PRODUCT TRAINING SMALL GROUP + INDIVIDUAL & FAMILY (KPIF) - 2022 | KAISER PERMANENTE - Kaiser ...
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2022 | KAISER PERMANENTE
PRODUCT
TRAINING
SMALL GROUP + INDIVIDUAL & FAMILY (KPIF)
1 | 2022 SBG/KPIF Product Training
TOPICS
The Kaiser Permanente model of care
• Leading the way in COVID-19 care
• Our unique telehealth difference
• Caring for the whole person
• Connected dental care
AGENDA
Updates and reminders
2022 small business medical plans
2022 small business dental plans
2022 KPIF medical plans
2022 KPIF dental plans
Q&A
2 | 2022 SBG/KPIF Product Training
THE KAISER PERMANENTE
MODEL OF CARE
3 | 2022 SBG/KPIF Product Training
It’s easier to find your healthy place
with connected care
We combine care and coverage:
Doctors
Hospitals
Health plan
Care feels easier and faster and
is centered around you.
4 | 2022 SBG/KPIF Product Training
Northwest
Serving Oregon and Southwest Washington
Kaiser Permanente locations
Our service area extends from Eugene, OR, to Longview, WA
Medical offices
Dental offices
Vision Essentials by Kaiser Permanente retail locations
Urgent care
Hospitals
Care Essentials by Kaiser Permanente
For the most current facility information, and to find the
nearest facility to you, visit kp.org/locations.
5 | 2022 SBG/KPIF Product Training
LEADING THE WAY IN
COVID-19 CARE
6 | 2022 SBG/KPIF Product Training
KAISER PERMANENTE’S RESPONSE TO COVID-19
Providing support during
the COVID-19 pandemic
• Resilience Compass website (resiliencecompass.org):
Funding opportunities, training webinars, technology
discounts, and more for small businesses.
• Better Way COVID-19 resources (kp.org/choosebetter):
Central location for information around COVID-19 for
businesses and their employees. They’ll find:
o Coronavirus support for you and your employees
o COVID-19 vaccine — what employers need to know
o COVID-19 resources in the Thrive at Work Resource Center
o Mental Health & Wellness Webinar (4-part series)
• For the most up-to-date information, please
visit kp.org/coronavirus.
7 | 2022 SBG/KPIF Product Training
The easy-to-access convenience of virtual care
With an enhanced suite of virtual care choices, your employees can get care in more ways — and in more places — than
ever before. All without setting foot in a doctor’s office. Virtual Complete plans allow members to:
Schedule phone or face-to-face video Talk with a licensed health care Order prescriptions on our mobile
visits1 with their care team and any clinician day or night for advice, app or kp.org and get prescriptions
specialists they’ve been referred to.2 prescription refills, and more mailed free of charge or delivered same-
day or next-day (delivery fee applies).3,4
NEW! On-demand video and phone –
Email their Kaiser Permanente Get questions addressed quickly by
Kaiser Permanente clinicians, available
care team with nonurgent questions and chatting online with member
day or night, 24/7, for urgent care needs,
get a reply within 2 business days. services.5
no appointment necessary. 1,2
1. When appropriate and available. Video visits are available to Kaiser Permanente members who have a camera-equipped computer or mobile device and are registered
at kp.org. For high deductible health plan members, phone and video appointments are subject to your plan’s annual deductible. 2. While traveling out of state, phone and
video visits may not be available due to state laws that may prevent doctors from providing care across state lines. Laws differ by state. 3. Available on most prescription
orders. Standard delivery at no cost. Additional fees may apply for same-day and next-day delivery. 4. Targeted for California deployment by July 1, 2021. 5. See note 4.
8 | 2022 SBG/KPIF Product Training
MORE THAN MENTAL HEALTH
CARING FOR THE WHOLE PERSON
9 | 2022 SBG/KPIF Product Training
A holistic ecosystem with 360-degree
mental health support
Recovery
and social
support Inpatient
Educational
services
classes
Self-care and wellness resources
Healthy Intensive
Available to all members at no additional cost. Tools can be used alone or lifestyle outpatient
as complements to a personalized treatment plan. programs services
Primary care
Wellness Outpatient
Members can bring up concerns with their doctor at any time. Primary care coaching services
doctors do depression and unhealthy substance use screenings at every by phone
visit to help catch problems early and connect members to support.
Specialty care Wellness
apps
Preventive
care
Digital
Members can reach out to their local mental health department directly — self-help
without a referral — or connect to support through their primary, specialty, or tools
emergency department care teams.
Telehealth-enabled*
Designed to help meet the
needs of all our members:
Members experiencing symptoms Members who want to improve Members who are
but not seeking support their overall emotional wellness actively seeking support
*When appropriate and available. For high deductible health plan members, phone and video appointments are subject to your plan’s annual deductible. If you
10 | 2022 SBG/KPIF Product Training travel out of state, phone appointments and video visits may not be available due to state laws that may prevent doctors from providing care across state lines.
Laws differ by state. To have a video visit, members must be registered on kp.org and have a camera-equipped computer or mobile device.Self-care tools to help support emotional and physical
well-being1,2
Meditation and relaxation app designed to help
strengthen mental fitness and help with stress,
anxiety, insomnia, depression, and more
Personalized program with interactive activities
to track current emotional states and ongoing
life events to help improve awareness and
change behaviors
Access to thousands of on-demand workout
videos, live-streaming, and in-person exercise Go to kp.org/selfcare to learn
classes from top studios worldwide
more and download apps.
1. These services aren't covered under your health plan benefits and aren't subject to the terms set forth in your Evidence
of Coverage or other plan documents. These services may be discontinued at any time without notice. 2. Only available to
Kaiser Permanente members with medical coverage. myStrength® is a trademark of Livongo Health, Inc., a wholly owned
11 | 2022 SBG/KPIF Product Training subsidiary of Teledoc Health, Inc.A QUALITY DENTAL EXPERIENCE
THAT IS CONNECTED
12 | 2022 SBG/KPIF Product TrainingThe triple aim of medical-dental integration
Quality
Increased patient touch points that help members better
manage chronic diseases and help drive better outcomes
Affordability
A care-under-one-roof approach that helps lower total
health expenditures by reducing system redundancies
Service
Safe and convenient care that helps meet the needs of
our members
Selling points for
your clients include:
Coordination Convenience Health outcomes One carrier
13 | 2022 SBG/KPIF Product TrainingDENTAL TECHNOLOGY
INVESTMENTS
Investing in improvements that will help make the
dental experience more convenient for members
Fast Pass Kiosks, Express Dental-Only Access Online Dental Virtual Care
Check-In, eArrival on kp.org Appointing Expansion
LIVE NOW Q3/Q4 2021 Q3/Q4 2021 Q1/Q2 2022 Q3/Q4 2022
14 | 2022 SBG/KPIF Product TrainingUPDATES AND
REMINDERS
15 | 2022 SBG/KPIF Product TrainingMAKING IT EASIER TO WELCOME NEW MEMBERS New Member Welcome Desk
1-888-491-1124
MEMBER ONBOARDING
kp.org/newmember ID card and
quick guide to New member Personalized
welcome site email welcome book
getting started
MEMBER
Anytime Within 1 to 14 days of coverage starting
SIMPLE STEP-BY-STEP WELCOME PROGRAM
16 | 2022 SBG/KPIF Product TrainingAccount.kp.org updates
• A new, upgraded online experience for
account.kp.org launched in March (phase 1).
• For now, all the pages and features behind sign-in
(registration, sign-in, delegation, account
administration, etc.) will look and work same way.
