Kaiser Permanente Medicare Plus (Cost) Member Handbook

Transcription

MEDICARE PLUS
MEMBER HANDBOOK
Kaiser Permanente Medicare Plus (Cost)
OHIO REGION
WELCOME!
Welcome to
KAISER PERMANENTE MEDICARE PLUS!
We’re glad that you’ve chosen us as your health plan, and we look forward to
having you as a member. To help you get started with us, we’ve produced this
Member Handbook. The Handbook contains information on choosing a doctor,
seeking routine and specialty care, and using our pharmacies, in addition to
important information on member rights, responsibilities, and privacy. This
Handbook was developed with you in mind, it covers most of the important
information you’ll need. Please keep it handy for quick reference.
Kaiser Permanente makes it convenient for you to access medical care by
giving you the information you need. This Member Handbook contains the
following materials:
• Detailed information explaining how you can receive care and access benefits
through your health care plan.
• Phone numbers, addresses, and office hours for the Kaiser Permanente
medical offices throughout Northeast Ohio, and addresses and phone
numbers for our network hospital locations, retail pharmacies, and
optical stores.
Also, look for your Evidence of Coverage, which will be mailed to you shortly.
It contains important information about your benefits, copayments, limitations,
and services. This Member Handbook is an overview of your benefits, and your
Evidence of Coverage always takes precedence over the Handbook.
We want your health care experience with us to be a positive one. If you have any
questions, please call Customer Relations at 1-800-493-6004 or 1-866-513-9966
(TTY/TDD); seven days a week, 8 a.m. – 8 p.m. Or you can write to us at:
Kaiser Permanente
Customer Relations
P.O. Box 5309
Cleveland, OH 44101
Once again, welcome to Kaiser Permanente Medicare Plus. We look forward to a
long and healthy relationship with you.
kp.org
Kaiser Permanente Member Handbook | 1
TABLE OF CONTENTS
GETTING CARE AND UTILIZING YOUR BENEFITS ................................ 4
Getting started with Kaiser Permanente Medicare Plus ................ 4
Your benefits ............................................................................... 4
You and your primary care physician ........................................... 5
Using your Kaiser Permanente Medicare Plus ID card ................ 6
Special needs .............................................................................. 6
Your appointments ........................................................................ 6
Making appointments ................................................................. 6
Canceling appointments ............................................................. 7
Paying for your visit ..................................................................... 7
Getting a second opinion............................................................ 7
Seeing a specialist ....................................................................... 7
Asking for advice......................................................................... 8
Emergency Care ............................................................................ 9
After Hours Care ......................................................................... 9
When to call 911 ......................................................................... 9
Kaiser Permanente emergency facilities ..................................... 9
Non–Kaiser Permanente emergency facilities ........................... 10
Traveling within another Kaiser Permanente service area ........... 10
Pharmacy services ....................................................................... 10
Getting prescriptions filled ....................................................... 10
Our drug formulary ................................................................... 11
Having refills mailed to you ....................................................... 12
Health Care Tools ...................................................................... 13
Getting and staying well ............................................................. 14
Alternative and complementary medicine ................................ 14
Fitness ....................................................................................... 14
Nonprescription products available .......................................... 15
Education .................................................................................. 15
2 | Kaiser Permanente Member Handbook
TABLE OF CONTENTS
HOW TO REACH US......................................................................... 16
Important phone numbers .......................................................... 16
Kaiser Permanente medical facilities ........................................... 18
Hospitals ..................................................................................... 22
Emergency Services .................................................................... 23
Urgent Care Locations ................................................................ 24
Pharmacies .................................................................................. 25
Optometry locations ................................................................... 27
RIGHTS, RESPONSIBILITIES, AND PRIVACY .................................... 31
Your rights as a Kaiser Permanente member............................... 31
Your responsibilities as a Kaiser Permanente member ................ 32
Advance directives for health care .............................................. 33
End of participation by Kaiser Permanente in
the Medicare program ................................................................ 33
Privacy notice .............................................................................. 35
kp.org
GETTING CARE AND UTILIZING YOUR BENEFITS
Getting Care And
Utilizing Your Benefits
GETTING STARTED WITH
KAISER PERMANENTE MEDICARE PLUS
YOUR BENEFITS
Thank you for choosing Kaiser Permanente
Medicare Plus. We want you to understand
and feel comfortable with your health-related
needs and decisions. The more you learn about
our quality care, the more confident you can
feel about your Kaiser Permanente Medicare
Plus membership.
Kaiser Permanente is a Medicare Health Plan
with a Medicare Cost contract.* The Medicare
program pays us to manage health services
for people with Medicare who are members
of Kaiser Permanente Medicare Plus. Kaiser
Permanente provides medical services through
Medicare-certified health care facilities. In
addition, our health care professionals are
in compliance with Medicare credentialing
standards.
*Kaiser Permanente contracts with the Federal
Government. This contract is renewed annually.
The availability of coverage beyond the current
year is not guaranteed.
Kaiser Permanente Medicare Plus is not
a Medicare supplement policy. Medicare
supplement policies are sometimes called
“Medigap” insurance policies.
Kaiser Permanente Medicare Plus gives you
all of the usual Medicare services that are
covered for everyone with Medicare. Since
Kaiser Permanente Medicare Plus is a cost
paying contract, this means that you will
be getting most or all of your health care
services from the doctors, hospitals, and other
health care providers that are part of Kaiser
Permanente Medicare Plus. And since these
doctors, hospitals, and other providers are the
ones we are paying to care for you, they are the
ones you must use for routine care.
You may use non-Kaiser Permanente providers,
but you will have to pay Original Medicare
out-of-pocket amounts for your care. This
means you would be responsible for paying the
Original Medicare coinsurance and deductibles
for those services. For example, you would
pay 20% of the cost of the visit, plus any
amount due toward the annual deductible that
Medicare requires.
For more specific information about which
services are covered, refer to your Evidence
of Coverage (EOC). It contains important
details about your health plan, including
limitations and exclusions. If you have
questions and haven’t yet received your
EOC, please call Customer Relations at
1-800-493-6004; 1-866-513-9966 (TTY/TDD);
seven days a week, 8 a.m. – 8 p.m.
YOU AND YOUR PRIMARY CARE PHYSICIAN
We believe it’s important for you (and every
member of your family covered by your plan)
to have a primary care physician (PCP) who
will be your primary point of contact and who
will oversee your care. Your PCP will take the
time to get to know you and your health needs.
You’ll see your PCP for most appointments,
and he or she will refer you to specialists when
necessary. Your primary care physician is your
health advocate, committed to working with
you to help you achieve and maintain good
health over the long term. Your primary care
team includes your PCP and a select group of
physicians, nurse practitioners and/or physician
assistants, and nursing staff who work with and
support your PCP.
When you call for your first appointment, we
will verify your PCP selection. When choosing
your PCP, please keep in mind that your choice
will determine where you receive covered
specialty care. Your PCP has an established
relationship with a specific group of specialty
care physicians with whom he or she works. By
referring only to a select group of specialists,
your PCP is better able to coordinate and
oversee your medical care.
If you’re choosing your PCP for the first time, or
if you’d like to change PCPs, you may choose
one from the Internal Medicine, Pediatric, or
Family Practice physicians listed in the Provider
kp.org
Directory included with your enrollment
materials. To choose another physician, call
Member Support Services at (216) 524-5001 or
1-877-524-5001, or (216) 398-3187 or
1-877-398-3187 (TTY/TDD), for assistance,
Monday through Friday, 8 a.m. to 5:00 p.m.
and Saturday 8 a.m. to noon. We can provide
you with information about the professional
qualifications, medical school attended,
residency completed, and board certification
status of any Kaiser Permanente or network
primary or specialty care physician.
You may change PCPs once a month for any
reason as long as the new PCP you’ve chosen is
accepting new patients. Generally, the transfer
will become effective the first day of the month
following your request.
Kaiser Permanente has hundreds of physicians
practicing throughout Northeast Ohio.
Physicians who are part of the Ohio Permanente
Medical Group (OPMG) practice in Kaiser
Permanente facilities and serve only Kaiser
Permanente members. We refer to these
physicians as Kaiser Permanente physicians.
Our affiliated community physicians are those
who participate in our network but are not
part of OPMG. They maintain their own offices
and serve other patients in addition to Kaiser
Permanente members.
There are 10 conveniently located Kaiser
Permanente medical offices in Northeast Ohio.
If you selected a Kaiser Permanente primary
care physician, you will receive most of your
care at the medical office where your doctor
is located. Many of the services you might
need—including pharmacy, radiology, and
laboratory testing—are usually available in the
same location as your physician. In addition, we
will keep your medical records on our secure
electronic medical record system My Health
Manager so that your primary care team can
access them from any Kaiser Permanente
medical facility in Northeast Ohio.
If you have selected a primary care physician
