colorado small business enrollment guide...to keep your employees and your bottom line healthy....

to keep your employees—and your bottom line—healthy.

Colorado Small Business Enrollment Guide

2016 | SMALL BUSINESS HEALTH

Colorado Small Business Enrollment Guide

Have questions? Call us at 1-866-331-2091 or contact your agent or broker

kp.org

It’s time for A BET TER WAY

Choose a clear path to

healthier people and a

healthier business

You face big challenges Costs keep going up You have a critical business decision to make every year—how to select high-quality health care for your employees at a time when the cost of care continues to accelerate at an impossible rate. Since 2001, premiums for employer-sponsored health coverage have increased 113 percent.1

Employees are getting sicker Many employers think of health care as just another line item—a necessary expense. But on average, 90 percent of your employees have at least one chronic condition.2 So a healthier workforce can be an investment in the future of your business.

To successfully manage your costs and improve business performance, you need a healthcare partner who addresses the health of your employees before costs escalate.

WHAT’S INSIDE

A BETTER WAY to manage costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

A BETTER WAY to keep your employees healthier . . . . . . . . . . . . . .5

Your partner for better health Virtual Care Innovations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Employee Health and Wellness . . . . . . . . . . . . . . . . . . . . . . . . . .7 Enhancing the Employee Experience . . . . . . . . . . . . . . . . . . . . .8

It starts with a plan Accessing care in Denver/Boulder . . . . . . . . . . . . . . . . . . . . . . .9 Accessing care in Northern Colorado . . . . . . . . . . . . . . . . . . . .12 HMO plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 POS and PPO Plans Offered in Colorado . . . . . . . . . . . . . . .16 Accessing care in Southern Colorado . . . . . . . . . . . . . . . . . . . .18 KP Select . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 KP Select plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Accessing care in Mountain Communities . . . . . . . . . . . . . . . .23 Medicare Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 Adult & Pediatric Dental Plans . . . . . . . . . . . . . . . . . . . . . . . . . .24 2016 Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

3

to keep your employees—and your bottom line—healthy. Colorado Small Business

Enrollment Guide

Have questions? Call us at 1-866-331-2091 • Or contact your agent or broker

4 5

A BETTER WAY to manage costs.

BETTER OUTCOMES, SATISFIED MEMBERS

After caring for employees for more than 65 years, we’re recognized as today’s gold standard in high-quality, cost-effective care — delivering value that other health care organizations just can’t match.

Kaiser Permanente Colorado ranked “Highest Member Satisfaction among Commercial Health Plans in Colorado” for the 8th year in a row in the J.D. Power 2015 Member Satisfaction Study.3

BETTER ACCOUNTABILITY

With our health plan, Kaiser Permanente physicians and affiliated provider partners work together to keep costs low while improving quality to keep your employees healthy at an affordable price.

National Committee for Quality Assurance ranks Kaiser Permanente Colorado’s #1 Private Health Plan and #1 Medicare Plan in Colorado for the 6th year in a row.4

LOWER COSTS, HIGHER QUALITY

We keep costs in line while achieving high standards of care and we’re #1 in the nation on 17 out of 28 care measures, many of which target preventable conditions.5

For the 6th year in a row, Aon Hewitt reports Kaiser Permanente offers the most cost-effective plan and outperforms other plans in clinical quality.6

A BETTER WAY to keep your employees healthierWe give you a better way to invest in your employees’ health. They get more effective support from our top doctors, clinical and hospital partners, leading workforce health programs, and award-winning disease management. The result is healthier, more engaged, and more productive employees.

Healthy and engaged employees—Healthy employees offer a higher return on investment. We make it easy and convenient for them to get better care in fewer office visits, so they have fewer sick days and emergency visits—keeping them at work and more productive. They’ll have access to tools and resources to actively participate in their health at home, online, with their smartphone, and at our one-stop, Kaiser Permanente facilities.

Raising the bar for healthcare—Kaiser Permanente is one of the largest health and research systems in the world. Our size and scale, combined with the industry’s leading electronic health information system, allows us to deliver better care faster than most other organizations. We’re a national and international model for cost-effective, high-quality, and innovative care and we’re quickly advancing new best practices and saving lives.

Award-winning chronic care—Eighty-five percent of health care costs are due to chronic conditions and nine out of ten employees in the U.S. have chronic conditions.7,8 Your employees will benefit from the latest thinking in disease management, reducing health emergencies, sick days, disability time, and overall costs.

Top physicians—Better doctors provide better care, and that’s a smarter way to invest in employee health. Kaiser Permanente has world-class doctors from schools like Yale, Johns Hopkins, and Harvard. Additionally, year over year, 5280 Magazine recognizes many Kaiser Permanente Colorado physicians in its “Top Doctors” issue.

D ID YOU KNOW

Weight management is an important factor

in controlling lost productivity, health

care costs, and chronic conditions. And obesity is the second-most-prevalent

condition affecting productivity at work.

On average, it costs an employer $1,500 more to insure an obese employee

than a normal-weight employee.9

Health care costs for patients with chronic conditions such

as diabetes or congestive heart failure were 30–50 percent higher when the

patient was obese.10

Obesity costs an estimated $64 billion in direct medical

costs and $59 billion in indirect costs such as lost

productivity.11

$140,000in total annual

costs for 100 obese employees


Enrollment Guide


6 7

T IME-SAVING ALTERNATIVES TO OFFICE VIS ITS

IN Q1 2015:

442,433Kaiser Permanente Colorado members were seen in an office visit.

317,595members accessed care through secure email consultations.

