treatments that producethe best results.

• Access innovative healthmanagement tools.

Our physicians practice in numerous medical and surgical specialties and sub-specialties:

• Allergy • Neurology• Bariatric surgery • Pain management• Cancer care/oncology • Pediatric specialties• Cardiology • Plastic surgery• Dermatology • Rheumatology• Endocrinology • Urology• Gastroenterology • Many more• High-risk pregnancy

CONTINUING YOUR CARE WITH SPECIALISTS

Referrals are typically not needed for you to see a Kaiser Permanente specialist. As your advocate, your doctor will discuss specialty care with you—including which specialist is best for you—and can directly book an appointment for you to see that specialist. He/she can also immediately order lab work, X-rays, and other tests.

OUR DOCTORS = HEALTHIER YOU

kp.org/searchdoctorsChoose your doctor, change at any time

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That not only helps you get to the right care when you need it, but also helps keep you from getting bounced around from specialist to specialist.

We have doctors practicing in numerous medical and surgical specialties. They are experts in their fields and work with your primary care doctor and others to diagnose and help you decide on the best course of

care, whether you have a broken bone, are facing a new disease, or have an ongoing medical condition. Many are recognized as top doctors by major local publications.

OUR DOCTORS = HEALTHIER YOUYOUR PCPYOU

When you need specialty care, you’re not on your own to find doctors, secure appointments, arrange for your own tests, forward and share results among physicians, coordinate prescriptions, or get approvals from an insurance company. Instead, your primary care doctor will navigate the process on your behalf.

WHEN YOU NEED SPECIALTY CARE, YOU’RE NOT ON YOUR OWN

When you need specialty care, you’re not on your own to find doctors, secure appointments, arrange for your own tests, forward and share results among physicians, coordinate prescriptions, or get approvals from an insurance company. Instead, your primary care physician will navigate the ins and outs for you.

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YOUR LIFE, HEALTHIER

PROGRAMS TO HELP YOU THRIVE

We believe that joy is the key to motivation. When you find the healthy thing you love to do, you'll be more motivated to do it—bringing you closer to reaching your goals every day. Read on—you’ll find suggestions for how to engage your body, mind, and spirit. Why not explore the tools that can help you thrive?

MOVE

Being active helps you be healthier and stronger, and feel your best at any age. Whether you're a couch potato imagining a more active life, a senior with a few aches, a busy parent, or a weekend warrior, it can be tough to start, and keep, moving. That's why we've put together some tips and inspiration to help. We’ve got:

• Ideas for fun activities that can get your whole family moving

• Tools and apps to help you start a fitness routine and track your fitness

• Local programs and classes, from dancercise to yoga

• Ways to help prevent injuries, overcome challenges, and adjust for limitations

It’s all at kp.org/fitness.

LISTEN AND WATCH

Check out our Pandora Relaxation Radio station (choosing a health plan might be more fun when you're listening to some tunes). Download podcasts about health conditions, emotional wellness, and more. Some use guided imagery to help you quit smoking or lose weight. Our videos are also a great way to get information about living healthier or about medical conditions. A feast for your eyes and ears is at kp.org/podcasts.

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HEALTHIER LIVING. REWARDED. 2019 WELLNESS PROGRAM

Ready to make a healthy change? You and your spouse can earn up to $200 each to pay for qualified medical expenses6 by completing these activities:

EARN UP TO

$400 6

What can you pay for with your rewards?We’ll send you a Kaiser Permanente Health Payment Card upon completion of all activities. It can be used to pay for qualified medical expenses, including:

• Your deductible• Cost-sharing, such as your copays• Dental treatment costs• Prescription eyeglasses or contact lenses

expenses

• Prescription medications in our KaiserPermanente Medical Facility Pharmacies

• Other IRS-qualified medical expenses

STEP

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Take Your Total Health Assessment

Complete your 2019 Kaiser Permanente Total Health Assessment (THA) online. The questionnaire is confidential and takes about 20 minutes.

Complete Your Biometric Screenings

You'll be on your way to healthier living by completing the following biometric screenings: • Blood Glucose • Blood Pressure• Body Mass Index (BMI) • Total Cholesterol

Learn more at kp.org/feds

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COACHING, CLASSES, AND MORE

kp.org/healthylivingWellness information, health calculators, videos, podcasts, and recipes.

kp.org/healthylifestylesOnline programs to help you lose weight, quit smoking, reduce stress, and more, all at no cost.

kp.org/classesNo-cost and low-cost classes and support groups at many of our facilities.

kp.org/wellnesscoachOne-on-one personal wellness coaching by phone to help you reach your health goals, at no cost.

kp.org/choosehealthy or 877-335-2746Learn about reduced rates on products and services that can help you stay healthy, such as $25/month access to over 9,000 fitness centers/YMCAs. You can also get discounts on products like FitBit trackers and smart watches, massage therapy, chiropractic care, acupuncture, and more.

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

Learn more at kp.org/feds

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STAN

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Outpatient services (per visit or procedure) You payDeductible does not applyPreventive care $0Primary care $20/$0 for children through age 17Specialty care $40Most lab tests and X-rays $0Preferred Generic prescription drugs (up to a 30-day supply at plan medical center pharmacies)

$5

Emergency and Urgent CareEmergency care $200Urgent care $40

YOUR PREMIUM SHARE STANDARD OPTIONSelf Only Biweekly Non-Postal $60.71

Biweekly Postal Category 1 $58.29Biweekly Postal Category 2 $50.39Monthly Non-Postal $131.55

Self Plus One Biweekly Non-Postal $137.22Biweekly Postal Category 1 $131.73Biweekly Postal Category 2 $113.89Monthly Non-Postal $297.30

Self and Family Biweekly Non-Postal $137.22Biweekly Postal Category 1 $131.73Biweekly Postal Category 2 $113.89Monthly Non-Postal $297.30

These rates do not apply to all enrollees. If you are in a special enrollment category, please contact the agency or tribal employer that maintains your health benefits enrollment.

2019 STANDARD OPTION QUICK LOOK

For a more complete benefits summary, see page 29 or visit kp.org/feds.

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COULD OUR STANDARD OPTION BE RIGHT FOR YOU?

