2016 Kaiser Permanente Plan Highlights

2016 Kaiser Permanente Plan Highlights

Individual and Family Plans
Georgia
2016 Kaiser Permanente
Plan Highlights
Kaiser Permanente for Individuals and Families
Important deadlines
There’s a deadline to apply for health care coverage, whether you apply during open enrollment
or during a special enrollment period.
Get started today
This booklet will show you
how to find a new plan
that best fits your needs.
Enrolling during the 2016 open enrollment period
You may change or apply for 2016 coverage during the open enrollment
period, which runs from November 1, 2015, through January 31, 2016.
You can do so either through the Health Insurance Marketplace or through
Kaiser Permanente.
Important deadlines........ 2
To start coverage on:
Send your completed application
and premium by:
Health plan
benefit highlights............. 3
January 1, 2016
February 1, 2016
March 1, 2016
December 15, 2015
January 15, 2016
January 31, 2016
Working out your rate...... 8
Enrolling in a Kaiser
Permanente plan on
the Marketplace...............10
Enrolling during a special enrollment period
Outside of open enrollment, you may enroll or change your coverage if you
experience what’s known as a triggering event. Examples of triggering
events include getting married, having a baby, and losing coverage because
you lost your job.
From the date of your triggering event, the special enrollment period
generally lasts 60 days. That means you have 60 days to change or apply for
coverage for you and/or your dependents.
If you know you are going to have a triggering event, you may be able to
apply for new coverage ahead of time.
For more information, please refer to the Enrolling During a Special
Enrollment Period guide. If you didn’t receive this guide, you can find it at
buykp.org/apply, or you may call 1-800-494-5314 to request a copy.
31
Have questions? Call us at 1-800-494-5314.
60361911 Georgia 2016
To enroll during this open enrollment period,
you must make sure we receive your completed
Application for Health Coverage — along with
your first month’s premium — no later than
January 31, 2016.
•
Go to buykp.org/apply.
2
•
Or contact your agent or broker.
Kaiser Permanente for Individuals and Families
Health plan benefit highlights
The charts on the next few pages show you a sample of each plan’s benefits. Review the
diagram below to help you understand how to read those charts.
Here’s a quick look at how to use the chart
KP
KP GA Silver 2500/30
Plan type
Annual medical deductible
(individual/family)
$2,500/$5,000
Annual out-of-pocket maximum
(individual/family)
$6,850/$13,700
Preventive care
Routine physical exam, mammograms, etc.
Primary care office visit
$30
Specialty care office visit
$60
First $300 of office visit charges
covered at 100%, then remaining at
30% after deductible. Outpatient
Hospital covered at 50% after
deductible.
Preventive care at no charge
Most preventive care services — including routine
physical exams and mammograms — are covered at no
charge. Plus, they’re not subject to the deductible.
Office visit: $300
Outpatient Hospital: $500
30% after deductible
Mental health visit
$60
Covered before you reach the deductible
With some services, you’ll only pay a copay or
coinsurance, regardless of whether you’ve reached
your deductible. Under this plan, primary care visits
are covered at a $30 copay — even before you meet
your deductible. With our Silver deductible plans,
primary care, specialty care, and urgent care visits all
are covered before you reach the deductible.
Inpatient hospital care
30% after deductible
Maternity
Routine prenatal care visit,
first postpartum visit
30% after deductible
Delivery and inpatient well-baby care
30% after deductible
Coinsurance
Emergency and urgent care
Emergency Department visit
Ambulance services
After reaching your deductible, this is a percentage of
the charges that you may pay for covered services. Here,
you’d pay 30% of the cost per day for your inpatient
hospital care after you reach your deductible. Your plan
would pay the rest for the remainder of the calendar year.
30% after deductible
Urgent care visit
$100
30% after deductible
Prescription drugs (up to a 30-day supply)
Generic
Preventive generic: $5*
Preferred generic: $15*
Preferred brand
$451 after $500/$1,000 deductible
Non-preferred brand
50% after $500/$1,000 deductible
Specialty
50% after $500/$1,000 deductible
Copay
This is the set amount you pay for covered services,
usually after you reach your deductible. In this example,
you’d start paying a $100 copay for urgent care visits,
whether or not you have met your deductible.
