Advantage Plus Get dental, hearing aid, and additional vision benefits Kaiser Permanente Senior Advantage (HMO) Georgia Enroll now for 2019 H1170_018_18_M
Be healthy. Be vibrant. Now you have the option to add dental, hearing aid, and additional vision benefits to your Kaiser Permanente Senior Advantage (HMO) plan. And even better, it s affordable.
Get started here Our Quick Start Guide below will give you a good overview of Advantage Plus. To learn more, turn to the table of contents on page 3. Quick Start Guide A B C Go to page 4 for a quick look at how Advantage Plus makes it easy to expand your health care coverage. Turn to Benefits at a Glance on page 5 for a summary of the dental, hearing aid, and additional vision benefits of Advantage Plus. Ready to sign up? Apply for coverage by filling out the Advantage Plus enrollment form. For more information, visit us online at kp.org/advantageplus. 1
Take advantage of extra benefits today. To learn more or to enroll, call one of our Kaiser Permanente Medicare specialists toll-free at 1-877-471-1064 TTY 711 (for the deaf, hard of hearing, or speech impaired), seven days a week, 8 a.m. to 8 p.m. Or visit us online at kp.org/advantageplus. 2
Table of contents 1 Benefits at a glance...5 2 Dental coverage...6 Frequently asked questions... 7 Plan features... 8 3 4 5 6 Hearing aid coverage...10 Frequently asked questions... 11 Kaiser Permanente Contracted Hearing Aid Centers... 12 Vision coverage....13 Frequently asked questions... 14 Kaiser Permanente Vision Partners... 14 Enroll in Advantage Plus...19 Important information...20 3
Advantage Plus A BENEFITS PACKAGE FOR A HEALTHIER, MORE VIBRANT YOU As a Kaiser Permanente Senior Advantage member, having your Medicare coverage combined with your Kaiser Permanente coverage in a single plan could make life easier. Now, with Advantage Plus, you can get valuable dental, hearing aid, and additional vision benefits added to your plan. So you get the total health care coverage you need. And all of your health benefits are in one convenient package. Get more health coverage. More value. More benefits Only $15 a month premium adds Advantage Plus coverage to your Kaiser Permanente Senior Advantage plan. You ll get dental, hearing aid, and additional vision benefits. The convenience of one simple bill You ll get one bill that includes both your Kaiser Permanente Senior Advantage and Advantage Plus coverage so taking care of your health is easier than ever. If you like, you can pay your bill through monthly electronic bank payments. Advantage Plus gives you the choice to add more benefits to your Kaiser Permanente Senior Advantage plan. The Advantage Plus package is optional, so if you want to add these benefits, be sure to fill out the Advantage Plus enrollment form. Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. This information is not a complete description of benefits. Call 1-800-232-4404/TTY 711 for more information. You must continue to pay applicable Kaiser Permanente Senior Advantage premiums. You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll. You must be a Kaiser Permanente Senior Advantage (HMO) Basic, SNP, or Enhanced plan member to be eligible for Advantage Plus. Out-of-network/non-contracted providers are under no obligation to treat members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. 4 For more information, visit kp.org/advantageplus
