1. BETTER INFORMED. BETTER TOGETHER
BETTER INFORMED. BETTER TOGETHER. Open Enrollment presentation for University of the Pacific with Kaiser HMO HSA
easy to get appointments
Note to presenter: Insert the employer group that you’re presenting to located in the header of this slide.
test results online
excellent prenatal care
free to focus on my patients
I’m part of the decision
I can choose my doctor
wide range of specialists

2. Kaiser Permanente HSA-Qualified Deductible HMO Plan

3. Understanding your Kaiser Permanente HSA-Qualified Deductible HMO Plan
Preparing for your open enrollment: 11/06 Stockton, 11/05 SF, 11/128 Sacto
Note to presenter: Include the word “new” in the second bullet if employer is switching from an HMO plan to an HSA-Qualified Deductible HMO Plan. Remove “new” if same plan as last year.
If the plan you’re presenting to this group is new, i.e., the group has switched from an existing Kaiser Permanente HMO plan to a Kaiser Permanente HSA-qualified deductible HMO plan, use this following copy:
As you know, your open enrollment dates are [Insert Dates].
We are glad you are taking this opportunity to review your health plan options. Today we are here to discuss Kaiser Permanente’s HSA-qualified deductible HMO plan.
This presentation will help you better understand this new HSA-qualified deductible HMO plan that you’re being offered by Kaiser Permanente.
We also want to share with you some of the health tools and programs to take advantage as a Kaiser Permanente member.
If the plan you’re presenting to this group is simply making updates to their existing HSA-qualified deductible HMO plan, use this following copy:
This presentation will help you better understand and familiarize yourself with the benefit changes taking effect on [Insert Effective Date].
Understanding your Kaiser Permanente HSA-Qualified Deductible HMO Plan
The benefits of choosing Kaiser Permanente

4. Your Kaiser Permanente HSA-Qualified Deductible HMO Plan
Same great doctors
Same personalized attention
Same convenient locations
Same health resources
Note to presenter: If this is a new offering, please delete the word “same” in the bullets above.
A deductible plan really is just a different way of paying for the services you have come to expect from Kaiser Permanente.
With the HSA-qualified deductible HMO plan, you will still get the same great doctors, the same personalized attention, the same convenient locations, and the same healthy resources. And with a health savings account (HSA), you have an opportunity to make a financial investment in your health care.
Optional: Depending on how familiar this group is on the KP value, you can expand on these points:
With the deductible plan, you will still get:
Same choice of great doctors who are connected by your electronic health record when you receive care at Kaiser Permanente facilities and see the bigger picture of your health. You can choose your personal physician after browsing their profiles on kp.org.
Same personalized attention focused on your total health.
Same convenient locations, many of which have multiple services under one roof—primary care, lab and X-ray, pharmacy—so you can take care of many of your health needs in a single trip.
Same health resources, such as farmers markets and health classes, many of which are free, at facilities and online, to empower you to stay healthy.
Same access to My Health Manager, which is powered by your electronic health record, so you can your doctor, order prescription refills, view lab results, and more.
The HSA-qualified deductible HMO plan simply offers another way to pay for your care.
A different way to pay for your care

5. Overview of how your deductible plan works
Single Ded: $2, OOPM: $ 5,600
Family Ded: $5,600 OOPM: $11,200
80/20% coinsurance
Note to presenter: Use the following talking points to help explain this diagram.
The Kaiser Permanente deductible plan really is just a different way to pay for care, including:
the amount of your deductible and co-payments or coinsurance
and the out-of-pocket costs for services, procedures, treatments and tests
This diagram is to help you understand the different key terms.
Premium – this is the amount you pay or your employer pays (usually each month) for health care coverage.
Deductible – is the set amount you’ll need to reach each calendar year before you start paying copays or coinsurance for most services covered by your plan. With your deductible, you pay full charges for services received until you reach your set amount—then you pay just a copay or coinsurance for most services.
Copayment – is a set dollar amount you’ll pay for certain services covered by your plan. Copayments will vary depending on your plan and the service.
Coinsurance – is a percentage of charges you pay for certain covered services. Coinsurance amounts vary depending on your plan and the service.
Annual Out of Pocket Maximum – is the maximum amount that a member pays for certain covered services in a calendar year. Includes copayments, coinsurance, and deductible payments. The premium you pay each month is not included in the out-of-pocket total.