79,806members took advantage of telephone consultations with their primary care providers.

Virtual Care InnovationsEnhancing Physician e-Visit* consultations—For years, members have been able to email their Kaiser Permanente physicians through My Health Manager. Now though, they can also attach photos and have virtual email consultations. With our new store-and-forward functionality, a photo is taken, uploaded to their medical record, and viewed by a Kaiser Permanente specialist, who responds later with advice.

Adding New RN e-Visit capability—In addition to our 24/7 telephone nurse advice line, your employees have 24/7 access to online medical consultations with our Advice Call Center Registered Nurses. This new feature is available within our secure patient portal on kp.org.

D ID YOU KNOW

BRINGING THE DOCTOR’S OFFICE TO YOUR WORKFORCE

This year, we’re launching another convenient care option for your

employees—video visits.

Instead of seeing their Kaiser Permanente

provider in person, they can have secure,

convenient and personalized video consultations

through a computer, smart phone or tablet.*

Employee Health & Wellness

Total Health Assessment—Your employees can take a confidential, online health assessment on kp.org/succeed and receive a personalized report, along with their results, to share with their healthcare team.

Healthy Lifestyle Programs—We offer a complementary suite of online intervention programs, to help your employees achieve their health and wellness goals and thrive . Some of the topics include: Balance™ for weight management; Breathe™ for tobacco cessation and Care for Your Health™ for living with chronic conditions. To get started, visit kp.org/healthylifestyles .

Wellness Coaching—Whether your employees are trying to eat better, lose weight, get active or manage stress, getting started and staying motivated can be a challenge. With Kaiser Permanente, they can access free wellness coaching by phone, to get the extra support they need to make healthy changes and stick with them.

Wellness Webinars—With our convenient, live or recorded webinars, your workforce can take an active role in improving their health and fit wellness into their schedule, no matter how busy the day is. View free programs and register at kpwebinar.org .

Complementary Medicine—Kaiser Permanente’s Center for Complementary Medicine offers chiropractic, acupuncture, massage, and mind/body medicine services for your employees . Visit kp.org/cam or kpccm.org, to learn more about network providers and complementary medicine services.

ChooseHealthy™ Discounts—Employees can find savings on many services, including preferred membership rates at select health clubs; 25% off regular rates for massage therapy, chiropractic care and acupuncture. Our ChooseHealthy™ online store offers 15-40% off suggested retail prices on hundreds of health products and, at FitnessCoach.com, there are many tools to help them achieve their health and fitness goals. Providers and services are detailed on kp.org/choosehealthy .

DID YOU KNOW

Proactive Care

We help your employees stay healthy, not just

treat them when they are sick. Preventive screenings

help keep you and your employees healthy by

providing an early alert for many health conditions. That way, they can be

treated before they become serious. Under health care reform, many are available at no charge.

For a complete list of our preventive care services, visit

kp.org/prevention.

* This feature is available when you get care at Kaiser Permanente facilities or with Kaiser Permanente doctors.


Enrollment Guide


8 9

Enhancing the Employee Experience

New Online Treatment Cost Estimator Calculator—

To help your employees make more informed decisions about their health, they can now visit kp.org/costestimates, to get personalized estimates for out-of-pocket costs for some of the most common exams, tests, procedures, or treatment plans they may be discussing with their Kaiser Permanente physicians. They can continue to also call our financial counselors.

An even Better Pharmacy—As the second largest purchaser of pharmaceuticals in the nation, your employees will typically pay significantly lower costs for their generic and non-generic medications, when using Kaiser Permanente pharmacies and partners. We leverage our organizational purchasing power to manage costs from the start, negotiating prescription drug prices, buying drugs in bulk, and operating our own pharmacies and warehouses. With our newest pharmacy management system, prescriptions are still filled accurately; just in less time. Employee wait times have decreased, 97% of mail orders are shipped in less than 4 days and member satisfaction is at 94%.

Upgraded Call CentersEach year, we assist millions of member calls, so we upgraded capabilities for our Appointment and Advice Call Center and Clinical Pharmacy Call Centers . With new speech voice recognition, your employees can quickly talk with a representative, or utilize self-serve options, such as scheduling appointments or refilling prescriptions.

DID YOU KNOW

NEW MEMBER CONNECT DEPARTMENT

Whether it’s finding a physician, transitioning

prescriptions, understanding plan benefits or

understanding kp.org, our newest service helps your employees navigate their plan and connect to

the care they need

Accessing Care in Denver/Boulder Employees have a choice of more than 1,000 primary care physicians and specialists at any Kaiser Permanente medical office in Colorado. With many locations to choose from and most offering multiple services under one roof, they can see their doctor, get a lab test or an X-ray, and pick up medications — all without leaving the building.

Integrated Care In our integrated model, care teams are united for a single purpose—better health. Your employees receive better care that’s more efficient—which means healthier outcomes for them and lower costs for you. Look at the advantages built into our care approach within our Kaiser Permanente medical offices.

Fewer office visits—employees save time and money by getting primary care, specialty care, lab, pharmacy, and many other services at a Kaiser Permanente medical office.

Fewer sick days—our team approach puts your employees at the center and helps them proactively manage their care so they’re healthier, at work, and more productive.

Satisfied workers—consumers say we outperform all other health insurers in delivering high-quality customer service and making it easy to access care .12

Dependable access to great doctors—every one of our physicians goes through a rigorous selection process before we allow them to care for your employees. In Colorado, that means we only hire 11% of the physicians who apply.