• Great balance of low premiums andaffordable copays

• Up to $400 in rewards—use them to pay yourcopays, prescriptions, and other medicalexpenses

• $0 Deductible for preventive care services

CONSIDER THIS OPTION IF YOU:

• Have children through age 17: they'll have a$0 copay for primary care visits

• Want a lower premium with higher copaysthan High Option for most services andprescription drugs

• Prefer the predictable out-of-pocket costs youget with a plan that features mostly copaysinstead of coinsurance

EARN UP TO $400 IN REWARDS WITH THE STANDARD OPTION6

Take steps to improve your well-being to earn rewards to pay for qualified medical expenses. Standard Option subscribers and their enrolled spouses are eligible to earn $200 per person in rewards by completing the following activities:

• Taking our Total Health Assessment, anonline questionnaire that gives you awellness action plan

• Completing the following biometricscreenings:

• Blood Glucose• Blood Pressure• Body Mass Index (BMI)• Total Cholesterol

You must complete both activities during the 2019 calendar year to earn your rewards. Start by visiting kp.org/feds to learn more and get started.

What can you pay for with your rewards?

We’ll send you a Kaiser Permanente Health Payment Card upon completion of all activities. It can be used to pay for qualified medical expenses, including:

• Your deductible

• Cost-sharing, such as your copays

• Dental treatments

• Prescription eyeglasses or contact lenses

• Prescription medications in our KaiserPermanente Medical Facility Pharmacies

• Other IRS-qualified medical expenses

STANDARD OPTION

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Outpatient services (per visit or procedure) You payDeductible does not applyPreventive care $0Primary care $15/$0 for children through age 17Specialty care $30Most lab tests and X-rays $0Preferred Generic prescription drugs (up to a 30-day supply at plan medical center pharmacies)

$5

Emergency and Urgent CareEmergency care $200Urgent care $30

YOUR PREMIUM SHARE HIGH OPTIONSelf Only Biweekly Non-Postal $91.09

Biweekly Postal Category 1 $87.89Biweekly Postal Category 2 $78.30Monthly Non-Postal $197.37

Self Plus One Biweekly Non-Postal $233.80Biweekly Postal Category 1 $226.96Biweekly Postal Category 2 $206.45Monthly Non-Postal $506.56

Self and Family Biweekly Non-Postal $200.75Biweekly Postal Category 1 $193.45Biweekly Postal Category 2 $171.57Monthly Non-Postal $434.96

These rates do not apply to all enrollees. If you are in a special enrollment category, please contact the agency or tribal employer that maintains your health benefits enrollment.

2019 HIGH OPTION QUICK LOOK

For a more complete benefits summary, see page 29 or visit kp.org/feds.

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COULD OUR HIGH OPTION BE RIGHT FOR YOU?

• Lowest out-of-pocket costs

• No deductibles to pay

• Up to $400 in rewards—use them to pay yourcopays, prescriptions, and other medical expenses

CONSIDER THIS OPTION IF YOU:

• See the doctor often

• Believe you will exceed $4,000 in out-of-pocketcosts (such as copays) for the year; once you reachthat maximum, 100% of your costs will be coveredfor all services

• Want a higher premium to have lower copays formost services and prescription drugs

• Prefer the out-of-pocket cost predictability youget with a plan that features mostly copaysinstead of coinsurance

EARN UP TO $400 IN REWARDS WITH THE HIGH OPTION6

Take steps to improve your well-being to earn rewards to pay for qualified medical expenses. High Option subscribers and their enrolled spouses are eligible to earn $200 per person in rewards by completing the following activities:

• Taking our Total Health Assessment, an onlinequestionnaire that gives you a wellness action plan

• Completing the following biometric screenings:• Blood Glucose• Blood Pressure• Body Mass Index (BMI)• Total Cholesterol

You must complete both activities during the 2019 calendar year to earn your rewards. Start by visiting kp.org/feds to learn more and get started.

WHAT CAN YOU PAY FOR WITH YOUR REWARDS?

We’ll send you a Kaiser Permanente Health Payment Card upon completion of all activities, which can be used to pay for qualified medical expenses, including:

• Cost-sharing, such as your copays

• Dental treatments

• Prescription eyeglasses or contact lenses

• Prescription medications in our Kaiser PermanenteMedical Facility Pharmacies

• Other IRS-qualified medical expenses

HIGH OPTION

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Your 2019 benefits summary7

Benefits and Services High Option Standard Option

Deductible does not apply

Outpatient services (per visit or procedure)

Preventive care $0 $0

Primary care office visit $15, except $0 for children through age 17

$20, except $0 for children through age 17

Specialty care office visit $30 $40

Most X-rays $0 $0

Most lab tests $0 $0

Chiropractic services (up to 20 visits per year) $30 $40

Maternity

Routine prenatal care visit, first postpartum visit $0 $0

Emergency and Urgent Care (per visit or trip)

Emergency care as an outpatient at a hospital $200 $200

Urgent Care at an urgent care center $30 $40

Ambulance $100 $125

Prescription drugs (up to a 30-day supply at plan medical center pharmacies, or up to a 100-day supply for 2 copays–by mail order)†

Preferred Generic / Non-Preferred Generic $5/$10 $5/$10

Preferred brand $45 $45

Non-preferred brand $45 $55

Specialty $100 $150

Subject to the deductible

Deductible (2x per family maximum) None $100 per person

Hospital and facility

Outpatient surgery $150 $200*

Inpatient hospital care (per admission) $500 $750*

Maternity (delivery)

Delivery (per admission) $0 $250*

Out-of-pocket maximum (2x per family maximum) $4,000 per person $5,000 per person

* You pay the deductible, then your share of the cost.

† Plan providers determine the drug that is medically necessary. If you request another drug, you pay prices charged to members for non-covered drugs.

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2019 BENEFIT CHANGES

MATERNITY CARE

Reduced copays for inpatient maternity to $0 (High Option) and $250 (Standard Option). And you'll have a $0 copay for primary care visits through age 17.

REWARDS

Earn up to $400 rewards6 by taking your total health assessment and being up to date on your biometric screenings.

PRESCRIPTION DRUGS

$5 copay for Generic Drugs and $10 copay for Preferred Generic Drugs in both Standard and High Option plans.