6. What’s a deductible?
A deductible is the set amount you’ll need to reach each calendar year before you start paying copays or coinsurance for most services covered by your plan.
You’ll pay full charges for most covered services, including prescriptions, until you reach your deductible.
There’s one combined deductible for medical and pharmacy expenses.
Your individual deductible is $2,800.
Your family deductible for 2 or more is $5,600.
Note to presenter: Tell the group their individual and family deductible amounts here.
Individual deductible: You must pay full charges for most covered services, including prescriptions, before you reach your deductible. After you have reached your individual deductible, you’ll pay copays or coinsurance for most covered services for the rest of the calendar year.
Family deductible: After your family deductible is met, everyone in the family will pay copays or coinsurance for most covered services for the rest of the calendar year—even if they haven’t all reached their individual deductibles.
Your deductible resets to $0 on January 1 each year.
(Note to presenter: please revise date if not on a calendar year plan). 6

7. How does this work? Before you reach your deductible
Before you reach your deductible
After you reach your deductible
Kaiser Permanente service fees
Annual physical exam
$95
Office visit
$140
Prescription (generic)
$65
You pay
No charge
20% Coinsurance
$10 copay
Kaiser Permanente pays
$270
Note to presenter: Enter the copay or coinsurance amount in the “Office visit” and “Emergency room visit” cells within the “After you reach your deductible” column specific to their plan. Subtract the copay or coinsurance amount from the sum of the cells “After you reach your deductible” within the “Kaiser Permanente service fees” section and enter the new total within the “After you reach your deductible” column on the “Kaiser Permanente pays” row.
Presentation to members
With the HSA-qualified plan, you’ll pay full charges for most covered services, including prescriptions, until you reach your deductible. Most preventive care services—like routine physical exams, mammograms, and cholesterol screenings—are covered at little or no cost to you, even before you reach your deductible. After you reach your deductible, most services are available at a copay or coinsurance until you reach your out-of-pocket maximum.
The annual physical exam is $95.
The office visit is $140.
The generic prescription is $65.
For example: Before you reach your deductible (Note to presenter: you’ll need to update the copay amounts in the example to match the table in the slide).
You pay: $ = $205 total
For example: After you reach your deductible (Note to presenter: you’ll need to update the copay amounts in the example to match the table in the slide).
You pay: $0 + $20 copay + $10 copay = $30 total
Your annual physical exam is a preventive service, therefore, you end up paying “no charge” for this service, while Kaiser Permanente pays $95.
With this plan, you’ll pay full charges for most covered services, including prescriptions, until you reach your deductible; therefore you’ll end up paying $140 for your office visit and $65 for your generic prescription, before you reach your deductible.
Once you’ve reached your deductible, you’ll only pay a copay or coinsurance for your office visit and generic prescription.
Note: These are estimated costs only.

8. What services count toward my calendar year deductible?
Payments for most covered services (except for preventive services) can help you reach your calendar year deductible. Here are some examples that do apply:
ambulance services
Emergency Department visits
hospital care
imaging, laboratory, and special procedures
intensive psychiatric treatment programs
office visits (including services such as dialysis and physical, occupational, and speech therapy)
outpatient surgery
prescription drugs
transitional residential recovery services for chemical dependency
What medical services count toward the deductible?
All charges that you pay for covered services, except preventive care services, count toward your deductible. Some examples of services that count toward the deductible include: office visits, ambulance services, Emergency Department visits, hospital care, and outpatient surgery.
This is only a sample of some of the services that apply toward your deductible. Please refer to your Evidence of Coverage for a complete list. 8