*Mail order: 90-day supply of qualified prescriptions
for the cost of a 60-day supply
Have questions? Call us at 1-800-494-5314.
This is the most you’ll pay for care during the calendar
year before your plan starts paying 100% for most
covered services. In this example, you’d never pay
more than $6,850 for yourself and no more than
$13,700 for your family for your copays, coinsurance,
and deductible in a calendar year.
Office visit: 30% after deductible
Outpatient Hospital: 50% after
deductible
Outpatient surgery
Room and board, surgery, anesthesia, X-rays,
lab tests, medications, mental health care
Offered through the Health Insurance Marketplace
Annual out-of-pocket maximum
No charge
Outpatient services (per visit or procedure)
MRI, CT, PET
M
You need to pay this amount before your plan starts
helping you pay for most covered services. Under
this sample plan, you’d pay the full charges for covered
services until you reach $2,500 for yourself or
$5,000 for your family. Then you’d start paying copays
or coinsurance.
Benefits
Most lab tests
Offered through Kaiser Permanente
Annual deductible
Deductible
Features
Most X-rays
KP
M
•
Go to buykp.org/apply.
3
•
Or contact your agent or broker.
60361911 Georgia 2016
Kaiser Permanente for Individuals and Families
KP
Offered through Kaiser Permanente
M
Offered through the Health Insurance
Marketplace
KP
Financial assistance options with lower copays, coinsurance, and
deductibles are available for certain plans, and for Native Alaskans
and American Indians on healthcare.gov.
KP
M
KP
M
M
KP
M
KP GA Bronze
6000/40%/HSA
KP GA Bronze
5000/50
KP GA Bronze
4000/20
KP GA Silver
2750/20%/HSA
HSA-qualified
Deductible
Deductible
HSA-qualified
Annual medical deductible
(individual/family)
$6,000/$12,000
$5,000/$10,000
$4,000/$8,000
$2,750/$5,500
Annual out-of-pocket maximum
(individual/family)
$6,450/$12,900
$6,850/$13,700
$6,850/$13,700
$5,000/$10,000
No charge
No charge
No charge
No charge
Primary care office visit
40% after deductible
First 3 office visits: $50
4+ visits: 40% after deductible
First 3 office visits: $20
4+ visits: 30% after deductible
20% after deductible
Specialty care office visit
40% after deductible
First 3 office visits: $70
4+ visits: 40% after deductible
First 3 office visits: $50
4+ visits: 30% after deductible
20% after deductible
Most X-rays
Office visit: 40% after deductible
Outpatient Hospital: 50% after
deductible
Office visit: 40% after deductible
Outpatient Hospital: 50% after
deductible
Office visit: 30% after deductible
Outpatient Hospital: 50% after
deductible
Office visit: 20% after deductible
Outpatient Hospital: 40% after
deductible
Most lab tests
Office visit: 40% after deductible
Outpatient Hospital: 50% after
deductible
Office visit: 40% after deductible
Outpatient Hospital: 50% after
deductible
Office visit: 30% after deductible
Outpatient Hospital: 50% after
deductible
Office visit: 20% after deductible
Outpatient Hospital: 40% after
deductible
MRI, CT, PET
Office visit: 40% after deductible
Outpatient Hospital: 50% after
deductible
Office visit: 40% after deductible
Outpatient Hospital: 50% after
deductible
Office visit: $500 after deductible
Outpatient Hospital: $700 after
deductible
Office visit: 20% after deductible
Outpatient Hospital: 40% after
deductible
Outpatient surgery
40% after deductible
40% after deductible
30% after deductible
20% after deductible
Mental health visit
40% after deductible
First 3 office visits: $70
4+ visits: 40% after deductible
First 3 office visits: $50
4+ visits: 30% after deductible
20% after deductible
40% after deductible
40% after deductible
30% after deductible
20% after deductible
Routine prenatal care visit,
first postpartum visit
40% after deductible
40% after deductible
30% after deductible
20% after deductible
Delivery and inpatient well-baby care
40% after deductible
40% after deductible
30% after deductible
20% after deductible
Emergency Department visit
40% after deductible
40% after deductible
30% after deductible
20% after deductible
Urgent care visit
40% after deductible
$100
$100
20% after deductible
Ambulance services
40% after deductible
40% after deductible
30% after deductible
20% after deductible
Generic
Preventive generic: $51
Preferred generic: 40% after
medical deductible
Preventive generic: $51
Preferred generic: $201 after
medical deductible
Preventive generic: $51
Preferred generic: $251
Preventive generic: $51
Preferred generic: $151 after
medical deductible
Preferred brand
50% after medical deductible
50% after medical deductible
50% after $1,000/$2,000 deductible
$451 after medical deductible
Non-preferred brand
50% after medical deductible
50% after medical deductible
50% after $1,000/$2,000 deductible
50% after medical deductible
Specialty
50% after medical deductible
50% after medical deductible
50% after $1,000/$2,000 deductible
50% after medical deductible
Plan type
Features
Benefits
Preventive care
Routine physical exam, mammograms, etc.