APPLIED BEHAVIOR ANALYSIS

The age limit for coverage is through 20 years old with an increased annual maximum benefit of $35,000 for both Standard and High Option plans.

THERAPY

Predictable copayment of $40 for applied behavior analysis, physical, occupational and speech therapy, cardiac rehabilitation, and comprehensive rehabilitation (Standard Option only).

This is a summary of the features of the Kaiser Permanente health plan. For a complete list of 2019 benefit changes and before making a final decision, please read the plan's Federal Brochure (RI 73-321). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal Brochure.

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. The SBC summarizes important information in a standard format to help you compare plans and options. A copy of the plan's Federal Brochure (RI 73-321) and SBC are available online at kp.org/feds. They are also available, at no charge, by calling 404-261-2590, Monday through Friday, 7 a.m. to 7 p.m. For TTY, call 711. To find out more information about plans available under the FEHB Program, including SBCs for other FEHB plans, please visit opm.gov.

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READY TO ENROLL WITH KAISER PERMANENTE AND GET HEALTHIER CARE?

1. Choose an option• Standard Option• High Option

2. Select your enrollment type• Self only covers you (the enrollee).• Self Plus One covers you and one eligible family member.• Self and Family covers you and all eligible family members.

3. With your enrollment code in hand, sign up online or call us• Visit opm.gov to enroll online.• Contact your employing agency or retirement office for next steps.

Annuitants can contact the Retirement Information Center at 888-767-6738 or 855-887-4957 (TTY) or retire@opm.gov.

To sign up, 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.

ENROLLMENT CODE HIGH OPTION STANDARD OPTION

Self Only F81 F84

Self Plus One F83 F86

Self and Family F82 F85

Important Note: Enrollees covering themselves and one other eligible family member may choose either the “Self Plus One” or ”Self and Family“ enrollment type. If you choose the High Option, you will save money if you enroll in the "Self and Family." Current "Self Plus One" subscribers must make an active enrollment election to move to Self and Family and get a lower member contribution.

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.

Need help? Call us at 855-315-1006 (TTY 711), Monday through Friday, 10 a.m. to 8 p.m. During open enrollment season, Monday through Friday, 9 a.m. to 10 p.m.

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COVERAGE FOR VISION SERVICES

With Kaiser Permanente, you have access to many of our plan optometrists practicing within one of our Glenlake, Gwinnett, Southwood, and TownPark Medical Facilities. You pay no deductible—just a copay. You can then take your prescription to one of our partners for a discount on your vision hardware. To find a vision hardware partner, visit avesis.com or call 404-365-0966 for the location nearest you.

COVERAGE FOR PREVENTIVE DENTAL

Kaiser Permanente offers you a dental benefit included in your plan for preventive dental services through Delta Dental PPO. You also have the option to add a supplemental dental plan through DeltaCare® USA.

DELTA DENTAL PPO — PREVENTIVE SERVICES†

By visiting a Delta Dental PPO dentist, you’ll save money. If you have a dentist that you prefer, you can see them or any dentist you wish as well, but they may not be a part of the cost-saving benefits of the Delta Dental PPO network. You don’t need to sign up separately for Delta Dental PPO. This preventive dental benefit comes included with your Kaiser Permanente FEHB health plan. For Delta Dental PPO customer service, call 1-800-521-2651.

DELTACARE® USA — OPTIONAL DENTAL SERVICES*

With this optional plan, you pay a separate low premium. You’ll select a dentist from the DeltaCare USA network. There are no claim forms to fill out and no deductibles to reach. For other covered services, including orthodontic services, you’ll pay a simple copay. To find a participating dentist or for more information about DeltaCare USA, go to deltadentalins.com. You can also request a copy of the DeltaCare USA enrollment brochure by calling DeltaCare USA customer service at 1-844-519-8693.

† You pay the deductible, then your share of the cost.

* These services are neither offered nor guaranteed under contract with the FEHB Program, but are madeavailable to all enrollees and family members who become members of Kaiser Permanente.

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CUMBERLAND DOWNTOWN DECATUR DOUGLASVILLECRESCENT

ALPHARETTA BROOKWOOD AT PEACHTREE CASCADE CONYERS

WEST COBB

SUGAR HILL-BUFORD

SNELLVILLESANDY SPRINGS

STONECREST

HOLLY SPRINGS

LAWRENCEVILLE PANOLANEWNAN

HENRY TOWNE CENTERFORSYTH GLENLAKE

FAYETTE

GWINNETT

24/7 URGENT CARE

SOUTHWOOD

24/7 URGENT CARE

TOWNPARK

24/7 URGENT CARE

With 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.

SOUTHWOOD SPECIALTY

CARE THAT'S CLOSE BY

ATHENS

36

SPECIALTIES AND LOCATIONS

?

CT/MRIGlenlakeGwinnett

SouthwoodStonecrest*

TownPark

DEXA ScanCascadeCrescentGwinnett

SouthwoodTownPark

MammographyAlpharetta

CascadeCrescent

CumberlandHenry Towne

GlenlakeGwinnett

PanolaSouthwoodTownPark

UltrasoundCrescentGlenlakeGwinnett

SouthwoodTownPark

Audiology

GlenlakeGwinnett

SouthwoodSpecialty

Southwood

Bariatric Surgery

Behavioral Health

Cardiology

CascadeGlenlakeGwinnett

SouthwoodSouthwood

SpecialtyTownPark

Child Psychiatry

Dermatology

CrescentCumberland

GwinnettSandy Springs

SouthwoodSouthwood

SpecialtyTownPark

EndocrinologyCumberland

GwinnettSouthwood

Specialty

Gynecology

DecaturDouglasvilleHenry Towne

StonecrestSugar Hill-Buford

Gastroenterology

GlenlakeGwinnett

SouthwoodTownPark

General Surgery

GeriatricsCumberland

GwinnettSouthwood

Specialty

Geriatric PsychiatryCumberland

Hand SurgeryGlenlakeGwinnett

SouthwoodTownPark

Hematology/Oncology

Infectious Disease

Glenlake AlpharettaBrookwood

CascadeCrescent

CumberlandGwinnett

Sandy SpringsSouthwoodStonecrestTownPark

AlpharettaCrescent

CumberlandGwinnett

Sandy Springs

GlenlakeGwinnett

SouthwoodTownPark

GwinnettSouthwoodTownPark

BrookwoodCumberland

GwinnettSouthwood

Specialty

?