9. Preventive care services
Prevention has always been an essential part of Kaiser Permanente’s care philosophy. It’s about staying healthy and preventing illness. That’s why your deductible plan offers most preventive care services at little or no cost to you, even before you reach your deductible. Examples include:
cervical cancer screenings
cholesterol screenings
colon cancer screenings
diabetes screenings
immunizations
mammogram screenings
prenatal care visits
preventive annual exams
prostate cancer screenings
well-child visits
Some examples of preventive care include
At Kaiser Permanente, you’ll find that preventive care is an essential part of your health plan. That’s why with our deductible plans, you pay only a copay or coinsurance for most preventive care services and screenings, even if you haven’t reached your deductible.
Note to presenter: Indicate the actual copay amount and/or cost. If the client is Health Care Compliant, then the cost to the member for preventive care is “no charge”; otherwise, state the amount.
However, it’s a good idea to keep in mind that in some cases you may receive both preventive and nonpreventive or diagnostic services during the same visit. Although your cost for certain preventive care services may be “no charge”, you may have to pay for any nonpreventive or diagnostic services you receive during the same visit. Let me share an example:
During a routine physical exam, your doctor might find a mole during a routine physical exam and decide to remove it for testing. Because the mole removal is considered diagnostic rather than preventive, you might have to pay a copay, coinsurance, or deductible payment for this procedure. The actual lab tests ordered by your doctor would probably require an additional payment. So, although your routine physical exam would be covered at little or no cost as a preventive care service, you probably would have to pay for the two additional non-preventive services connected with your visit.
This is only a sample list of some of the preventive services we cover. For a complete list, please see our flier “What is a preventive care service?” For a copy, visit kp.org/deductibleplans, click on “Resources,” then click on “Download documents.”

10. Understanding copay and coinsurance
Depending on your plan, you’ll either pay a copay or coinsurance usually after you have reached your deductible.
Copay
A set dollar amount you’ll pay for certain services covered by your plan.
Coinsurance
A percentage of charges you pay for certain covered services or prescriptions.
You must pay full charges for most covered services before you reach your deductible. After you have reached your individual deductible, you’ll pay copays or coinsurance for most covered services for the rest of the calendar year.
While some people use these words interchangeably, they are different. Depending on your plan, you will pay either a copay or coinsurance payment for certain services when you come in for care after you’ve reached your deductible. So, what’s the difference?
A copay is a fixed (preset) amount. This amount will remain the same each time you come in for a visit. For example, if you have a $10 office visit copay, you’ll pay $10 for each office visit.
A coinsurance is a percentage of the charges you pay for certain covered health care services. Because the services you are scheduled to receive will probably change from visit to visit, so will your payment. This amount will go up or down depending on the services you need that day. As an example, if you have a 20 percent coinsurance on a $200 procedure, you’ll pay $40 for that procedure once you’re eligible.