• Transitioned to online billing for Oregon
and Washington groups (group must have
an account.kp.org profile set up).
• Sign in to account.kp.org to find out more.
17 | 2022 SBG/KPIF Product Training2022 SMALL BUSINESS PLANS
PRODUCTS AND UPDATES
Oregon and Southwest Washington
18 | 2022 SBG/KPIF Product TrainingSmall group commissions
and bonuses
2022 COMMISSIONS
Medical — increase for 2022
New member: $17.00 PMPM
Renewing member: $14.00 PMPM
Dental — increase for 2022
$3.00 PMPM
See 2022 Commission Schedule for standard New Sale and
Renewal bonus information.
The New Member rate will be paid for the first 12 months
following the effective date for a new group. The Renewing
member rate will be paid for all subsequent years.
19 | 2022 SBG/KPIF Product TrainingKPNW 2022 small group
medical rates*
OREGON & WASHINGTON
2022 Oregon rate filing: average 2.7% increase
• Q1 1.6%
• Q2 1.6%
• Q3 1.7%
• Q4 3.8%
2 geographic areas:
Portland Metro and Eugene-Springfield: Multnomah,
Washington, Clackamas, Yamhill, Lane, Linn, Benton counties
Salem: Marion and Polk counties
2022 Washington PRELIMINARY rate filing
• Average 3.0% increase
• 2 geographic areas: Clark and Cowlitz counties
*Rates pending state approval.
20 | 2022 SBG/KPIF Product TrainingKPNW 2022 small group
dental rates*
OR SG Family
• +1.4% on renewing HMO plans
• +3.8% on renewing PPO plans
• Adding Voluntary HMO and PPO options
• Removed leaner benefit plans and adding richer benefit plans
($3,000 BMAX options) on both HMO and PPO
OR SG Pediatric
• +2.1% on renewing HMO plans
• +7.2% on renewing PPO plans
• HMO plans are priced 14% to 18% below the PPO price point
WA SG Adult
• +2.8% on renewing HMO plans
• +2.8% on renewing PPO plans
• Adding Voluntary HMO and PPO options
• Removing leaner benefit plans and adding richer benefit plans
($3,000 BMAX options) on both HMO and PPO
WA SG Pediatric
• +2.47% on renewing PPO plans
21 | 2022 SBG/KPIF Product Training *Rates pending state approval.2022 SMALL BUSINESS
MEDICAL PLANS
22 | 2022 SBG/KPIF Product Training2022 OR Medical Plan Changes
WHAT’S NEW WHAT’S BEING DISCONTINUED
• No plans are being • No plans are being discontinued
added for 2022 for plan year 2022
WHAT’S CHANGING
There are no plan name changes for 2022, but the following plans have minor cost-share changes.
2022 plan year Plan level changes
KP OR Platinum 250/20
KP OR Platinum 250/20 3T POS & OOA MOOP to $3,000; coinsurance to 15%.
plan
KP OR Gold 1500/35 MOOP to $7,500; coinsurance to 25%.
KP OR Silver 3500/40 coinsurance to 35% and specialist OV to $55.
KP OR Silver 4500/45 coinsurance to 35% and specialist OV to $65.
23 | 2022 SBG/KPIF Product Training2022 OR Medical Alternative Care Changes
HMO/DHMO/HDHP
WHAT’S NEW
• Expanded coverage for Self-Referred Alternative Care services
• New Massage Buy-Up Option
2022 plan year Plan level changes
Acupuncture Services Self-Referred 12 visits per year at $25 copay (subject to deductible on HDHP plans)
*KP OR 6900/0% HSA plan will have a 0% coinsurance after deductible
Chiropractic Services Self-Referred 20 visits per year at $25 copay (subject to deductible on HDHP plans)
*KP OR 6900/0% HSA plan will have a 0% coinsurance after deductible
Naturopathic Care Self-Referred Unlimited visits at the Primary office visit cost share
Massage Buy-Up Option 12 visits per year $25 copay (subject to deductible on HDHP plans)
*KP OR 6900/0% HSA plan will have a 0% coinsurance after deductible
c WHAT’S BEING DISCONTINUED
• Physician-Referred Services for Acupuncture, Chiropractic, and Naturopathic
• Current Alternative Care Buy-Up Option
24 | 2022 SBG/KPIF Product Training Services provided by the CHP Group network of providers www.chpgroup.com/find-a-provider2022 OR Medical Alternative Care Changes
Added Choice
2022 plan year Plan level changes
Service Limits CHP Providers First Health Providers** Non-Contracted Providers
Acupuncture Services Self-Referred 12 visits per year $25* copay 20%* coinsurance 40%* coinsurance
Chiropractic Services Self-Referred 20 visits per year $25* copay 20%* coinsurance 40%* coinsurance
Naturopathic Care Self-Referred Unlimited visits Primary office visit Primary office visit Primary office visit
Massage Buy-Up Option 12 visits per year $25* copay 20%* coinsurance 40%* coinsurance
Choice products — say goodbye to “tiers” and hello to “networks”
*Cost share subject to the deductible on HDHP plans.
25 | 2022 SBG/KPIF Product Training **For OOA plan, they will have the $25* copay for services with both CHP and First Health providers.2022 OR Medical Plans
All plans except Standard
Product Type Platinum Gold Silver Bronze plans are available with
embedded adult vision
exam and hardware and/or
HMO: Traditional, massage coverage.
KP OR Platinum 0/20 KP OR Gold 0/30
nondeductible plans
KP OR Silver 2500/45 Small Employer Tax
KP OR Gold 1000/20 KP OR Bronze 7000/50 Credit:
KP OR Platinum KP OR Silver 3500/40
KP OR Gold 1500/35 KP OR Bronze 8550/40 Qualified small employers
DHMO: Traditional, 250/20 KP OR Silver 4500/45 who wish to claim the small
KP OR Gold 2000/40 KP Oregon Standard
deductible plans KP OR Platinum KP OR Silver 5500/50 business health care tax
KP Oregon Standard Bronze
500/20 KP Oregon Standard credit must select a plan
Gold
Silver without buy-up coverage.
Choice Products are not
HDHP: HSA-qualified high KP OR Silver KP OR Bronze 6900/0% qualified plans for purposes
deductible plans 2800/25% HSA HSA of the tax credit.
KP OR Gold 500/35
KP OR Platinum 3T POS KP OR Silver 2500/45
Added Choice: POS plans
250/20 3T POS KP OR Gold 1000/20 3T POS
3T POS
KP OR Gold 500/35
KP OR Platinum 3T POS OOA KP OR Silver 2500/45
Added Choice: OOA plans
250/20 3T POS OOA KP OR Gold 1000/35 3T POS OOA
3T POS OOA
Adult vision hardware and exam: hardware allowance of $200/2-year period for ages 19 and older and vision exam covered at primary office visit cost share.
Massage buy-up: $25 massage therapy (limit 12 per year per enrolled member).
26 | 2022 SBG/KPIF Product Training2022 WA Medical Plan Changes
WHAT’S NEW WHAT’S BEING DISCONTINUED
• No plans are being • No plans are being discontinued
added for 2022 for plan year 2022
WHAT’S CHANGING
2022 plan year Plan level changes
KP WA Platinum 250/20
KP WA Platinum 250/20 3T POS MOOP to $3,000; coinsurance from 10% to 15%.
& 250/20 PPO+ (OOA)
KP WA Gold 1500/35 MOOP to $7,500; coinsurance from 20% to 25%.
KP WA Silver 3500/40 coinsurance to 35% and specialist OV to $55.
KP WA Silver 4500/45 coinsurance to 35% and specialist OV to $65.