NephrologyCascadeCrescent

CumberlandGwinnett

PanolaSouthwood

Specialty

NeurologyCrescentGlenlakeGwinnett

SouthwoodTownPark

OB/GYN

AlpharettaCascadeCrescent

CumberlandGlenlakeGwinnett

PanolaSouthwoodTownPark

Orthopedic/Sports Medicine

GlenlakeGwinnett

SouthwoodTownPark

Optometry/Ophthalmology

GlenlakeGwinnett

SouthwoodTownPark

OtolaryngologyGlenlakeGwinnett

SouthwoodSpecialty

Southwood

Pain Management

Palliative Care

PerinatologyBrookwood

Glenlake

PlasticSurgery

PodiatryCumberland

CrescentGlenlakeGwinnett

Southwood

PsychiatryBrookwood

CascadeCrescent

CumberlandGwinnett

Sandy SpringsStonecrestSouthwoodTownPark

PsychologyCrescent

CumberlandGwinnett

Sandy SpringsStonecrestSouthwoodTownPark

PulmonologyGlenlakeGwinnett

SouthwoodTownPark

RheumatologyCumberland

GwinnettSouthwood

Specialty

SleepMedicine

UrologyGlenlakeGwinnett

Southwood

VascularSurgery

CumberlandGlenlakeGwinnett

Southwood

CumberlandSouthwood

SpecialtyGwinnett

GlenlakeSouthwood

Cumberland GlenlakeSouthwood

Adult, Family, and Pediatric

Medicine

Lab

Pharmacy

Services available at most Kaiser Permanente

medical centers

X-Ray

Primary Care Diagnostic Imaging Specialty Services

37

Specialties and locations subject to change. Call Member Services at 404-261-2590 to find a service near you.

?

CT/MRIGlenlakeGwinnett

SouthwoodStonecrest*

TownPark

DEXA ScanCascadeCrescentGwinnett

SouthwoodTownPark

MammographyAlpharetta

CascadeCrescent

CumberlandHenry Towne

GlenlakeGwinnett

PanolaSouthwoodTownPark

UltrasoundCrescentGlenlakeGwinnett

SouthwoodTownPark

Audiology

GlenlakeGwinnett

SouthwoodSpecialty

Southwood

BariatricSurgery

BehavioralHealth

Cardiology

CascadeGlenlakeGwinnett

SouthwoodSouthwood

SpecialtyTownPark

Child Psychiatry

Dermatology

CrescentCumberland

GwinnettSandy Springs

SouthwoodSouthwood

SpecialtyTownPark

EndocrinologyCumberland

GwinnettSouthwood

Specialty

Gynecology

DecaturDouglasvilleHenry Towne

StonecrestSugar Hill-Buford

Gastroenterology

GlenlakeGwinnett

SouthwoodTownPark

General Surgery

GeriatricsCumberland

GwinnettSouthwood

Specialty

Geriatric PsychiatryCumberland

Hand SurgeryGlenlakeGwinnett

SouthwoodTownPark

Hematology/Oncology

Infectious Disease

Glenlake AlpharettaBrookwood

CascadeCrescent

CumberlandGwinnett

Sandy SpringsSouthwoodStonecrestTownPark

AlpharettaCrescent

CumberlandGwinnett

Sandy Springs

GlenlakeGwinnett

SouthwoodTownPark

GwinnettSouthwoodTownPark

BrookwoodCumberland

GwinnettSouthwood

Specialty

?

NephrologyCascadeCrescent

CumberlandGwinnett

PanolaSouthwood

Specialty

NeurologyCrescentGlenlakeGwinnett

SouthwoodTownPark

OB/GYN

AlpharettaCascadeCrescent

CumberlandGlenlakeGwinnett

PanolaSouthwoodTownPark

Orthopedic/Sports Medicine

GlenlakeGwinnett

SouthwoodTownPark

Optometry/Ophthalmology

GlenlakeGwinnett

SouthwoodTownPark

OtolaryngologyGlenlakeGwinnett

SouthwoodSpecialty

Southwood

Pain Management

PalliativeCare

PerinatologyBrookwood

Glenlake

Plastic Surgery

PodiatryCumberland

CrescentGlenlakeGwinnett

Southwood

PsychiatryBrookwood

CascadeCrescent

CumberlandGwinnett

Sandy SpringsStonecrestSouthwoodTownPark

PsychologyCrescent

CumberlandGwinnett

Sandy SpringsStonecrestSouthwoodTownPark

PulmonologyGlenlakeGwinnett

SouthwoodTownPark

RheumatologyCumberland

GwinnettSouthwood

Specialty

Sleep Medicine

UrologyGlenlakeGwinnett

Southwood

Vascular Surgery

CumberlandGlenlakeGwinnett

Southwood

CumberlandSouthwood

SpecialtyGwinnett

GlenlakeSouthwood

Cumberland GlenlakeSouthwood

* MRI only

COWETA

SPALDING

HENRY

FAYETTE

CLAYTON

FULTON

DOUGLAS

BUTTS

NEWTON

ROCKDALE

DEKALB

WALTON

BARROW

ATHENS-CLARKE

FULTON

CHEROKEEBARTOW

PAULDING

CARROLL

PICKENS

DAWSON

COBB

FORSYTH

GWINNETT

HARALSON

HEARD

MERIWETHERPIKE

LAMAR

75

75

985

575

285

285

285

20

20

67575

85

85

8578

78

316

400

400

166

75

10

316

78

U

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UU

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KP

KP

KP

KP KP

KP

KP

KP

KP

KP

KP

KP

KP

KP

KP

KP

KP

KP

KP

KP

KP

KPKP

KP

KP

H

KP

Athens

Panola

Southwood

Stonecrest

Gwinnett

Crescent

Downtown Decatur

TownPark

Glenlake

Holly Springs

Douglasville

West Cobb

Alpharetta

Cumberland

Sugar Hill–Buford

Henry Towne Centre

Forsyth

Cascade

Snellville

Conyers

Fayette

Newnan

Sandy Springs

Brookwood at Peachtree

Southwood Specialty

Lawrenceville

KP

KP

KP

KP Kaiser Permanente Medical Facilities

Affiliated Community Urgent Care Centers

Affiliated Hospitals

CARE WHEN AND WHERE YOU NEED IT

Skip the trip. Ask about a $0 copay video visit. Call 404-365-0966.