Outpatient services (per visit or procedure)
Inpatient hospital care
Room and board, surgery, anesthesia, X-rays,
lab tests, medications, mental health care
Maternity
Emergency and urgent care
Prescription drugs (up to a 30-day supply)
Mail order: 90-day supply of qualified prescriptions for the cost of a 60-day supply.
1
This is a summary of the most frequently asked-about benefits and their copays, coinsurance, and deductibles. Detailed information about your plan is in the Evidence of Coverage,
which will be mailed to you upon enrollment or upon request. To request a copy of the Evidence of Coverage for a particular plan, please call us at 1-800-634-4579 or contact your
broker. For services subject to the deductible, you will have to pay health care expenses out of pocket until you meet your deductible. Most deductibles, copays, and coinsurance
contribute to the out-of-pocket maximum.
Have questions? Call us at 1-800-494-5314.
60361911 Georgia 2016
•
Go to buykp.org/apply.
4
•
Or contact your agent or broker.
KP
Offered through Kaiser Permanente
M
Offered through the Health Insurance
Financial assistance options with lower copays, coinsurance, and
deductibles are available for certain plans, and for Native Alaskans
and American Indians on healthcare.gov.
Marketplace
KP
KP
M
KP
M
M
KP
M
KP GA Silver
2500/30
KP GA Silver
1500/30
KP GA Gold
1500/20
KP GA Gold
1000/20
Deductible
Deductible
Deductible
Deductible
Annual medical deductible
(individual/family)
$2,500/$5,000
$1,500/$3,000
$1,500/$3,000
$1,000/$2,000
Annual out-of-pocket maximum
(individual/family)
$6,850/$13,700
$6,850/$13,700
$3,500/$7,000
$5,000/$10,000
No charge
No charge
No charge
No charge
Primary care office visit
$30
$30
$20
$20
Specialty care office visit
$60
$60
$40
$40
Office visit: 30% after deductible
Outpatient Hospital: 50% after
deductible
Office visit: 30% after deductible
Outpatient Hospital: 50% after
deductible
First $100 of office visit charges
covered at 100%, then remaining
at 20% after deductible. Outpatient
Hospital covered at 40% after
deductible.
First $100 of office visit charges
covered at 100%, then remaining
at 20% after deductible. Outpatient
Hospital covered at 40% after
deductible.
First $300 of office visit charges
covered at 100%, then remaining
at 30% after deductible. Outpatient
Hospital covered at 50% after
deductible.
First $300 of office visit charges
covered at 100%, then remaining
at 30% after deductible. Outpatient
Hospital covered at 50% after
deductible.
First $400 of office visit charges
covered at 100%, then remaining
at 20% after deductible. Outpatient
Hospital covered at 40% after
deductible.
First $400 of office visit charges
covered at 100%, then remaining
at 20% after deductible. Outpatient
Hospital covered at 40% after
deductible.