11. Out-of-pocket maximum
Your annual out-of-pocket maximum offers peace of mind by limiting the total amount you’ll pay for all covered services each year.
The way you reach your out-of-pocket maximum is similar to the way you reach your deductible.
Your copays, coinsurance, and deductible payments count towards your out-of-pocket maximum.
After you reach your out-of-pocket maximum, Kaiser Permanente will pay the full amount for all covered services for the rest of the calendar year.
Your health plan puts a limit on your out-of-pocket costs for all covered services. Knowing there's a limit on how much you will be asked to pay for all covered medical services each year can give you peace of mind. After you reach your out-of-pocket maximum, your health plan will pay the full cost of all covered services for the rest of the calendar year. This may help protect you if you have a serious illness or injury.
If group is on an embedded plan:
Each family member’s expenses for all covered services count toward his or her individual out-of-pocket maximum. Once that individual maximum is reached, Kaiser Permanente will pay for 100 percent of all covered services for that family member for the rest of the calendar year. Once the family out-of-pocket maximum collectively has been met, Kaiser Permanente will pay for 100 percent of covered services for all family members for the rest of the calendar year.
If group is on an aggregate plan:
For an individual plan, once the individual out-of-pocket maximum is reached, Kaiser Permanente will pay for 100 percent of all covered services for the rest of the calendar year.
For family coverage (two or more members), each family member’s expenses (including deductibles, copays, and coinsurance) count toward the family out-of-pocket maximum. Once you reach the family out-of-pocket maximum, Kaiser Permanente will pay for 100 percent of all covered services for all family members for the rest of the calendar year.
The out-of-pocket maximum applies to medical expenses such as:
Ambulance services ▪ Physical, occupational, and speech therapy
Allergy injections and testing ▪ Preventive care exams
Emergency Department services ▪ Primary and specialty care visits
Home health care ▪ Hospice care
Skilled nursing facility ▪ Outpatient surgery
X-rays, MRIs, CT scans, and lab tests ▪ Prescription drugs
The out-of-pocket maximum does not apply to services not covered by your health plan.
Use the out-of-pocket summary tool to help you see how close you are to reaching your deductible and out-of-pocket maximum. That way, you’ll have a better sense of whether you’ll pay a deductible payment, copay, or coinsurance the next time you receive care.
Your out-of-pocket maximum resets to $0 on January 1 each year.
Individual
Family
Annual out-of-pocket maximum
$5,600
$11,200

12. What’s a health savings account (HSA)?
An HSA is a savings account that works with an HSA-Qualified Deductible HMO Plan.
You contribute money to your HSA on a pre-tax bases each year and your employer contributes to your HSA, and use those funds to pay for qualified medical expenses, now or in the future.
You own the money in this account, which you can grow and take with you, even if you change jobs or retire.
You can elect to contribute any dollar amount, from $0 up to the annual maximum, each year. All contributions made by you and/or your employer count towards the annual maximum each year. If your employer contributes up to the annual maximum, you can not make contributions above this amount.
In 2014, the annual maximum contribution amounts are $3,300 for eligible individuals and $6,550 for families. For individuals 55 and older, a catch-up contribution of $1,000 per year is permitted.
To open an HSA, you must be enrolled in an HSA-qualified deductible health plan and meet other HSA eligibility rules, including:
The member must have no other first-dollar medical coverage other than injury, accident, disability, dental, vision, or long-term care.
The member must not be enrolled in Medicare.
The member must not be eligible to be claimed as a dependent on anyone else’s tax return.
The member must not have received Veterans Administration medical benefits during the most recent three months.

13. What’s a health savings account (HSA)? CONTINUED
The IRS determines how you can use the funds in your HSA.
You can use your HSA to pay for qualified medical expenses1 for yourself and your dependents
You receive triple tax advantages
The funds in your HSA are not considered part of your wages, so they’re not subject to federal income taxes.2
HSA funds used to pay for qualified medical expenses are not subject to taxes.
Any investment earnings3 in an HSA are tax-free so long as they’re used for qualified medical expenses.
Contributions can be made using pretax or post-tax payroll deductions, or you can make tax-deductible contributions directly to your account.
Anyone can deposit money into an HSA, including the individual who set up the account, the employer, or any other interested party.
HSA contributions must be made for a specific year, on or before the due date (without extensions) for filing tax returns for that year.
Any unused funds can be rolled over to the next plan year, to help you save for future qualified medical expenses.
1To view the list of qualified medical expenses defined under Internal Revenue Code Section 213(d), download IRS Publication 502, Medical and Dental Expenses, at irs.gov/publications.
2The tax references in this document relate to federal income tax only. Consult with a qualified professional for tax, investment, or legal advice.
3HSAs may also experience investment losses.