Built-in health advice and programs—disease management programs, health education, and nurse advice are part of your plan, so employees get consistent health information from one source .

Ensuring consistent care—our doctors have created one of the world’s largest, most inclusive electronic medical libraries, available only to our caregivers .

Healthier employees—primary care physicians and specialists can view each other’s treatment notes in real time via an employee’s electronic medical record. This allows for a thorough and accurate exchange of information, which can help keep your employees healthier .

SAVING LIVES AND DOLL ARS

89%Reduction in heart attack deaths in Colorado, avoiding related medical costs and productivity losses13


Enrollment Guide


10 11

Kaiser Permanente Medical Offices

To make an appointment at any medical office, call 303-338-4545 (TTY: 711), weekdays, 7 a.m. to 6 p.m.

1 Arapahoe Medical Offices 5555 E. Arapahoe Rd. Centennial, CO 80122

2 Aurora Centrepoint Medical Offices

14701 E. Exposition Ave. Aurora, CO 80012

3 Baseline Medical Offices 580 Mohawk Dr. Boulder, CO 80303

4 Brighton Medical Offices 859 S. 4th Ave. Brighton, CO 80601

5 Castle Rock Medical Offices 4318 Trail Boss Dr. Castle Rock, CO 80104

6 East Denver Medical Offices 10400 E. Alameda Ave. Denver, CO 80247

7 Englewood Medical Offices 2955 S. Broadway Englewood, CO 80113

8 Evergreen Medical Offices 2942 Evergreen Pkwy. Evergreen, CO 80439

9 Franklin Medical Offices 2045 Franklin St. Denver, CO 80205

10 Hidden Lake Medical Offices 7701 Sheridan Blvd. Arvada, CO 80003

11 Highlands Ranch Medical Offices 9285 Hepburn St. Highlands Ranch, CO 80129

12 Ken Caryl Medical Offices 7600 Shaffer Pkwy. Littleton, CO 80127

13 Lakewood Medical Offices 8383 W. Alameda Ave. Lakewood, CO 80226

Hospitals for scheduledinpatient care; emergency care hospitals/departments; and urgent care facilities

H E U

Behavioral Health offices (mental health, chemical dependency, and eating disorders)

25

25

25

270

7

7

74

52

119

119

287

85

85

85

285

76

85

36

7

13

12

11 14

22

5

20

8

1

2

H1

H2

H3

19

10

21

174

3

15

16

918

6

E4

E3

E5E2

E1

B3

B1

B2

Ken Caryl Ave

Hampden

Evergreen Pkwy

Evergreen

Boulder

Castle Rock

Longmont

C 470 E 470E 470

E 470

C 470 C 470

County Line Rd

Quincy Ave

Arapahoe Rd

Belleview Ave

Alameda Ave6th Ave

Colfax Ave

Founders Pkwy

TrD

sso

B lia

r.

E Inspiration Dr.

88th Ave

56th Ave

Evans Ave

64th Ave58th Ave

104th Ave

Colorado Blvd

Sable BlvdS. 4th

Washington St

Pecos StHuron St

Indiana St

N 95th St

Garrison St

Sheridan

University Blvd

Chambers Rd

Airport Rd

Sable

Colorado Blvd

Wadsworth

Simm

s St

Federal Blvd S. Broadway

Holly St

Peña BlvdPeoria St

T ower Rd

County Hwy 25

112th Ave120th Ave

E 160th Ave

E 152nd Ave/E. Bromley Ln.Northwest Pkwy

E 470

S Boulder RdBaseline RdArapahoe Rd

Nelson Rd

Valmont Rd

72nd Ave

80th Ave

Mississippi Ave

Parker RdN Jordon Rd

NiP

.rD

en

Smoky Hill Rd

E Main St

Lincoln Ave

287

42

Autumn Ridge Blvd

Exempla Cir

Maple Rd

Empire Rd

Campus DrS Pointe Dr

36to

17H2

P

PP

P

Humboldt St

Franklin St

Gilpin St

William

s Stg

Lafayette St

Marion St

Downing St

Ogden St

Emerson St

Clarkson St

Washington St

Pearl St

Pennsylvania S

Logan St

Park Ave

24th St

22nd St 20th Ave20th Ave

22nd Ave

23rd Ave

24th Ave

19th Ave

18th Ave

21st AveP

PConstruction

P

9

H3 U2E1

18

Medical offices Pharmacy

Medical Imaging

Audiology/hearing

Optical/optometry

Laboratory

U1

U2

U3

H4

Map is not to scale.

Medical offices Hospitals for scheduledinpatient care; emergency care hospitals/departments; and Urgent Care facilities

Behavioral Health offices (mental health, chemical dependency, and eating disorders)

H E U

14 Lone Tree Medical Offices 10240 Park Meadows Dr.Lone Tree, CO 80124

15 Longmont Medical Offices 2345 Bent Way Longmont, CO 80503

16 Parker Medical Offices 10168 Parkglenn Way Parker, CO 80138

17 Rock Creek Medical Offices 280 Exempla Cir. Lafayette, CO 80026

18 Skyline Medical Offices 1375 E. 20th Ave. Denver, CO 80205

19 Smoky Hill Medical Offices 16290 E. Quincy Ave. Aurora, CO 80015

20 Southwest Medical Offices 5257 S. Wadsworth Blvd. Littleton, CO 80123

21 Westminster Medical Offices 11245 Huron St. Westminster, CO 80234

22 Wheat Ridge Medical Offices 4803 Ward Rd. Wheat Ridge, CO 80033

After-Hours Care

Hours and locations for after-hours care are subject to change. Please call 303-338-4545 (TTY: 711) at the time of need to confirm current hours and locations.