Office visit: $300
Outpatient Hospital: $500
Office visit: $250
Outpatient Hospital: $500
Office visit: $150
Outpatient Hospital: $250
Office visit: $150
Outpatient Hospital: $250
Outpatient surgery
30% after deductible
30% after deductible
20% after deductible
20% after deductible
Mental health visit
$60
$60
$40
$40
30% after deductible
30% after deductible
20% after deductible
20% after deductible
Routine prenatal care visit,
first postpartum visit
30% after deductible
30% after deductible
20% after deductible
20% after deductible
Delivery and inpatient well-baby care
30% after deductible
30% after deductible
20% after deductible
20% after deductible
30% after deductible
30% after deductible
20% after deductible
20% after deductible
$100
$100
$75
$75
30% after deductible
30% after deductible
20% after deductible
20% after deductible
Preventive generic: $51
Preferred generic: $151
Preventive generic: $51
Preferred generic: $151
Preventive generic: $51
Preferred generic: $101
Preventive generic: $51
Preferred generic: $101
Preferred brand
$451 after $500/$1,000 deductible
$451 after $500/$1,000 deductible
$301 after $500/$1,000 deductible
$301 after $500/$1,000 deductible
Non-preferred brand
50% after $500/$1,000 deductible
50% after $500/$1,000 deductible
45% after $500/$1,000 deductible
45% after $500/$1,000 deductible
Specialty
50% after $500/$1,000 deductible
50% after $500/$1,000 deductible
45% after $500/$1,000 deductible
45% after $500/$1,000 deductible
Plan type
Features
Benefits
Preventive care
Routine physical exam, mammograms, etc.
Outpatient services (per visit or procedure)
Most X-rays
Most lab tests
MRI, CT, PET
Inpatient hospital care
Room and board, surgery, anesthesia, X-rays,
lab tests, medications, mental health care
Maternity
Emergency and urgent care
Emergency Department visit
Urgent care visit
Ambulance services
Prescription drugs (up to a 30-day supply)
Generic
Mail order: 90-day supply of qualified prescriptions for the cost of a 60-day supply.
1
This is a summary of the most frequently asked-about benefits and their copays, coinsurance, and deductibles. Detailed information about your plan is in the Evidence of Coverage,
which will be mailed to you upon enrollment or upon request. To request a copy of the Evidence of Coverage for a particular plan, please call us at 1-800-634-4579 or contact your
broker. For services subject to the deductible, you will have to pay health care expenses out of pocket until you meet your deductible. Most deductibles, copays, and coinsurance
contribute to the out-of-pocket maximum.
Have questions? Call us at 1-800-494-5314.
•
Go to buykp.org/apply.
5
•
Or contact your agent or broker.
60361911 Georgia 2016
Kaiser Permanente for Individuals and Families
KP
Offered through Kaiser Permanente
M
Offered through the Health Insurance
Financial assistance options with lower copays, coinsurance, and
deductibles are available for certain plans, and for Native Alaskans
and American Indians on healthcare.gov.
Marketplace
KP
Plan type
KP
M
M
M
M
KP GA Gold
500/20
KP GA Catastrophic
6850/02
KP GA Silver
1500/30/73% CSR
2500/30/73% CSR
KP GA Silver
1500/30/87% CSR
2500/30/87% CSR
Deductible
Deductible
Deductible
Copay
$500/$1,000
$6,850/$13,700
$1,500/$3,000
None/None
$6,350/$12,700
$6,850/$13,700
$5,200/$10,400
$2,250/$4,500
No charge
No charge
No charge
No charge
$20
First 3 office visits: no charge
4+ visits: no charge after deductible
$30
$15
Features
Annual medical deductible
(individual/family)
Annual out-of-pocket maximum
(individual/family)
Benefits
Preventive care
Routine physical exam, mammograms, etc.
Outpatient services (per visit or procedure)
Primary care office visit
Specialty care office visit
$40
No charge after deductible
$50
$25
Most X-rays
First $100 of office visit charges
covered at 100%, then remaining at
30% (ded waived). Outpatient Hospital
covered at 50% (ded waived).
No charge after deductible
Office visit: 20% after deductible
Outpatient Hospital: 40% after
deductible
Office visit: 20%
Outpatient Hospital: 40%
Most lab tests
First $400 of office visit charges
covered at 100%, then remaining at
30% (ded waived). Outpatient Hospital
covered at 50% (ded waived).