1 Benefits at a glance Take a look at the key dental, hearing aid, and additional vision benefits you receive when you add Advantage Plus to your Kaiser Permanente Senior Advantage Plan. You pay a $15 monthly premium for all three benefits which is added to your monthly Kaiser Permanente Senior Advantage Plan premium. To learn more about how to enroll, please see Enroll in Advantage Plus on page 19. Kaiser Permanente Senior Advantage coverage only Advantage Plus coverage combined with Kaiser Permanente Senior Advantage DENTAL Dental services are generally not covered except for the dental services covered by Medicare.* Key dental benefits:* $10 per office visit that includes the following: Oral examinations: Preventive X-rays and cleanings covered twice a year. Nonroutine services: From $0 to $580 (in addition to office visit copay). Restorative services: From $18 to $580 (in addition to office visit copay). Endodontics, periodontics, extractions: From $0 to $400 (in addition to office visit copay). Prosthodontics, Oral/Maxillofacial Surgery: From $18 to $580 (in addition to office visit copay). Benefits at a glance HEARING AIDS Hearing aids are generally not covered except for certain implanted hearing devices covered by Medicare, which are provided at no additional charge.* VISION HARDWARE Vision hardware is generally not covered except for post-cataract surgery eyewear covered by Medicare.* $500 allowance per hearing aid, per ear, every three years. Certain implanted hearing devices covered by Medicare are provided at no additional charge. $500 allowance every two years. * See your Evidence of Coverage for information about dental, hearing, and vision services provided under the Kaiser Permanente Senior Advantage Plan. You must also continue to pay applicable Kaiser Permanente Senior Advantage premiums. For more information, visit kp.org/advantageplus 5
2 Enjoy the power of a healthy smile Your dental health is key to your overall health. Healthy teeth and gums allow you to eat better and feel better in body and mind. And nothing attracts the people around you like a bright smile. Preventing and treating dental problems are important at any stage of life. You may feel more tooth sensitivity or have dental problems as a result of certain medications or health conditions. Regular oral exams not only keep your mouth healthy; they can also help spot medical problems. Advantage Plus makes it easy to smile because you know you re getting the dental care you need. HEALTH TIP: Reduce your risk of infection Brushing and flossing are important for healthy teeth and gums. They also help reduce the risk of infection. With proper oral health, including brushing, flossing, and regular check-ups and cleanings, you can help keep your whole body healthy. 6 For more information, visit kp.org/advantageplus
Frequently asked questions Advantage Plus dental benefits are provided through DeltaCare USA Program offered by Delta Dental Insurance Company (Delta Dental). Q: What is the DeltaCare USA Program? A: The DeltaCare USA Program, offered by Delta Dental, provides dental care through the DeltaCare USA network of dentists. When you enroll, Delta Dental will assign you to a contract dentist. The DeltaCare USA network consists of private practice dental facilities that have been carefully screened for quality. You can contact Delta Dental to change your contract dentist. Q: When can I begin to use my dental benefits? A: Once you receive confirmation of your enrollment in Advantage Plus, you can begin using your dental benefits on your effective date at your assigned facility. You will also receive a dental identification card from Delta Dental. Q: How do I choose my dentist? A: When you enroll in Advantage Plus, Delta Dental will assign you to a contract dentist based on your home ZIP code. If you would like to change your assigned dentist, you can do so at any time. Call Delta Dental s Customer Service Department toll free at 1-844-519-8693 (TTY 711), Monday through Friday, 8 a.m. to 9 p.m. Delta Dental is always expanding its network and adding new dentists and areas. For the most up-to-date list of dentists, visit deltadentalins.com/directory. Q: How do I make an appointment? A: To make an appointment, simply call your assigned dentist s facility and identify yourself as a DeltaCare USA Program enrollee. To get covered services, you must go to your assigned Delta dentist. Services provided by a specialist pre-approved by Delta Dental or emergency services are exceptions. Any other treatment