1 Arapahoe Medical Offices 6 p.m.–10 p.m., Mon. - Fri. 8 a.m.–9 p.m., Sat. 9 a.m.–9 p.m., Sun.

6 East Denver Medical Offices 8 a.m.–4 p.m., Sat. 9 a.m.–4 p.m., Sun.

13 Lakewood Medical Offices 8 a.m.–4 p.m., Sat. 9 a.m.–4 p.m., Sun.

21 Westminster Medical Offices 8 a.m.–4 p.m., Sat. 9 a.m.–4 p.m., Sun.

Pediatric Urgent Care

U1 Children’s Hospital Colorado Urgent Care North Campus, Broomfield

469 West Highway 7 Broomfield, CO 80023

U2 Children’s Hospital Colorado Urgent Care, Uptown Denver

1835 Franklin Street Denver, CO 80218

U3 Children’s Hospital Colorado Urgent Care, Wheat Ridge

3455 Lutheran Parkway, Suite 230 Wheat Ridge, CO 80033

Emergency Care

If you have an emergency medical condition, call 911 or go to the nearest hospital. Or, if time and safety permit, you can go to the Emergency Department at one of the following hospitals:

H3 Saint Joseph Hospital1375 East 19th Avenue Denver, CO 80218

H2 Good Samaritan Medical Center

200 Exempla Circle Lafayette, CO 80026

H3 Senior ER at Saint Joseph Hospital

1375 East 19th Avenue Denver, CO 80218

H1 Children’s Hospital Colorado on Anschutz Medical Campus

13123 E. 16th Ave. Aurora, CO 80045

H4 Children’s Hospital Colorado North Campus, Broomfield

469 West Highway 7 Broomfield, CO 80023

E1 Children’s Hospital Colorado at Saint Joseph Hospital

1835 Franklin St. Denver, CO 80218

H3 Rocky Mountain Hospital for Children

1719 E. 19th Ave. Denver, CO 80218

E3 HealthONE Sky Ridge Medical Center

10101 Ridgegate Pkwy. Lone Tree, CO 80124

E4 HealthONE Swedish Medical Center

501 E. Hampden Ave. Englewood, CO 80110

E5 HealthONE Swedish Southwest ER

6196 S. Ammons Way Littleton, CO 80123

E2 HealthONE Centennial Medical Plaza

14200 E. Arapahoe Rd. Centennial, CO 80112

Behavioral Health Offices

For appointments, call 303-471-7700. B1 Hidden Lake

Behavioral Health 7701 Sheridan Blvd. Arvada, CO 80003

B2 Highline Behavioral Health* 10350 E. Dakota Ave. Denver, CO 80247 * Entrance located on East side of building.

B3 Ridgeline Behavioral Health Center

9139 S. Ridgeline Blvd. Highlands Ranch, CO 80129

Additional locations and access

In addition to the locations shown on this map, you have access to all Kaiser Permanente medical offices in Northern and Southern Colorado.


Enrollment Guide


12 13


1 Fort Collins Medical Offices2950 E. Harmony Road, Suite 190 Fort Collins, CO 80528 970-207-7171

2 Loveland Medical Offices4901 Thompson Parkway Loveland, CO 80534-6426 970-207-7171

3 Greeley Medical Offices2429 35th Avenue Greeley, CO 80634 970-207-7171

Emergency Care

E1 Estes Park Medical Center555 Prospect Avenue Estes Park, CO 80517 970-586-2317

E2 McKee Medical Center2000 Boise Avenue Loveland, CO 80538 970-669-4640

E3 North Colorado Medical Center1801 16th Street Greeley, CO 80631 970-352-4121

E4 Banner Fort Collins Medical Center

4700 Lady Moon DriveFort Collins, CO 80528970-229-4000

Urgent Care

U1 Banner Health Clinic – Skyline Urgent Care

2555 E 13th Street, Suite 110 Loveland, CO 80537 970-461-6140

U2 Banner Health Clinic – Summit View Urgent Care

2001 70th Ave., Suite 110 Greeley, CO 80634 970-378-4155

U3 Banner Health Clinic – Windsor Urgent Care

1300 Main Street Windsor, CO 80550 970-686-5646

U4 The Healthcare Clinic of Fort Collins

1721 W. Harmony Road #102 Fort Collins, CO 80526 970-223-1999


In addition to the locations shown on the map, you have access to hundreds of network providers throughout the service area; however, they are not represented on this map. Network provider information and locations can be found at kp.org/facilities.

Additionally, you have access to all Kaiser Permanente medical offices in Denver/Boulder or Southern Colorado.

Estes Park25

25

25

85

85

87

8587

87

34

34

34

3434

34

287

287

287

257

402

392392

257

257

1414

60

6060

256 256

Fort Collins

GreeleyLoveland

2

E3

1

3

E2

E Harmony Rd CO Rd 74CO Rd 74

E Mulberry St

E Prospect Rd

TdR

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W 29th StE Eisenhower Blvd

W 1st St esi

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C4th St

W 20th St

W 37th St

16th St

N 8th Ave

ht 9

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dr 3

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Medical offices

Hospitals for scheduled inpatient care H

U1

U4E4

U3

34

3434

60

3434

34

Moccasin Cir Dir

Prospect Ave

Highland Ln

Ponderosa Dr

Stanley

Cir Dir

St. Vrain Av.