No charge after deductible
Office visit: $250
Outpatient Hospital: $500
No charge after deductible
Office visit: $250
Outpatient Hospital: $500
Office visit: $150
Outpatient Hospital: $300
30% after deductible
No charge after deductible
20% after deductible
20%
$40
First 3 office visits: no charge
4+ visits: no charge after deductible
$50
$25
$500 per day up to 3 days after
deductible, then covered at 100%
No charge after deductible
20% after deductible
20%
No charge
No charge after deductible
20% after deductible
20%
$2,000 per admission
No charge after deductible
20% after deductible
20%
$250
No charge after deductible
20% after deductible
20%
Urgent care visit
$75
No charge after deductible
$100
$50
Ambulance services
$300
No charge after deductible
20% after deductible
20%
Preventive generic: $51
Preferred generic: $101
No charge after deductible
Preventive generic: $51
Preferred generic: $151
Preventive generic: $51
Preferred generic: $151
Preferred brand
$301 after $500/$1,000 deductible
No charge after deductible
$451 after $250/$500 deductible
$451
Non-preferred brand
45% after $500/$1,000 deductible
No charge after deductible
50% after $250/$500 deductible
50%
Specialty
45% after $500/$1,000 deductible
No charge after deductible
50% after $250/$500 deductible
50%
MRI, CT, PET
Outpatient surgery
Mental health visit
First $300 of office visit charges covered First $300 of office visit charges
at 100%, then remaining at 20% after covered at 100%, then remaining
deductible. Outpatient Hospital covered
at 20%. Outpatient Hospital
at 40% after deductible.
covered at 40%.
Inpatient hospital care
Room and board, surgery, anesthesia, X-rays,
lab tests, medications, mental health care
Maternity
Routine prenatal care visit,
first postpartum visit
Delivery and inpatient well-baby care
Emergency and urgent care
Emergency Department visit
Prescription drugs (up to a 30-day supply)
Generic
Mail order: 90-day supply of qualified prescriptions for the cost of a 60-day supply.
Only applicants under age 30, or applicants age 30 and older who provide a certificate from Health Insurance Marketplace in Georgia demonstrating hardship
or lack of affordable coverage, may purchase a KP GA Catastrophic 6850/0 plan.
1
2
This is a summary of the most frequently asked-about benefits and their copays, coinsurance, and deductibles. Detailed information about your plan is in the Evidence of Coverage,
which will be mailed to you upon enrollment or upon request. To request a copy of the Evidence of Coverage for a particular plan, please call us at 1-800-634-4579 or contact your
broker. For services subject to the deductible, you will have to pay health care expenses out of pocket until you meet your deductible. Most deductibles, copays, and coinsurance
contribute to the out-of-pocket maximum.
Have questions? Call us at 1-800-494-5314.
60361911 Georgia 2016
•
Go to buykp.org/apply.
6
•
Or contact your agent or broker.
KP
Offered through Kaiser Permanente
M
Offered through the Health Insurance
Financial assistance options with lower copays, coinsurance, and
deductibles are available for certain plans, and for Native Alaskans
and American Indians on healthcare.gov.
Marketplace
M
M
M
KP GA Silver
1500/30/94% CSR
2500/30/94% CSR
KP GA Silver
2750/20%/73% CSR3
KP GA Silver
2750/20%/87% CSR3
KP GA Silver
2750/20%/94% CSR3
Copay
Deductible
Deductible
Deductible
None/None
$1,400/$2,800
$500/$1,000
$100/$200
$1,900/$3,800
$5,000/$10,000
$2,250/$4,500
$1,400/$2,800
No charge
No charge
No charge
No charge
Primary care office visit
$5
20% after deductible
10% after deductible
5% after deductible
Specialty care office visit
$10
20% after deductible
10% after deductible
5% after deductible
Office visit: 5%
Outpatient Hospital: 40%
Office visit: 20% after deductible
Outpatient Hospital: 40% after
deductible
Office visit: 10% after deductible
Outpatient Hospital: 40% after
deductible
Office visit: 5% after deductible
Outpatient Hospital: 40% after
deductible
First $300 of office visit charges
covered at 100%, then remaining
at 5%. Outpatient Hospital covered
at 40%.