KP

KP

Kaiser Permanente Medical Facilities

Kaiser Permanente Comprehensive Medical Centers

Affiliated Urgent Care Centers

Affiliated Hospitals

COWETA

SPALDING

HENRY

FAYETTE

CLAYTON

FULTON

DOUGLAS

BUTTS

NEWTON

ROCKDALE

DEKALB

WALTON

BARROW

ATHENS-CLARKE

FULTON

CHEROKEEBARTOW

PAULDING

CARROLL

PICKENS

DAWSON

COBB

FORSYTH

GWINNETT

HARALSON

HEARD

MERIWETHERPIKE

LAMAR

75

75

985

575

285

285

285

20

20

67575

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KP

KP

KP

KP KP

KP

KP

KP

KP

KP

KP

KP

KP

KP

KP

KP

KP

KP

KP

KP

KP

KPKP

KP

KP

H

KP

Athens

Panola

Southwood

Stonecrest

Gwinnett

Crescent

Downtown Decatur

TownPark

Glenlake

Holly Springs

Douglasville

West Cobb

Alpharetta

Cumberland

Sugar Hill–Buford

Henry Towne Centre

Forsyth

Cascade

Snellville

Conyers

Fayette

Newnan

Sandy Springs

Brookwood at Peachtree

Southwood Specialty

Lawrenceville

KP

KP

KP

KP Kaiser Permanente Medical Facilities

Affiliated Community Urgent Care Centers

Affiliated Hospitals

39

ATHENS-CLARKE COUNTY

Athens Medical Office2142 West Broad St., Bldg. 200Athens, GA 30606706-583-5000

CHEROKEE COUNTY

Holly Springs Medical Office684 Sixes Rd., Ste. 275 Holly Springs, GA 30115770-852-2440

CLAYTON COUNTY

Southwood Comprehensive Medical Center 2400 Mt. Zion Pkwy. Jonesboro, GA 30236 770-603-3649

Southwood Specialty Center 2470 Mt. Zion Pkwy. Jonesboro, GA 30236 404-365-0966

COBB COUNTY

Cumberland Medical Center2525 Cumberland Pkwy. SE Atlanta, GA 30339770-431-4235

TownPark Comprehensive Medical Center 750 TownPark Ln. Kennesaw, GA 30144 770-514-5401

West Cobb Medical Center 3640 Tramore Pointe Pkwy. Austell, GA 30106 770-439-4700

COWETA COUNTY

Newnan Medical Office 205 Newnan Crossing Bypass Newnan, GA 30263 770-304-4400

DEKALB COUNTY

Crescent Medical Center200 Crescent Centre Pkwy. Tucker, GA 30084 770-496-3414

Downtown Decatur Medical Office 201 W. Ponce de Leon Ave. Ste. A Decatur, GA 30030 404-687-7700

Panola Medical Center 5440 Hillandale Dr. Lithonia, GA 30058 770-322-2777

Stonecrest Medical Center8011 Mall Pkwy. Lithonia, GA 30038678-323-7500

DOUGLAS COUNTY

Douglasville Medical Office6875 Douglas Blvd., Ste. A Douglasville, GA 30135678-838-2225

FAYETTE COUNTY

Fayette Medical Office101 Banks Rd. Fayetteville, GA 30214 678-610-3700

FORSYTH COUNTY

Forsyth Medical Office1400 Northside Forsyth Dr. Ste. 350 Cumming, GA 30041 678-455-1407

FULTON COUNTY

Alpharetta Medical Center3550 Preston Ridge Rd. Alpharetta, GA 30005 770-663-3110

Brookwood at Peachtree Medical Office1745 Peachtree Rd., Ste. U Atlanta, GA 30309 404-888-7688

Cascade Medical Center1175 Cascade Pkwy. Atlanta, GA 30311 404-505-4006

Glenlake Comprehensive Specialty Center 20 Glenlake Pkwy. Sandy Springs, GA 30328 770-677-6075

Sandy Springs Medical Office 1100 Lake Hearn Dr. NE Suites 250 and 500 Atlanta, GA 30342 404-845-4500

GWINNETT COUNTY

Gwinnett Comprehensive Medical Center3650 Steve Reynolds Blvd. Duluth, GA 30096 770-931-6012

Lawrenceville Medical Office455 Philip Blvd., Ste. 130 Lawrenceville, GA 30046678-985-5000

Snellville Medical Office2240 Fountain Dr. Snellville, GA 30078770-978-5400

Sugar Hill–Buford Medical Center1435 Broadmoor Blvd. Sugar Hill, GA 30518678-765-5700

HENRY COUNTY

Henry Towne Centre Medical Center1125 Towne Centre Village Dr. McDonough, GA 30253678-583-6600

ROCKDALE COUNTY

Conyers Medical Office1478 Dogwood Dr. Conyers, GA 30013 678-413-4320

KAISER PERMANENTE MEDICAL FACILITIES

U

U

U

E

E

E

E

E

E

U

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24/7Advanced Urgent Care

Same-day Express Care

CONVENIENT CARE NEAR YOU

It’s easy to find a Kaiser Permanente medical center near home or work. You’ll find same-day, next-day, and after-hours options available. Just hop online or grab your smartphone or tablet to search by ZIP code, keyword, or the service you want. kp.org/facilities.

URGENT CARE + 24/7 ADVANCED CARE

When you need care quickly, same day appointments are often available. Three of our locations offer 24/7 advanced urgent care, where lab, X-ray, and pharmacy are all in the same building. You also have access to numerous affiliated urgent care locations throughout metro Atlanta and while traveling. Just call 404-365-0966 for help finding the care that's right for you.

TAKE A TOUR WITHOUT LEAVING HOME

“Walk” through a 360o tour of any of our medical centers and see what it’s like when so much care is under one roof. You can link to a tour from each of our medical center web pages: kp.org/facilities.