Stanley Ave

MacGregor Ave

W Elkhorn Ave

Aspen Ave

Birch Ave

Driftwood Ave

U2

H E

Medical offices


34 36

High St

7

E1

25

25

25

85

85

87

8587

87

34

34

34

3434

34

287

287

287

257

402

392392

257

257

1414

60

6060

256 256

Fort Collins

GreeleyLoveland

2

E3

1

3

E2

E Harmony Rd CO Rd 74CO Rd 74

E Mulberry St

E Prospect Rd

TdR

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W 29th StE Eisenhower Blvd

W 1st St esi

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C

4th St

W 20th St

W 37th St

16th St

N 8th Ave

ht 9

5vAe

dr 3

2vAe

Medical offices

Hospitals for scheduled inpatient care H

U1

U4E4

U3

34

3434

60

3434

34

Moccasin Cir Dir

Prospect Ave

Highland Ln

Ponderosa Dr

Stanley

Cir Dir

St. Vrain Av.

Stanley Ave

MacGregor Ave

W Elkhorn Ave

Aspen Ave

Birch Ave

Driftwood Ave

U2

H E

Medical offices


34 36

High St

7

E1

Estes Park

Accessing Care Northern Colorado

In Northern Colorado, we offer comprehensive health services and health care coverage to Loveland, Fort Collins, Greeley and surrounding areas. Currently, more than 27,000 Northern Colorado members use Kaiser Permanente as their partner in health. Take a look and you’ll see why Kaiser Permanente is a better choice.

Integrated Care

Your employees can access care at any of our locations in Northern Colorado and at any of our 28 Kaiser Permanente locations throughout Colorado. With primary care, pharmacy, laboratory and medical imaging all under one roof – receiving care at a Kaiser Permanente Medical Office can save your employees time.

They’ll also benefit from Kaiser Permanente’s integrated approach to health care delivery, when receiving care at our Kaiser Permanente medical offices. My Health Manager on kp.org allows them the ability to schedule appointments, view most lab results, order prescriptions and email their Kaiser Permanente doctors . With innovative web-based tools through kp.org and the recently launched app for mobile devices, your employees will have access to information in their secure medical record .

The Power to Choose

We also offer your employees and additional choice in Northern Colorado: they can visit a Kaiser Permanente medical office or see one of the 400+ network physicians from Banner Health and other community providers. Our network in Northern Colorado works collaboratively with Kaiser Permanente care teams to ensure quality, patient-centered care .


Enrollment Guide


14 15

HMO Plans Offered in Colorado

Plan Metal Tier

Deductible Coinsurance (Member's Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab & X-ray

MRI, CT, & PET

Prescription DrugsGeneric/Brand/

Non-Preferred/Specialty

Relativity to KP CO Platinum

0/25

HMO (Simple and straightforward coverage for your employees)

KP CO Platinum 0/25

Platinum None 10% $3,000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10% $200 $10/$35/$250/$250 0%

KP CO Gold 0/30

Gold None 30% $4,500 $30 $60 $75 $300 $1,000 $1,000 per day (up to 4 days)

30% $500 $15/$45/$375/$375 -6%

KP CO Silver 0/50

Silver None 40% $6,850 $50 $70 $100 $500 40% $1,500 per day (up to 4 days)

40% $500 $15/$50/$570/$570 -12%

Deductible HMO (Deductible-based plans designed to fit any budget)

KP CO Platinum 250/20

Platinum $250 10% $2,000 $20 $40 $75 $200 10% after deductible

10% after deductible 10% after deductible

10% after deductible

$10/$25/10%/10% 2%

KP CO Gold 500/30

Gold $500 20% $4,000 $30 $50 $75 $300 20% after deductible



$15/$45/$325/$325 -9%

KP CO Gold 1000/30

Gold $1,000 10% $3,500 $30 $50 $75 $300 10% after deductible



$15/$45/10%/10% -6%

KP CO Gold 1500/30




$15/$45/10%/10% -8%

KP CO Silver 2500/30

Silver $2,500 20% $5,800 $30 $50 $100 $350 20% after deductible



$15/$45/20%/20% Non-Generic drugs are subject to a separate $250 prescription

drug deductible

-18%

KP CO Silver 3500/30

Silver $3,500 20% $5,500 $0 for the first visit, then $30 per visit

$50 $100 $350 20% after deductible



$15/$45/$450/$450 -19%

KP CO Bronze 5500/50

Bronze $5,500 40% $6,850 $50 per visit for 3 visits, then 40% after deductible







$25/$110/$570/$570 -36%

KP CO Bronze 6850/50

Bronze $6,850 0% $6,850 $50 per visit for 3 visits, then no charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible





No charge after deductible -33%

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) and Health Reimbursement Accounts (HRAs) to pay for routine health care expenses)

KP CO Gold HRA 1500/30($500, $600, $700)

Gold $1,500 25% $6,350 $30 $50 $100 25% after deductible




$15/$45/50%/25% -15%

KP CO Silver HRA 3500/50($500, $600, $700)

Silver $3,500 40% $6,350 $50 after deductible $70 after deductible






$15/$45/40%/40% after deductible -33%

KP CO Silver 2750/30/HSA








KP CO Bronze 4750/50/HSA

Bronze $4,750 30% $6,500 $50 after deductible $70 after deductible


$500 after deductible





KP CO Bronze 6500/100%/HSA

Bronze $6,500 0% $6,500 No charge after deductible No charge after

deductible

No charge after

deductible








Enrollment Guide


16 17

POS and PPO Plans Offered in Colorado

Plan Metal Tier

Deductible Coinsurance (Member's Cost)



Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab & X-ray MRI, CT, & PET Prescription DrugsGeneric/Brand/



0/25

In Network

Out of Network

In Network

Out of Network

In Network

Out of Network

In Network

Out of Network

In Network

Out of Network

In Network

Out of Network

In Network

Out of Network

In Network

Out of Network

In Network

Out of Network

In Network

Out of Network

In Network

Out of Network

In Network

Out of Network

POS (Offer your employees the value of a HMO plan combined with the flexibility of a PPO plan to make the transition to Kaiser Permanente easier)

KP CO Platinum POS 0/25

Platinum $0 $1,000 10% 30% $2,000 $4,000 $25 $45 $45 $65 $75 $75 $200 $200 10% 30% after deductible

10% 30% after deductible



$10/$25/10%/10% Covered in network only

22%

KP CO Gold POS 1500/30

Gold $1,500 $3,000 20% 40% $3,500 $7,000 $30 $50 $50 $70 $75 $75 $350 $350 20% after deductible








$10/$35/20%/20% Covered in network only

7%

KP CO Silver POS 2500/35

Silver $2,500 $5,000 30% 50% $5,500 $11,000 $35 $55 $55 $75 $100 $100 $400 $400 30% after deductible








$15/$45/30%/30%Non-Generic drugs are subject to a separate

$250 prescription drug deductible

Covered in network only

-6%

KP CO Bronze POS 5750/60

Bronze $5,750 $11,500 40% 50% $6,850 $13,700 3 visits at $60, then 40% after

deductible

3 visits at $80, then 50% after

deductible















$25/$110/ $570/$570

Covered in network only

-26%

PPO (For employees located outside Kaiser Permanente’s service area)

KP CO Silver PPO 1500/40

Silver $1,500 $4,500 30% 50% $6,350 $16,000 $40 50% after deductible

$60 50% after deductible











$300 after Ded


$15/$45/ $525/$525

Covered in network

only

-36%


Enrollment Guide


18 19

Accessing Care in Southern Colorado

In Southern Colorado, more than 61,000 people turn to us as their trusted partner in total health. We offer comprehensive health services and health care coverage to Colorado Springs, Pueblo, Cañon City and surrounding areas. Take a look and you’ll see why Kaiser Permanente is a better partner in health.

Integrated Care

We’ve expanded, to bring good health closer to our Southern Colorado members. We opened a new Kaiser Permanente medical office in central Colorado Springs; launched new, affordable health insurance plans; expanded specialty services at our Briargate location, where patients of all ages can be seen.

Your employees can access care at any of our locations in Southern Colorado and at any of our 28 Kaiser Permanente locations throughout Colorado. With primary care, pharmacy, laboratory and medical imaging all under one roof – receiving care at a Kaiser Permanente Medical Office can save your employees time.


The Power to Choose

We also offer your employees an additional choice in Southern Colorado: they can visit any Kaiser Permanente medical office in Colorado or choose from a comprehensive network of local physicians in their plan .

Collaborative Care

We’re partnering in new ways with network providers to bring best practices to your employees through innovative, personalized care programs . A care team that’s informed and focused on your employees can lead to better health .

Kaiser Permanente Care Connection is a team of local Kaiser Permanente nurses and health professionals who work with our network providers and your employees, to manage their health, help with care coordination, preventative care, wellness coaching, educational resources, and medication management.

Pay for Value: We identify nationally recognized quality metrics that align with best practices for certain preventive measures and disease states, such as hypertension and diabetes. Through this program, we’re seeing great results and showing improvements in quality of care for patients with chronic conditions, such as Type 2 diabetes and hypertension, as well as improving rates of prevention screenings (breast, colorectal, and cervical cancer).

Kaiser Permanente Select

An affordable, high-quality health care plan for Colorado Springs and surrounding areas .

Kaiser Permanente Select (KP Select) is all about keeping your employees healthy and keeping your health care costs down. Employees who choose the KP Select plan will benefit from the same high-quality care from Kaiser Permanente at an affordable price, while following a few guidelines. Employees can receive care at any Kaiser Permanente medical office in Colorado, with three located in Southern Colorado, and have access to more than 400 KP Select providers in the Colorado Springs area . Scheduled inpatient hospital care and outpatient care is available at select facilities and refills for maintenance medications must be filled at a Kaiser Permanente medical office pharmacy or through mail order.


Enrollment Guide


20 21

KP Select Plans Offered in Colorado Springs

Plan Metal Tier

Deductible Coinsurance (Member's

Cost)



Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab & X-ray

MRI, CT, & PET

Prescription DrugsGeneric/Brand/



0/25

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 0/25 Platinum None 10% $3,000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10% $200 $10/$35/$250/$250 0%

KP Select CO Gold 0/30

Gold None 30% $4,500 $30 $60 $75 $300 $1,000 $1,000 per day (up to 4 days)

30% $500 $15/$45/$375/$375 -6%

KP Select CO Silver 0/50 Silver None 40% $6,850 $50 $70 $100 $500 40% $1,500 per day (up to 4 days)

40% $500 $15/$50/$570/$570 -12%

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 250/20 Platinum $250 10% $2,000 $20 $40 $75 $200 10% after deductible



$10/$25/10%/10% 2%


Gold $500 20% $4,000 $30 $50 $75 $300 20% after deductible



$15/$45/$325/$325 -9%





$15/$45/10%/10% -6%





$15/$45/10%/10% -8%

KP Select CO Silver 2500/30

Silver $2,500 20% $5,800 $30 $50 $100 $350 20% after deductible



$15/$45/20%/20% Non-Generic drugs are subject to a separate $250

prescription drug deductible

-18%

KP Select CO Silver 3500/30 Silver $3,500 20% $5,500 $0 for the first visit, then $30 per visit