Office visit: 20% after deductible
Outpatient Hospital: 40% after
deductible
Office visit: 10% after deductible
Outpatient Hospital: 40% after
deductible
Office visit: 5% after deductible
Outpatient Hospital: 40% after
deductible
Office visit: $50
Outpatient Hospital: $150
Office visit: 20% after deductible
Outpatient Hospital: 40% after
deductible
Office visit: 10% after deductible
Outpatient Hospital: 40% after
deductible
Office visit: 5% after deductible
Outpatient Hospital: 40% after
deductible
Outpatient surgery
5%
20% after deductible
10% after deductible
5% after deductible
Mental health visit
$10
20% after deductible
10% after deductible
5% after deductible
5%
20% after deductible
10% after deductible
5% after deductible
Routine prenatal care visit,
first postpartum visit
5%
20% after deductible
10% after deductible
5% after deductible
Delivery and inpatient well-baby care
5%
20% after deductible
10% after deductible
5% after deductible
Emergency Department visit
5%
20% after deductible
10% after deductible
5% after deductible
Urgent care visit
$20
20% after deductible
10% after deductible
5% after deductible
Ambulance services
5%
20% after deductible
10% after deductible
5% after deductible
Preventive generic: $51
Preferred generic: $51
Preventive generic: $51
Preferred generic: $151 after
medical deductible
Preventive generic: $51
Preferred generic: $51 after
medical deductible
Preventive generic: $51
Preferred generic: $51 after
medical deductible
Preferred brand
$101
$451 after medical deductible
$101 after medical deductible
$101 after medical deductible
Non-preferred brand
50%
50% after medical deductible
50% after medical deductible
50% after medical deductible
Specialty
50%
50% after medical deductible
50% after medical deductible
50% after medical deductible
Plan type
M
Features
Annual medical deductible
(individual/family)
Annual out-of-pocket maximum
(individual/family)
Benefits
Preventive care
Routine physical exam, mammograms, etc.
Outpatient services (per visit or procedure)
Most X-rays
Most lab tests
MRI, CT, PET
Inpatient hospital care
Room and board, surgery, anesthesia, X-rays,
lab tests, medications, mental health care
Maternity
Emergency and urgent care
Prescription drugs (up to a 30-day supply)
Generic
Mail order: 90-day supply of qualified prescriptions for the cost of a 60-day supply.
1
This is a summary of the most frequently asked-about benefits and their copays, coinsurance, and deductibles. Detailed information about your plan is in the Evidence of Coverage,
which will be mailed to you upon enrollment or upon request. To request a copy of the Evidence of Coverage for a particular plan, please call us at 1-800-634-4579 or contact your
broker. For services subject to the deductible, you will have to pay health care expenses out of pocket until you meet your deductible. Most deductibles, copays, and coinsurance
contribute to the out-of-pocket maximum.
Have questions? Call us at 1-800-494-5314.
•
Go to buykp.org/apply.
7
•
Or contact your agent or broker.
60361911 Georgia 2016
Kaiser Permanente for Individuals and Families
Working out your rate
Use the monthly rates chart on the following page to help you evaluate your plan options, or
apply on kp.org/apply to have your rate calculated automatically. Along with your monthly rate,
consider what you will need to pay when you get care.
What determines your rate?
The rates on page 9 apply to the counties below.
Please check that your county is listed below. If it
isn’t, call us at 1-800-494-5314 for information on
other rate areas.
Your rate is based on the following:
■
The plan you select
■
Your age on your start date (effective date)
■
Whether you use tobacco
Service Area—Counties
Barrow
Bartow
Butts
Carroll
Cherokee
Clayton
Cobb
Rates are determined based on each person’s age on
the plan’s start date, whether they apply individually or
as a family. For example, if your 29th birthday is on
February 14 and you submit your completed application
on January 15, you’ll have a start date of February 1 and
the rate for a 28-year-old.
However, if you submit your application on January 16,
your start date will be March 1. Since this is after your
birthday, you’ll have the rate for a 29-year-old.
Coweta
Dawson
DeKalb
Douglas
Fayette
Forsyth
Fulton
Gwinnett
Hall
Haralson
Heard
Henry
Lamar
Meriwether
Newton
Paulding
Pickens
Pike
Rockdale
Spalding
Walton
Although family members can enroll in different
plans, there are some advantages to enrolling family
members in the same plan:
■
Children can be covered under your plan until they
reach age 26, whether or not they’re in school or
living at home.
