Health Insurance

These numbers are current for 12/07 through 11/08.

We currently have Kaiser Permanente health insurance. Our group number is n11367-001. The names of our plans are as follows:

HMO plan

Deductible plan SB-250

260.55/person/month

Deductible: $250 ~indicates deductible waived for service

Regular office visits: $15 copay~

Specialty care: $25 copay~

urgent care: $15 copay~

Lab tests and xrays: $10~

Outpatient surgery: 20%

Hospital stay: 20%

Emergency services: 20%

Ambulance services: 20%~

To make an appointment or to talk to an advice nurse, call Membership Services: 503-813-2000

Prescription plan

29.76/person/month

Plan GV $20 ($20 per prescription)

Dental plan

$38.73/person/month

Plan L ($10 office visits and up to $2000 of coverage, preventive and basic surgeries covered by office visit)

To make an appointment, Call the appointment center: 503-286-6868

Appointment Center Hours are 6:30 AM to 7PM Monday through Friday, and 7:30 AM to 4 PM Saturday

Vision plan

$4.90/person/month

Plan Y (up to $150 every 2 years for glasses/contacts)

Alternative Care rider

$4.88/person/month

$15 per chiropropractic, acupuncture or naturopathic visit: $25 massage therapy visit for up to 12 visits a year. Eligible providers can be found at http://chpplans.us $1000 maximum payout per year.

To schedule an appointment, call Membership Services 503-813-2000

We currently pay $338.82 per person per month (from 12/2007 through 11/2008) for these services. There is no pre-existing condition exclusion for our group health coverage.

Online Account

Access our online account by going to http://employers.kaiserpermanente.org/kpweb/gatewaycas/entrypage.do and clicking on "Sign In". You can enroll and terminate coverage and pay the bill online.

Enrollment

Coverage begins on the first day of the month after the new employee is hired. We need to fill out all the forms and stuff less than 30 days after they've been hired.

Employees are eligible for the health plan if they work at least 17.5 hours/week on a regular basis, and are permanent workers.

Online

1. Have our new enrollee fill out and sign the enrollment.pdf form (located in fgstaff/health_insurance).
2. Log onto our account. Under "Member Functions", click on "Enroll Subscriber".
3. Fill out form and submit.
4. So that we have the signature on file, keep the form in the health insurance file in Richard's office.

Offline

1. Have our new enrollee fill out and sign the enrollment.pdf form (located in fgstaff/health_insurance; hard copies in the health insurance file).
2. Fax form to (503)813-4426 and (503)246-3816.
3. Send form to:
   

Kaiser Foundation Health Plan of the Northwest
Membership Administration
P.O. Box 921008
Fort Worth TX 76121-0008

Waiving Coverage

If someone waives coverage, they can't sign up for Kaiser until our next open enrollment month (generally November of every year), unless they've lost their non-Kaiser coverage through no fault of their own.

To waive coverage, print out the waive.pdf form located in fgstaff/health_insurance; hard copies in the health insurance file and have the waive-er fill it out.

• Fax to (817)255-4420
• Keep it on file in his/her real-world personnel file in the filing cabinet.

If we have over 10 employees (by Kaiser's definition: work at least 17.5 hours/week regularly, permanent), up to 25% of them can be without coverage at all. If the employee has coverage originating elsewhere, like on their partner's health insurance, they're not included in this count.

Termination

We can do this online.

1. Log onto our account.
2. Under "Member Functions", select "Subscriber List".
3. Select the outgoing employee with the radio button, then select "Terminate Coverage" from the Member Functions menu.
4. Fill out the form and press the "Submit" button.

• We must also offer continuation to the outgoing employee. Please see below for instructions.

Continuation Option

By Oregon law, we must offer up to 6 months of continued health insurance for terminated/laid off/resigning employees. It should be offered as part of the Staff Exit Procedure. The employee would pay their own premium, copays, other fees, etc. Please see Health Insurance Continuation for instructions on how to offer this coverage.

Yearly Census

There's a census form in the fgstaff/health_insurance directory. Kaiser wants us to fill one of these out every November so they know how many employees we have and how many of them have Kaiser and stuff.

Timeline

Some dates to remember. All approximate.

• October 1 Begin considering new plan. Survey staff, review options.
• November 15 Kaiser renewal due
• December 1 Renewed/new plan starts
• December Review new plan with staff/hand out new packets during staff meeting

Other Underwriting Questions?

Check out the "<year>_Underwriting_Guidelines.pdf" in the fgstaff/health_insurance directory.

Invoice Flow and Payment

• Email reminders: should go to payables [at]
• Paper invoices: are checked over for changes/errors, then filed in the Monkeyhouse
• Bills are on autopay. Premiums for the month are paid on the last day of the previous month.