from our list of network physicians, you will
receive care at his or her office. Your primary
care physician will coordinate all of the other
non-emergency services you may need.
USING YOUR KAISER PERMANENTE ID CARD
Now that you are a member of Kaiser
Permanente Medicare Plus, you have a Kaiser
Permanente Medicare Plus ID card. You must
use your Kaiser Permanente Medicare Plus
ID card instead of your red, white, and blue
Medicare card to obtain services covered by
Kaiser Permanente Medicare Plus.
Some providers may ask to see your red, white, and
blue Medicare card, but for the most part you will
not use it to get services while you are a member.
Only use your red, white, and blue Medicare card
when you want to receive services from non-Kaiser
Permanente providers (except for emergency or
out-of-area urgently needed services).
Your Kaiser Permanente Medicare Plus ID card
identifies you as a member and includes your
Medical Record Number (MRN). Your MRN
allows us to efficiently make appointments for
you, properly access your medical records, and
more. Please carry your Kaiser Permanente
Medicare Plus ID card with you at all times.
If you are a new member, check your card to
make sure all the information is correct. If your
card has inaccurate information—or if you lose
your card—please call Customer Relations at
1-800-493-6004 or 1-866-513-9966 (TTY/TDD);
seven days a week, 8 a.m. – 8 p.m. We’ll send
you a new card with the correct information or
replace your lost card.
SPECIAL NEEDS
We strive to provide services in a way that
embraces all members, including those with
limited English language ability or reading
skills, diverse cultural and ethnic backgrounds,
and any physical or mental disabilities. This
information may be available in alternate
formats, including large print. If you have
special needs, questions or concerns, please
call Customer Relations at 1-800-493-6004;
1-866-513-9966 (TTY/TDD); seven days a week,
8 a.m. – 8 p.m.
For our deaf, hard of hearing, or speech
impaired members, we list (TTY/TDD) numbers
throughout this Handbook whenever they
are available. However, not all services can
be provided in the same way via (TTY/TDD)
lines. When applicable, we’ve included nontelephone methods to access the same
information or service, such as mail or Internet.
For assistance when no (TTY/TDD) number is
available or for clarification of other methods
of accessing information and services, please
contact Customer Relations at 1-866-513-9966
(TTY/TDD), seven days a week, 8 a.m. – 8 p.m.
YOUR APPOINTMENTS
MAKING APPOINTMENTS
If you’ve chosen a Kaiser Permanente primary
care physician, call the Member Service Center
to schedule an appointment, 24 hours a day,
seven days a week, at (216) 524-7377 or
1-800-524-7377, or (216) 398-3187 or
1-877-398-3187 (TTY/TDD). When you call,
please have your Medical Record Number
handy (it is printed on your ID card).
We offer same-day appointments when
medically necessary. If your primary care
physician is not available, you will be scheduled
to see another provider within your primary
healthcare team.
If you’ve selected a network primary care
physician, call his or her office directly when you
need care.
CANCELING APPOINTMENTS
Please let us know as soon as possible if you
need to cancel an appointment. To cancel a
routine appointment with a Kaiser Permanente
physician, just call our automated Appointment
Cancellation Line at (216) 749-7170 or 1-800589-7170, 24 hours a day, seven days a week.
Deaf, hard of hearing, or speech impaired
members may call the Member Service Center
at 1-877-398-3187 (TTY/TDD), 24 hours a day,
seven days a week.
To cancel an appointment with a network
physician, please contact his or her office directly.
PAYING FOR YOUR VISIT
As a Kaiser Permanente member, you
are expected to pay for services on the
date services are provided. This includes
copayments, coinsurance, and deductibles.
For non-covered services such as cosmetic
procedures, we may require a deposit or
advance payment. For your convenience,
we accept cash, checks, VISA, MasterCard,
Discover, and American Express.
If charges are not paid on the date of service,
we will bill you. If you are unable to pay your
account in full, you must notify our Patient
Accounting Department to make payment
arrangements. Please call (216) 265-8844 or
1-866-265-8844, Monday – Friday, 8:30 a.m.
to 4 p.m. Deaf, hard of hearing, or speech
impaired members may call Customer Relations
at 1-866-513-9966 (TTY/TDD); seven days a
week, 8 a.m. – 8 p.m. for assistance contacting
our Patient Accounting Department.
kp.org
Your Evidence of Coverage (EOC) contains
information regarding your financial
responsibility for covered benefits and
services, including copayments, coinsurance,
and deductibles. If you have any questions,
please contact Customer Relations at 1-800493-6004 or 1-866-513-9966 (TTY/TDD);
GETTING A SECOND OPINION
If you’d like a second opinion, you can ask to
see another Kaiser Permanente physician.
If you seek a second opinion outside of the
Kaiser Permanente network, Kaiser Permanente
Medicare Plus will not pay for those services.
Medicare Plus members who seek a second
opinion outside of the Kaiser Permanente network
will pay for those services under the terms and
conditions of Original Medicare, which means that
you will be responsible for paying the Original
Medicare coinsurance and deductibles.
For help with getting a second opinion, please
talk with your primary care physician.
SEEING A SPECIALIST
SELF-REFERRAL SPECIALIST
You don’t need a referral from your PCP for the
following services or specialties:
• Mammography (for women over age 40)
• Flu vaccinations or pneumococcal vaccine
• Obstetrics/Gynecology
• Mental health
• Alcohol/Chemical dependency
While no referral is needed for the above
services or specialties, you must seek care at
a Kaiser Permanente medical office or from a
specialist who is affiliated with your PCP.
Contact Customer Relations at 1-800-493-6004
or 1-866-513-9966 (TTY/TDD); seven days a
week, 8 a.m. – 8 p.m., to verify affiliation.
Appointments with all other specialists require
a referral from your primary care physician. You
must speak with your PCP before seeking care
from a specialist. He/she will then consult with
Medical Management for approval. Once the
referral is approved you will receive a formal
authorization. Failure to wait for the approval
could result in loss of benefit and increased out
of pocket cost to you.
Keep in mind that your PCP choice will
determine which referral specialists, Ohio
Permanente Medical Group (OPMG) or
affiliated community providers, are available to
you. So if you see an OPMG PCP he/she will
refer you to an OPMG specialist.
If for any reason there is not a referral specialist
available within our network, your primary care
physician will coordinate your care appropriately.
If there are specific specialists you want to use,
find out whether your PCP sends patients to those
specialists by calling Customer Relations at 1-800-4936004 or 1-866-513-966 (TTY/TDD) seven days a week 8
a.m. - 8 p.m. Each PCP has certain specialists he/she
use for referrals. This means that the specialists
you can use may depend on which physician you
chose to be your PCP. You can change your PCP
at any time (once per month) if you want to see a
specialist that your current PCP cannot refer you
to. Please see the above section “You and your
primary care physician” for more information about
choosing another PCP.
The Kaiser Permanente medical network
includes a variety of specialists, and we can
provide most of your medical care. If you need
to see a specialist or receive hospital services,
your PCP will give you the appropriate referral.
If you need a specialist or services that are not
available within our network, your PCP will
coordinate your care appropriately and will
refer you to a provider outside of our network
and these services will be covered by
Kaiser Permanente.
Your referral will be limited to specific services,
a specific length of time, or a specific number of
visits. If the referral specialist wants to prescribe
tests, services, or follow-up visits not approved in
advance, he or she must get written authorization
from your PCP. If additional tests are required,
you will get a letter confirming your referral. Most
tests that an outside specialist might request will
be provided within our network.
The Kaiser Permanente medical network includes
a variety of specialists and we can provide most of
your medical care. If you need to see a specialist,
your PCP will give you the appropriate referral.
If you need to receive hospital services, your
physician needs to call 1-866-433-1333 or
1-877-398-3187 TDD/TTY in advance of when you
need hospital services. (For your convenience, this
telephone number is also printed on the back of
your Kaiser Permanente ID card.)
Remember, you may get care from a nonKaiser Permanente Medicare Plus provider
without a referral. However, if that care is not
emergency or urgently-needed care, Kaiser
Permanente will not pay for those services.
ASKING FOR ADVICE
Many conditions can be treated at home or
in your doctor’s office during business hours,
but some problems can’t wait for a scheduled
appointment. If you are feeling ill but aren’t
sure that a trip to the doctor’s office is
necessary, we have many options for you.
If your PCP is a Kaiser Permanente physician,
please call our Member Service Center to speak
with a nurse. Our nurses are available 24 hours
a day, seven days a week and they can advise
you regarding what action to take in response
to your questions. Our nurses can be reached at
(216) 524-7377 or 1-800-524-7377, or
(216) 398-3187 or 1-877-398-3187 (TTY/TDD).
If your PCP is a network physician, please call
his or her office 24 hours a day, seven days a
week for advice.
If you’re not sure what kind of medical care you
need and you have a Kaiser Permanente physician,
call (216) 524-7377 or 1-800-524-7377 (TTY/TDD
1-877-398-3187), 24 hours a day to speak with a
nurse or physician.
Our Web site, kp.org, is also a valuable resource
for advice and at-home care options. You can
research health topics and information, and
send nonurgent medical questions to a health
professional via email (you’ll receive an answer
within 24 hours, excluding weekends and holidays).
WHEN TO CALL 911
In an emergency situation, if you believe
taking the time to call Kaiser Permanente
would cause serious injury to your health, call
911 or go to the nearest emergency room to
obtain immediate medical attention.
AFTER HOURS CARE
An emergency medical condition is a medical or
psychiatric condition that manifests itself by acute
symptoms of sufficient severity (including severe
pain) such that a prudent layperson, with an
average knowledge of health and medicine, could
reasonably expect the absence of immediate
medical attention to result in serious jeopardy to
health, serious impairment to bodily functions,
serious dysfunction of any bodily organ or part,
or serious jeopardy to the health of a pregnant
woman or her unborn child. “Active labor” is also
an emergency medical condition, that means
there is inadequate time for safe transfer to a
network (or designated) hospital before delivery,
or if transfer poses a threat to the health of the
member or unborn child.
Right Care, Right Time at the Right Place
At Kaiser Permanente we are committed to
providing our members with the right care, at