EMERGENCY CARE

If you ever need emergency care, you’re covered worldwide—anytime, anywhere.4

40 TOWNPARK MEDICAL CENTER

41

AFFILIATED

HOSPITALSMETRO ATLANTA

Children’s Healthcare of Atlanta at Egleston 404-785-6000

Children’s Healthcare of Atlanta at Scottish Rite 404-785-5252

Emory Johns Creek 678-474-7000

Emory Hospital Midtown 404-686-4411

Emory's St. Joseph's Hospital 678-843-7001

Emory University Hospital 404-712-2000

Gwinnett Medical Center–Duluth 678-312-6800

Gwinnett Medical Center–Lawrenceville 678-312-4321

Northside Hospital 404-851-8000

Northside Hospital Cherokee 770-720-5100

Northside Hospital Forsyth 770-844-3200

Piedmont Hospital 404-605-5000

Piedmont Athens Regional 706-475-7000

Piedmont Fayette Hospital 770-719-7000

Piedmont Henry Hospital 770-389-2200

Piedmont Mountainside Hospital 706-692-2441

Piedmont Newnan Hospital 770-400-1000

Piedmont Newton Hospital 770-786-7053

AFFILIATED COMMUNITY

URGENT CAREBARROW COUNTY

Regional First Care 678-963-7171

CARROLL COUNTY

Peachtree Immediate Care-Villa Rica 770-456-0911

CHATHAM COUNTY

Concentra-Garden City 866-944-6046

CHEROKEE COUNTY

Children's at Cherokee 404-785-5437

MedPost Urgent Care - Woodstock 770-517-4621

Northside Family Medicine and Urgent Care of Holly Springs 678-426-5450

Peachtree Immediate Care-Canton 770-720-7000

CLARKE COUNTY

Athens Reddy Urgent Care 706-621-7575

Broad Street Reddy Urgent Care 706-850-9855

Regional FirstCare-Athens 706-353-6000

CLAYTON COUNTY

Concentra Urgent Care - Conley 404-366-2900

Concentra Urgent Care - Morrow 678-422-8824

COBB COUNTY

Children’s Healthcare of Atlanta at Town Center 404-785-8010

Concentra Urgent Care - Marietta 770-424-7125

MedPost Urgent Care - East Cobb 770-971-5494

Northside Family Medicine & Urgent Care of East Cobb 770-509-1025

Physicians Immediate Med - Acworth 770-974-3911

Physicians Immediate Med - Kennesaw 770-423-0000

Summit Urgent Care - Marietta 770-835-4147

COWETA COUNTY

Summit Urgent Care - Newnan 770-502-2021

DAWSON COUNTY

Northside Family Medicine and Urgent Care of Dawson 706-216-6000

DEKALB COUNTY

Children's at Chamblee Brookhaven 404-785-5437

Peachtree Immediate Care-Decatur 404-634-4443

Urgent Care at Druid Hills 678-805-7981

DOUGLAS COUNTY

Get Well Urgent Care 404-937-3508

Peachtree Immediate Care - Douglasville 770-947-1112

FAYETTE COUNTY

Peachtree City Urgent Care 770-487-2273

Summit Urgent Care - Fayetteville 770-835-4925

Summit Urgent Care - Peachtree City 770-847-8786

FORSYTH COUNTY

Children’s Healthcare of Atlanta Forsyth 404-785-8900

42

AFFILIATED COMMUNITY

URGENT CARENorthside Family Medicine & Urgent Care of Cumming 770-205-2804

Peachtree Immediate Care - Johns Creek 770-888-8777

FRANKLIN COUNTY

Royston Reddy Urgent Care 706-246-9700

FULTON COUNTY

Children’s Healthcare of Atlanta Northpoint 404-785-3020

Concentra - Fulton Industrial 404-344-3930

Concentra - Hapeville 404-768-3351

Concentra - Johns Creek 770-441-0444

Concentra - Sandy Springs 678-812-2277

Concentra - Spring Street 404-881-1155

MedPost Urgent Care - Atlanta Highway (770)343-6364

MedPost Urgent Care - Camp Creek 404-344-7286

MedPost Urgent Care - Crabapple Road 678-762-0574

North Atlanta Urgent Care II 404-327-8744

Northside Family Medicine & Urgent Care of Roswell 770-619-3860

Roswell Urgent Care 770-992-4700

Summit Urgent Care - East Point 404-344-7337

Urgent Care at Peachtree 678-805-7425

GWINNETT COUNTY

Children’s Healthcare of Atlanta Hamilton Creek 404-785-5437

Children’s Healthcare of Atlanta Satellite Boulevard 404-785-8330

ChoiceOne Urgent Care - Hamilton Mill Road 470-326-7300

ChoiceOne Urgent Care - Suwanee Dam Road 470-326-7600

Concentra - Jimmy Carter 770-242-7744

Concentra - Lawrenceville 770-995-1500

Gwinnett Urgent Care 770-831-5525

Peachtree Immediate Care - Buford 678-546-0200

Peachtree Immediate Care - Duluth 770-476-3000

Peachtree Immediate Care - Norcross 770-263-1000

Sugarloaf Urgent Care 470-375-5940

HART COUNTY

Hartwell Reddy Urgent Care 706-376-6200

HENRY COUNTY

Children’s Healthcare of Atlanta Hudson Bridge 404-785-8660

MedPost Urgent Care - Stockbridge 770-474-7448

JACKSON COUNTY

Regional FirstCare - Jefferson 706-387-5555

MADISON COUNTY

Regional FirstCare - Jefferson 706-621-7555

MUSCOGEE COUNTY

Concentra - Columbus 706-322-2511

MyCare Urgent Care - Blackmon Road 706-321-3750

MyCare Urgent Care - Columbus 706-494-4949

Urgent Care & Occupational Medicine 706-507-1213

OCONEE COUNTY

Regional FirstCare 706-769-0000

PAULDING COUNTY

New Hope Urgent Care 770-443-6111

Peachtree Immediate Care - Hiram 770-222-8900

ROCKDALE COUNTY

Concentra - Conyers 866-944-6046

TROUP COUNTY

Peachtree Immediate Care - LaGrange 706-884-7822

WALTON COUNTY

Monroe Reddy Urgent Care 706-363-9228

43

1 Kaiser Foundation Health Plan of Georgia has been the top-ranked commercial plan in Georgia for 9 consecutive years and the top-rated commercial plan in Georgia for 3 years. NCQA’s Private Health Insurance Plan Ratings 2017–2018, National Committee for Quality Assurance, 2017: Kaiser Foundation Health Plan of Georgia, Inc. — HMO (rated 4 out of 5); NCQA’s Private Health Insurance Plan Ratings 2016–2018, National Committee for Quality Assurance; NCQA’s Private Health Insurance Plan Rankings 2006–2015, National Committee for Quality Assurance.