27 | 2022 SBG/KPIF Product Training2022 WA Medical Alternative Care Changes
HMO/DHMO/HDHP
WHAT’S NEW WHAT’S BEING DISCONTINUED
• Expanded coverage for Self- • Physician-Referred Naturopathic care
Referred Naturopathic services
2022 plan year Plan level changes
Naturopathic Care Self-Referred Unlimited visits at the primary office visit cost share
Naturopathic Care Physician-Referred No longer covered (as members have unlimited access to self-referred)
Services provided by the CHP Group network of providers www.chpgroup.com/find-a-provider
28 | 2022 SBG/KPIF Product Training2022 WA Medical Alternative Care Changes
Added Choice/PPO Plus
WHAT’S NEW WHAT’S BEING DISCONTINUED
• Expanded coverage for Self-Referred • Physician-Referred services for Naturopathic care
Naturopathic services
• Expanded network coverage for Physician-
Referred Acupuncture and Chiropractic care
WHAT’S CHANGING
• Expanded coverage for Self-Referred Naturopathic services
• Expanded network coverage for Physician-Referred Acupuncture and Chiropractic care
2022 plan year Plan level changes
Service Limits CHP Providers First Health Providers** Non-Contracted Providers
Naturopathic Care Self-Referred Unlimited visits Primary office visit Primary office visit Primary office visit
Acupuncture Physician-Referred Subject to medical necessity Specialty office visit Specialty office visit Specialty office visit
Chiropractic Physician-Referred Subject to medical necessity Specialty office visit Specialty office visit Specialty office visit
*Cost share subject to the deductible on HDHP plans.
**For PPO plans, they will have the $25* copay for services with First Health providers.
29 | 2022 SBG/KPIF Product Training2022 WA Medical Plans
All plans available with
Product Type Platinum Gold Silver Bronze embedded adult vision
exam and hardware.
HMO: Traditional,
KP WA Platinum 0/20 KP WA Gold 0/30
nondeductible plans
KP WA Platinum KP WA Silver 2500/45
KP WA Gold 1000/20 KP WA Bronze 7000/50
DHMO: Traditional, 250/20 KP WA Silver 3500/40
KP WA Gold 1500/35 KP WA Bronze 8550/40
deductible plans KP WA Platinum KP WA Silver 4500/45
KP WA Gold 2000/40
500/20 KP WA Silver 5500/50
HDHP: HSA-qualified high KP WA Silver KP WA Bronze
deductible plans 2800/25% HSA 6900/0% HSA
KP WA Gold 500/35
KP WA Platinum 3T POS KP WA Silver 2500/45
Added Choice: POS plans
250/20 3T POS KP WA Gold 1000/20 3T POS
3T POS
KP WA Platinum KP WA Gold 1000/35 KP WA Silver 2500/45
PPO: PPO Plus OOA plans
250/20 PPO Plus PPO Plus PPO Plus
Adult vision hardware and exam: $200 hardware benefit allowance every 2-year period for ages 19 and older and vision exam covered at primary office visit
cost share.
30 | 2022 SBG/KPIF Product Training2022 SMALL
BUSINESS
DENTAL PLANS
31 | 2022 SBG/KPIF Product TrainingOREGON AND WASHINGTON
Overall
• Stand-alone Dental, down to 2 lives
• Dual Dental plan offering available (1 Traditional plan
2022 KAISER PERMANENTE + 1 PPO Choice plan)
• Voluntary plans, down to 5 lives or 25% (whichever is
DENTAL VALUE greater)
• No waiting periods for major or orthodontia services
• PreventaMax feature on all Family and Adult plans;
preventive and diagnostic services do not reduce
annual benefit maximum
• KP integrated medical and dental electronic health
record
• PPO out-of-network dentists reimbursed 90th UCC
kp.org/dental/nw
32 | 2022 SBG/KPIF Product Training2022 Dental Plan Changes (OR)
WHAT’S DIFFERENT FOR 2022
$3000 benefit maximum options New Voluntary Family Discontinued Plans
Traditional Family plans Dental Plans • Traditional 80%
• KP OR Family Traditional 100 Traditional & PPO network Preventive plans
$50 Ded/$3000 Max plan options
• PPO 80% Preventive
• KP OR Family Traditional 100 • $50 Deductible plans
$100 Ded/$3000 Max • $1000, $1500, $2000 Benefit
• KP OR Family Traditional 100 Maximums Mandated Pediatric
$100 Ded/$3000 Max + Implant OOPM Change
• KP OR Family Traditional 100 • Pediatric OOPM
$3000 Max + Ortho changed to $375/$750
• KP OR Family Traditional 100
$3000 Max + Ortho/Implant
33 | 2022 SBG/KPIF Product Training2022 Family Traditional Plans (OR)
Family Traditional 100
Benefit Maximum Annual
$3,000
(Adults 19+ only)
Deductible Annual (3x’s family) $50 $100 $100 $100 $100
Pediatric Annual Out-of-Pocket
$375 / $750 $375 / $750 $375 / $750 $375 / $750 $375 / $750
Maximum (18 and under)
Office Visit Copay $10 $10 $10 $10 $10
Preventive & Diagnostic* $0 $0 $0 $0 $0
Basic Services** 20% 20% 20% 20% 20%
Oral Surgery, Periodontics &
20% 20% 20% 20% 20%
Endodontics**
Major Restorative & Prosthetics** 50% 50% 50% 50% 50%
$25 (13+ years old) $25 (13+ years old) $25 (13+ years old) $25 (13+ years old) $25 (13+ years old)
Nitrous Oxide
$0 (12 years and under) $0 (12 years and under) $0 (12 years and under) $0 (12 years and under) $0 (12 years and under)
Implants** No coverage No coverage 50% up to benefit maximum No coverage 50% up to benefit maximum
Medically Necessary Orthodontia (18
and under only)**
50% 50% 50% 50% 50%
50% up to $1,500 50% up to $1,500
Cosmetic Orthodontia No coverage No coverage No coverage
lifetime max benefit lifetime max benefit
*Preventive & diagnostic service does not apply to adult annual benefit maximum.
**Deductible applies.
34 | 2022 SBG/KPIF Product Training2022 Family Traditional Voluntary Dental Plans* (OR)
KP OR Family Traditional KP OR Family Traditional KP OR Family Traditional
100 - $50 Ded/$1000 Max 100 - $50 Ded/$1500 Max 100 - $50 Ded/$2000 Max
Oregon - Voluntary - Voluntary - Voluntary
Deductible Annual $50 individual / $150 family $50 individual / $150 family $50 individual / $150 family
Out-of-Pocket Maximum
$375 / $750 $375 / $750 $375 / $750
Individual / Family
Preventive & Diagnostic $0 $0 $0
Basic Services** 20% 20% 20%
Oral Surgery** 50% 20% 20%
Periodontics &
50% 20% 20%
Endodontics**
Major Restorative &
50% 50% 50%
Prosthetics**
$25 (13+ years old) $25 (13+ years old) $25 (13+ years old)
Nitrous Oxide
$0 (12 years and under) $0 (12 years and under) $0 (12 years and under)
Medically Necessary
50% 50% 50%
Orthodontia**
Cosmetic Orthodontia No coverage No coverage No coverage
PreventaMax plans.