the right time, in the right place. Anytime a
member, whose physician practices at a Kaiser
Permanente facility, has a medical concern, such
as where to seek care after hours, all you need
to do is call us. A member of our trained staff
will assess the call and help the member seek
the most appropriate treatment. Some of the
treatment options available are:
• Nurse advice - free
• Physician advice - free
• A scheduled physician telephone visit– free
• A same day appointment with the doctor –
office visit copays apply
• An urgent care visit – Urgent Care copays apply
• An emergency department visit – Emergency
Department copays apply
All of this is available at your finger tips 24/7,
by calling 1-800- 524-7377 (1-877-398-3187,
TTY/TDD).
EMERGENCY CARE
If you need emergency medical assistance, call
911 or go to the nearest emergency room.
kp.org
If you have a network PCP, please call his or her
office for assistance.
KAISER PERMANENTE EMERGENCY
FACILITIES
Emergency Services at the Kaiser Permanente
Parma Medical Center and Cleveland Heights
Medical Center are open 24 hours a day
for emergency care. You can also receive
emergency care at the Kaiser Permanente
network hospitals listed in the “How to reach
us” section of this Handbook.
NON–KAISER PERMANENTE
EMERGENCY FACILITIES
If you seek emergency care at a non–Kaiser
Permanente network hospital and you need
to be admitted, you, a member of your family,
or the admitting physician must notify us
either before you are admitted, or if that is
not possible, within 48 hours or as soon as
medically possible after you are admitted. Many
hospitals have the correct phone number and
can assist you in contacting us, or simply call
us at the number on your Kaiser Permanente
Medicare Plus ID card. We will decide whether
to make arrangements for necessary continued
hospitalization, or transfer you to a designated
hospital. If you do not notify us or refuse to be
transferred, Kaiser Permanente Medicare Plus
will not cover any services you receive after
transfer would have been possible. However,
Original Medicare may cover those services.
This means you would be responsible for
paying the Original Medicare deductibles and
coinsurance for those services. Present your
Medicare card upon admission.
If you receive emergency care from a provider
outside of the Kaiser Permanente network,
or urgent care services outside the Kaiser
Permanente service area, bills for emergency
or urgent care should be sent to Kaiser
Permanente within 60 days from the date of
service. We will review your claim to verify
coverage under the terms of your health
care plan, as described in your Evidence
of Coverage. Send all bills or requests for
payment to:
Kaiser Permanente
Claims and Referrals
P.O. Box 5316
Cleveland, OH 44101-9774
For a complete description of your coverage
for emergency care, see your Evidence of
Coverage.
TRAVELING WITHIN ANOTHER KAISER
PERMANENTE SERVICE AREA
You may obtain emergency and urgent care, as
well as some additional services, from Kaiser
Permanente medical facilities and providers
when you are in the service area of another
Kaiser Permanente plan.
Please note that service areas and facilities
where you may obtain visiting member benefits
may change at any time. Call Customer Relations
at 1-800-493-6004 or 1-866-513-9966 (TTY/TDD);
seven days a week, 8 a.m. – 8 p.m., to receive
information about our visiting member program
including facility locations across the United
States. You may also access our visiting member
brochure online at kp.org.
PHARMACY SERVICES
GETTING PRESCRIPTIONS FILLED
Kaiser Permanente Medicare Plus members
who have a prescription drug benefit may
obtain prescriptions from our “network
pharmacies” because we have made
arrangements with them to provide prescription
drugs to Plan members. A network pharmacy
is a pharmacy where beneficiaries obtain
prescription drug benefits provided by Kaiser
Permanente Medicare Plus. In most cases,
your prescriptions are covered under Kaiser
Permanente Medicare Plus only if they are filled
at a Kaiser Permanente Medicare Plus network
pharmacy or the Kaiser Permanente Direct
Mail pharmacy. Once you go to one, you are
not required to continue going to the same
pharmacy to fill your prescription, you can go
to any of our network pharmacies. We will fill
prescriptions at non-network pharmacies under
certain circumstances as described later.
Kaiser Permanente Medicare Plus may
add or remove pharmacies from our pharmacy
directory. To get current information about Kaiser
Permanente Medicare Plus network pharmacies
in your area, please visit our Web site at kp.org
or call our Customer Relations Department at
1-800-493-6004 or 1-866-513-9966 (TTY/TDD),
7 days a week, from 8 a.m. to 8 p.m.
pharmacy, and other plan rules are followed.
To find out if your Kaiser Permanente Medicare
Plus plan includes Medicare Plus prescription
drug coverage, and for a complete description
of that coverage and for more information on
how to fill your prescriptions, please review
your Evidence of Coverage.
The locations and phone numbers for all Kaiser
Permanente network pharmacies are listed in
the “How to reach us” section of this Handbook
and the Kaiser Permanente Medicare Plus
Provider/Pharmacy Directory. Availability of
locations may change; please visit kp.org or
call Customer Relations at 1-800-493-6004
or 1-866-513-9966 (TTY/TDD); seven days a
week, 8 a.m. – 8 p.m., to locate a participating
pharmacy near you.
Drugs covered in the formulary may change
throughout the year but generally, if you
are taking a drug on our formulary that was
covered at the beginning of the year, we will
not discontinue or reduce coverage of the
drug during the coverage year except when
a new, less expensive generic drug becomes
available or when new adverse information
about the safety or effectiveness of a drug is
released. Other types of formulary changes,
such as removing a drug from our formulary, will
not affect members who are currently taking
the drug. It will remain available at the same
cost-sharing for those members taking it for
the remainder of the coverage year. We feel
it is important that you have continued access
for the remainder of the coverage year to the
formulary drugs that you are taking and that
were available when you chose our plan, except
for cases in which you can save additional
money or improve the safety of your drugs.
For a complete explanation of changes to the
drugs listed in the formulary please refer to the
current Kaiser Permanente Medicare Plus Drug
Formulary and your Evidence of Coverage.
To fill your prescription at a network
pharmacy, you must show your Kaiser
Permanente Medicare Plus Member ID card.
If you do not have your ID card with you when
you fill your prescription, you may have to pay
the full cost of the prescription (rather than
paying just your co-payment). If this happens,
you can ask us to reimburse you for our share
of the cost by submitting a claim to us. To
find out how to submit a claim, look in your
Evidence of Coverage or call our Customer
Relations Department.
OUR DRUG FORMULARY
A formulary is a list of drugs selected by
Kaiser Permanente Medicare Plus in
consultation with a team of health care
providers, which represents the prescription
therapies believed to be a necessary part of a
quality treatment program. Kaiser Permanente
Medicare Plus will generally cover the drugs
listed in our formulary as long as the drug is
medically necessary, the prescription is filled
at a Kaiser Permanente Medicare Plus network
kp.org
To get updated information about the drugs
covered by Kaiser Permanente Medicare Plus,
please visit our Web site at kp.org/seniormedrx
or call Customer Relations at
1-800-493-6004 or 1-866-513-9966 (TTY/TDD),
7 days a week, from 8 a.m.-8 p.m.
Prescription drug benefits are subject to
limitations. Some covered drugs may have
additional requirements or limits on coverage.
These requirements and limits may include, prior
authorization, quantity limits and step therapy.
Please refer to your Evidence of Coverage for
specific details about your benefits through
Kaiser Permanente Medicare Plus.
For more information on changes, limitations
and other general information about your
prescription drug coverage please review
your Kaiser Permanente Medicare Plus Drug
Formulary and Evidence of Coverage.
If you have questions about Kaiser Permanente
Medicare Plus, please call Customer Relations
at 1-800-493-6004 or 1-866-513-9966 (TTY/
TDD), 7 days a week, from 8 a.m.-8 p.m. or visit
kp.org/seniormedrx.
HAVING REFILLS MAILED TO YOU
To get information about filling your
prescriptions by mail, please contact the Kaiser
Permanente Direct Mail pharmacy at
1-877- 676-6280 or 1-877-676-6677 (TTY/TDD),
Monday through Friday, 9 a.m.- 5 p.m. Please
note that you must use the Kaiser Permanente
Direct Mail pharmacy mail order service.
Prescription drugs that you get through any
other mail order service are not covered.
You can order your prescription from the
Kaiser Permanente Direct Mail pharmacy in one
of three ways:
• Mail your prescription or refill request in a
Direct Mail envelope available at all Kaiser
Permanente Medical Office pharmacies.
• Call the Kaiser Permanente Direct Mail
pharmacy at 1-877- 676-6280 or
1-877-676-6677 (TTY/TDD).
• Order online at kp.org/rxrefill.
You can use the Kaiser Permanente Direct Mail
pharmacy mail order service to fill prescriptions
for any drug on the formulary list with the
exception of Control II substances and all
refrigerated items except insulin.
If you have prescription drug coverage and use
our Direct Mail Pharmacy, you may be eligible
to receive a 90-day supply of maintenance
medication for the cost of two copayments.
You are not required to use the Kaiser
Permanente Direct Mail pharmacy to obtain an
extended supply of maintenance medications.
Instead, you have the option of using a retail
pharmacy in the Kaiser Permanente Medicare
Plus network to obtain a maintenance supply of
medications. Some retail pharmacies may agree
to accept the mail order reimbursement rate for
an extended supply of medications, which may
result in no out-of-pocket payment difference to
you. Other retail pharmacies may not agree to
accept the mail order reimbursement rate for an
extended supply of medication. In this case, you
will be responsible for the difference in price.
Please look in the Evidence of Coverage for
more information or call 1-800-493-6004, 7 days
a week, from 8 a.m. - 8 p.m. TTY users should
call 1-866-513-9966.
The maximum expected turnaround time for the
processing and shipment of all prescriptions by
the Kaiser Permanente Direct Mail pharmacy is
two weeks. The Kaiser Permanente Direct Mail
pharmacy asks that you order your medications
two weeks in advance to ensure adequate
processing time.
If your mail order is delayed, please contact the
Kaiser Permanente Direct Mail pharmacy at
1-877-676-6280, between 9 a.m. - 5 p.m., Monday
through Friday. (TTY/TDD users should call
1-877- 676-6677.) We will assist you in obtaining
a prescription from a Kaiser Permanente Medical
Office pharmacy, a network pharmacy, or a local
pharmacy in an emergency. To find out if your
Kaiser Permanente Medicare Plus plan includes
Medicare Plus prescription drug coverage, and for
a complete description of that coverage, please
review your Evidence of Coverage.
HEALTH CARE TOOLS
MY HEALTH MANAGER – GET CONNECTED
WITH YOUR HEALTH ONLINE
The launch of My Health Manager on kp.org