14. Examples of qualified medical expenses*
You can use the funds in your HSA to pay for qualified medical expenses, which may include:
copays, coinsurance, and deductible payments
hospital visits
nonpreventive office visits with your personal physician specialists
X-rays, MRIs, CT scans, PET scans, and lab tests
physical, occupational, and speech therapy visits
Emergency Department visits
prescription drugs (generic and brand name)
*To view the list of qualified medical expenses defined under Internal Revenue Code Section 213(d), download IRS Publication 502, Medical and Dental Expenses, at irs.gov/publications. 14

15. Paying for care Before you reach your deductible
When you check in for your visit, you will be asked to make a payment. You can use funds in your HSA to make this payment for yourself or your dependents.
If you receive a Health Payment Card (debit card), you can use it to make a payment. The charges will automatically be deducted from your account.
Before you reach your deductible
Payment is a portion of the full charges for the expected service. You will be billed for the full amount after the visit and the amount will count toward your deductible and out-of-pocket maximum.
After you reach your deductible
Payment is just a copay or coinsurance, and will count toward your out-of-pocket maximum.
Note to presenter: Select Health Payment Card if the employer is offering the HSA administered through Kaiser Permanente. Select debit card if the employer has selected a different administrator.
Before you’ve reached your deductible, you will be asked to make a payment toward the services you are scheduled to receive. In most cases, this will only cover a portion of the total charges for the services you receive during your visit. You’ll receive a bill later for any balance due.
You will get a bill after your visit if your payment at check-in didn’t cover the amount you owe for the services you received during your visit, or if you received additional services during your visit.
Once you’ve reached your deductible, you will pay only a copay or coinsurance amount for most covered services, depending on your plan. Your deductible as well as most copayments and coinsurance payments count toward the out-of-pocket maximum. Once you reach the out-of-pocket maximum, Kaiser Permanente will pay for 100 percent of most covered services for the rest of the calendar year.
Please remember that when you’re submitting HSA claims, further documentation may be required for substantiation. Be sure to keep your Summary of Accumulation (SOAs), bills, and receipts.
A Summary of Accumulation (SOA) is a document that lists all of your medical charges throughout the calendar year. Once you begin using your deductible plan, you will receive an SOA for periods when you have charges that count toward your deductible and annual out-of-pocket maximum.
You will get a bill after your visit if:
Your payment at check-in didn’t cover the full amount you owe for the services you received during your visit.
You received additional services during your visit.

16. How do you pay for services?
Payment method
Action required 1.
Your HSA Health Payment Card (debit card ) to pay for care.
None. You won’t need to request a distribution from
your HSA 2.
Another payment method (e.g., cash, check, or credit card) at point of service.
Submit a request for Distribution from your HSA. 3.
Split a payment between your HSA Health Payment Card (debit card ) and another payment method (if your qualified medical expense is greater than the funds available in your HSA) at the point of service.
After more funds have been deposited into your HSA, submit a claim for reimbursement for the amount paid with the other payment method.
Note to presenter: Select Health Payment Card if the employer is offering the HSA administered through Kaiser Permanente.
Select debit card if the employer has selected a different administrator.
Medical expenses not covered by your health plan won’t contribute to your deductible or your out-of-pocket maximum.
You can use funds in your HSA for yourself or your dependents.
Be sure to keep your Summary of Accumulation (SOA), bills, and receipts for income tax purposes.
With an HSA, you’ll be responsible for determining whether an expense is a qualified medical expense. To view the list of qualified medical expenses defined under Internal Revenue Code Section 213(d), download IRS Publication 502, Medical and Dental Expenses, at irs.gov/publications. 4.
Receive Kaiser Permanente bill after service and pay accordingly.
Write your HSA Health Payment Card (debit card ) number in the credit card section of the bill and return it to Kaiser. If you don’t have sufficient funds on this card, please use another credit card to pay for the remaining balance. Please refer to payment method 3 above to receive reimbursement for the amount available in your HSA.