*Voluntary plans, down to 5 lives or 25% (whichever is greater)
**Deductible applies.
35 | 2022 SBG/KPIF Product Training2022 Family Choice Voluntary Dental Plans* (OR)
c KP OR Family Choice KP OR Family Choice KP OR Family Choice
100 - $50 Ded/$1000 Max 100 - $50 Ded/$1500 Max 100 - $50 Ded/$2000 Max
Oregon - Voluntary - Voluntary - Voluntary
Deductible Annual $50 individual / $150 family $50 individual / $150 family $50 individual / $150 family
Out-of-Pocket Maximum
$375 / $750 $375 / $750 $375 / $750
Individual / Family
Preventive & Diagnostic $0 $0 $0
Basic Services** 20% 20% 20%
Oral Surgery** 20% 20% 20%
Periodontics &
20% 20% 20%
Endodontics**
Major Restorative &
50% 50% 50%
Prosthetics**
$25 (13+ years old) $25 (13+ years old) $25 (13+ years old)
Nitrous Oxide
$0 (12 years and under) $0 (12 years and under) $0 (12 years and under)
Medically Necessary
50% 50% 50%
Orthodontia**
Cosmetic Orthodontia No coverage No coverage No coverage
PreventaMax plans.
*Voluntary plans, down to 5 lives or 25% (whichever is greater)
**Deductible applies.
36 | 2022 SBG/KPIF Product Training2022 Discontinuing Traditional 80% Preventive Family Dental
Plans (OR)
Discontinued Migrate to
KP OR Family Traditional 80 - $1000 Max KP OR Family Traditional 100 - $1000 Max
KP OR Family Traditional 80 - $50 Ded/$1000 Max KP OR Family Traditional 100 - $50 Ded/$1000 Max
KP OR Family Traditional 80 - $100 Ded/$1000 Max KP OR Family Traditional 100 - $100 Ded/$1000 Max
KP OR Family Traditional 80 - $1000 Max + Ortho KP OR Family Traditional 100 - $1000 Max + Ortho
Discontinuing underutilized Traditional 80% preventive plans
• Migrate membership/groups from 80% preventive to 100% preventive coverage version of each plan (as shown above)
• Promotes preventive care by removing cost share barrier on preventive services
37 | 2022 SBG/KPIF Product Training2022 Discontinuing Choice (PPO) 80% Preventive Family
Dental Plans (OR)
Discontinued Migrate to
KP OR Family Choice 80 - $50 Ded/$1000 Max KP OR Family Choice 100 - $50 Ded/$1000 Max
KP OR Family Choice 80 - $100 Ded/$1000 Max KP OR Family Choice 100 - $100 Ded/$1000 Max
KP OR Family Choice 80 - $1000 Max + Ortho KP OR Family Choice 100 - $1000 Max + Ortho
Discontinuing underutilized PPO 80% preventive plans
• Migrate membership/groups from 80% preventive to 100% preventive coverage version of each plan (as shown above)
• Promotes preventive care by removing cost share barrier on preventive services
38 | 2022 SBG/KPIF Product Training2022 Dental Plan Changes (WA)
WHAT’S DIFFERENT FOR 2022
$3000 benefit maximum options New Voluntary Adult Dental Discontinued Plans
Traditional plans Plans • Traditional 80%
Traditional & PPO network Preventive plans
• KP WA Adult Traditional 100
plan options
$50 Ded/$3000 Max • PPO 80% Preventive
• $50 Deductible plans
• KP WA Adult Traditional 100
$100 Ded/$3000 Max • $1000, $1500, $2000 Benefit
Maximums Mandated Pediatric
• KP WA Adult Traditional 100
OOPM Change
$100 Ded/$3000 Max + Implant
• Pediatric OOPM
• KP WA Adult Traditional 100
changed to $375/$750
$3000 Max + Ortho
• KP WA Adult Traditional 100
$3000 Max + Ortho/Implant
39 | 2022 SBG/KPIF Product Training2022 Adult Traditional Plans (WA)
Adult Traditional 100
Benefit Maximum Annual
$3,000
(Adults 19+ only)
Deductible Annual (3x’s family) $50 $100 $100 $100 $100
Pediatric Annual Out-of-Pocket
$375 / $750 $375 / $750 $375 / $750 $375 / $750 $375 / $750
Maximum (18 and under)
Office Visit Copay $10 $10 $10 $10 $10
Preventive & Diagnostic* $0 $0 $0 $0 $0
Basic Services** 20% 20% 20% 20% 20%
Oral Surgery, Periodontics &
20% 20% 20% 20% 20%
Endodontics**
Major Restorative & Prosthetics** 50% 50% 50% 50% 50%
$25 (13+ years old) $25 (13+ years old) $25 (13+ years old) $25 (13+ years old) $25 (13+ years old)
Nitrous Oxide
$0 (12 years and under) $0 (12 years and under) $0 (12 years and under) $0 (12 years and under) $0 (12 years and under)
Implants** No coverage No coverage 50% up to benefit maximum No coverage 50% up to benefit maximum
Medically Necessary Orthodontia (18
and under only)**
50% 50% 50% 50% 50%
50% up to $1,500 50% up to $1,500
Cosmetic Orthodontia No coverage No coverage No coverage
lifetime max benefit; lifetime max benefit;
*Preventive & diagnostic service does not apply to adult annual benefit maximum.
**Deductible applies.
40 | 2022 SBG/KPIF Product Training2022 Adult Traditional Voluntary Dental Plans* (WA)
KP WA Adult Traditional KP WA Adult Traditional KP WA Adult Traditional
100 - $50 Ded/$1000 Max 100 - $50 Ded/$1500 Max 100 - $50 Ded/$2000 Max
Oregon - Voluntary - Voluntary - Voluntary
Deductible Annual $50 individual / $150 family $50 individual / $150 family $50 individual / $150 family
Out-of-Pocket Maximum
$375 / $750 $375 / $750 $375 / $750
Individual / Family
Preventive & Diagnostic $0 $0 $0
Basic Services** 20% 20% 20%
Oral Surgery** 50% 20% 20%
Periodontics &
50% 20% 20%
Endodontics**
Major Restorative &
50% 50% 50%
Prosthetics**
$25 (13+ years old) $25 (13+ years old) $25 (13+ years old)
Nitrous Oxide
$0 (12 years and under) $0 (12 years and under) $0 (12 years and under)
Medically Necessary
50% 50% 50%
Orthodontia**
Cosmetic Orthodontia No coverage No coverage No coverage
PreventaMax plans.
*Voluntary plans, down to 5 lives or 25% (whichever is greater)
**Deductible applies.
41 | 2022 SBG/KPIF Product Training2022 Adult Choice Voluntary Dental Plans* (WA)
KP WA Adult Choice 100 KP WA Adult Choice 100 KP WA Adult Choice 100
- $50 Ded/$1000 Max - - $50 Ded/$1500 Max - - $50 Ded/$2000 Max -
Oregon Voluntary Voluntary Voluntary
Deductible Annual $50 individual / $150 family $50 individual / $150 family $50 individual / $150 family
Out-of-Pocket Maximum
$375 / $750 $375 / $750 $375 / $750
Individual / Family
Preventive & Diagnostic $0 $0 $0
Basic Services** 20% 20% 20%
Oral Surgery** 20% 20% 20%
Periodontics &
20% 20% 20%
Endodontics**
Major Restorative &
50% 50% 50%
Prosthetics**
$25 (13+ years old) $25 (13+ years old) $25 (13+ years old)
Nitrous Oxide
$0 (12 years and under) $0 (12 years and under) $0 (12 years and under)
Medically Necessary
50% 50% 50%
Orthodontia**
Cosmetic Orthodontia No coverage No coverage No coverage
PreventaMax plans.