provides you and your family with instant
access to important information for managing
health care needs from wherever you have
internet capability. When you choose an Ohio
Permanente Medical Group provider you will be
connected to your health record online. You can
enjoy increased access to your doctor and more
tools to take an active role in your health. This is
exclusive to members receiving care at a Kaiser
Permanente medical facility.
You may view most lab test results, request
appointments, print your child’s immunization
records and email their Kaiser Permanente
doctors. If you have children, Act for a Family
Member makes it easier to stay on top of your
child’s health as well by giving you access to
your child’s health information online. Only
Kaiser Permanente members who are registered
on kp.org and are legally authorized to act for
your child may use this feature. Teens, who are
13–17 years old can use some of the features
using their own password. Parents will have
limited access to their teen’s records.
All members logging on kp.org can use the
direct mail pharmacy, access health and drug
encyclopedias and find resources to help them
manage a well balanced life.
Register today at kp.org/register and receive
a password immediately or have one mailed to
your home in three to seven days.
TOTAL HEALTH ASSESSMENT (THA)
When you’re ready to make a healthy change in
your life, knowing where to start can help you
figure out your next steps.
With HealthMedia® Succeed™, our free, online
total health assessment (THA) tool, you can get
a good look at your current overall health—from
how often you exercise to what you eat in the
mornings. It helps you prioritize what kinds of
health changes you may want to make, based
not only on your risk for developing certain
health conditions, but also on your confidence
and readiness to make a change.
You’ll find the total health assessment tool
under My Health Manager at kp.org. Once
you’ve completed an online questionnaire, you’ll
receive a customized action plan to get you
started on a better, healthier you. This feature
requires you to be registered and signed on to
our Web site. If you haven’t registered yet, start
by going to kp.org/register.
GETTING AND STAYING WELL
As your health care provider, we want to help you
live a healthier, happier, and more fulfilling life. So
in addition to our health care services, we offer a
variety of programs and resources that go above
and beyond treating you when you’re sick.
For information on everything that’s available
to you, please visit kp.org. Here are just a few
valuable services and resources:
All of your information is secure since you
send and receive messages via the kp.org/
myhealthmanager section, not from your
personal email account.
kp.org
ALTERNATIVE AND COMPLEMENTARY
MEDICINE
The products and services described below
are neither offered nor guaranteed under the
contract Kaiser Foundation Health Plan of Ohio
has with the Medicare program, but are made
available to all enrollees who are members of
Kaiser Permanente Medicare Plus. These products
and services are not subject to the Medicare
appeals process. Any disputes regarding these
products and services may be subject to the
Kaiser Foundation Health Plan grievance process.
If you have questions or a complaint about these
products and services, please call Customer
Relations at 1-800-493-6004 or 1-866-513-9966
(TTY/TDD); seven days a week, 8 a.m. – 8 p.m.
As a Kaiser Permanente Medicare Plus
member, you receive special rates on a range of
services that can help you reduce stress, relieve
pain, and improve your overall well-being.
Providers of these services include chiropractors,
acupuncturists, and massage therapists. Members
also have access to education and information
on a variety of alternative/complementary
medicine topics, and receive discounts on herbal,
homeopathic, and natural products.
For more information, please call our affiliate,
American Specialty Health Network (ASHN) at
1-877-335-2746 or 1-877-710-2746 (TTY/TDD),
Monday through Friday from 8 a.m. to 9 p.m.
You may also visit ASHN online by going to
kp.org, and clicking on “Your plan.” Click on
“Optional programs & services” and select
“Complementary health program.” Choose the
link labeled “Healthyroads,” and proceed to
ASHN’s Web site.
FITNESS
Relations at 1-800-493-6004 or 1-866-513-9966
Kaiser Permanente members receive discounts
on memberships at fitness clubs in Northeast
Ohio through Kaiser Permanente’s K-Plus Fitness
program. Fitness clubs in our program can be
found in Cuyahoga, Geauga, Lake, Medina, and
Summit counties.
Call the K-Plus Fitness/Recreation line at
(216) 749-8451 or 1-800-722-9717, 24 hours a
day, to hear recorded information. Deaf, hard of
hearing, or speech impaired members may call
Customer Relations at 1-866-513-9966 (TTY/
TDD); seven days a week, 8 a.m. – 8 p.m. for
assistance. To review or download the list of
participating facilities, please visit
kp.org/formsandpubs. Click on the tab labeled
“Kaiser Permanente K-Plus fitness and recreation
program” under the header “Health and wellness
information”.
Kaiser Permanente Medicare Plus members may
also learn healthy eating and exercise habits
with discounts from Weight Watchers. For
more information on meeting locations, online
programs, and in home kits, call
1-866-639-3300, Monday through Thursday,
8 a.m. to 9 p.m.; Friday, 8 a.m. to 8 p.m.; or
Saturday, 9 a.m. to 2 p.m. (ET) Deaf, hard of
hearing, or speech impaired members may call
Customer Relations at 1-866-513-9966 (TTY/TDD);
seven days a week, 8 a.m. – 8 p.m. for assistance.
To receive your discount, please tell Weight
Watchers that you are a Kaiser Permanente of
Ohio member. Or visit our Web site at kp.org/
weightwatchers.
NONPRESCRIPTION PRODUCTS AVAILABLE
Relations at 1-800-493-6004 or 1-866-513-9966
Kaiser Permanente pharmacies also stock
many nonprescription products that members
can purchase at favorable prices. If you are
interested in purchasing any of these
products, please speak with your pharmacist.
Some of the nonprescription product categories
include the following:
• Antacids, antidiarrheals, and laxatives
• Cold, cough, and allergy
• Diabetic supplies
• Ear, eye, nose, and mouth
• Pain and fever
• Skin care and externals
• Vitamins and herbals
many are open to the public. To learn about our
health education programs, call (216) 524-5948
or 1-800-456-6099, Monday through Friday,
10 a.m. to 4 p.m. Speech and hearing impaired
members may call Customer Relations at
8 a.m. – 8 p.m. for assistance. You may also visit
our Web site for information. Go to
kp.org/classes.
Kaiser Permanente’s publications are provided
to help you learn about health issues and new
developments in medicine. Our newsletter,
Partners in Health that is mailed to your home
three times a year, features health tips, medical
news, and health plan information. The Kaiser
Permanente Healthwise® Handbook is a selfcare guide to more than 200 health conditions
and is mailed to all new members’ homes.
In addition, you can obtain health education
pamphlets on a variety of subjects from our
pharmacies, or by calling our Health
Education Department at (216) 524-5948 or
1-800-456-6099, Monday through Friday,
10 a.m. to 4 p.m. Deaf, hard of hearing, or
speech impaired members may call Customer
Relations at 1-866-513-9966 (TTY/TDD); seven
days a week, 8 a.m. – 8 p.m. for assistance.
EDUCATION
Kaiser Permanente offers classes on topics such
as asthma, diabetes, and heart disease. You can
schedule a one-on-one visit with a nutritionist
to learn healthier ways of eating, or participate
in programs to quit smoking. All of our classes
are available at no charge or for a small fee, and
kp.org
HOW TO REACH US
How To Reach Us
This section provides many of the phone numbers you may need as a Kaiser Permanente
member. In addition to the general numbers below, we’ve included phone numbers, addresses,
and office hours for the Kaiser Permanente medical offices throughout Northeast Ohio, as
well as affiliated hospital locations. You will also find the addresses and phone numbers for our
network retail pharmacies and optical stores.
IMPORTANT PHONE NUMBERS
If you need emergency medical assistance, call 911 or go to the nearest emergency room.
Member Service Center
(216) 524-7377 or 1-800-524-7377
(216) 398-3187 or 1-877-398-3187 TTY/TDD
To schedule an appointment with or leave a message for a Kaiser Permanente physician, or to
find the right care available to you, 24 hours a day, seven days a week.
Member Support Services
(216) 524-5001 or 1-877-524-5001
Monday–Friday 8 a.m. – 5 p.m.,
(216) 398-3187 or 1-877-398-3187 TTY/TDD
Saturday 8 a.m. – noon
If you have questions regarding a PCP, a specialist or to change your PCP.
Customer Relations
1-800-493-6004
Seven days a week, 8 a.m. – 8 p.m.
1-866-513-9966 (TTY/TDD)
For questions about our Health Plan, benefits or Medicare Prescription Drug Coverage (Part D).
Appointment Cancellation (24-hour)
(216) 749-7170 or 1-800-589-7170
1-877-398-3187 TTY/TDD
Automated line for canceling routine appointments with Kaiser Permanente physicians 24 hours a day.
24-hour Telephone Care Line
1-800-524-7377
(216) 398-3187 or 1-877-398-3187 TTY/TDD
If you have a KP physician and need to speak with a nurse or physician 24 hours a day.
Direct Mail Pharmacy
(216) 676-6098 or 1-877-778-6695
To order a prescription refill to be mailed to your home, 24 hours a day. Deaf, hard of hearing,
or speech impaired members may call Customer Relations for assistance regarding alternative
methods of placing orders at 1-866-513-9966 (TTY/TDD); seven days a week, 8 a.m. – 8 p.m.
You may also use the postage-paid envelopes at all Kaiser Permanente medical facility
pharmacies to contact us by mail. Or register on our Web site at kp.org to order refills online.
HOW TO REACH US
Health Education
(216) 524-5948 or 1-800-456-6099
Monday-Friday 10 a.m. – 4 p.m.
To learn about health education classes near you.
Deaf, hard of hearing, or speech impaired members may call Customer Relations at
1-866-513-9966 (TTY/TDD); seven days a week, 8 a.m. – 8 p.m. for assistance.
You may also access health education information online at kp.org.
K-Plus Fitness
(216) 749-8451 or 1-800-722-9717
For information about member discounts on health clubs and products, 24 hours a day.
1-866-513-9966 (TTY/TDD); seven days a week, 8 a.m. – 8 p.m. for assistance.
To review or download the list of participating fitness facilities and stores, please visit
members.kp.org. Click on the tab labeled “Your plan” and then “Optional programs and
services,” and then choose “Fitness discounts.”
Travel Clinic
1-800-888-8540
Monday-Friday 10 a.m. – 7 p.m.
For medical advice and requirements for traveling abroad, including scheduling vaccinations
1-866-513-9966 (TTY/TDD); seven days a week, 8 a.m. – 8 p.m. for assistance accessing travelrelated health information.
You may also review travel-related health information in the Health Encyclopedia at
kp.org.
kp.org
HOW TO REACH US
KAISER PERMANENTE MEDICAL FACILITIES
Smoke Free Facilities
As of December 7, 2006, under law by the state of Ohio (Issue 5 – Smoke Free Ohio),
smoking is prohibited in all Kaiser Permanente – owned or leased facilities. Under law, Kaiser
Permanente is not permitted to make any accommodations for smokers on its property.
Therefore, all designated smoking areas, smoking lounges, etc. have been converted back to