$50 $100 $350 20% after deductible



$15/$45/$450/$450 -19%

KP Select CO Bronze 5500/50

Bronze $5,500 40% $6,850 $50 per visit for 3 visits, then 40% after deductible







$25/$110/$570/$570 -36%

KP Select CO Bronze 6850/50

Bronze $6,850 0% $6,850 $50 per visit for 3 visits, then no charge after deductible









Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) and Health Reimbursement Accounts (HRAs) to pay for routine health care expenses)

KP Select CO Gold HRA 1500/30($500, $600, $700)

Gold $1,500 25% $6,350 $30 $50 $100 25% after deductible




$15/$45/50%/25% -15%

KP Select CO Silver HRA 3500/50 ($500, $600, $700)








KP Select CO Silver 2750/30/HSA








KP Select CO Bronze 4750/50/HSA

Bronze $4,750 30% $6,500 $50 after deductible $70 after deductible


$500 after deductible





KP Select CO Bronze 6500/100%/HSA

Bronze $6,500 0% $6,500 No charge after deductible No charge after deductible









Enrollment Guide


22 23


1 Briargate Medical Offices 4105 Briargate Pkwy, Suite 125 Colorado Springs, CO 80920 719-282-2533

2 Parkside Medical Offices215 Parkside Drive Colorado Springs, CO 80910 719-327-6540

3 Pueblo North Medical Offices 3670 Parker Boulevard, Suite 200 Pueblo, CO 81008 719-595-5755

Emergency Care

COLORADO SPRINGS

H1 Children’s Hospital at Memorial Hospital*

1400 East Boulder Street Colorado Springs, CO 80909 719-365-5000

H1 Memorial Hospital Central* 1400 East Boulder Street Colorado Springs, CO 80909 719-365-5000

H2 Memorial Hospital North* 4050 Briargate Parkway Colorado Springs, CO 80920 719-364-5000

H3 Penrose Hospital 2222 North Nevada Avenue Colorado Springs, CO 80907 719-776-5000

H4 St. Francis Medical Center 6001 East Woodmen Road Colorado Springs, CO 80920 719-571-5000

PUEBLO

H5 Parkview Medical Center 400 West 16th Street Pueblo, CO 81003 719-584-4000

H6 St. Mary-Corwin Medical Center1008 Minnequa Avenue Pueblo, CO 81004 719-557-4000

CAÑON CITY

H7 St. Thomas More Hospital 1338 Phay Avenue Cañon City, CO 81212 719-285-2000

WOODLAND PARK

H8 Pikes Peak Regional Hospital*16420 U.S. Highway 24 Woodland Park, CO 80863 719-687-9999

*KP Select members have access to these hospitals for scheduled inpatient care.


In addition to the locations shown on the map, you have access to hundreds of network providers throughout the service area; however, they are not represented on this map. Network provider information and locations can be found at kp.org/facilities.

Additionally, you have access to all Kaiser Permanente medical offices in Denver/Boulder or Northern Colorado.


50

50

50

5050

25

25

25

25

85

115

115115

9

67

96

231

96

96

47

78

45

24

85

24

24

2485

85

85

115

94

21

83

21

H7

H8

H1

H3

H4

1 H2

H5

H6

3

2

N Powers Blvd

E Woodmen Rd

E 4th St

E Platte Ave

Marksheffel Rd

Squirrel Creek Rd

Briargate Pkwy

W Northern Ave

Central Ave

State Hwy 120Co R

d 17

Doyle Rd

Co Rd 5013 M

eridian Rd

Hanover Rd

S Peyton Hwy

Falcon Hwy

Curtis Rd

Black Forest Rd

Meridian Rd

Peyton Hwy

Pueblo

Colorado Springs

Woodland Park

Cañon City

Accessing Care in Mountain CommunitiesAt Kaiser Permanente, we believe there’s no better choice than choosing good health. That’s why we’re expanding our mission to provide high-quality, affordable health care services into Mountain communities for the first time, opening our Frisco medical office in Summit County, in early 2016, and a second location in Eagle County.

Integrated Care

Your employees can access care at our locations in the mountains and at any of our 28 Kaiser Permanente locations throughout Colorado . With primary care, laboratory and medical imaging all under one roof – receiving care at a Kaiser Permanente Medical Office can save your employees time .



1 Kaiser Permanente Frisco Medical Offices

226 Lusher Court Frisco CO 80443

2 Eagle County location opening in 2016.

Mea

dow

Driv

e

Dillon Reservoir

Lusher Ct.

9

6Map is notto scale.

1


Enrollment Guide


24 25

2016 Resources Kaiser Permanente is committed to supporting you and your business . Below, you’ll find important contact information and business resources to save you time .

Calling the right person should be...EASY

Our goal is to have one-call resolution whenever possible. Communicating with the right department is the first step. With that in mind, we’ve set up ONE Number. Easy. 303-306-2727 (866-710-2727).

If your question is about You need to talk to

Group Billing and Invoicing: Account ReconciliationAdds, Drops, Cancels or Changes

Consolidated Service CenterOption 1

SG Contracts: Brochures, Forms, New Employee Packets, Group Cancellation

Small Group Sales & ServiceOption 2

Benefits, Eligibility: Service Resolution, Escalated Issues, Employee-level Claims

Client Services Unit (CSU)Option 4

Customer Experience Department

We’re here to help you transition to Kaiser Permanente. Our Customer Experience Team will visit your employees on-site and help them:

• Understand new plans & benefits

• Find & choose physicians

• Connect to the care they need

• Transition prescriptions

To reach our Customer Experience team, email [email protected] or call 303-338-3990 .