*Voluntary plans, down to 5 lives or 25% (whichever is greater)
**Deductible applies.
42 | 2022 SBG/KPIF Product Training2022 Discontinuing 80% Preventive Adult Traditional Dental
Plans (WA)
Discontinued Migrate to
KP WA Adult Traditional 80 - $1000 Max KP WA Adult Traditional 100 - $1000 Max
KP WA Adult Traditional 80 - $50 Ded/$1000 Max KP WA Adult Traditional 100 - $50 Ded/$1000 Max
KP WA Adult Traditional 80 - $100 Ded/$1000 Max KP WA Adult Traditional 100 - $100 Ded/$1000 Max
KP WA Adult Traditional 80 - $1000 Max + Ortho KP WA Adult Traditional 100 - $1000 Max + Ortho
Discontinuing underutilized Traditional 80% preventive plans
• Migrate membership/groups from 80% preventive to 100% preventive coverage version of each plan (as shown above)
• Promotes preventive care by removing cost share barrier on preventive services
43 | 2022 SBG/KPIF Product Training2022 Discontinuing 80% Preventive Adult Choice (PPO)
Dental Plans (WA)
Discontinued Migrate to
KP WA Adult Choice 80 - $50 Ded/$1000 Max KP WA Adult Choice 100 - $50 Ded/$1000 Max
KP WA Adult Choice 80 - $100 Ded/$1000 Max KP WA Adult Choice 100 - $100 Ded/$1000 Max
KP WA Adult Choice 80 - $1000 Max + Ortho KP WA Adult Choice 100 - $1000 Max + Ortho
Discontinuing underutilized PPO 80% preventive plans
• Migrate membership/groups from 80% preventive to 100% preventive coverage version of each plan (as shown above)
• Promotes preventive care by removing cost share barrier on preventive services
44 | 2022 SBG/KPIF Product TrainingQUESTIONS FOR
SMALL GROUP?
• Contact your Sales and Account Management team:
503-813-2630
• Option 2 for New Sales
• Option 3 for Account Management
45 | 2022 SBG/KPIF Product Training2022 KAISER PERMANENTE
INDIVIDUAL AND FAMILY PLANS
PRODUCTS AND UPDATES
Oregon and Southwest Washington
46 | 2022 SBG/KPIF Product Training2022 KPIF
MEDICAL PLANS
DIRECT AND EXCHANGE
47 | 2022 SBG/KPIF Product Training2022 OR Medical Plan Changes
WHAT’S NEW WHAT’S BEING DISCONTINUED
• KP OR Silver 2500/40 X • No plans will be discontinued in 2022
• KP OR Silver 3650/40 X
• KP OR Silver 4500/40 X
WHAT’S CHANGING
2021 plan year 2022 plan year
KP OR Gold 1500/30 KP OR Gold 2000/30 deductible to $2,000
KP OR Silver 2500/40 (On/Off) KP OR Silver 2500/40 Silver off-exchange plan has Urgent Care at $55 (vs. $50)
KP OR Silver 2500/40 X
KP OR Silver 4500/40 (On/Off) KP OR Silver 4500/40* coinsurance to 35%, specialist OV $70 after deductible. Silver off-
KP OR Silver 4500/40 X exchange plan has Urgent Care at $55 (vs. $50).
KP OR Standard Silver Plan KP OR Standard Silver Plan Silver off-exchange plan has Urgent Care at $75 (vs. $70). Name
(On/Off) KP OR Silver 3650/40 X change to follow Kaiser Permanente convention.
48 | 2022 SBG/KPIF Product Training *Change applies to CSR versions of plan as well.2022 OR Product Portfolio
On Exchange (HealthCare.gov)
Gold Silver Bronze #
HMO KP OR Gold 0/20 1
KP OR Silver 2500/40 KP OR Bronze 5500/50
KP OR Gold 2000/30
DHMO KP OR Silver 4500/40 KP OR Bronze 8550/75 8
KP OR Standard Gold Plan
KP OR Standard Silver Plan KP OR Standard Bronze Plan
Bold = Cost share changes for 2022
HDHP KP OR Bronze 6900/0% HSA 1 Blue = Oregon Standard plan
Total (On) 3 3 (+9 CSRs) 4 10 (19) On Exchange = 10 plans (with 9 CSR plans)
Off Exchange = 11 plans
Off Exchange
*Offered Off Exchange only.
Gold Silver Bronze #
HMO KP OR Gold 0/20 1 Note: Does not include American Indian/Alaska
Native CSR totals.
KP OR Silver 2500/40 X KP OR Bronze 5500/50
KP OR Gold 2000/30
DHMO KP OR Silver 4500/40 X KP OR Bronze 8550/75 8
KP OR Standard Gold Plan
KP OR Silver 3650/40 X* KP OR Standard Bronze Plan
HDHP KP OR Silver 3000/20% HSA* KP OR Bronze 6900/0% HSA 2
Total (Off) 3 4 4 11
49 | 2022 SBG/KPIF Product Training2022 OR Medical Alternative Care Changes
HMO/DHMO/HDHP
WHAT’S NEW WHAT’S BEING DISCONTINUED
• Expanded coverage for Self-Referred • Physician-Referred services for Acupuncture,
Alternative Care services Chiropractic and Naturopathic
WHAT’S CHANGING
• New coverage limits for 2022 NEW Oregon EHBs (Acupuncture and Chiropractic)
• Expanded coverage for Naturopathic services
2022 plan year Plan level changes
Acupucture Services Self-Referred 12 visits per year at $25 copay (subject to deductible on HDHP plans)
Chiropratic Services Self-Referred 20 visits per year at $25 copay (subject to deductible on HDHP plans)
Naturopthic Care Self-Referred Unlimited visits at the primary office visit cost share
Services provided by the CHP Group network of providers www.chpgroup.com/find-a-provider
50 | 2022 SBG/KPIF Product Training2022 WA Medical Plan Changes
WHAT’S NEW WHAT’S BEING DISCONTINUED
• No new plans for 2022 • No plans discontinuations for
2022
WHAT’S CHANGING
2021 plan year 2022 plan year Updates
KP WA Gold 1500/20 KP WA Gold 2000/30 deductible to $2,000
51 | 2022 SBG/KPIF Product Training2022 WA Product Portfolio
On Exchange (Washington Healthplanfinder)
Gold Silver Bronze #
HMO KP WA Gold 0/20 1
KP WA Bronze 6350/65
KP WA Gold 2000/30 KP WA Silver 2500/40
DHMO KP WA Bronze 8550/75 7
KP Cascade Gold KP Cascade Silver
KP Cascade Bronze
HDHP KP WA Bronze 6900/0% HSA 1 Bold = Cost share changes for 2022
Green = Washington Standard plan
Total (On) 3 2 (+6 CSRs) 4 9 (15) On Exchange = 9 plans plus 6 CSR plans
Off Exchange = 8 plans – 8 with Pediatric Dental
Off Exchange embedded
*Silver 3000/20% HSA offered Off Exchange only.
Gold Silver Bronze #
Note: Does not include American Indian/Alaska
KP WA Gold 0/20 w/Embedded Native CSR totals.