their original purpose. In accordance with the law, all smoking receptacles in or around the
buildings have been removed and no one may smoke outside on Kaiser Permanente property even if he/she is in a personal vehicle.
Office Hours
Please note that office hours may change throughout the year. Please call Customer Relations
at 1-800-493-6004 or 1-866-513-9966 (TTY/TDD); seven days a week, 8 a.m. – 8 p.m., with
questions. All 800, 888, and 877 numbers are toll-free from anywhere in the United States.
Avon Medical Offices
Avon Pointe Professional Campus
Office hours
8:30 a.m. – 6 p.m., M–Th
8:30 a.m. – 5 p.m., F
Pharmacy hours
10 a.m. - 6 p.m.,M-F
36711 American Way, Avon, OH 44011
Appointments and advice ...... (216) 524-7377 or 1-800-524-7377;
................................ (216) 398-3187 or 1-877-398-3187 (TTY/TDD)
Pharmacy ................................................................ (440) 937-2350
Prescription Refill Line ............. (216) 778-6109 or 1-877-778-6109
Deaf, hard of hearing, or speech impaired members may call
Customer Relations for assistance contacting the Pharmacy or
Behavioral Health services at 1-866-513-9966 (TTY/TDD); seven
days a week, 8 a.m. – 8 p.m.
Bedford Medical Offices
Office hours
8:30 a.m.–6:30 p.m., M/Th
8:30 a.m.–5 p.m., Tu/W/F
8:30 a.m.–noon, Sa
Pharmacy hours
8:30 a.m.–8 p.m., M–F
9 a.m.–5 p.m., Sa
19999 Rockside Road, Bedford, OH 44146
Appointments and advice ....... (216) 524-7377 or 1-800-524-7377;
................................ (216) 398-3187 or 1-877-398-3187 (TTY/TDD)
Pharmacy ................................................................. (440) 439-6622
Prescription Refill Line .............. (216) 749-2705 or 1-800-289-2705
HOW TO REACH US
Chapel Hill Medical Offices
Office hours
8:30 a.m.–6:30 p.m., M/Th
8:30 a.m.–5 p.m., Tu/W/F
Pharmacy hours
8:30 a.m.–8 p.m., M–F
9 a.m.–5 p.m., Sa
............................................................... (330) 633-1161 (TTY/TDD)
Pharmacy ................................................................. (330) 633-8463
Prescription Refill Line ............................................1-800-589-4343
Cleveland Heights Medical Center
Office hours
8:30 a.m.–6:30 p.m., M–Th
8:30 a.m.–5 p.m., F
Chemical Dependency
office hours
8:30 a.m. – 8:30 p.m., M–Th
Behavioral Health office hours
8:30 a.m.– 8:30 p.m.,M/W
8:30 a.m.– 5 p.m.,Tu/Th/F
Pharmacy hours
8:30 a.m. – 9 p.m., M–F
9 a.m. – 9 p.m., Sa
10 a.m. – 5 p.m., Su/Holidays
Emergency Services hours
24 hours a day, 7 days a week
kp.org
1260 Independence Avenue, Akron, OH 44310
10 Severance Circle, Cleveland Heights, OH 44118
Appointments and advice (216) 524-7377 or 1-800-524-7377;
.........................(216) 398-3187 or 1-877-398-3187 (TTY/TDD)
Behavioral Health ..............(216) 297-2360 or 1-800-360-4160
Pharmacy ..........................................................(216) 297-2600
Prescription Refill Line .......(216) 749-3526 or 1-800-284-3526
Customer Relations for assistance contacting the Pharmacy
or Behavioral Health services at 1-866-513-9966 (TTY/TDD);
HOW TO REACH US
Fairlawn Medical Offices
Office hours
8:30 a.m.–6:30 p.m., M/Th
8:30 a.m.–5 p.m., Tu/W/F
Behavioral Health
services
M-F, hours vary
Pharmacy hours
10 a.m.– 6 p.m., M–F
4055 Embassy Parkway, Suite 110 Fairlawn, OH 44333
............................................................... (330) 873-4811 (TTY/TDD)
Behavioral Health .................................................... (330) 873-4880
Pharmacy ................................................................. (330) 873-4850
Prescription Refill Line ............................................1-800-759-7521
Lakewood Medical Offices
Moving to Rocky River, OH Spring 2010
Office hours
8:30 a.m.–6:00 p.m.,
M/Tu
8:30 a.m.–5 p.m.,W–F
Pharmacy hours
10 a.m. – 6 p.m.,M–F
14600 Detroit Avenue, Lakewood, OH 44107
20575 Center Ridge Rd Suites 500 and 502
Rocky River, OH 44116
................................ (216) 398-3187 or 1-877-398-3187 (TTY/TDD)
Pharmacy ................................................................. (216) 228-4544
Parma Medical Center
12301 Snow Road, Parma, OH 44130
Office hours
8:30 a.m.–7 p.m., M–Th
................................ (216) 398-3187 or 1-877-398-3187 (TTY/TDD)
8:30 a.m.–5 p.m., F
Behavioral Health ..................... (216) 265-6800 or 1-800-366-6801
Pharmacy ................................................................. (216) 524-5927
Behavioral Health
services hours
8:30 a.m.–5 p.m., M–F
Pharmacy hours
8:30 a.m.–9 p.m., M–F
9 a.m.– 9 p.m., Sa
10 a.m.–5 p.m. Su/Holidays
Emergency Services hours
24 hours a day, 7 days a week
HOW TO REACH US
Strongsville Medical Offices
Office hours
8 a.m.–6:30 p.m., M/W
8:30 a.m.–5 p.m., Tu/Th/F
Pharmacy hours
10 a.m.–6 p.m., M-F
................................ (216) 398-3187 or 1-877-398-3187 (TTY/TDD)
Pharmacy ................................................................. (440) 572-1002
Twinsburg Medical Offices
Office hours
8 a.m.–5 p.m., M-F
Behavioral Health
services
Thursday, hours vary
Pharmacy hours
10 a.m.–6 p.m., M-F
8920 Canyon Falls Blvd., Twinsburg, OH 44087
................................ (216) 398-3187 or 1-877-398-3187 (TTY/TDD)
Behavioral Health ..................... (216) 265-6800 or 1-800-366-6801
Pharmacy .................................. (330) 486-2850 or 1-888-486-2850
Willoughby Medical Offices
Office hours
8:30 a.m.–6:30 p.m., M/W
8:30 a.m.–5 p.m., Tu/Th/F
Behavioral Health
services hours
M-F, hours vary
Pharmacy hours
8:30 a.m.–8 p.m., M–F
9 a.m.– 5 p.m., Sa
17406 Royalton Road, Strongsville, OH 44136
5105 S.O.M. Center Road, Willoughby, OH 44094
................................ (216) 398-3187 or 1-877-398-3187 (TTY/TDD)
Behavioral Health .................................................... (440) 975-4681
Pharmacy ................................................................. (440) 953-5711
If you can’t find a number or the information you need, please call Customer Relations,
1-800-493-6004 or 1-866-513-9966 (TTY/TDD); seven days a week, 8 a.m. – 8 p.m.
kp.org
HOW TO REACH US
| HOSPITALS
HOSPITALS
Kaiser Permanente contracts with the hospitals listed on this page for inpatient care and other
specific services. For Emergency Room and Urgent Care Services, please refer to the Emergency
Services and Urgent Care Locations section of this handbook.
If you have questions or need more information, please see your Evidence of Coverage, or
contact Customer Relations at 1-800-493-6004 or 1-866-513-9966 (TTY/TDD); seven days a
week, 8 a.m. – 8 p.m.
AKRON CITY
HOSPITAL
Summa Health System
525 East Market Street
Akron, OH 44309
(330) 375-3000
AMHERST HOSPITAL
254 Cleveland Avenue
Amherst, OH 44001
(440) 988-6000
CHILDREN’S
HOSPITAL MEDICAL
CENTER OF AKRON
One Perkins Square
Akron, OH 44308
(330) 379-8200
CLEVELAND CLINIC
FOUNDATION
9500 Euclid Avenue
Cleveland, OH 44195
(216) 444-2273
EMH REGIONAL
MEDICAL CENTER
630 East River Road
Elyria, OH 44035
(440) 329-7500
FAIRVIEW HOSPITAL
Cleveland Clinic
Health System
(for OB referrals only)
18101 Lorain Avenue
Cleveland, OH 44111
(216) 476-7000
LAKEWEST MEDICAL
CENTER
Lake Health
36000 Euclid Avenue
Willoughby, OH 44094
(440) 953-9600
LAURELWOOD
HOSPITAL
35900 Euclid Avenue
(440) 953-3000
MARYMOUNT
HOSPITAL
Cleveland Clinic
Health System
12300 McCracken
Road
Garfield Heights, OH
44125
(216) 581-0500
MEDINA GENERAL
HOSPITAL
1000 E. Washington
Street
Medina, OH 44256
(330) 725-1000
METROHEALTH
MEDICAL CENTER
2500 MetroHealth
Drive
Cleveland, OH 44109
(216) 778-7800
PARMA COMMUNITY
GENERAL HOSPITAL
7007 Powers Blvd.
Parma, OH 44129
(440) 743-3000
ROBINSON
MEMORIAL
HOSPITAL
6847 North Chestnut
Street
Ravenna, OH 44266
(330) 297-0811
SOUTH POINTE
HOSPITAL
4110 Warrensville
Center Road
Warrensville Heights,
OH 44122
(216) 491-6000
ST. THOMAS
HOSPITAL
Summa Health System
444 North Main Street
Akron, OH 44310
(330) 375-3000
SUMMA WESTERN
RESERVE HOSPITAL
1900 23rd Street
Cuyahoga Falls, OH
44223
(330) 971-7000
TRIPOINT MEDICAL
CENTER
Lake Health
7590 Auburn Road
Concord, Township,
OH 44077
(440) 375-8100
HOW TO REACH US
| EMERGENCY SERVICES
EMERGENCY SERVICES
If you have an emergency seek medical help as quickly as possible. Call 911 or go to the nearest
emergency room for help.
The Kaiser Permanente and contracted emergency facility locations are listed below for your reference.
If you have questions or need more information, please see your Evidence of Coverage, or
contact Customer Relations at 1-800-493-6004 or 1-866-513-9966 (TTY/TDD); seven days a week,
8 a.m. – 8 p.m.
AKRON CITY
HOSPITAL
SUMMA HEALTH
SYSTEM
525 E. Market Street
Akron, OH 44309
(330) 375-3000
AMHERST HOSPITAL
254 Cleveland Avenue
Amherst, OH 44001
(440) 988-6000
CHILDREN’S
HOSPITAL MEDICAL
CENTER OF AKRON
One Perkins Square
Akron, OH 44308
(330) 379-8200
EMH REGIONAL
MEDICAL CENTER
630 E. River Street
Elyria, OH 44035
(440) 329-7500
kp.org
KAISER
PERMANENTE
CLEVELAND
HEIGHTS MEDICAL
CENTER
24-Hour Emergency
Facility
10 Severance Circle
Cleveland Heights, OH
44118
KAISER
PERMANENTE
PARMA MEDICAL
CENTER
24-Hour Emergency
Facility
12301 Snow Road
Parma, OH 44130
LAKEWEST MEDICAL
CENTER
LAKE HOSPITAL
SYSTEM
36000 Euclid Avenue
(440) 953-9600
MEDINA GENERAL
HOSPITAL
1000 E. Washington St.
Medina, OH 44256
(330) 725-1000
METROHEALTH
MEDICAL CENTER
2500 MetroHealth
Drive
Cleveland, OH 44109
(216) 778-7800
ROBINSON
MEMORIAL
HOSPITAL
6847 N. Chestnut
Street
Ravenna, OH 44266
(330) 297-0811
SUMMA WESTERN
RESERVE HOSPITAL
1900 23rd Street
Cuyahoga Falls, OH
44223
(330) 971-7000
TRIPOINT MEDICAL
CENTER
Lake Health
7590 Auburn Road
Concord, Township,
OH 44077
(440) 375-8100
ST. THOMAS
MEDICAL CENTER
SUMMA HEALTH
SYSTEM
444 N. Main St.
Akron, OH 44310
(330) 375-3000
HOW TO REACH US
| URGENT CARE LOCATIONS
URGENT CARE LOCATIONS
Urgent Care Services are covered and may be provided in your doctor’s office or a plan urgent
care facility for unexpected illness or injury that does not meet the definition described in your
Evidence of Coverage under “Emergency Services”. Contact your PCP for your urgent care needs.
You will pay the office visit copayment for urgent care services received in your doctor’s office.
If your Kaiser Permanente doctor’s office is closed and you need assistance, call us 24 hours a day,
seven days a week at 1-800-524-7377 (TTY/TDD 1-877-398-3187). Our trained staff will help you
with your health care needs.
If you have chosen a MetroHealth physician for your primary care, call the MetroHealth 24- hour Advice
Line at 216-778-7878 (TDD (216) 778-3889). If you have selected an Affiliated Community Physician as
your PCP, always call that office for assistance. You may be directed to a plan urgent care facility.
CUYAHOGA
Kaiser Permanente
Cleveland Heights
Medical Ctr
24-Hour Emergency
Facility
10 Severance Circle
Cleveland Heights, OH
44118
1-800-524-7377
(TTY/TDD
1-877-398-3187)
Kaiser Permanente
Parma Medical
Center
24-Hour Emergency
Facility
12301 Snow Road
Parma, OH 44130
1-800-524-7377
(TTY/TDD
1-877-398-3187)
Rocky River Urgent
Care
19895 Detroit Avenue
Rocky River, OH
44116
1-800-524-7377
(TTY/TDD
1-877-398-3187)
GEAUGA
Lake Health Urgent
Care Center –
Chardon
510 Fifth Street
Chardon, OH 44024
1-800-524-7377
(TTY/TDD
1-877-398-3187)
LAKE
Lake Health Urgent
Care Center –
Madison
6270 North Ridge
Road
Madison, OH 44057
1-800-524-7377
(TTY/TDD
1-877-398-3187)
Lake Health Urgent
Care Center – Mentor
7956 Tyler Blvd.
Mentor, OH 44060
1-800-524-7377
(TTY/TDD
1-877-398-3187)
Lake Health Urgent
Care Center –
Willowick
30498 Lakeshore Blvd.