If you have more than 3 children under 21 on the same
plan, you will only be charged for the 3 oldest. Other
children under 21 are covered at no additional cost. If
you have a child-only account and everyone on the
account is under 21, you will only be charged for the
subscriber and the 3 oldest children under 21.
■
Have questions? Call us at 1-800-494-5314.
60361911 Georgia 2016
•
Go to buykp.org/apply.
8
•
Or contact your agent or broker.
Do you qualify for federal financial assistance? If so, you may
pay lower rates than those listed in this chart.
2016 Monthly rates
Age on 2016
effective
date
0–18
19–20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64+
KP GA Bronze
6000/40%/
HSA
$123.61
123.61
194.63
194.63
194.63
194.63
195.36
199.24
203.84
211.36
217.66
220.81
225.41
230.02
232.93
236.08
237.77
239.23
240.93
242.38
245.53
248.68
253.29
257.65
263.95
271.71
280.92
291.83
303.94
318.00
331.82
347.33
362.84
379.81
396.78
415.20
433.86
453.74
474.10
495.67
506.33
527.90
546.57
558.93
574.20
583.65
KP GA Bronze
5000/50
$130.80
130.80
205.95
205.95
205.95
205.95
206.72
210.83
215.70
223.65
230.32
233.65
238.53
243.40
246.48
249.81
251.61
253.15
254.94
256.48
259.81
263.15
268.02
272.64
279.31
287.51
297.26
308.80
321.63
336.50
351.12
367.54
383.95
401.90
419.86
439.35
459.10
480.13
501.67
524.50
535.79
558.61
578.36
591.44
607.60
617.60
KP GA Bronze
4000/20
$134.28
134.28
211.43
211.43
211.43
211.43
212.22
216.43
221.44
229.60
236.44
239.87
244.87
249.87
253.03
256.45
258.30
259.88
261.72
263.30
266.72
270.15
275.15
279.89
286.73
295.16
305.16
317.01
330.18
345.45
360.46
377.31
394.16
412.59
431.02
451.03
471.31
492.90
515.01
538.45
550.03
573.47
593.74
607.17
623.76
634.03
KP GA Silver
2750/20%/
HSA
KP GA Silver
2500/30
KP GA Silver
1500/30
KP GA Gold
1500/20
KP GA Gold
1000/20
KP GA Gold
500/20
KP GA
Catastrophic
6850/0
$159.33
159.33
250.87
250.87
250.87
250.87
251.80
256.80
262.74
272.42
280.54
284.61
290.54
296.48
300.23
304.29
306.47
308.35
310.54
312.41
316.47
320.53
326.47
332.09
340.21
350.21
362.08
376.14
391.76
409.88
427.69
447.68
467.68
489.55
511.42
535.16
559.21
584.83
611.07
638.88
652.62
680.43
704.48
720.42
740.10
752.28
$159.79
159.79
251.60
251.60
251.60
251.60
252.54
257.55
263.50
273.22
281.36
285.43
291.39
297.34
301.10
305.17
307.37
309.25
311.44
313.32
317.39
321.47
327.42
333.06
341.21
351.23
363.14
377.24
392.90
411.08
428.94
448.99
469.04
490.97
512.90
536.72
560.84
586.54
612.85
640.74
654.53
682.41
706.54
722.52
742.26
754.47
$167.68
167.68
264.01
264.01
264.01
264.01
265.00
270.26
276.50
286.70
295.24
299.52
305.77
312.01
315.96
320.23
322.53
324.51
326.81
328.78
333.05
337.33
343.58
349.49
358.04
368.56
381.06
395.85
412.29
431.36
450.10
471.14
492.18
515.20
538.21
563.20
588.52
615.48
643.09
672.36
686.82
716.08
741.40
758.17
778.88
791.70
$189.71
189.71
298.70
298.70
298.70
298.70
299.82
305.77
312.84
324.37
334.04
338.87
345.94
353.01
357.47
362.31
364.91
367.14
369.75
371.98
376.82
381.65
388.72
395.41
405.09
416.99
431.12
447.86
466.46
488.04
509.24
533.05
556.85
582.89
608.93
637.20
665.84
696.35
727.59
760.70
777.07
810.17
838.81
857.79
881.22
895.73
$191.33
191.33
301.25
301.25
301.25
301.25
302.38
308.38
315.51
327.14
336.89
341.77
348.90
356.03
360.53
365.41
368.03
370.28
372.91
375.16
380.04
384.91
392.04
398.80
408.55
420.55
434.81
451.69
470.45
492.21
513.59
537.60
561.61
587.88
614.14
642.65
671.54
702.30
733.81
767.20
783.71
817.10
845.99
865.12
888.75
903.39