HMO 1
Pedi Dental
KP WA Silver 2500/40 KP WA Bronze 6350/65
w/Embedded Pedi Dental w/Embedded Pedi Dental
KP WA Gold 2000/30
DHMO 5
w/Embedded Pedi Dental
KP WA Silver 4500/40 KP WA Bronze 8550/75
w/Embedded Pedi Dental w/Embedded Pedi Dental
KP WA Silver 3000/20% HSA KP WA Bronze 6900/0% HSA
HDHP 2
w/Embedded Pedi Dental* w/Embedded Pedi Dental
Total (Off) 2 3 3 8
52 | 2022 SBG/KPIF Product Training2022 WA Medical Alternative Care Changes
HMO/DHMO/HDHP
WHAT’S NEW WHAT’S BEING DISCONTINUED
• Expanded coverage for Self- • Physician-Referred Naturopathic care
Referred Naturopathic services
WHAT’S CHANGING
• Expanded coverage for Naturopathic services
• Discontinuation of Physician-Referred Services Naturopathic services
2022 plan year Plan level changes
Naturopathic Care Self-Referred Unlimited visits at the primary office visit cost share
Naturopathic Care Physician-Referred No longer covered (as members have unlimited access to self-referred)
Services provided by the CHP Group network of providers www.chpgroup.com/find-a-provider
53 | 2022 SBG/KPIF Product Training2022 KPIF
DENTAL PLANS
DIRECT AND EXCHANGE
54 | 2022 SBG/KPIF Product Training2022 Oregon Dental Portfolio**
FAMILY TRADITIONAL PLANS
PLAN NAME KP OR Dental 100 KP OR Dental 80H KP OR Dental 80L
$50 individual $100 individual
DEDUCTIBLE (Annual) None
$100 family $300 family
BENEFIT MAXIMUM
$1,000 $1,000 None
(Annual, applies to members 19 and older only)
OUT-OF-POCKET MAX $375 individual $375 individual $375 individual
(Annual, applies to members 18 and younger only) $750 family $750 family $750 family
BENEFITS Member Pays
OFFICE VISIT COPAY $0 $0 $0
PREVENTIVE & DIAGNOSTIC $0 20% 20%
BASIC RESTORATIVE 20%* 75% 50%*
ORAL SURGERY 20%* 75% 50%*
PERIODONTICS 20%* 75% 50%*
ENDODONTICS 20%* 75% 50%*
MAJOR RESTORATIVE/PROSTHETICS 50%* 75% 50%*
ORTHODONTIA — Medically Necessary only (Pediatric members
50% 50% 50%
18 and younger only; members 19 and older are not covered)
NITROUS OXIDE $0 (2022 Washington Dental Portfolio**
ADULT TRADITIONAL PLANS: OFF EXCHANGE
PLAN NAME KP WA Dental 100 KP WA Dental 80
$50 individual $100 individual
DEDUCTIBLE (Annual)
$100 family $300 family
BENEFIT MAXIMUM (Annual) $1,000 None
BENEFITS Member Pays
OFFICE VISIT COPAY $0 $0
PREVENTIVE & DIAGNOSTIC $0 20%
BASIC RESTORATIVE 20%* 50%*
ORAL SURGERY 50%* 50%*
PERIODONTICS 50%* 50%*
ENDODONTICS 50%* 50%*
MAJOR RESTORATIVE/PROSTHETICS 50%* 50%*
NITROUS OXIDE $25 $25
ORTHODONTIA Not available
*Subject to deductible.
**Not available as a stand-alone dental option. Available to members 19 years and older. Plans available OFF Exchange only.
56 | 2022 SBG/KPIF Product Training2022 Washington Dental Portfolio
EMBEDDED PEDIATRIC TRADITIONAL PLANS
• KP WA Silver 2500/40 with Pediatric Dental
• KP WA Gold 0/20 with
Embedded in these Pediatric Dental • KP WA Silver 4500/40 with Pediatric Dental • KP WA Silver • KP WA Bronze
3000/20% HSA with 6900/0% HSA with
Medical plans: • KP WA Gold 2000/30 • KP WA Bronze 6350/65 with Pediatric Dental Pediatric Dental Pediatric Dental
with Pediatric Dental • KP WA Bronze 8550/75 with Pediatric Dental
Subject to medical Subject to medical
DEDUCTIBLE (Annual) None None
deductible deductible
OUT-OF-POCKET MAX (OOPM)
Subject to medical Subject to medical Subject to medical
(Annual; applies through the end of Subject to medical OOPM
OOPM OOPM OOPM
the year in which member turns 19)
BENEFITS Member Pays
OFFICE VISIT COPAY $0 $0 $0 0%+
PREVENTIVE & DIAGNOSTIC $0 $0 $0 0%+
BASIC RESTORATIVE 50%* 50%* 50%*+ 0%+
ORAL SURGERY 50%* 50%* 50%*+ 0%+
PERIODONTICS 50%* 50%* 50%*+ 0%+
ENDODONTICS 50%* 50%* 50%*+ 0%+
MAJOR
50%* 50%* 50%*+ 0%+
RESTORATIVE/PROSTHETICS
ORTHODONTIA
50%* 50%* 50%*+ 0%+
Medically Necessary Only**
$0 (2022 Washington Dental Portfolio
PEDIATRIC TRADITIONAL PLANS: ON EXCHANGE
PLAN NAME KP WA Pediatric Dental 100
$50 individual
DEDUCTIBLE (Annual)
$150 max per family
$375 individual
OUT-OF-POCKET MAXIMUM (Annual)
$750 max per family
BENEFITS Member Pays
PREVENTIVE $0
BASIC RESTORATIVE 20%*
PERIODONTICS 20%*
ENDODONTICS 50%*
ORAL SURGERY 50%*
MAJOR RESTORATIVE/PROSTHETICS 50%*
ORTHODONTIA — Medically Necessary ONLY 50%*
NITROUS OXIDE $0 (KPIF TOOLS AND
RESOURCES
59 | 2022 SBG/KPIF Product TrainingSign Me Up (SMU) sales Homepage
tool: overview
• The Sign Me Up (SMU) (kp.org/applyonline) sales tool is Kaiser
Permanente’s online application site for Off- Exchange KPIF applications
• Here you can:
• Generate and send quotes
• Create a personalized URL (PURL)
• Start an application for clients
• Track application status
• Quick tip: SMU automatically attaches your producer information to
applications, making it easier to start an application for your client, whether
Broker
they prefer to apply via paper or electronically: Dashboard
• Electronic (fastest processing time): generate a personalized URL
(PURL) that you can send to your client to complete the application
with your broker details attached
• Paper (slower processing time): download a customized paper
application (fillable PDF) that has your broker information attached
60 | 2022 SBG/KPIF Product TrainingApplications, tools,
and resources
SUBMITTING A PAPER APPLICATION:
Applications can be faxed to:
• 1-855-355-5334
Applications can be mailed, but please note that the effective
date is based on the received date.
Canceling coverage:
Members can ask to terminate their coverage via a written letter
submitted to Kaiser Permanente.
• Fax to: 1-855-355-5334
61 | 2022 SBG/KPIF Product TrainingApplications, tools,
and resources
MAKING PLAN CHANGES:
• Off-exchange (direct) members can use our online account
change form tool for simple plan changes during open
enrollment.
• Visit kp.org/planchange to submit simple plan changes
for direct plans.
• For all other plan changes and outside of open enrollment,
direct members can still use our paper account change form.
• Fax to: 1-855-355-5334
• To get this form and other materials, visit account.kp.org.
• On-exchange members must contact their health benefit
exchange for plan changes.
62 | 2022 SBG/KPIF Product TrainingDirect Members Exchange Members
• For recurring payment, please have • Initial payment — 3 options:
invoice handy. • Can be made through exchange portal
• Online: kp.org/payonline • KP will mail binder invoice
• Phone: 1-877-729-5590
BILLING*
• Pay on kp.org/paypremium
• Mail: Send check or money order to: Note: Client is not a member until the
Kaiser Foundation Health Plan binder payment is received.