is not covered under this dental program. Q: What happens if I have an emergency? A: If emergency services are needed, you should get in touch with your contract dentist whenever possible. If you are a new member and do not have an assigned contract dentist yet, and you need emergency services, you should contact Delta Dental s Customer Service department toll free at 1-844-519-8693 (TTY: 711 for the hearing/speech impaired), Monday through Friday, 8 a.m. to 9 p.m., Eastern time. For more information about emergency benefits, see your Kaiser Permanente Senior Advantage Evidence of Coverage. Dental coverage For more information, visit kp.org/advantageplus 7
Q: Can I get a second opinion? A: You may ask for a second opinion if you disagree with or question your contract dentist s diagnosis and/or treatment plan. Delta Dental may also ask you to get a second opinion to confirm that your contract dentist s treatment or your use of benefits is necessary and appropriate. For more information, see your Kaiser Permanente Senior Advantage Evidence of Coverage. Q: What if I need to change my Delta dentist? A: You may change your dentist at any time by calling Delta Dental s Customer Service department toll free at 1-844-519-8693 (TTY 711), Monday through Friday, 8 a.m. to 9 p.m. You must make your request for a contract dentist change before the 21st of the month for the change to be effective the first day of the next month. Before you can change your contract dentist, you must also complete any treatment in progress, such as (a) partial or full dentures for which final impressions have been taken, (b) completion of root canals, or (c) delivery of crowns when teeth have been prepared. DeltaCare USA Plan With enrollment in Advantage Plus, you will receive dental coverage for comprehensive services through the DeltaCare USA Program. You must visit a dentist in the DeltaCare USA network to receive benefits. Services provided by out-of-network dentists will not be covered. Please refer to your Evidence of Coverage for more information on benefits, limitations, and exclusions. For more information regarding your medical plan benefits, please refer to your Summary of Benefits. For full information on Kaiser Permanente Senior Advantage benefits, call our Member Services department toll free at 1-800-232-4404, seven days a week, 8 a.m. to 8 p.m. TTY users should call 711. 8 For more information, visit kp.org/advantageplus
How your plan works Features Cost to patient Covered services Copays Dentist network advantages DeltaCare USA Program Coverage is included in your $15 Advantage Plus monthly premium. Comprehensive dental services provided by your assigned contract dentist. Out-of-pocket costs are clearly defined. When you enroll, Delta Dental will assign you to a contract dentist. You can contact Delta Dental to change your contract dentist. The DeltaCare USA network consists of private practice dental facilities that have been carefully screened for quality. Services provided by out-of-network dentists will not be covered. Out-of-area coverage Deductibles/maximums Additional advantages Services provided by out-of-network dentists will not be covered. You must receive services from your assigned DeltaCare USA provider. No deductible or maximums on covered procedures. Claims convenience DeltaCare USA providers file all claims for you and process all referrals to specialty care. Dental coverage Contact us DeltaCare USA Customer Service (includes automated voice attendant) Call toll free: 1-844-519-8693 TDD & TTY: 711 8 a.m. 9 p.m. Monday Friday Dentist Search, Online Eligibility, Benefits, and Claims Status deltadentalins.com Claims Submission Delta Dental Insurance Company P.O. Box 1809 Alpharetta, GA 30023-1809 For more information, visit kp.org/advantageplus 9