17. Know what to expect Step 1: Step 2: Step 3: Before your visit —
Getting an estimate
Get a personalized cost estimate for scheduled services using our online Estimates tool.
The Estimates tool knows your plan details and whether or not you’ve met your annual deductible—so estimates are based on your personal situation.
Step 2:
During your visit —
What to expect
When you check-in for your visit, you’ll be asked to make a partial payment for your scheduled services toward your deductible, copay, or coinsurance requirements.
You can use your HSA Health Payment Card (debit card) to pay for qualified medical expenses.
Note to presenter: Please note, with steps 2 and 3, select Health Payment Card if the employer is offering the HSA administered through Kaiser Permanente or select debit card if the employer has selected a different administrator. If there’s no Health Payment Card or debit card, remove bullet #2 from step 2 and step 3.
Kaiser Permanente understands that total health means your physical and financial well-being. That is why we work hard to provide you tools and resources so you’ll know what to expect when you go in and pay for care.
1.) Before you go in for a visit you can use our Estimates tool which provides you a personalized cost estimate for the services you are scheduled to receive, based on your plan benefits and how much you’ve paid toward your deductible.
2.) When you check-in, you’ll be asked to make a partial payment toward your deductible, copay and/or coinsurance requirements. Keep in mind, this payment may only cover a portion of the total charges for the services you receive. You'll receive a bill later for any balance due.
3.) After your visit, you should expect to receive a bill in the mail. You’ll also receive a Summary of Accumulation statement, which tracks how close you are to reaching your deductible and out-of-pocket maximum.
4.) At anytime you can use a couple different tools to help you stay on top of your payments. Our out-of-pocket summary tool on kp.org shows you how close you are to reaching your deductible and out-of-pocket maximum.
Step 3:
After your visit —
Receiving your bill
You’ll receive a bill in the mail if your payment at check-in didn’t cover the full cost of the services you received during your visit and/or you received additional services during your visit.
You can pay it by writing your HSA Health Payment Card (debit card) number in the credit card section of the bill.
Step 4:
Any time —
Tracking your expenses
You’ll also receive a Summary of Accumulation (SOA) in the mail. It shows how close you are to reaching your deductible and out-of-pocket maximum.
Use our Out-of-Pocket Summary tool on or to see how close you are to reaching your deductible and out-of-pocket maximum. 17 17

18. Getting started is easy
Once enrolled in the plan, Kaiser Permanente will provide you with a Kaiser Permanente HSA Health Payment Card, which you can use to pay for qualified medical expenses at any Kaiser Permanente facility or other health care provider, such as physician offices, hospitals, and pharmacies.
Along with your health payment card, you’ll receive instructions to activate your card by calling the number on the activation sticker found on the card.
In order to use your HSA, you’ll need to accept the terms and conditions by logging in for the first time to use your health payment account.
Note to presenter: Only use this slide if the group is sponsoring an HSA with KP.
*A monthly account administration fee of $3.25 per account may be paid by you or your employer. The fee is waived once your average daily account balance reaches $2,000.

19. HSA administered through Kaiser Permanente
You’ll receive two Kaiser Permanente Health Payment cards when you enroll.
One login, one online experience—24-hour access to your HSA account online when you sign on to
You have mobile access for viewing your account balance and receiving text-message alerts.
When you can’t go online, get real-time information about your account by using our interactive voice-recognition (IVR) system. IVR is available in English & Spanish.
You can always get personalized help from our customer services representatives.
Note to presenter: Use this slide when an employer is sponsoring an HSA administered through Kaiser Permanente. If not, remove this slide.
Remove the text box located at the top right hand corner if group is sponsoring an HSA administered through Kaiser Permanente.
With an HSA administered through Kaiser Permanente, you’ll receive:
Secure online account access, 24/7, at kp.org/healthpayment
Dedicated Kaiser Permanente Health Payment Services at
Note to presenter: Health Payment cards issued—background information just in case you get a question from the group.
4 cards issued at no cost; 2 of which are provided at set up and an additional 2 cards may be requested.
Replacement costs will be charged after first 4 cards have been issued; $10 each or $35 each if expedited
To order additional cards, call the customer service number at , Monday through Friday from 5 a.m. to 7 p.m. Pacific time. (closed holidays)