P.O. Box 34157
Seattle, WA 98124-1157 • Online: Register on kp.org/premiumbill for
one-time payments or monthly automatic
payments. Autopay is simple, secure, and
available at no cost. Please reference
Billing ID.
• Phone: 1-844-524-7370
• Mail: Send check or money order to:
Kaiser Foundation Health Plan
*When mailing a payment, the payment
P.O. Box 60508
received date will be used — not the City of Industry, CA 91716-0508
mailed date or any other date.
Visit healthy.kp.org/support/pay-bills to learn more.
63 | 2022 SBG/KPIF Product Training2021 Open Enrollment Period (OEP)
for 2022 Coverage
• Oregon and Washington Residents*
Starts: November 1, 2021
Ends: January 15, 2022
ENROLLMENT *To obtain coverage effective January 1, 2022, we
must receive a completed application by December
OPTIONS 15, 2021.
2022 Special Enrollment Period (SEP)
• Need information on qualifying events, timelines, and
what types of proof are accepted for coverage? Find out
more at kp.org/specialenrollment.
64 || 2022 SBG/KPIF Product TrainingRenewals
• Renewals are sent only to subscribers. If you want
to review your book of business, please visit
account.kp.org.
• If members would like to receive a paperless
renewal, they can visit kp.org/paperlessrenewals
to learn more.
• On Exchange: FFM and Washington
Healthplanfinder
RENEWALS • Renewal notices will be received before their
required notification requirement.
• Off Exchange/Direct
• Renewal notices will be received before their
required notification requirement.
65 | 2022 SBG/KPIF Product TrainingADMINISTRATIVE
UPDATES AND
REMINDERS
66 | 2022 SBG/KPIF Product TrainingKPIF commissions
2022 COMMISSIONS
In 2021, Kaiser Permanente* began paying commissions on a
per-member-per-month basis. This payment schedule will
continue for 2022.
Medical — Increase for 2022
$16 PMPM for all KPIF
Dental — No Change
$2.50 PMPM for all KPIF
Commission will be paid on the subscriber, spouse/partner,
and up to 3 dependents.
See 2022 Commission Schedule for additional information.
67 | 2022 SBG/KPIF Product Training *Change does not apply to members contracted with KPWA.KPNW 2022 KPIF medical
rates*
OREGON
• 2022 Oregon rate filing: average 2.9% increase
• KP is one of the lowest priced carriers in the market: KP has the
lowest priced Silver and Gold plans in all geographic areas
• 3 geographic areas:
• Portland Metro, Salem, and Eugene-Springfield: Multnomah,
Washington, Clackamas, Yamhill, Lane, Linn, Benton, Marion, and
Polk counties
Washington
• 2022 Washington rate filing: average 0.9% increase
• KP is focused on providing low, stable rate increases year over
year to our members
• 2 geographic areas: Clark and Cowlitz counties
*WA rates pending state approval.
68 | 2022 SBG/KPIF Product TrainingYOUR KAISER PERMANENTE
TEAM
69 | 2022 SBG/KPIF Product TrainingYOUR KAISER PERMANENTE TEAM
National broker/producer support services
Telephone Support Solutions: Option 3: Kaiser Permanente Compensation
• Appointments
1-844-394-3978 • Book of business reconciliation and compensation, transfers, reports
• Commissions
Option 1: Enrollment Status and Membership
• Producer of record
• Application, enrollment, plan status
• Billing inquiries Option 4: New Sales
• Current plan and product information • Plan, benefits, rates
• Member administration requests • Application submissions
• Evidence of coverage and ID cards • SMU technical support
*Option 2 is for CA compensation services For more information, email us at kpif-broker-escalations@kp.org
KPIF REGIONAL SALES AND ACCOUNT MANAGEMENT
Melissa Hand Heather Williams
Account Manager Senior Territory Manager
Office: 503-813-3545 Office: 503-813-4216
Cell: 503-457-6766 Cell: 971-235-8936
melissa.m.hand@kp.org heather.j.williams@kp.org
70 | 2022 SBG/KPIF Product TrainingTHANK YOU
71727033661_B2B_08-21
| All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest. 500 NE Multnomah St., Suite 100, Portland, OR 97232. ©2021 Kaiser Foundation Health Plan of the NorthwestAPPENDIX 72 | 2022 SBG/KPIF Product Training
Portland metro-area care options
CLOSE WHEN YOU NEED US
Kaiser Permanente locations
• 18 medical offices
• 14 dental offices
• 2 Kaiser Permanente hospitals
• 2 Care Essentials clinics
Access to affiliate providers including:
• OHSU Doernbecher Children's Hospital
• The Portland Clinic
• Orchid Health - Wade Creek Clinic
• Canby HealthCare Clinic
73 | 2022 SBG/KPIF Product Training• Neighborhood-based convenient care clinics
• Same copay as a Kaiser Permanente visit
• Preventive care services and treatment for
minor illnesses and injuries
• Open to Kaiser Permanente members and
nonmembers and accept most insurance plans
COVID-19 Updates: To help ensure the safety of our members, staff, and community, we may temporarily
close or limit in-person services at some of our medical and dental facilities. Members can still get the care
they need, including emergency care, e-visits, phone or video visits, and more.
1 When appropriate and available.
2 These features available when you get care at Kaiser Permanente facilities.
3 to have a video visit, members must be registered on kp.org and have a camera-equipped computer or mobile device.
74 | 2022 SBG/KPIF Product TrainingAFFILIATE PARTNERS 75 | 2022 SBG/KPIF Product Training
• Panel to a doctor at The Portland Clinic.
• Costs are the same for covered services
whether you seek care from Kaiser Permanente
or The Portland Clinic.*
• Services not performed at The Portland Clinic
can be performed at Kaiser Permanente
facilities.
*Not available as an in-network provider to members on Medicaid, receiving full Medical Financial Assistance from Kaiser Permanente, or visiting from
another Kaiser Permanente region.
76 | 2022 SBG/KPIF Product TrainingSouthwest Washington-area care options
Kaiser Permanente locations:
• 6 medical offices
• 3 dental offices
Access to affiliate providers including:
• Legacy Salmon Creek Medical Center
• PeaceHealth St. John Medical Center
77 | 2022 SBG/KPIF Product TrainingSalem-area locations
• 4 medical offices
• 3 dental offices
• Salem Hospital
• + affiliate providers
78 | 2022 SBG/KPIF Product TrainingMcMinnville-area locations
Primary Care Specialty Care
• Kaiser Permanente McMinnville Primary Care • Valley Women’s Health
• McMinnville Internal Medicine • McMinnville Eye Clinic
• Any Kaiser Permanente facility • Willamette Valley Medical Center (for general surgery and
orthopedics)
Lab Tests and Imaging
• Willamette Valley Medical Center Pharmacy
• Kaiser Permanente mail-order pharmacy
Pediatric Care • First fill at Safeway Pharmacy (2490 N. OR-99W)
• + More options for Added Choice® members
• Kaiser Permanente McMinnville Primary Care
• Willamette Valley Pediatrics and Adolescent Medicine
• Newberg Urgent Care*
*With a Kaiser Permanente family medicine provider.
79 | 2022 SBG/KPIF Product TrainingStayton-area locations
Primary Care Specialty Care
• Santiam Hospital primary care clinics • Santiam Hospital specialists
• Kaiser Permanente facilities • Cardiology
• General Surgery
Lab Tests and Imaging • Ob-Gyn
• Santiam Hospital primary care clinics • Orthopedics
• Kaiser Permanente facilities • Podiatry
• Pulmonology
Pharmacy • Kaiser Permanente facilities
• Kaiser Permanente pharmacies + mail-order
pharmacy Pediatric Care
• + More options for Added Choice® members • Santiam Family Medicine clinics
• Kaiser Permanente facilities
80 | 2022 SBG/KPIF Product TrainingWhy choose Kaiser Have questions about getting started with Kaiser Permanente?