3 Hear well. Live well. Good hearing allows you to participate in life more fully. You re more confident, more secure, and more connected to your world. Millions of Americans experience some degree of hearing loss. Among people over 50, it s the third most common ailment, behind heart disease and arthritis. But now, more than ever, hearing loss doesn t mean that your quality of life has to change. Today s hearing products are smaller, more effective, and more comfortable. Hearing benefits from Advantage Plus can help make sure you re not missing the sounds and conversations that make life more fulfilling. HEALTH TIP: Quick hearing self-check Do you often ask people to speak up or repeat themselves? Do you have trouble following conversations in a noisy room or understanding speech on the phone? Do you have trouble hearing the sound of your telephone, alarm clock, or doorbell? Do others complain that your TV or stereo is too loud? 10 For more information, visit kp.org/advantageplus
Frequently asked questions The hearing aids that Advantage Plus covers are provided at select Kaiser Permanente facilities and by referral at designated contracted providers. Q: If I have a hearing loss, are hearing aids covered? A: As a Kaiser Permanente member with the Advantage Plus package, you will receive a $500 allowance toward the purchase of a hearing aid in each ear (maximum $1,000 for both ears). This credit is available once every three years. You will be responsible for the difference between the $500 allowance and the price of the hearing aid. Q: Where can I obtain my hearing aids? A: You may use your hearing aid benefit at our core Kaiser Permanente audiology facilities and by referral at designated contracted providers. Q: How does my hearing aid benefit work? A: If a hearing aid is prescribed, you may use your hearing aid benefit at our core Kaiser Permanente audiology facilities and by referral at designated contracted providers. Q: What if I have a medical problem with my hearing? A: If a medical problem is identified during the hearing examination, the audiologist will notify your primary care physician of the results and assist you in obtaining the appropriate medical follow-up. Q: What if I need service or repairs on my hearing aid? A: The hearing aid you purchase at our core Kaiser Permanente audiology facilities and by referral at designated contracted providers may be covered by the manufacturer s warranty. The warranty details will be explained at the time of purchase. Batteries and accessories are not covered under this hearing aid benefit. Hearing aid coverage Q: Are there any limitations to the type or style of hearing aid that is covered? A: You may purchase your hearing aid at our core Kaiser Permanente audiology facilities and by referral at designated contracted providers. The audiologist will assist you in selecting the hearing aids that best meet your needs. A complete range of technologies and styles is available, and you will receive a thorough explanation of your test results and recommended treatment options. For more information, visit kp.org/advantageplus 11
Kaiser Permanente Audiology and Core Facilities CLAYTON COUNTY Jonesboro Southwood Comprehensive Medical Center 2400 Mount Zion Pkwy. Jonesboro, GA 30326 770-603-3649 FULTON COUNTY Atlanta Glenlake Comprehensive Medical Center 20 Glenlake Pkwy. Atlanta, GA 30328 770-677-6075 Designated Contracted Providers Kaiser Permanente Referral Required DEKALB COUNTY Decatur Atlanta Hearing Aid Services of Decatur 2655-D North Decatur Rd. Decatur, GA 30033 404-373-2411 GWINNETT COUNTY Duluth Gwinnett Comprehensive Medical Center 3650 Steve Reynolds Blvd. Duluth, GA 30096 770-931-6012 12 For more information, visit kp.org/advantageplus