Customer Account Services

An easy-to-use web site link that provides online account management for you and your broker. You can view group eligibility and billing information, update employee data, or pay your invoices.

If you would like to set up an account, please contact your Account Executive or Associate Account Manager for assistance .

Medicare Coverage

Kaiser Permanente offers group and individual Medicare Advantage and Prescription Drug Plans .

For information on our individual plans, contact a licensed sales specialist toll free at 1-855-843-8396 (TTY 711) seven days a week, 8 a .m . to 8 p .m . or visit kp.org/medicare .

Adult and Pediatric Dental Care

Kaiser Permanente and Delta Dental of Colorado know good oral health is an important component of overall health, so we’ve partnered to provide small group employers pediatric dental benefits and adult-only dental plans to complement Kaiser Permanente’s medical plans .

NEW 2016 Embedded Pediatric Dental Benefit

Separate Annual Deductible (applies to all services)

$50

Diagnostic & Preventive Services

Oral Exams & Cleanings (Limited to 2 per calendar year)

Covered 100% after Deductible

Fluoride Treatments (Limited to 2 per calendar year)

Covered 100% after Deductible

Sealants (1 per lifetime per tooth per year) Covered 100% after Deductible

Bitewing X-rays (1 set per calendar year) Covered 100% after Deductible

Basic Services (limited to 2 basic procedures per year)

Fillings, Oral Surgery, Endodontics Covered 50% after Deductible

Major Services (limited to 1 major procedure per year)

Crowns Covered 50% after Deductible

Embedded Pediatric

Employee’s children (up through the month they turn 19) can receive any of the procedures listed below each calendar year.

Adult Dental

Our adult-only plans complement the embedded pediatric dental coverage and are not tied to medical. The lowest-cost plan starts at $13/month. These plans also offer:

• No waiting period

• Dual option choices

• $2,000 benefit maximum on the high plan

For more information, email Delta Dental directly at [email protected] Monday-Friday, 8 a.m.-5 p.m.

Important: The pediatric dental benefit is embedded in all Small Group plans EXCEPT the KP CO Silver PPO 1500/40 plan. The KP CO Silver PPO 1500-40 plan does not include pediatric dental coverage.

to keep your employees—and your bottom line—healthy.


26

Have questions?Call us at 1-866-331-2091 or contact your agent or broker

kp.org

2016 Reference

1 Employer Health Benefits 2011 Annual Survey, Kaiser Family Foundation and Health Research & Educational Trust, September 2011. Kaiser Family Foundation is a nonprofit, private organization not affiliated with Kaiser Permanente.

2 Dan Witters and Sangeeta Agrawal, “Unhealthy U.S. Workers Absenteeism Costs $153 Billion,” Gallup-Healthways Well-Being Index, January 2–October 2, 2011, www.gallup.com/poll/150026/Unhealthy-Workers-Absenteeism-Costs-153-Billion.aspx .

3 Kaiser Foundation Health Plan of Colorado, Inc. received the highest numerical score among commercial health plans in the Colorado region in the proprietary J.D. Power 2008-2015 U.S. Member Health Plan Studiessm. Study based on 31,543 total member responses, measuring four plans in Colorado (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.

4 Please refer to “NCQA’s Private Health Insurance Plan Rankings 2013-2014” posted online at www.ncqa.org.

5 Kaiser Permanente 2012 HEDIS® scores . Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compass® and represent all non- PPO lines of business. Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality. The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA. Quality Compass 2012 includes certain CAHPS® data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass® and HEDIS® are registered trademarks of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality.

6 The 2014 Hewitt Health Value InitiativeTM showed Kaiser Permanente is the most cost-efficient plan across all markets served for the sixth year in a row—12% more cost-effective than the average HMO and 17% more cost-effective than the all-plan average. Kaiser Permanente also outperformed other plans in clinical quality, scoring 49% better than the average HMO and 209% better than the all-plan average. Hewitt Health Value InitiativeTM benchmarking study — Kaiser Foundation Health Plan, Inc., Aon Hewitt, April 3, 2014. To get a copy of the Hewitt Health Value Initiative report for your region, contact your account manager.

7 Chronic Care: Making the Case for Ongoing Care, Robert Wood Johnson Foundation, 2010.

8 Dan Witters and Sangeeta Agrawal, “Unhealthy U.S. Workers Absenteeism Costs $153 Billion,” Gallup-Healthways Well-Being Index, January 2–October 2, 2011, www.gallup.com/poll/150026/Unhealthy-Workers-Absenteeism-Costs-153-Billion.aspx .

9 “Worksite Wellness,” Preventdisease.com, http://preventdisease.com/worksite_wellness/worksite_wellness.html, accessed November 2, 2009.

10 See Note 9 . 11 “Obesity by the Numbers,” obesityinamerica.org, accessed March 24, 2008.12 See Note #313 Thomas Delate, PhD, et al., “Reduced Health Care Expenditures After Enrollment

in a Collaborative Cardiac Care Service,” Pharmacotherapy, November 2010. Results from our cardiac rehabilitation program in Colorado .

Kaiser Foundation Health Plan, Inc., of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Colorado marketplace. ©2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questions?Call us at 1-866-331-2091 • Or contact your agent or broker

colorado small business enrollment guide...to keep your employees and your bottom line healthy....

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