Kaiser Permanente Bridge Program Keeping communities healthy September

Kaiser Permanente Bridge Program Keeping communities healthy September 2016

Bridge Program Overview Kaiser Permanente’s mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. The Kaiser Permanente Bridge Program is uniquely designed to help those who are actively enrolled in a training program with a participating community partner and who cannot afford health insurance pay for a standard Kaiser Permanente for Individuals and Families (KPIF) plan. The program will cover the cost of the monthly premium for up to 24 months. Coverage also includes preventative services, comprehensive pharmacy, and more. Kaiser Permanente will cover medical and pharmacy visits at Kaiser Permanente facilities. * *All covered health care services must be provided, authorized or prescribed by the Southeast Permanente Medical Group or an affiliated health care provider. The subsidy will not cover services outside of Kaiser Permanente or elective services. September 2016

Community Partners To assist in the identification and eligibility determination of potential members, Kaiser Permanente partners with local organizations, schools and workforce development agencies. All community partners must implement a training program requirement as criteria for applying for the Bridge Program. Workforce Development Agencies Colleges and Universities Service Organizations Response to growing workforce shortage Strategically targets healthcare of professional students Intended to reach individuals/families facing shortterm issues Atlanta Regional Workforce Board Chattahoochee Technical College Atlanta Children’s Shelter Cherokee Career Resource Center Clayton State University, School of Nursing C 4 Atlanta Clayton Career Resource Center Georgia Perimeter College East Lake Foundation Cobb. Works! Workforce Investment Act Georgia State University First African Community Development Corporation De. Kalb Workforce Development Gwinnett Technical College/Workforce Investment Act Multi-Agency Alliance for Children, Inc. (MAAC) Douglas & Rockdale Career Resource Centers New Hope Enterprises Fulton County Office of Workforce Development Nicholas House Gwinnett Career Resource Center North Fulton Community Charities Year Up Atlanta Ser Familia The Center for Working Families September 2016 Zion Hill Community Development Corporation

Eligibility Requirements The applicant must meet the following eligibility requirement in order to receive subsidized health care coverage under the Bridge Program: • The applicant must be actively enrolled in a training program with a participating community partner. • All applicants, and applying dependents, must live in Kaiser Permanente's metro Atlanta 20 county service area. * • The annual combined household income for the applicant must be less than the current income guidelines of 100% FPL for enrollment. • The applicant and all applying dependents cannot be eligible for or enrolled in any other health insurance program including Medicare, Medicaid, Peach. Care for Kids, and employer-sponsored health care. • The applicant must be age 64 or younger, and all child dependents must be younger than 26. • No applicant and/or applying dependent(s) can be a previous member of the Bridge program. *Bartow, Butts, Cherokee, Clayton, Cobb, Coweta, De. Kalb, Douglas, Fayette, Forsyth, Fulton, Gwinnett, Henry, Lamar, Newton, Paulding, Pike, Rockdale, Spalding, and Walton counties. September 2016

Income Guidelines Family size* Monthly gross income Annual gross income 1 $990 $11, 880 2 $1, 335 $16, 020 3 $1, 680 $20, 160 4 $2, 025 $24, 300 5 $2, 370 $28, 440 6 $2, 715 $32, 580 * Family Size = Self, Spouse and Dependents • For each additional person, add $4, 160 to annual gross income. • Self, spouse, or dependents are defined by ACA as number of individuals for whom the taxpayer can claim a deduction under section 151 of the Internal Revenue Code. September 2016

Bridge Program Highlights Members in the Bridge Program will receive help with out-of-pocket expenses such as copayments and coinsurance for services provided at Kaiser Permanente medical facilities. Benefit Description $0 PREMIUM PER MONTH At our KP Medical Office Affiliated Community Provider Annual Deductible None Primary Care Office Visit $0 copay $20 copay Specialty Care Office Visit $0 copay $40 copay Preventative Generic Drugs $0 copay $15 copay Vision Exam – one exam per year $0 copay $20 copay Urgent Care $0 copay $75 copay Outpatient Hospital or Surgical Facility $0 copay 30% Coinsurance Laboratory Services $0 copay 50% Coinsurance Radiology Services $0 copay 50% Coinsurance Mental Health/Behavioral Health Services $0 copay $40 copay Emergency Room Visit N/A $250 copay (waived if admitted) September 2016