4 Focus on a healthier you Here s an immediate way to enhance your life: improve your vision. It s possible that your vision has changed but you haven t noticed. When you see clearly, your daily activities, such as driving and reading, become noticeably easier. Vision coverage It s important to have your eyes checked regularly to identify minor as well as more serious eye problems. Advantage Plus adds a material eyewear allowance to your Senior Advantage plan. So you ll have more choices to help you see a brighter, more vibrant world. HEALTH TIP: Better night vision Keep these helpful nighttime-driving guidelines in mind: Drive more slowly so that you have more time to react. Keep your windshield, as well as all the lights on your car, clean. Ask your eye care professional about getting anti-reflective coating on your eyeglass lenses to cut down on glare. Check with your doctor to find out if any medications you are taking can affect your night vision. For more information, visit kp.org/advantageplus 13
Frequently asked questions The vision hardware benefits covered by Advantage Plus are provided at our core Kaiser Permanente facilities and vision partners in the Atlanta metro area. For information about vision services (including limitations and exclusions) covered by Senior Advantage and Advantage Plus, see your Kaiser Permanente Senior Advantage Evidence of Coverage. Q: What is my coverage for eyeglasses and contact lenses? A: As a Kaiser Permanente member with the Advantage Plus package, you will receive a credit of $500 to use toward the purchase of eyeglasses and contact lenses every two years. If you do not use the entire $500 credit at the initial point of sale, you cannot use it later. If the eyewear you purchase costs more than $500, you will be responsible for paying the difference. Q: After I first use my Advantage Plus vision benefit, when can I use it again? A: You are eligible to use your Advantage Plus vision benefit two years from the date that you last obtained your eyeglasses or contact lenses using this benefit. Q: Where can I obtain my eyeglasses and contact lenses? A: You may use your vision benefit for contacts and eyeglasses at our vision partner locations listed below. You can also find out more information about your vision benefit by calling our Member Services department at 1-800-232-4404 (TTY: 711). Kaiser Permanente vision partners CHEROKEE COUNTY Canton MyEyeDr 217 Riverstone Dr Canton, Ga 30114 770-345-5220 Woodstock Eyes On Towne Lake 1075 Buckhead Crossing Suite 130 Woodstock, Ga 30189 770-702-5996 MyEyeDr 12924 Hwy 92 Suite 100 Woodstock, Ga 30188 678-717-9121 MyEyeDr 9801 Hwy 92 Suite 100 Woodstock, Ga 30188 770-592-7100 14 For more information, visit kp.org/advantageplus
CLAYTON COUNTY DEKALB COUNTY Morrow Marietta Atlanta Clayton Eye Center 1000 Corporate Center Dr Suite 100 Morrow, Ga 30260 770-968-8888 For Eyes Optical Co. 1297 Mount Zion Rd Morrow, Ga 30260 770-960-9077 COBB COUNTY Acworth Eye Contact 1720 Mars Hill Rd Northwest Suite 160 Acworth, Ga 30101 770-529-1925 Austell Mobley Eye Care 2345 East West Connector Suite 1010 Austell, Ga 30106 770-941-2323 Kennesaw Hobson Eye Associates 1415 Wooten Lake Rd NW Suite 100 Kennesaw, Ga 30144 770-424-2020 Tasman Eye Consultants 1415 Wooten Lake Rd NW Suite 100 Kennesaw, Ga 30144 770-792-3937 Eye Site Optical Of Marietta 596 Cobb Pkwy S Marietta, Ga 30060 770-429-1847 For Eyes Optical Co 4101 Roswell Rd NE Suite 905 Marietta, Ga 30062 770-565-6763 The Eye Gallery-East Cobb 1311 Johnson Ferry Rd Marietta, Ga 30068 770-977-4139 Smyrna Eye Associates Of Smyrna 2430 Herodian Way SE Suite 200 Smyrna, Ga 30080 770-953-9000 COWETA COUNTY Newnan Clayton Eye Surgeons 2700 Hwy 34 East Bldg 100 Newnan, Ga 30265 770-968-8888 Sharpsburg Mobley B Dean, OD 3339 Hwy 34 East Sharpsburg, Ga 30277 770-304-2025 MyEyeDr 2184 Henderson Mill Rd NE Suite 12B Atlanta, Ga 30345 770-938-2923 Brookhaven MyEyeDr 1418 Dresden Dr NE Brookhaven, Ga 30319 404-239-0272 MyEyeDr 3369 Buford Hwy NE Brookhaven, Ga 30329 404-320-9100 Decatur Belvedere Eye Center 3479 Memorial Dr Suite A & B Decatur, Ga 30032 404-534-1222 Tucker For Eyes Optical Co. 4104 La Vista Rd Tucker, Ga 30084 770-493-3995 Vision coverage For more information, visit kp.org/advantageplus 15