$196.67
196.67
309.65
309.65
309.65
309.65
310.81
316.98
324.31
336.26
346.29
351.30
358.63
365.95
370.58
375.59
378.29
380.61
383.31
385.62
390.63
395.65
402.97
409.91
419.94
432.28
446.93
464.29
483.57
505.93
527.91
552.59
577.27
604.27
631.26
660.57
690.26
721.88
754.27
788.59
805.56
839.88
869.57
889.24
913.53
928.57
$105.45
105.45
166.04
166.04
166.04
166.04
166.66
169.96
173.89
180.30
185.68
188.37
192.30
196.22
198.71
201.39
202.84
204.08
205.53
206.77
209.46
212.15
216.07
219.80
225.17
231.79
239.65
248.95
259.29
271.28
283.07
296.30
309.53
324.01
338.48
354.20
370.12
387.07
404.44
422.84
431.94
450.35
466.27
476.81
489.84
497.90
Rates are effective January 1, 2016, through December 31, 2016.
Have questions? Call us at 1-800-494-5314.
•
Go to buykp.org/apply.
9
•
Or contact your agent or broker.
60361911 Georgia 2016
Kaiser Permanente for Individuals and Families
Enrolling in a Kaiser Permanente plan on the Marketplace
Need help choosing a plan? Visit buykp.org, call us at 1-800-494-5314, or contact your agent
or broker. We can also help you apply for federal financial help through healthcare.gov.
Kaiser Permanente makes it easy:
1. Get ready
Here are some examples of documents and information you may need
to complete your application:
Most recent pay stub and tax return
Birthdates of everyone in your family (even if they DON’T want coverage)
Social Security numbers for all family members who DO want coverage
Proof of citizenship or immigration status
Policy numbers of any current health insurance plan
Paperwork for health insurance available through your employer
2. Get your plan
Visit www.healthcare.gov. Select “Get Coverage,” then select Georgia
and then click “Get Coverage.” Enter your ZIP code and select “Start a
marketplace application,” followed by “Create an Account.” Fill in the
account setup page. Sign in to your email and click on the link that says
verify your email address.
Accept the Terms and Conditions and complete all 4 sections.
Review and sign.
On the next page, click “Find a Plan.” In the Getting Started section, hit
“Continue.” Choose “Health” as your Coverage Type, and click “Continue.”
Under Decision Support for Medical, click “Skip & View Plans.” Use the
green filter on the left to check “Kaiser Permanente” and hit “Apply Filter.”
Select a plan and click “Add to Cart.” Finally, scroll up and hit “Save and
Continue to Checkout.”
Click “Continue” to confirm your selections on the next several screens.
When you reach the Proceed to the Initial Payment Details page, click
“Make a Payment” and then click “Continue.”
Read and accept the User Agreement, add your digital signature,
and hit “Finish.”
Thank you for choosing Kaiser Permanente, the right choice for a healthier you.
Have questions? Call us at 1-800-494-5314.
60361911 Georgia 2016
•
Go to buykp.org/apply.
10
•
Or contact your agent or broker.
Have questions? Call us at 1-800-494-5314.
•
Go to buykp.org/apply.
11
•
Or contact your agent or broker.
60361911 Georgia 2016
Kaiser Permanente for Individuals and Families
Have questions? Call us at 1-800-494-5314.
60361911 Georgia 2016
•
Go to buykp.org/apply.
12
•
Or contact your agent or broker.
The right choice for a healthier you
Learn more about all that Kaiser Permanente has to offer. Visit kp.org/thrive
or call us at 1-800-494-5314 (711 TTY for the deaf, hard of hearing, or
speech impaired).
Kaiser Foundation Health Plan of Georgia, Inc.
kp.org
Please recycle. 60361911 Georgia 2016