Want to learn more about our services? Use this information to
Permanente? explore the resources available to members, or to get answers
to any questions you have.
Discover Kaiser Permanente Additional Resources
kp.org/thrive Find resources for healthier living: kp.org/healthyliving
Enrollment Resources Get in touch with us by phone
• Apply online: kp.org/applyonline • Broker Support: 1-844-394-3978
• Get started if you’re a new member: kp.org/newmember • Member Services: 1-800-813-2000, TTY 711
• Enroll during a special enrollment period: kp.org/specialenrollment
Member Resources Stay connected to good health
• Manage your care: kp.org facebook.com/kpthrive
• Find a location near you: kp.org/facilities youtube.com/kaiserpermanente.org
• Choose your doctor: kp.org/searchdoctors
• Create your online account: kp.org/registernow @kpthrive, @aboutkp, @kpnorthwest
• Get an idea of what your care will cost: kp.org/treatmentestimates
• Get an estimate of what you’ll pay for your care: kp.org/costestimates
• Get a copy of your Evidence of Coverage: kp.org/plandocuments
81 | 2022 SBG/KPIF Product TrainingDecision Support Tool The Decision Support Tool (DST) (buykp.org) is Kaiser Permanente’s online quoting tool
where you can compare On and Off-Exchange KPIF plans, see if your client may qualify
(DST) overview
for a subsidy and get a quick quote. To submit an application, you will need to use the
Kaiser Permanente Sign Me Up (SMU) tool.
Compare
Homepage
Plans Page
82 | 2022 SBG/KPIF Product TrainingSign Me Up (SMU) sales Broker
Registration
Page
tool: tips and tricks
• You must be a Kaiser Permanente appointed
producer in order to register as a producer on SMU
• Contact our Broker Compensation team (see
Producer/Broker Support Services) to get appointed to
sell Kaiser Permanente
• First-time users: Register here to create a
producer account: https://apply-individual-
family.kaiserpermanente.org/brokervalidation Get Quotes
Page
• If you’re appointed to sell KP in more than one region,
you’ll need to register for a separate SMU account for
each KP region
• Your producer details (name, license number, state,
and phone number) will be automatically populated
once your account is verified
• Check out the SMU tutorials on the “Get Quotes and
Apply for Coverage” page on account.kp.org
83 | 2022 SBG/KPIF Product Training• On March 11, 2021, President Joe Biden signed into law
the American Rescue Plan Act of 2021 (ARPA) to help
reduce health care costs, expand access to coverage,
and help ensure nearly everyone who buys their own
The American Rescue individual or family health coverage through an Individual
Health Benefit Exchange, can receive a tax credit to
Plan Act (ARPA) of 2021 •
reduce their premiums.
The American Rescue Plan provides 3 new ways to
subsidize coverage:
Visit account.kp.org for detailed ARPA FAQ
1. COBRA coverage through September 2021
for Individual & Family producers
subsidized at 100%
2. Expanded premium subsidies in the Individual
Health Benefit Exchanges for PY 2021 and 2022
3. Premium tax credit to anyone who has filed for
unemployment, only for PY 2021
84 | 2022 SBG/KPIF Product TrainingHR 133 new producer compensation
disclosure requirements for Individual Market
• The Consolidated Appropriations Act, 2021, or
CAA, was a stimulus bill passed on December
27, 2020.
• As part of overall health care price
transparency, the bill imposes new disclosure
requirements on issuers regarding direct or
indirect compensation the issuer pays to an
agent or producer associated with enrolling
individuals in coverage.
• What does it mean?
• Starting in 2022 OE, consumers and
applicants will see new disclosures on
coverage applications, Account Change
Forms, and welcome letters that include
information about how much producers
are compensated for the coverage.
85 | 2022 SBG/KPIF Product TrainingClient/member requests Email us at kpif-broker-escalations@kp.org or call 1-
844-394-3978 option 1 for your client/member inquiries
KP staff can provide the following information to the The following requests require a written authorization from the
producer of record for a client/member without written authorization: client/member:
• Application status Appointment information/PCP
• Benefit information/clarification Claims payment
• Claims status Effective date change requests
• Deductible billing/payment/accumulation Letter requests for eligibility/benefit clarification/termination*
• Enrollment issues HRN request
• Evidence of Coverage requests Plan change request and processing*
• ID card requests Reinstatement request
• KPIF On/Off-Exchange payment Members must submit signed "Account Change Form" to
information complete:*
• Plan change — education only • Demographic changes — name and address changes
• Status of plan change request • Dependent additions/drops
• Premium and billing inquiries • Requests to combine accounts
• Member current effective dates • Requests to change plans
Visit account.kp.org to find the Account Change Form*
Please have ready your client (subscriber)’s full name, DOB, address, and Please have your client complete and sign the HIPAA
HRN (optional); your broker ID; and mention that you are producer of record for disclosure authorization form on account.kp.org
the subscriber.
86 | 2022 SBG/KPIF Product Training *Applies to Off-Exchange plans only; contact HealthCare.gov (OR) or wahealthplanfinder.org (WA) to request for On-Exchange plans.• Visiting members at
KPWA facilities/providers
IMPROVED MEMBER • Same cost share
BILLING EXPERIENCE
• No upfront payment or
post-visit billing
87 | 2022 SBG/KPIF Product TrainingCONVENIENT, HIGH-QUALITY Flexible coverage options:
Traditional plan
DENTAL CARE AND COVERAGE PPO plan
21 DENTAL 165 KP DENTISTS GENERAL RIGHT CARE AT MEDICAL-DENTAL
OFFICES Plus a network of DENTISTRY THE RIGHT TIME INTEGRATION (MDI)
Eugene, OR, to 415,000+ PPO dentists SPECIALTY CARE Urgent dental care Integration with electronic
Longview, WA nationwide Including orthodontics, available 24 hours a health record, co-location,
Many co-located with endodontics, oral day, 7 days a week and coordination with
or near a Kaiser surgery, and Virtual dentistry medical team for quality
Permanente medical periodontics options, including outcomes
facility video, phone, and
email*
*When appropriate and available. These features are available when you get care at Kaiser Permanente facilities. If you travel out of state, phone appointments and video
visits may not be available due to state laws that may prevent doctors from providing care across state lines. Laws differ by state. To have a video visit, members must be
registered on kp.org and have a camera-equipped computer or mobile device.
88 | 2022 SBG/KPIF Product TrainingVIRTUAL DENTISTRY
100% INTEGRATED — $0 COSTS
A virtual visit with a dentist may cover a member’s
dental history, assess the severity of the concern,
and provide recommendations and next steps.
• Telephone advice 24 hours a day, 7 days
a week
• Telephone and video visits (available after
a member is triaged)1,2,3
• Dental advice email on kp.org and the
Kaiser Permanente app4,5
• Ability to email patient photos through
kp.org and Kaiser Permanente app4,5
1. When appropriate and available. If you travel out of state, phone appointments and video visits may not be available due to state laws that may
prevent doctors from providing care across state lines. Laws differ by state.
2. These features available when you get care at Kaiser Permanente facilities.
3. To have a video visit, members must be registered on kp.org and have a camera-equipped computer or mobile device.
4. Available for members with both Kaiser Permanente medical and dental coverage.
5. To use the Kaiser Permanente app, you must be a Kaiser Permanente member registered on kp.org.
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