FAYETTE COUNTY Fayetteville A Plus Optique 1240 Hwy 54 West Suite 306 Fayetteville, Ga 30214 678-834-7411 Mobley Eye Care 539 North Glynn St Suite A Fayetteville, Ga 30214 678-817-7722 FORSYTH COUNTY Cumming Complete Family Eyecare & Optique, PC 2350 Atlanta Hwy Suite 110 Cumming, Ga 30040 678-965-5558 FULTON COUNTY Alpharetta For Eyes Optical Co. 5230 Windward Pkwy Ste 100 Alpharetta, Ga 30004 678-537-0002 b.spectacled Alpharetta 50 Canton St Suite 112 Alpharetta, Ga 30009 678-894-1650 MyEyeDr 3975 Old Milton Pkwy Suite 2 Alpharetta, Ga 30005 678-624-7766 Atlanta Atlanta Vision Clinic 5445 Meridian Mark Rd Suite 370 Atlanta, Ga 30342 404-765-2020 Atlanta Vision Group 2385 Peachtree Rd NE Suite A2EF Atlanta, Ga 30305 404-237-4922 Eye Center Of Atlanta PC 501 Pulliam St SW Suite 139 Atlanta, Ga 30312 404-589-8517 Eye Elements 867 Peachtree St NE Suite 2 Atlanta, Ga 30308 470-823-4375 Eyecare One Vision Center 590 Cascade Rd Atlanta, Ga 30310 404-753-7777 For Eyes Optical Co. 2391 Peachtree Road North East Suite B3AB Atlanta, Ga 30305 404-262-2017 MyEyeDr 2549 Piedmont Rd NE Suite 120 Atlanta, Ga 30324 404-467-0717 MyEyeDr 3155 Cobb Pkwy SE Suite 110 Atlanta, Ga 30339 770-644-0012 Southern Eye Specialists, PC 3071 Campbellton Rd SW Suite 1 Atlanta, Ga 30311 404-344-3556 The Eye Gallery Atlantic Station 1380 Atlantic Dr Atlanta, Ga 30363 404-593-2926 The Eye Gallery Buckhead 3330 Piedmont Rd Ne Atlanta, Ga 30305 404-231-3772 West End Eye Center 807 Ralph David Abernathy Blvd Atlanta, Ga 30310 404-755-4300 College Park Leah Johnson Mcferren, OD, PC 1704 Virginia Ave College Park, Ga 30337 404-768-3500 16 For more information, visit kp.org/advantageplus
Duluth Eye 1St Vision & Laser 10080 Medlock Bridge Rd Duluth, Ga 30097 770-623-3931 Sugarloaf Eyecare 6555 Sugarloaf Pkwy Suite 305 Duluth, Ga 30097 770-495-0937 Hapeville Atlanta Vision Cataract & Laser Center 3619 South Fulton Ave Hapeville, Ga 30354 404-765-2020 Roswell Visual Eyes 2300 Holcomb Bridge Rd Suite 306 Roswell, Ga 30076 678-722-3937 Sandy Springs 20/15 Eyecare, LLC 2090 Dunwoody Club #126 Sandy Springs, Ga 30350 770-676-7848 Eye 1St Vision Center 901 Abernathy Rd Suite 100 Sandy Springs, Ga 30328 404-252-1702 For Eyes Optical Co 6015 Roswell Rd NE Suite B Sandy Springs, Ga 30328 404-843-8277 MyEyeDr 5940 Roswell Rd NE Sandy Springs, Ga 30328 404-843-2020 The Eye Gallery-Sandy Springs 5975 Roswell Rd Sandy Springs, Ga 30328 404-252-4111 Union City Monique Batchelor, LLC 4735 Jonesboro Rd Union City, Ga 30291 770-969-5976 GWINNETT COUNTY Duluth For Eyes Optical Co 2130 Pleasant Hill Rd Duluth, Ga 30096 770-622-8883 Gwinnett Eye Clinic 3455 Peachtree Industrial Blvd Suite 845 Duluth, Ga 30096 770-476-3606 The Eye Gallery GW 2100 Pleasant Hill Rd Suite 259 Duluth, Ga 30096 678-473-1226 Grayson Nanston Vision Snellville 1707 Bristol Farms Ct Grayson, Ga 30017 770-668-6693 Lawrenceville Brookwood Eyecare/ Dr. Jamilah Birdsong 3370 Sugarloaf Pkwy Suite B3 Lawrenceville, Ga 30044 770-736-7774 MyEyeDr 875 Lawrenceville Suwanee Rd Lawrenceville, Ga 30043 770-963-0370 Sugarloaf Vision Center, LLC 4825 Sugarloaf Pkwy Suite F Lawrenceville, Ga 30044 770-559-9670 Lilburn Eye Elements 4153 Lawrenceville Hwy NW Suite 5 Lilburn, Ga 30047 770-921-4707 Vision coverage For more information, visit kp.org/advantageplus 17
GWINNETT COUNTY continued Norcross Norcross Eye Center 1560 Indian Trail Lilburn Rd Suite 108 Norcross, Ga 30093 678-580-0195 Pure Vue Vision Care, LLC 6050 Peachtree Pkwy Suite 210 Norcross, Ga 30092 770-903-4555 The Eye Gallery The Forum 5165 Peachtree Pkwy Norcross, Ga 30092 770-447-4790 Peachtree Corners Ferdon Family Eyecare 5270 Peachtree Pkwy Suite 109A Peachtree Corners, Ga 30092 678-271-3445 Snellville For Eyes Optical Co. 2055 Scenic Hwy Suite B Snellville, Ga 30078 770-736-8311 Suwanee MyEyeDr 1000 Peachtree Industrial Blvd Suwanee, Ga 30024 770-271-0611 HENRY COUNTY Hampton Advanced Family Eyecare of Hampton, LLC 990 Bear Creek Blvd Suite D Hampton, Ga 30228 770-707-0711 Locust Grove Eye Associates of Locust Grove 4946 Bill Gardner Pwky Locust Grove, Ga 30248 770-957-9814 McDonough MyEyeDr 1044 Avalon Pkwy McDonough, Ga 30253 770-898-7078 Stockbridge Henry Vision Center, LLC 3564 Hwy 138 SE Stockbridge, Ga 30281 770-474-5618 18 For more information, visit kp.org/advantageplus