Willowick, OH 44095
1-800-524-7377
(TTY/TDD
1-877-398-3187)
LORAIN
Avon Urgent Care
2100 Center Road
Avon, OH 44094
1-800-524-7377
(TTY/TDD
1-877-398-3187)
Elyria Medical Center
160 Cleveland Street
Elyria, OH 44035
1-800-524-7377
(TTY/TDD
1-877-398-3187)
MEDINA
Brunswick Immediate
Care Center
3724 Center Road
Brunswick, OH 44212
1-800-524-7377
(TTY/TDD
1-877-398-3187)
SUMMIT
Medgroup – Fairlawn
2640 W Market Street
Fairlawn, OH 44333
1-800-524-7377
(TTY/TDD
1-877-398-3187)
Medgroup – Stow
3913 Darrow Road
Stow, OH 44224
1-800-524-7377
(TTY/TDD
1-877-398-3187)
HOW TO REACH US
| PHARMACIES
PHARMACIES
There are many locations to choose from for your prescription needs. This list is subject to change
throughout the year. Please contact Customer Relations at 1-800-493-6004 or 1-866-513-9966
(TTY/TDD); seven days a week, 8 a.m. – 8 p.m. with questions.
CUYAHOGA
COUNTY
Bedford
Kaiser Permanente
Bedford Medical
Offices
19999 Rockside Road
(440) 439-6622
Brooklyn Heights
Kaiser Permanente
Direct Mail Pharmacy
5410 Lancaster Road
(877) 676-6280
Cleveland
*
Metrohealth
Medical Center
2500 MetroHealth Drive
Cleveland, OH 44109
(216) 778-3017
*
Metrohealth Buckeye
Health Center
2816 East 116th Street
Cleveland, OH 44120
(216) 957-4050
Cleveland Heights
Kaiser Permanente
Cleveland Heights
Medical Center
10 Severance Circle
(216) 297-2600
Lakewood
Kaiser Permanente
Lakewood Medical
Offices
14600 Detroit Avenue
(216) 228-4544
(Moving to Rocky
River Spring 2010)
Parma
Kaiser Permanente
Parma Medical Center
12301 Snow Road
(216) 362-2213
Strongsville
Kaiser Permanente
Strongsville Medical
Offices
17406 Royalton Road
(440) 572-1002
*
Prescription filled
at these locations
must be written by a
MetroHealth Provider.
kp.org
GEAUGA COUNTY
Chagrin Falls
Drug Mart
16765 Chillicothe
Road
(440) 543-8844
Chardon
The Medicine Shoppe
325 Center Street
(440) 286-6166
Avon
Kaiser Permanente
Avon Medical Offices
36711 American Way
(440) 937-2350
LAKE COUNTY
Madison
Giant Eagle Pharmacy
6556 North Ridge Road
(440) 428-6111
Walgreens
9400 Mentor Avenue
(440) 255-6247
Painesville
1201 Mentor Avenue
(440) 358-7769
Walgreens
132 Richmond Street
(440) 350-1928
Willoughby
Kaiser Permanente
Willoughby Medical
Offices
5105 S.O.M. Center
Road
(440) 953-5711
LORAIN COUNTY
Amherst
Drug Mart
300 Leavitt Road
(440) 984-2439
Elyria
Gates Pharmacy
125 East Broad Street
(440) 329-7300
Grafton
Rite Aid Pharmacy
480 Main Street
(440) 926-2126
Oberlin
Drug Mart
12289 Leavitt Road
(440) 774-5212
Vermilion
Drug Mart
4208 Liberty Avenue
(440) 967-3000
The Vintage Pharmacy
1605 State Route 60 #11
(440) 967-3100
Wellington
Drug Mart
814 North Main Street
(440) 647-6634
HOW TO REACH US
MEDINA COUNTY
| PHARMACIES
Lodi
Drug Mart
661 Wooster Street
(330) 948-0520
Ravenna
Spiedels Medical Arts
Pharmacy
6693 North Chestnut
Street
(330) 296-6014
Medina
Buehler’s Forest
Meadows
275 Forest Meadows Dr.
(330) 725-0535
Triangle Pharmacy
219 West Main Street
(330) 296-8508
Buehler’s Riverstyx
3626 Medina Road
(330) 725-2255
Marc’s
1041 N. Court St.
(330) 722-3662
Seville
Ritzman Pharmacy
9056 Center Street
(330) 769-1995
Wadsworth
Ritzman Pharmacy
120 High Street
(330) 334-1549
PORTAGE COUNTY
Garrettsville
Garrettsville Family
Pharmacy
8295 Windham Street
(330) 527-4349
Mantua
Mantua Station
Pharmacy
10870 Main Street
(330) 274-2209
Windham
Windham Pharmacy
9680 East Center Street
(330) 326-3851
SUMMIT COUNTY
Akron
Kaiser Permanente
Chapel Hill Medical
Offices
1260 Independence
Avenue
(330) 633-8463
Rite-aid pharmacy
4053 S. Main Street
(330) 724-5219
Barberton
41 5th Street, Se
(330) 861-0849
Fairlawn
Kaiser Permanente
Fairlawn Medical
Offices
4055 Embassy
Parkway, Suite 110
(330) 873-4850
Twinsburg
Kaiser Permanente
Twinsburg Medical
Offices
8920 Canyon Falls
Boulevard
(330) 486-2850
HOW TO REACH US
|
OPTOMETRY
OPTOMETRY LOCATIONS
Kaiser Permanente contracts with VSP® (Vision Service Plan) to provide vision services including
refractive eye exams and eyewear (if applicable) to our members.
This section includes the names, addresses and phone numbers of optometrists and optical stores
that are affiliated with VSP in our seven county service area. When making an appointment with a
VSP provider please let the provider know that you have VSP and they will verify eligibility.
With the partnership between Kaiser Permanente and VSP you will be able to receive exams and
use your hardware (contacts and glasses) allowance (if applicable) at any VSP provider throughout
the US, of which 200 are located within our service area. For a complete list of providers, visit
www.vsp.com/advantage or call 1-800-877-7195 (TTY 1-800-428-4833 for the hearing/speech
impaired). If you have questions or need more information, please call Customer Relations at
1-800-493-6004 or 1-866-513-9966 (TTY/TDD); seven days a week, 8 a. m.- 8 p.m.
CUYAHOGA
COUNTY
Bay Village
Thomas M Kelly OD Inc
Thomas M. Kelly, O.D.
457 Dover Center Rd
(440) 871-1139
Beachwood
Douglas R Cox OD
Douglas R. Cox, O.D.
3795 Green Rd
(216) 292-6900
Western Reserve Vision
Care Inc
Jessica A. Simon, O.D.
Mary Jo Stiegemeier,
O.D.
Haley A. Unkefer, O.D.
3690 Orange Pl Ste 150
(216) 839-0200
Bedford
Marcela B Vizmuller OD
Marcela B. Vizmuller,
O.D.
767 Broadway Ave
(440) 232-3615
kp.org
Berea
Procare Vision Center
Mary C. Gerhart, O.D.
343 W Bagley Rd
(440) 891-1940
Brecksville
Stage House Vision
Center
Alicia G. Manenti, O.D.
Joseph A. Ravagnani,
O.D.
8879 Brecksville Rd
(440) 526-3160
Broadview Heights
Broadview Eye Center
Josephine Kosunick,
O.D.
Nicolette E. Scott, O.D.
403 E Royalton Rd
Ste 118
(440) 526-7070
Brooklyn
David R Oldenburgh
OD
David R. Oldenburgh,
O.D.
4342 Ridge Rd Ste 1
(216) 741-3733
Cleveland
Abrams Eye Center Inc
Marc A. Abrams, M.D.
2322 East 22nd St
Ste 102
(216) 937-2020
Berris Optical
Jeffrey J. Borodkin,
O.D.
Kenneth S. Kovach,
O.D.
2183 S Green Rd
(216) 381-1466
Cleveland Vision
Center Inc
John Bazilius Jr, O.D.
6204 Brookpark Rd
(216) 351-6270
Cynthia J Jemiola OD
Cynthia J. Jemiola, O.D.
Nazia N. Maredia, O.D.
Bp Bldg 200 Public Sq
Ste 219
(216) 621-2815
Daniel R Freson OD Inc
Daniel R. Freson, O.D.
2012 W 25th St Ste 1
(216) 771-8311
Dr Stephen A Figler
and Associates Inc
Stephen A. Figler, O.D.
7211 Broadway Ave
(216) 641-0055
Frederick D Blank OD
Frederick D. Blank, O.D.
2512 Clark Ave
(216) 241-2040
Jeffrey D Kovesdy OD
Jeffrey D. Kovesdy, O.D.
17730 Lorain Ave
(216) 252-5090
Primary Eyecare
Phillip Michalos, O.D.
10680 Lorain Ave
(216) 671-2998
Svs Vision Inc
Stephen F. Sasala, O.D.
6835 Pearl Rd Unit 111
(440) 884-4725
HOW TO REACH US
|
OPTOMETRY
Cleveland Heights
I Care Vision Center
Arlogia Brister, O.D.
13437 Cedar Rd
(216) 321-9630
Mayfield Heights
Eyezone
Gerald Marsh, O.D.
5852 Mayfield Rd
(440) 684-0800
East Cleveland
Forest Hills Vision
Center
Joaquin Lim, O.D.
13545 Euclid Ave
(216) 451-4400
Middleburg Heights
Southland Vision Care
Inc
William D. Marks, O.D.
6879 B Southland Dr
(440) 888-3515
Euclid
Shore Vision Clinic
Arthur A. Bram, O.D.
22472 Shore Center Dr
(216) 261-1900
North Olmsted
Eyewear 20/20
Les Rosenberg, O.D.
26041 Lorain Rd
(440) 777-8686
Highland Heights
Cleveland Eye Care &
Optical
Salwa Saliba, O.D.
850 Brainard Rd
(440) 684-0080
North Royalton
Philip E Glanville OD
Philip E. Glanville, O.D.
6785 Wallings Rd
(440) 237-9120
Independence
Performance Vision
Care Inc
Daniel J. Uzl, O.D.
Ryan S. Zimmerman,
O.D.
6901 Rockside Rd
(216) 525-0740
Lakewood
Madison Eye Care
Associates
Gregory J. Kovats, O.D.
Peter V. Mogyordy, O.D.
17520 Madison Ave
(216) 228-3343
Lyndhurst
Hillcrest Family Vision
Giselle A. Lander, O.D.
5035 Mayfield Rd
Ste 110
(216) 291-2020
Premier Eye Care Inc
John M. Porter, O.D.
12794 Royalton Rd
(440) 230-4362
Parma
Capital Eyes
Ophthalmology
Mirfee Ungier, M.D.
6820 Ridge Rd Ste 102
(440) 743-7456
Eye Care Plus
Nick Zunich, O.D.
12000 Snow Rd Unit 1A
(440) 885-1060
James D Bing/Lois B
Bing
James Bing, O.D.
7054 W 130th
Southland Opt BLD
(440) 845-5210
Pleasant Valley Eye
Care Inc
Gary J. Crapanzano,
O.D.
7630 Broadview Rd
(216) 642-5500
Vision World Inc
Daniel S. Kretch, O.D.
7835 W Ridgewood Dr
Ste 437
(440) 888-3937
Parma Heights
Laszlo S Tomaschek MD
Laszlo S. Tomaschek,
M.D.
6390 Pearl Rd
(440) 843-2301
South Euclid
Michael D Schloss OD
Inc
Michael D. Schloss,
O.D.
14433 Cedar Rd
(216) 291-1255
Strongsville
Andros Gagliani Eye
Center
Paula M. Andros
Andrzejewska, O.D.
15247 Pearl Rd
(440) 268-0808
Berris Optical of
Strongsville
Ronald J. Trepke, O.D.
20914 Drake Rd
(440) 878-0122
Richmond Heights
Eyewear 20/20
Cynthia J. Jemiola,
O.D.
5194 Wilson Mills Rd
(440) 461-2500
Eye & Vision Center
George E. Atanasoff,
O.D.
11925 Pearl Rd
(440) 238-7865
Rocky River
Europtical Inc
Mark A. Davis, O.D.
19113 Detroit Rd
(440) 895-3030
Westlake
Europtical Inc
Mark A. Davis, O.D.
30319 Detroit Rd
(440) 892-2000
Solon
Gales Vision Source
David J. Gale, O.D.
33541 Aurora Rd
(440) 248-2020
Madison Eye Care
Associates
Gregory J. Kovats, O.D.
Peter V. Mogyordy,
O.D.
Beth A. Workman, O.D.
30588 Center Ridge Rd
(440) 892-5367
Solon Berris Optical
Corp
Joy A. Stoler, O.D.
33532 Aurora Rd
(440) 349-2225
Skyvision Centers
Gregory J. Kaye, O.D.
Scott Schlegel, O.D.
Darrell E. White, M.D.
2237 Crocker Rd Ste
100
(440) 892-3931
HOW TO REACH US
GEAUGA COUNTY
Chagrin Falls
Chagrin Valley Opt Inc
Ronald Jurcak, O.D.
5210B Chillicothe Rd
(440) 338-5900
David A DelPrincipe
OD Inc
David A. DelPrincipe,
O.D.
1541 Cooper Foster
Park Rd
(440) 282-2020
LAKE COUNTY
Eastlake
Twin Value Optical
Christopher R.
Decastecker, O.D.
34690 Vine St
(440) 946-6662
Professional Eye Care
Molly M. Lescher, O.D.
Eric C. Martin, O.D.
2268 Kresge Dr
(440) 282-4418
Mentor
Great Lakes Eyecare
James M. Bozic, O.D.
7348 Mentor Ave
(440) 953-2020
Painesville
Family Eye Care Inc
Todd M. DAlessandro,
O.D.
Brian J. Kane, O.D.
77 Normandy Dr
(440) 352-0616
Willoughby
Family Eye Care Inc
Todd M. DAlessandro,
O.D.
Anna M. Ellsesser, O.D.
Edward S. Friedman,
O.D.
Brian J. Kane, O.D.
37131 Euclid Ave
(440) 946-8809
LORAIN COUNTY
Amherst
Amherst Vision Center
Stephen Koos, O.D.
1927 Cooper Foster
Park Rd
(440) 282-6100
kp.org
Avon
Avon Family Eyecare
LLC
Huan V. Pham, O.D.
36941 Detroit Rd
(440) 934-3770
Avon Lake
Avon Lake Eye Care
Michael P. Good, O.D.
33398 Walker Rd Ste B
(440) 933-3214
Elyria
Matthias Helfrich OD
Matthias Helfrich, O.D.
1027 E Broad St
(440) 366-6700
Lorain
David J Sterna OD &
Associates LLC
Bradd D. Haney, O.D.
David J. Sterna, O.D.
1710 Cooper Foster
Park Rd W
(440) 960-2020
Downtown Vision
Center
Brett D. McVey, O.D.
209 5th St
(440) 246-2020
Paul J Alton OD Inc
Paul J. Alton, O.D.
4650 Oberlin Ave
(440) 282-9800
North Ridgeville
North Coast Eye Care
LLC
David A. DelPrincipe,
O.D.
Thomas M. Kelly, O.D.
35888 Center Ridge Rd
Ste 2
(440) 327-2747
Sheffield Lake
Sheffield Lake Vision Ctr
Gregory Dziama, O.D.
4282 E Lake Rd
(440) 949-2204
Svs Vision Inc
Eric L. Hohenberger,
O.D.
Ting Li, O.D.
5249 Detroit Rd
Unit 111
(440) 934-3267
MEDINA
Brunswick
Visionquest Eyecare Inc
F Todd Perzy, O.D.
4014 Center Rd
(330) 225-1254
Lodi
Ohio Eye Care
Consultants LLC
Alison R. Bolinger, O.D.
221 Elyria St Ste 104
(330) 948-5714
|
OPTOMETRY
Medina
Ohio Eye Care
Consultants
Thomas S. Chi, M.D.
Amy M. Fernandez, O.D.
3583 Reserve
Commons Dr
(330) 722-8300
Tim Milburn OD
Annamarie W. Milburn,
O.D.
Tim M. Milburn, O.D.
735 N Court St
(330) 725-4680
Valley City
Valley City Vision
Center
Norma J. Jesse, O.D.
6621 Center Rd
(330) 483-4035
Wadsworth
Ohio Eye Consultants
Thomas S. Chi, M.D.