2 Video appointments with primary care physicians (PCPs) are available only with Kaiser Permanente physicians for certain medical conditions for members 18 and older who are registered on kp.org and have seen their doctor in the past year. Ask if a phone or video visit is right for you. Just call 404-365-0966.

3 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.

4 If you reasonably believe you have an emergency medical condition, which is a medical or psychiatric condition that requires immediate medical attention to prevent serious jeopardy to your health, call 911 or go to the nearest emergency department. For the complete definition of an emergency medical condition, please refer to your Evidence of Coverage.

5 This number can be dialed from inside and outside the United States. Outside, you must dial the U.S. country code “001” for land lines and “+1” for mobile before the phone number. Long-distance charges may apply, and we cannot accept collect calls. This phone line is closed on major holidays.

6 Participating members will get a Kaiser Permanente Health Payment Card that can be used to pay for qualifying medical expenses.

See the full list of qualified medical expenses in IRS Publication 502, Medical and Dental Expenses and 929, Health Savings Accounts and Other Tax-Favored Health Plans, at irs.gov/publications.

7 This is a summary of your benefits and their copays. This is not a contract. A complete list, exclusions and limitations are contained in the Evidence of Coverage. 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 Kaiser Permanente Member Services at 855-315-1006.

8 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 73-321). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.

ENDNOTES

44

60577109_ACA_1557_MarCom_GA_2017_Taglines_Landscape

NONDISCRIMINATION NOTICEKaiser Foundation Health Plan of Georgia, Inc. (Kaiser Health Plan) complies with applicable Federal civil rights lawsand does not discriminate on the basis of race, color, national origin, age, disability, or sex. Kaiser Health Plan does notexclude people or treat them differently because of race, color, national origin, age, disability, or sex. We also:

• Provide no cost aids and services to people with disabilities to communicate effectively with us, such as:• Qualified sign language interpreters• Written information in other formats, such as large print, audio, and accessible electronic formats

• Provide no cost language services to people whose primary language is not English, such as:• Qualified interpreters• Information written in other languages

If you need these services, call 1-888-865-5813 (TTY: 711)

If you believe that Kaiser Health Plan has failed to provide these services or discriminated in another way on the basis ofrace, color, national origin, age, disability, or sex, you can file a grievance by mail at: Member Relations Unit (MRU), Attn: Kaiser Civil Rights Coordinator, Nine Piedmont Center, 3495 Piedmont Road, NE Atlanta, GA 30305-1736.Telephone Number: 1-888-865-5813.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rightselectronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf,or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F,HHH Building, Washington, DC 20201, 1-800-368-1019, 1-800-537-7697 (TDD). Complaint forms are available athttp://www.hhs.gov/ocr/office/file/index.html.

________________________________________________________________________________________________

HELP IN YOUR LANGUAGE ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-888-865-5813 (TTY: 711).

አማርኛ (Amharic) ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-888-865-5813 (TTY: 711).

تتحدث:ملحوظة (Arabic)العربية ، فإن خدماتالعربيةإذا كنتبالمجان تتوافر لك اللغوية 5813-865-888-1اتصل برقم.المساعدة

(TTY :711.)中文 (Chinese)注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-888-865-5813（TTY：711）。

60577109_ACA_1557_MarCom_GA_2017_Taglines_Landscape

اگر به زبان فارسی گفتگو می کنيد، توجه: (Farsi) فارسیتسهيالت زبانی بصورت رايگان برای شما فراهم می باشد.

تماس بگيريد.1-888-865-5813 (TTY: 711) با

Français (French) ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-888-865-5813 (TTY: 711).

Deutsch (German) ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-888-865-5813 (TTY: 711).

ગજુરાતી (Gujarati) સચુના: જો તમે ગજુરાતી બોલતા હો, તો નન:શલુ્ક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો 1-888-865-5813 (TTY: 711).

Kreyòl Ayisyen (Haitian Creole) ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-888-865-5813 (TTY: 711).

हिन्दी (Hindi) ध्यान दें: यहद आप हििंदी बोलते िैं तो आपके ललएमुफ्त में भाषा सिायता सेवाएिं उपलब्ध िैं। 1-888-865-5813 (TTY: 711) पर कॉल करें। 日本語 (Japanese)注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-888-865-5813（TTY: 711）まで、お電話にてご連絡ください。

한국어 (Korean)주의: 한국어를 사용하시는 경우, 언어지원 서비스를 무료로 이용하실 수 있습니다. 1-888-865-5813 (TTY: 711)번으로 전화해 주십시오.

Naabeehó (Navajo) Díí baa akó nínízin: Díí saad bee yáníłti’go Diné Bizaad, saad bee áká’ánída’áwo’dé̖é̖’, t’áájiik’eh, éí ná hóló̖, koji̖’ hódíílnih 1-888-865-5813(TTY: 711).

Português (Portuguese) ATENÇÃO: Se fala português,encontram-se disponíveis serviços linguísticos, grátis.Ligue para 1-888-865-5813 (TTY: 711).

Pусский (Russian) ВНИМАНИЕ: eсли вы говоритена русском языке, то вам доступны бесплатныеуслуги перевода. Звоните 1-888-865-5813 (TTY: 711).

Español (Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-888-865-5813 (TTY: 711).

Tagalog (Tagalog) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.Tumawag sa 1-888-865-5813 (TTY: 711).

Tiếng Việt (Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-888-865-5813 (TTY: 711).