5 Enroll in Advantage Plus Applying for Advantage Plus is easy! 1. Go online today! To learn more and to download an enrollment form, visit kp.org/advantageplus. 2. We re here to help. If you re ready to enroll or have questions, call a Kaiser Permanente Medicare specialist at 1-877-471-1064 (TTY 711), seven days a week, 8 a.m. to 8 p.m. Other important information about applying for Advantage Plus: You must be a Kaiser Permanente Senior Advantage individual plan member to enroll in the Advantage Plus package. fill out a new enrollment form, you can add Advantage Plus within 30 days of enrolling in Kaiser Permanente Senior Advantage. Enroll in Advantage Plus If you re already a Kaiser Permanente Senior Advantage member, you can enroll in the Advantage Plus package any time from October 15, 2018 through March 31, 2019. If you re a new Kaiser Permanente Senior Advantage member, or enrolling because you have moved and need to The premium for your Advantage Plus dental, hearing aid, and additional vision benefits is $15 per month. The $15 monthly premium is in addition to your monthly Kaiser Permanente Senior Advantage premium, if any, and you must also continue to pay your Medicare Part B premium. Thank you for taking this step toward better dental, hearing, and vision health. We ll let you know when your enrollment form has been approved and give you more details about your coverage and start date. For more information, visit us online at kp.org/advantageplus. Or call one of our Kaiser Permanente Medicare specialists at 1-877-471-1064 (TTY 711), seven days a week, 8 a.m. to 8 p.m. We ll be happy to help. For more information, visit kp.org/advantageplus 19
6 Important information The Advantage Plus benefit package gives you additional dental,* hearing aid, and extra vision coverage for an additional monthly premium of $15. This is in addition to any premiums required for Kaiser Permanente Senior Advantage described in your Kaiser Permanente Senior Advantage Evidence of Coverage, and you must also continue to pay your monthly Medicare premiums. For more information about dental, hearing aid, and additional vision coverage through Advantage Plus, see your Kaiser Permanente Senior Advantage Evidence of Coverage. Enrollment and disenrollment Enrollment To enroll in Advantage Plus, you must complete the Advantage Plus enrollment form. If you are already a Kaiser Permanente Senior Advantage member, you may add Advantage Plus benefits to your Kaiser Permanente Senior Advantage individual plan coverage by sending us the enrollment form before March 31, 2019, for coverage to become effective on April 1, 2019. Coverage is effective the 1st of the month following the date we receive your completed enrollment form. If you are enrolling in Kaiser Permanente Senior Advantage either as a new member or because you have moved and you must complete a new Kaiser Permanente Senior Advantage enrollment form, you can add Advantage Plus within 30 days of enrolling in Kaiser Permanente Senior Advantage. Coverage is effective the 1st of the month following the date we receive your completed enrollment form. Disenrollment You can stop your Advantage Plus coverage anytime. Your disenrollment will be effective the first of the month following the date we receive your completed disenrollment form. To request a disenrollment form, please call our Member Service Contact Center toll free at 1-800-232-4404 (TTY 711 for the hearing/speech impaired), seven days a week, 8 a.m. to 8 p.m. For more details about disenrollment, see your Kaiser Permanente Senior Advantage Evidence of Coverage. For additional information about the Kaiser Permanente Senior Advantage individual plan, see your Kaiser Permanente Senior Advantage Evidence of Coverage. * Kaiser Permanente has an agreement with Delta Dental to provide you comprehensive dental care through a network of dentists that contract with Delta Dental s DeltaCare USA Dental program. For information about dental coverage, please refer to your Kaiser Permanente Senior Advantage Evidence of Coverage. 20 For more information, visit kp.org/advantageplus