20. A limit on your expenses
Employee only
Employee + spouse
Employee + family
Annual deductible1
$2,800
$5,600
Deductible type
Embedded
Annual out-of-pocket maximum2
$11,200
HSA employer contribution (Pacific-based on 12 months)
$1,250
$2,500
Note to presenter: Insert group’s HSA-Qualified Deductible HMO Plan design.
Annual deductible: After you have reached your individual deductible, you’ll pay copays or coinsurance for most covered services for the rest of the calendar year.
Annual out-of-pocket maximum: Your plan offers you peace of mind by limiting the amount of money you have to pay out of your own pocket. This limit is called the annual out-of-pocket maximum.
Knowing there's a limit on how much you will be asked to pay for all covered medical services each year can give you peace of mind. After you reach your out-of-pocket maximum, we will pay the full cost of all covered services for the rest of the calendar year. This may protect you if you have a serious illness or injury.
All of your out-of-pocket expenses for covered services (e.g., deductibles, copayments, and coinsurance) are applied to the annual out-of-pocket maximum.
Once you reach your annual out-of-pocket maximum, all services are covered at no charge.
Aggregate definition: With these plans, there is only one deductible for the whole family. Once it’s met, either individually or collectively, the family pays only copays and coinsurance for the remainder of the calendar year.
Embedded definition: For individual subscribers, once the individual deductible has been met, they pay only the copay and coinsurance for the remainder of the calendar year. For family enrollment, the first member of the family to satisfy the individual deductible pays only copays and coinsurance. Other enrolled family members, either individually or collectively, will continue to pay for their care until the remainder of the family deductible has been satisfied. Once the family deductible is met, all family members will pay only copays and coinsurance for the remainder of the calendar year.
1Set amount you’ll need to reach before you start paying copays or coinsurance for most covered services for the rest of the calendar year.
2The maximum you’ll pay out of pocket during the calendar year for all covered services.

21. Embedded Deductible
For individual subscribers, once the individual deductible has been met, they pay only the copayments and coinsurance for the remainder of the calendar year. For family enrollment, the individual deductible is part of the family deductible. If one member of the family satisfies the individual deductible, that person will pay only copayments and coinsurance for the remainder of the calendar year. All remaining family members will continue to pay full member charges for services that are subject to the deductible until they each meet their individual deductible or until the family as a whole meets its family deductible. Once the family deductible has been met, all family members will pay only copayments and coinsurance for the remainder of the calendar year. The same methodology applies to the out-of-pocket maximum
Note to presenter: Only use this slide if the group is sponsoring an HSA with KP.
*A monthly account administration fee of $3.25 per account may be paid by you or your employer. The fee is waived once your average daily account balance reaches $2,000.

22. Highlights of your group’s HSA plan benefits*
After you reach your deductible, here’s what you can expect to pay for common services.
Covered service
You pay
Routine physical exams
No charge (plan Deductible doesn’t apply)
Primary care office visits
20% Coinsurance after Plan Deductible
Specialty care office visits
X-rays and lab tests
Outpatient surgery
Hospitalization
Urgent care visits
Emergency Department visits
Generic prescription drugs
$10 for up to a 30-day supply after Plan Deductible
Brand-name prescription drugs
$20 for up to a 30-day supply after Plan Deductible
Note to presenter: If you choose to include this slide, be sure to customize it per the specific plan benefits for the group.
*This is a summary of some benefits and their copayments and coinsurance. Please see your Evidence of Coverage for information about coverage, limitations, and exclusions for all benefits, including those not listed in this summary. 22