KP Member Experience September 2016

KP Member Experience, cont. Our Doctors, Your Advocates We carefully screen and hire our own doctors (more than 500 of them), many from top schools like Emory and Harvard. You can review credentials on kp. org, choose your own doctor, and can switch at any time, for any reason. From primary care to specialty care, our doctors are your advocates in health. We’re recognized leaders in prevention — with an entire program based on keeping you healthy through routine appointments, preventive screenings, wellness coaching, healthy living programs, and more. Medical Services Include: • Adult Medicine • Behavioral Health • Cardiology • Dermatology • Gynecology • Internal Medicine • Ophthalmology • Optometry • Podiatry • And much more! September 2016

KP Member Experience, cont. Coordinated Care You Can Count On Having one of the largest and most advanced electronic medical system in the world also means your doctors and specialists are on the same real-time page when it comes to your care. You can count on your care team to communicate with each other and with you to help you be as healthy as possible — and stay that way. Care the Way You Want • Call our advice nurses 24/7. • Email your doctor anytime. • Choose your appointment type. Ø See your doctor in person, or schedule either a telephone appointment or video visit. • Manage your care online at kp. org. Ø Schedule and cancel routine appointments, refill prescriptions, see lab test results, and more. • Use the Kaiser Permanente app. Ø Download our app and use all the online features of kp. org from your mobile device. Find locations near you, get directions, and more. September 2016

My Health Manager At kp. org you have secure 24 -hour access to your health record online. Kaiser Permanente’s electronic patient health record system enables you to stay connected to your health, and it allows your doctor to view your information instantly right in the exam room. Below are just some of the features available to you: • Email your doctor’s office • Review past office visits • Schedule, request, cancel, and view appointments • View lab test results • Order prescription refills and view current medications* • View immunization history *Available to members receiving care/filling prescriptions at Kaiser Permanente Medical Centers. September 2016

Total Health Assessment Learning how to become healthier can be hard. Many do not know where to start. You can learn how to make changes to your health by taking a Total Health Assessment. • It only takes 30 minutes • During the assessment, you answer questions about yourself • After the assessment, you will have an action plan for a healthier lifestyle Your action plan will help you make healthier decisions, prevent future health problems, and feel your very best. Members are encouraged to register at www. kp. org and complete a Total Health Assessment. **Bridge members who complete the Total Health Assessment will qualify for a prize!** September 2016

Health & Wellness As a member of Kaiser Permanente, you have unlimited access to health programs and classes to keep a healthy lifestyle, free of charge. Fitness and educational classes are offered at our medical facilities and online. Take advantage of a wide range of tools to help you stay well • Health classes: Choose from a large variety of fitness classes and support groups offered at our facilities. • Healthy lifestyle programs: Our free online programs can help you lose weight, reduce stress, quit smoking, and sleep better. • Wellness coaching: Our wellness coaches will work one-on-one with you by phone. It’s free and no referrals needed. • And many more resources: helpful articles, wellness podcasts, recipes, and more. Learn more at kp. org/livehealthy September 2016

Pediatric Medicaid: Family Healthcare in One Place • Did you know all of our available pediatricians accept patients with Medicaid? • Simply contact your Care Manangement Organization (Amerigroup, Peachstate, Care. Source, or Wellcare) and ask them to switch your child’s provider to Kaiser Permanente. September 2016

Open Enrollment Schedule Application Received Date Effective Date November 1, 2016 — December 15, 2016 January 1, 2017 December 16, 2016 — January 15, 2017 February 1, 2017 January 16, 2017 — January 31, 2017 March 1, 2017 Note: Applicants approved during 2017 Enrollment Period will term 12/31/2018, regardless of their effective date. Special enrollment period is a time outside the open enrollment during which you have a right to sign up for health coverage because of a qualifying event such as marriage or a birth of Loss of eligibility under GA Code Section 49 -4 -1 or 49 -5 -273. September 2016

Enrollment Process Completion of the Kaiser Permanente Bridge Program enrollment process requires five easy steps: 1. Complete the Kaiser Permanente for Individuals and Families (KPIF) Gold 500/20 application. 2. Complete the Community Benefit Subsidy application 3. Submit the Gold 500/20 & Community Benefit Subsidy Applications, as well as supply all necessary supporting documents to the agency contact. The agency will attest that the applicant is currently a client/member or student. 4. The agency will send the applications and supporting documentation on your behalf to Charitable Health Coverage Operations (CHCO) for eligibility verification. 5. CHCO will process the applications and documents for coverage and eligibility including: identity, residency, income, access to other health insurance programs, and prior Bridge membership. If approved, the applicant receives an acceptance letter with effective date. A member can use the letter with the effective date to verify insurance until membership card arrives. Please make copies of your application in case you need proof of completion after it has been mailed September 2016