Hearing aid and vision coverage For more information about hearing and vision coverage, including exclusions and limitations, please see the Kaiser Permanente Senior Advantage Evidence of Coverage (EOC). Dental coverage For more information about dental coverage including exclusions and limitations, please see your Kaiser Permanente Senior Advantage Evidence of Coverage for detailed information about dental services provided under your Senior Advantage individual plan. Information you need to know For more information, visit kp.org/advantageplus 21
Notice of nondiscrimination Kaiser Permanente complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Kaiser Health Plan does not exclude 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 Member Services at 1-800-232-4404 (TTY 711), 8 a.m. to 8 p.m., seven days a week. If you believe that Kaiser Permanente has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with our Civil Rights Coordinator by writing to Attention: Member Services, Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305 or calling Member Services at the number listed above. You can file a grievance by mail or phone. If you need help filing a grievance, our Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically 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, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. 61104516 22 For more information, visit kp.org/advantageplus
Multi-language Interpreter Services English ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-800-232-4404 (TTY: 711). Spanish ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-232-4404 (TTY: 711). 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 1-800-232-4404 (TTY:711) Vietnamese CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-232-4404 (TTY: 711). Korean 주의 : 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다. 1-800-232-4404 (TTY: 711) 번으로전화해주십시오. Russian ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-800-232-4404 (телетайп: 711). 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 1-800-232-4404(TTY:711) まで お電話にてご連絡ください Amharic ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች በነጻ ሊያግዝዎት ተዘጋጀተዋል ወደ ሚከተለው ቁጥር ይደውሉ 1-800-232-4404 (መስማት ለተሳናቸው: 711). H1170_016_11 accepted 60505608 For more information, visit kp.org/advantageplus 23
Farsi توجھ: اگر بھ زبان فارسی گفتگو می کنید تسھیلات زبانی باشد. با (711 (TTY: 1-800-232-4404 تماس بگیری بصورت رایگان برای شما فراھم می Arabic ملحوظة: إذا كنت تتحدث اذكر اللغة فا ن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم 4044-232-008-1 (رقم ھاتف الصم والبكم: -117). German ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-800-232-4404 (TTY: 711). French ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-800-232-4404 (ATS : 711). Portuguese ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-800-232-4404 (TTY: 711). French Creole ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-800-232-4404 (TTY: 711). 24 For more information, visit kp.org/advantageplus
For a healthier, more vibrant you. Enroll in Advantage Plus today. Get more value from your Kaiser Permanente Medicare health plan by adding Advantage Plus. You can get extra benefits such as dental, vision, and hearing aid coverage for an affordable monthly premium. More health benefits, great care. Now that s a healthy addition to your coverage. Want more info? Visit kp.org/advantageplus to enroll online today. Or call one of our Kaiser Permanente Medicare specialists toll free at 1-877-471-1064 (TTY 711), seven days a week, 8 a.m. to 8 p.m.
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