1 Park Center Dr
Ste 106
(330) 334-1300
Park Centre Optical
Edmond R. Hakim, O.D.
1 Park Center Dr
Ste 101
(330) 335-3881
PORTAGE COUNTY
Kent
Kent Optometric
William U. Reeves, O.D.
Paul D. Simmons, O.D.
143 E Main St
(330) 678-8079
HOW TO REACH US
Mantua
The Mantua Eye Center
Christopher J. Meyer,
O.D.
10730 Main St
(330) 274-0502
Ravenna
Portage Vision Care
Daniel L. Jones, O.D.
950 E Main St
(330) 296-0100
Streetsboro
Phillip A Kades OD
Phillip A. Kades, O.D.
9088 Superior Ave
(330) 626-2020
SUMMIT COUNTY
Akron
Arlington Eye Care
Thomas H. Handel,
O.D.
Ronald C. Nelson, O.D.
919 E Turkeyfoot Lake
Rd Ste C
(330) 899-0202
Co Op Optical
Vernon F. Siber, O.D.
1354 S Arlington St
(330) 724-8515
Daniel Jone OD and
Associates
Daniel L. Jones, O.D.
2492B Wedgewood
(330) 784-1158
Dr Andrew M Dodd LLC
Andrew M. Dodd, O.D.
Gary L. Dodd, O.D.
2282 Newton St
(330) 794-9700
|
OPTOMETRY
Eye & Vision Center
George E. Atanasoff,
O.D.
1000 Ghent Rd
(330) 666-6786
Lisa M Testa OD Inc
Lisa M. Testa, O.D.
2383 S Main St
Ste B100
(330) 785-5111
Novus Clinic Coventry
Todd L. Beyer, D.O.
Trang D. Phan, O.D.
Jerome Sude, O.D.
3510 Manchester Rd
(330) 630-9699
Visioncare Associates
Susie H. Kim, O.D.
1558 Akron Peninsula
Rd
(330) 922-0828
Visioncare Associates
R Timothy Miller, O.D.
Sheri Miller, O.D.
3235 Manchester Rd
(330) 644-7138
Barberton
Eye Care Services
Edmond R. Hakim, O.D.
254 Norton Ave
(330) 753-2004
Copley
The Eye Site
Jennifer Hazelwood,
O.D.
1394 S Cleve Mass Rd
Ste 200
(330) 668-0150
Fairlawn
Borodkin Eyecare
Jeffrey J. Borodkin, O.D.
2820 W Market St
Ste 140
(330) 253-2436
Handel Vision Clinic
Thomas H. Handel,
O.D.
Kenneth B. King, O.D.
Ronald C. Nelson, O.D.
3631 Brookwall Dr Ste
B103
(330) 666-1766
Hudson
Ohio Optometric
Consultants Inc
William B. Keller, O.D.
126 W Streetsboro St
(330) 653-8500
Western Reserve Vision
Care Inc
Jessica A. Simon, O.D.
Mary Jo Stiegemeier,
O.D.
Haley A. Unkefer, O.D.
5992 Darrow Rd
(330) 656-4384
North Canton
Gary J Guido OD
Gary J. Guido, O.D.
5399 Lauby Rd Ste 205
(330) 494-8814
Northfield
Brandywine Vision
Center
Michael P. Good, O.D.
William B. Keller, O.D.
James R. Pearl, O.D.
9391 Olde 8 Rd
(330) 467-7600
Tallmadge
System Optics Inc
Todd L. Beyer, D.O.
James L. Johnston Jr,
D.O.
Trang D. Phan, O.D.
Joseph Pirman, O.D.
Jerome Sude, O.D.
518 West Ave
(330) 630-9699
Tallmadge Vision Clinic
Lawrence J. Roth, O.D.
384 Northeast Ave
(330) 633-9190
Uniontown
Eye Tech of Green Inc
Carl T. Cefalu, O.D.
Brad Kaster, O.D.
1790 Town Park Blvd
Ste A
(330) 896-3937
RIGHTS, RESPONSIBILITIES, AND PRIVACY
Rights,
Responsibilities,
and Privacy
YOUR RIGHTS AS A KAISER
PERMANENTE MEMBER
You are our partner in your health care. Your
participation in decisions about your health
care and your willingness to communicate
with your physician (practitioner) and other
health care professionals help us to provide
you appropriate and effective health care.
As an adult member, you can exercise these
rights yourself. If you are a minor or if you
become incapable of making decisions about
your health care, these rights will be exercised
by the person having legal responsibility for
participating in decisions concerning your
medical care.
You have the right to...
• Receive information about Kaiser
Permanente, its services, the practitioners
and providers who provide your health care,
and your rights and responsibilities as a Kaiser
Permanente member.
• Be assured of privacy and confidentiality.
You have the right to be treated with respect
and recognition of your dignity and need
for privacy. Kaiser Permanente will not
release your medical information without
your authorization, except as required or
permitted by law. You have the right to review
and receive copies of your medical records,
unless the law restricts our ability to make
them available.
• Participate with practitioners in your health
care and receive the medical information
you need to make health care decisions.
We will try to make this information as
understandable as possible. You have the
right to have ethical issues that arise in
connection with your health care reviewed.
You have the right to accept or refuse a
recommended treatment. Emergencies or
other circumstances occasionally may limit
your participation in a treatment decision.
In general, however, you will not receive any
medical treatment before you or your legal
representative gives consent. You are entitled
to an interpreter if you need one.
• Have a candid discussion of appropriate or
medically necessary treatment options for
your condition, regardless of cost or benefit
coverage.
• Use customer satisfaction resources. We
welcome your questions and comments
about Kaiser Permanente, our services,
the practitioners and other health care
professionals providing your care, and your
kp.org
•
•
•
•
•
rights and responsibilities. You have the right
to voice complaints or file appeals without
concern that your care will be affected. You
have the right to know about the complaints,
grievances and appeals procedures. In order
to assist you, the Customer Relations staff
is available to answer your questions and
resolve problems.
Make recommendations regarding
Kaiser Permanente’s members’ rights and
responsibilities policies.
Express your wishes concerning future
care in an advance directive. You have the
right to choose a person to make medical
decisions for you if you are unable to do
so. Your choices regarding your future care
may be expressed in such documents as a
durable power of attorney for health care or a
living will. You should inform your family and
practitioner of your wishes, and give them
any documents that describe your choices
regarding future care.
Have impartial access to medically indicated
treatment that is a covered benefit, regardless
of your race, religion, sex, sexual orientation,
national origin, cultural background, disability,
or financial status. You have the right to
access emergency health care services
for conditions of sufficient severity that a
prudent layperson could expect the absence
of immediate medical attention to result in
serious jeopardy to your health, or serious
impairment or dysfunction of bodily functions.
Have a safe, secure, clean, and accessible
health care environment.
Participate in physician selection. You have
the right to select a physician with an open
practice as your primary care practitioner
and to change your primary care practitioner
at a future date. You have the right to a
second opinion by a Kaiser Permanente
practitioner. You have the right to consult with
•
•
•
•
•
a non-Kaiser Permanente practitioner at your
own expense.
Receive relevant information and education
that helps ensure your safety in the course
of treatment.
Receive information about the outcomes
of care you have received, including
unanticipated outcomes.
Make complaints and receive a summary of
information on the appeals and grievances
other members have filed in the past.
Have prescriptions fulfilled in a timely
manner.
Receive information about drug coverage
and costs.
YOUR RESPONSIBILITIES AS A KAISER
PERMANENTE MEMBER
You have the responsibility to...
• Provide accurate and complete information
about your present and past medical
conditions (to the extent possible) that the
organization, its practitioners, and providers
need in order to provide care. You should
report unexpected changes in your condition
to your practitioner.
• Follow the treatment plan to which you
and your health care practitioner agree. You
should inform your practitioner if you do not
clearly understand your treatment plan and
what is expected of you. If you believe you
cannot follow through with your treatment,
you are responsible for telling
your practitioner.
• Understand your health problems and
participate in developing mutually agreedupon treatment goals to the degree possible.
• Know the extent and limitations of your
health care benefits. An explanation of these
is contained in your Evidence of Coverage.
• Identify yourself with your member ID card.
You are responsible for your membership
•
•
•
•
•
card, for using it only as appropriate, and
for ensuring that other people do not use
your card.
Keep scheduled appointments or cancel,
in a timely manner, any appointments you
are unable to keep. You are responsible for
promptly canceling any appointment that you
don’t need or cannot keep.
Provide accurate and complete
information regarding your current address,
your eligibility status, the eligibility status of
your dependents and coverage or payments
for health services available to you from
other sources.
Recognize the effect of your lifestyle on
your health. Your health depends not just on
care provided by Kaiser Permanente, but also
on the decisions you make in your daily life.
Be considerate of others. You should respect
other people and their property as well as the
people and property of Kaiser Permanente.
Fulfill financial obligations. You should
pay on time any money you owe Kaiser
Permanente.
ADVANCE DIRECTIVES FOR HEALTH CARE
Our members have the right to express their
wishes concerning future health care in the
event they become incapable of accepting
or refusing health care on their own. Kaiser
Permanente’s policy is to include such advance
directives in the medical record and to
implement them as permitted by Ohio law.
Under Ohio law, such choices may be expressed
in advance directives known as the Health Care
Power of Attorney or the Living Will.
You are not required to initiate an advance
directive, and you will not be denied care if you
do not have an advance directive.
prepared by the Ohio Hospice & Palliative
Care Organization in cooperation with the
Ohio State Medical Association, the Ohio
Hospital Association, and the Ohio Osteopathic
Association. The packet includes instructions
and preprinted forms for the Living Will and the
Health Care Power of Attorney developed by
the Ohio State Bar Association. Please write to:
Kaiser Permanente
Customer Relations Department
P.O. Box 5309
Cleveland, OH 44101-0309
You may also call us to request the information
packet. Please leave your name and mailing
address on the voicemail at (216) 479-5077 (24
hours a day, seven days a week) and we will
send a packet to you. Deaf, hard of hearing, or
speech impaired members may call Customer
Relations for assistance at 1-800-493-6004 or
8 a.m. – 8 p.m.
If you believe your Provider has not complied
with your advanced directive, you may file a
complaint with Kaiser Permanente by following
the Kaiser Permanente Grievance Procedure
outlined in your Evidence of Coverage.
END OF PARTICIPATION BY KAISER
PERMANENTE IN THE MEDICARE PROGRAM
Kaiser Permanente’s Medicare Cost contract
is renewed on an annual basis. Each year,
either Kaiser Permanente or the Centers for
Medicare & Medicaid Services (CMS) can end
the contract.
Contact us for an informational packet
Should we elect not to renew our contract with
CMS, we must notify our members at least 60
days before the termination is effective. Should
CMS decide to terminate this contract, CMS
kp.org
would then notify the general public and our
Medicare members at least 30 days before the
effective date of termination.
With any of the above notifications, your
options would be explained at that time and
alternatives provided for obtaining available
Medicare services within the service area,
including other Medicare managed care plans.
You would also have the option to return to
Original Medicare and obtain supplemental