Applying for the Bridge Program John Smith X X X Only if selfemployed Only if you report zero income Only for domestic partners X X September 2016 X

KPIF Application September 2016

KPIF Application, cont. ALL PAGES: Once you flip over to the second page of the application, you’ll notice you’re asked to list the ‘Primary Applicant’ at the top of each page. Please write your name on all SEVEN pages. John Smith Once you’ve written your name at the top of all SEVEN pages of the KPIF application, please stop and await instructions for Step 1. September 2016

KPIF Application, cont. STEP 1: Select Open enrollment if applying between 11/1/2016 – 1/31/2017. September 2016

KPIF Application, cont. STEP 2: Select KP GA Gold 500/20 Plan. Do NOT Select any other plan. September 2016

KPIF Application, cont. STEP 3: Complete only for family members requesting coverage; including yourself. John X X X X X Smi t h 404 X D 1 234 Mai n A t l an ta 04 491 2 15 6 10 19 76 S t r ee t GA 3 031 7 Fu l t on j ohn. smi t h @gmai l. com September 2016 X

KPIF Application, cont. STEP 3: (continued): Add spouses or domestic partners here if applicable & disregard parent or legal guardian section (applicant should be over 18 because he or she would otherwise qualify for Medicaid). J a n e R Sm i t h X XX X 0 8 0 7 XX XX 1 9 7 8 X September 2016

KPIF Application, cont. STEP 3: (continued): List dependents here if applicable. J e r e my D S m i t h X X C h i l d September 2016 0 2 X X 1 8 X X 1 9 9 6

KPIF Application, cont. STEP 4: This step is required only of you would like someone to act for you in matters related to this application. J a n e R S m i t h 4 0 4 Jane Smith September 2016 1 1 4 6 7 1 5 7 8 9 1 2 0 1 6

KPIF Application, cont. STEP 5: All applicants age 19 or over must sign and date. Failure to do so will delay the processing of your application. September 2016 John Smith 1 1 1 5 2 0 1 6 Jane Smith 1 1 1 5 2 0 1 6 Jeremy Smith 1 1 1 5 2 0 1 6

KPIF Application, cont. STEP 6: Please disregard payment details. September 2016

KPIF Application, cont. STEP 7: Please disregard. September 2016

Bridge Subsidy Application September 2016

Bridge Subsidy Application, cont. September 2016

Bridge Subsidy Application, cont. Envelopes with pre-paid postage will be provided to all CPs. September 2016

Bridge Subsidy Application, cont. September 2016

Bridge Subsidy Application, cont. Note: Additional information is requested for those who select selfemployed September 2016

Bridge Subsidy Application, cont. John Smith Note: Only complete this section if you would like someone to represent you on your behalf September 2016 John Smith

Applying for the Bridge Program Recap Kaiser Permanente for Individuals and Families (KPIF) Application for health coverage (black ink) Kaiser Permanente Community Benefit Subsidy Application (blue ink) ALL PAGES: Please fill in ‘Primary Applicant’ at the top of each page. SECTION 1: Parent or legal guardian – please disregard STEP 1: Select Open enrollment if applying between 11/1/2016 – 01/31/2017. SECTION 2: Primary applicant information SECTION 3: Family information (if any) STEP 2: Select KP GA Gold 500/20. Do NOT select any other plan. SECTION 4: Household income – verify family size, income and expenses STEP 3: Complete only for family members requesting coverage; including yourself. Disregard ‘Parent or legal guardian’; the primary applicant for the Bridge Program must be age 18 or above. • Family size includes all members in household; including those that my not apply for coverage. STEP 4: This step is required only if you would like someone to act for you in matters related to this application. • Additional information regarding self-employment is included in section 4. STEP 5: All applicants age 18 or over must sign and date. Failure to do so will delay the processing of your application. SECTION 5: Certification STEPS 6 & 7: Please disregard. • Include an authorized representative only if you would like someone to act on your behalf for matters pertaining to enrollment in the Bridge Program. September 2016 • Household income includes “all income from the family (self, spouse, minor dependents/those claimed on tax return)”. • Primary applicant sign and date.