60577109_ACA_1557_MarCom_GA_2017_Taglines_Landscape

NONDISCRIMINATION NOTICEKaiser Foundation Health Plan of Georgia, Inc. (Kaiser Health Plan) complies with applicable Federal civil rights lawsand does not discriminate on the basis of race, color, national origin, age, disability, or sex. Kaiser Health Plan does notexclude people or treat them differently because of race, color, national origin, age, disability, or sex. We also:

• Provide no cost aids and services to people with disabilities to communicate effectively with us, such as:• Qualified sign language interpreters• Written information in other formats, such as large print, audio, and accessible electronic formats

• Provide no cost language services to people whose primary language is not English, such as:• Qualified interpreters• Information written in other languages

If you need these services, call 1-888-865-5813 (TTY: 711)

If you believe that Kaiser Health Plan has failed to provide these services or discriminated in another way on the basis ofrace, color, national origin, age, disability, or sex, you can file a grievance by mail at: Member Relations Unit (MRU), Attn: Kaiser Civil Rights Coordinator, Nine Piedmont Center, 3495 Piedmont Road, NE Atlanta, GA 30305-1736.Telephone Number: 1-888-865-5813.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rightselectronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf,or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F,HHH Building, Washington, DC 20201, 1-800-368-1019, 1-800-537-7697 (TDD). Complaint forms are available athttp://www.hhs.gov/ocr/office/file/index.html.

________________________________________________________________________________________________

HELP IN YOUR LANGUAGEATTENTION: If you speak English, language assistance services, free of charge, are available to you.Call 1-888-865-5813 (TTY: 711).

አማርኛ (Amharic) ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉምእርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥርይደውሉ 1-888-865-5813 (TTY: 711).

، فإن خدمات العربيةإذا كنت تتحدث :ملحوظة (Arabic) العربية 5813-865-888-1 اتصل برقم. المساعدة اللغوية تتوافر لك بالمجان

(TTY :711.)中文 (Chinese) 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-888-865-5813 （TTY：711）。

60577109_ACA_1557_MarCom_GA_2017_Taglines_Landscape

کنيد،توجه:(Farsi)فارسی می گفتگو فارسی به زبان اگرباشد. می فراهم بصورت رايگان برای شما تسهيالت زبانی

711)با :TTY) تماس بگيريد.1-888-865-5813Français (French) ATTENTION: Si vous parlez français,des services d'aide linguistique vous sont proposésgratuitement. Appelez le 1-888-865-5813 (TTY: 711).

Deutsch (German) ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.Rufnummer: 1-888-865-5813 (TTY: 711).

ગજુરાતી (Gujarati) સચુના: જો તમે ગજુરાતી બોલતા હો, તો નન:શલુ્ક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો 1-888-865-5813 (TTY: 711).

Kreyòl Ayisyen (Haitian Creole) ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-888-865-5813 (TTY: 711).

हिन्दी (Hindi) ध्यान दें: यहद आप हििंदी बोलते िैं तो आपके ललएमुफ्त में भाषा सिायता सेवाएिं उपलब्ध िैं। 1-888-865-5813(TTY: 711) पर कॉल करें।日本語 (Japanese) 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-888-865-5813 （TTY: 711）まで、お電話にてご連絡ください。

한국어 (Korean) 주의: 한국어를 사용하시는 경우, 언어지원 서비스를 무료로 이용하실 수 있습니다. 1-888-865-5813 (TTY: 711) 번으로 전화해 주십시오.

Naabeehó (Navajo) Díí baa akó nínízin: Díí saad bee yáníłti’go Diné Bizaad, saad bee áká’ánída’áwo’dé̖é̖’, t’áá jiik’eh, éí ná hóló̖, koji̖’ hódíílnih 1-888-865-5813 (TTY: 711).

Português (Portuguese) ATENÇÃO: Se fala português,encontram-se disponíveis serviços linguísticos, grátis.Ligue para 1-888-865-5813 (TTY: 711).

Pусский (Russian) ВНИМАНИЕ: eсли вы говоритена русском языке, то вам доступны бесплатныеуслуги перевода. Звоните 1-888-865-5813 (TTY: 711).

Español (Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-888-865-5813 (TTY: 711).

Tagalog (Tagalog) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.Tumawag sa 1-888-865-5813 (TTY: 711).

Tiếng Việt (Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-888-865-5813 (TTY: 711).

60577109_ACA_1557_MarCom_GA_2017_Taglines_Landscape

کنيد،توجه:(Farsi)فارسی می گفتگو فارسی به زبان اگرباشد. می فراهم بصورت رايگان برای شما تسهيالت زبانی

711)با :TTY) تماس بگيريد.1-888-865-5813Français (French) ATTENTION: Si vous parlez français,des services d'aide linguistique vous sont proposésgratuitement. Appelez le 1-888-865-5813 (TTY: 711).

Deutsch (German) ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.Rufnummer: 1-888-865-5813 (TTY: 711).

ગજુરાતી (Gujarati) સચુના: જો તમે ગજુરાતી બોલતા હો, તો નન:શલુ્ક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો 1-888-865-5813 (TTY: 711).

Kreyòl Ayisyen (Haitian Creole) ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-888-865-5813 (TTY: 711).

हिन्दी (Hindi) ध्यान दें: यहद आप हििंदी बोलते िैं तो आपके ललएमुफ्त में भाषा सिायता सेवाएिं उपलब्ध िैं। 1-888-865-5813(TTY: 711) पर कॉल करें।日本語 (Japanese)注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-888-865-5813（TTY: 711）まで、お電話にてご連絡ください。

한국어 (Korean)주의: 한국어를 사용하시는 경우, 언어지원 서비스를 무료로 이용하실 수 있습니다. 1-888-865-5813 (TTY: 711)번으로 전화해 주십시오.

Naabeehó (Navajo) Díí baa akó nínízin: Díí saad bee yáníłti’go Diné Bizaad, saad bee áká’ánída’áwo’dé̖é̖’, t’áájiik’eh, éí ná hóló̖, koji̖’ hódíílnih 1-888-865-5813(TTY: 711).

Português (Portuguese) ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-888-865-5813 (TTY: 711).

Pусский (Russian) ВНИМАНИЕ: eсли вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-888-865-5813 (TTY: 711).

Español (Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-888-865-5813 (TTY: 711).

Tagalog (Tagalog) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-888-865-5813 (TTY: 711).

Tiếng Việt (Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-888-865-5813 (TTY: 711).

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