health insurance. Whether you enroll in another
Medicare managed care health plan or not,
there would be no gap in coverage. You
would remain a member of Kaiser Permanente
Medicare Plus until you return to Original
Medicare.
PRIVACY NOTICE
KAISER PERMANENTE GRAMM-LEACH-BLILEY ACT (GLBA)
This notice is designed to inform you about the types of individually identifiable information
collected, how such information is used, the circumstances under which we share it within
our medical care program, and the circumstances under which nonpublic personal health and
financial information is disclosed to persons outside our program. Since Kaiser Permanente
does not sell or otherwise disclose your information except as allowed by law, an “opt-out”
provision is not offered.
Our policy
The Kaiser Permanente Medical Care Program
is committed to protecting the privacy of
its members and patients, including former
members and patients. Kaiser Permanente
considers maintaining the confidentiality
of members’ personal health and financial
information important to our mission of
providing quality care to members. We
maintain policies regarding confidentiality of
individually identifiable health and financial
information, including policies regarding access
to medical records and disclosure of health and
financial information. All Kaiser Permanente
staff and employees are required to maintain
the confidentiality of members’ and former
members’ individually identifiable health
and financial information. The unauthorized
disclosure of individually identifiable health and
financial information is prohibited. Permanente
Medical Group physicians and medical
professionals and practitioners and providers
with whom Kaiser Permanente contracts are
also subject to maintaining confidentiality.
Information collected
Kaiser Permanente collects various types
of nonpublic personal health and financial
information either from you or from other
sources in order to provide health care services
kp.org
and customer services, evaluate benefits
and claims, administer health care coverage,
and fulfill legal and regulatory requirements.
Examples include:
• Medical information, including medical and
hospital records, mental health records,
laboratory results, X-ray reports, pharmacy
records and appointment records.
• Information contained on surveys,
applications, and related forms, such as
your name, address, date of birth, Social
Security number, gender, marital status, and
dependents.
• Information about your relationship with
Kaiser Permanente such as medical coverage
purchased, medical services received, account
balances, payment history, and claims history.
• Information provided by your employer,
benefits plan sponsor, or association
regarding any group coverage you may have.
• Information from consumer or medical
reporting agencies or other sources such
as credit history, medical history, financial
background, and demographic information.
• Information from visitors to our Web sites
such as online forms, site visit data, and
online communications.
Collection of information
Kaiser Permanente collects information using a
variety of techniques. Examples include:
• Collecting information from you through
surveys, applications, related forms, and other
written requests and communications.
• Collecting information from your employer,
benefits plan sponsor, or association
regarding group coverage that you may have
through group applications, census data, and
other written requests and communications.
• Collecting information from visitors to our
Web site such as online forms, site visit data,
and other online communications.
• Collecting information from consumer or
medical reporting agencies or other sources
such as insurance-support organizations and
credit bureaus.
Uses of shared information
Certain nonpublic personal health and financial
information of members and former members
will need to be used or shared during the
normal course of providing you services.
We may use or disclose nonpublic personal
health and financial information under certain
circumstances, which may include:
• Personal health and financial information
will be shared only with proper written
authorization as required by law, or as
expressly required or permitted by law
without written authorization.
• Personal health and financial information
will be shared within Kaiser Permanente in
order to provide services to you, and to meet
our responsibilities under the law such as
quality assurance, reviewing the competence
or qualifications of health care providers,
conducting training programs for health care
providers, fraud and abuse detection and
compliance programs, certification, licensing
and credentialing, research, compiling
information for use in a legal proceeding and
billing and payment.
• Demographic information such as information
from your enrollment application may be
shared within Kaiser Permanente to enable
us to provide customer service or account
maintenance in connection with your benefits.
• Information such as your name, address, or
telephone number may be used by Kaiser
Permanente to tell you about other products
or services that might be useful or beneficial
to you.
• Under the federal Fair Credit Reporting
Act, we are permitted to share your name,
address, and facts about your transactions
and experiences with us such as payment
history within Kaiser Permanente.
Information obtained from insurance
support organizations
Information obtained from reports prepared
by insurance support organizations may be
retained by the insurance support organizations
and disclosed to other persons.
Information shared with non-affiliated
third parties
We occasionally disclose nonpublic personal
health and financial information of members
and former members outside of Kaiser
Permanente for the following activities:
• State and federal law generally require that
we disclose health and financial information
when disclosure is compelled by a court,
a board, a commission or administrative
agency, a party to a proceeding before a
court or administrative hearing pursuant to
a subpoena or other provision authorizing
discovery, an arbitrator or arbitration panel, a
search warrant; or a coroner.
• State and federal law also requires other
disclosures. Examples include among other
things: records of communicable diseases and
workers’ safety or industrial accident records
•
•
•
•
•
•
disclosed to public agencies, birth and death
information, and state tumor registries.
State and federal law permit the disclosure
of health information without patient
authorization under specific circumstances.
Examples include, disclosures to providers
or health plans for purposes of diagnosis or
treatment of a patient, emergency medical
personnel, peer review committees, insurance
regulatory and public licensing agencies,
and private accrediting bodies, and other
persons for purposes of performing business,
professional, or insurance functions on behalf
of Kaiser Permanente.
Information may be shared with other
companies that perform marketing services
on our behalf to develop and mail offers to
our customers about products and services.
Information may be shared with medical
care professionals, practitioners, and
institutions for purposes of verifying coverage
or benefits, informing you of medical
problems of which you may not be aware, or
conducting an operations or services audit
to verify that you have been treated by the
medical care professional or practitioner, or at
the medical care institution.
Information may be shared with law
enforcement or governmental authority to
protect the interests of Kaiser Permanente
in preventing or prosecuting acts of fraud or
otherwise investigating illegal activities that
Kaiser Permanente reasonably believes have
been committed.
Information may be shared with employers,
benefits plan sponsors, and associations
regarding group coverage that you may
have for the purpose of reporting claims
experience or conducting program audits of
Kaiser Permanente’s operations and services.
Information may be shared for purposes of
conducting actuarial or research studies.
kp.org
Protecting information
Kaiser Permanente protects the confidentiality
and security of private information of members
and former members. We maintain physical,
electronic, and procedural safeguards that
comply with federal and state standards to
protect your private information and to assist
us in preventing unauthorized access to that
information. Employee access to personal
health and financial information is provided
on a need-to-know basis such as to make
benefit determinations, pay claims, manage
care, manage the quality of care, underwrite
coverage, administer a plan, or provide
customer service.
Accessing, reviewing, and correcting
information
You have the right to look at or get a copy
of your health and financial information. If
you request copies, there will be a charge. If
you believe that information in your record is
incorrect or if important information is missing,
you have the right to request that we amend
the existing information.
Kaiser Permanente Medical Care Program
This notice applies to all companies within the
Kaiser Permanente Medical Care Program.
I. Kaiser Foundation Health Plan, Inc. and
subsidiaries and affiliated entities:
- Kaiser Foundation Health Plan, Inc.
- Kaiser Foundation Health Plan of Colorado
- Kaiser Foundation Health Plan of Georgia, Inc.
- Kaiser Foundation Health Plan of the MidAtlantic States, Inc.
- Kaiser Foundation Health Plan of the
Northwest
- Kaiser Foundation Health Plan of Ohio
- Camp Bowie Service Center
- Lokahi Assurance, Ltd.
- Kaiser Health Alternatives
- Kaiser Health Plan Asset Management, Inc.
- Kaiser Permanente Insurance Company
- Kaiser Permanente Oregon Plus, LLC
- Kaiser Properties Services, Inc.
- KP Cal, LLC
- Oak Tree Assurance, Ltd.
- OHP
- Ordway Indemnity, Ltd.
- Ordway International, Ltd.
III. The Permanente Federation and affiliated
entities
- The Permanente Federation, LLC
- The Permanente Company, LLC
- Colorado Permanente Medical Group, PC
- Hawaii Permanente Medical Group, Inc.
- Mid-Atlantic Permanente Medical Group, PC
- Northwest Permanente PC, Physicians and
Surgeons
- Ohio Permanente Medical Group, Inc.
- Permanente Dental Associates, PC
- Southern California Permanente Medical
Group
- The Permanente Medical Group, Inc.
- The Southeast Permanente Medical
Group, Inc.
This notice fulfills federal disclosure requirements
mandated by the Gramm-Leach-Bliley Act of 1999
(GLBA).
II. Kaiser Foundation Hospitals and subsidiaries
and affiliated entities
- Kaiser Foundation Hospitals
- Archimedes, Inc.
- HAMI–Colorado, LLC
- Health Care Management Solutions, LLC
- KP OnCall, LLC
- Kaiser Hospital Asset Management, Inc.
- Kaiser Permanente International
- Rainbow Dialysis, LLC
H6360_09_25 (01/20/2010)
Kaiser Foundation Health Plan of Ohio
North Point Tower
Suite 1200
1001 Lakeside Avenue
Cleveland, Ohio 44114-1153
© 2009 Kaiser Foundation Health Plan of Ohio
H6360_09_25 (01/20/2010)
#90938 2M

Kaiser Permanente Medicare Plus (Cost) Member Handbook

Transcription

Similar documents

Board 31_Amy Compton

Get Active Atlanta! FREE 8-week Training Promotion

Spring 2016

WINTER - CaliforniaChoice

An Overview of Kaiser Permanente: Integrated Health Care and

Kaiser Permanente — South San Francisco Hospital

Presentation

Kaiser Permanente Service Areas

Echinacea - Kaiser Permanente

Implementation Strategy Report