23. Take control of your health
As a Kaiser Permanente member, you can save time and money, and enjoy the time you’ll be saving, and the 24/7 online convenience of My Health Manager on
Schedule routine appointments.
View most lab test results.
your doctor’s office.
Refill prescriptions.
Stay informed with our online health and drug encyclopedias and much more.
Note to presenter: Describe the five overarching values or benefits that a consumer should expect from a health plan: A great doctor for you, 24/7 access to care, convenience – saves you time, maximize your total health, the future is now.
<Important: The text below is an example; you are expected to customize this slide based on what you know about the concerns / interests of your audience (or consumer). Try to speak directly to their personal situation. Use this strategy throughout the presentation.>
Communicate:
Achieving good health comes from a combination of things.
Like being able to choose a doctor you can trust and build a relationship with over time.
Having access to care when and where you need it.
Making managing your health easier, so you can spend more time enjoying life.
A focus on keeping you at your healthiest in mind, body, and spirit.
And staying at the forefront with information and technology.
At Kaiser Permanente, we deliver these benefits to you and your family, plus so much more.
Let’s look at why Kaiser Permanente is the right choice for you.
*Available when you receive care at Kaiser Permanente facilities.

24. Participate in your health
Kaiser Permanente encourages our members to live healthy and thrive. Get active, and take control of these healthy resources.
Health classes at Kaiser Permanente facilities. (Many classes are free.)
Healthy lifestyle programs help you
lose weight
eat healthy
manage diabetes
reduce stress
quit smoking
live with ongoing conditions
reduce pain
manage depression
get a good night’s sleep
Discounts on additional health care services give you more options
acupuncture
massage therapy
If you’re ready for the extra boost you need to put some healthy habits into your routine, talk with a health professional by phone. Your personal wellness coach will listen to your health needs and help you create—and stick with—a step-by-step plan for reaching your goals.
Wellness coaching is a service for Kaiser Permanente members provided at no cost and takes place over several months in a series of coaching sessions by phone. It can help you:
Increase your physical activity,
Quit smoking,
Lose weight,
Eat healthier,
Or manage stress

25. Be well in mind, body, and spirit
We don’t care for you only when you’re sick—we help you stay healthy too. You have access to resources, both online and off, so you can get the support you need to reach your health goals.
Take a health class at one of our facilities, many of which are free. Choose a class
Download an audio program or watch a health video at or .
Find tools, tips, and information for living well at
Use our online health and drug encyclopedias at or
Visit your local Health Education Department for other healthy resources. 25

26. Appendix

27. Supplemental insurance
Your employer has purchased the following supplemental insurance for you. Your HSA dollars can be used to pay for your portion of the cost.
Chiropractic : $15/VISIT TO 30 VISITS after Plan Deductible
Note to presenter: This slide is optional. It’s only to be used if the employer group has purchased supplemental insurance.
If chiropractic is selected, this service is subject to the deductible.
1. Add in benefit information specific to employer
Remove “optional slide” text box at upper right

28. Example of how payment works for a member
Kimberly is generally healthy and seeks care about twice a year. Here’s her experience when she goes in for her annual physical and an eye exam:
Cost of service
HSA account balance
Deductible/ out-of-pocket maximum accumulation
Kimberly’s original balance
N/A
$1,000
$0/$0
Kimberly goes to her annual physical exam. Since preventive services are covered at 100%, there is no cost to Kimberly for this service. $0
$1,000
$0/$0
Note to presenter: Select Health Payment Card if the employer is offering the HSA administered through Kaiser Permanente.
Select debit card if the employer has selected a different administrator.
Cost of Service is for illustration only. Please refer to the sample fee list at kp.org/deductibleplans for an estimate of costs.
The eye exam is covered as a qualified medical expense per Section 213(d) of the Internal Revenue Code.
However, the cost of the sunglasses is not covered and will therefore not count toward her deductible and out-of-pocket maximum.
During the visit, Kimberly’s physician orders additional lab work that is not routine. Later, Kimberly gets a bill for additional lab services in the mail. She writes her HSA Health Payment Card (debit card) information on the bill, and mails it back to Kaiser Permanente for payment. The amount is deducted from her HSA account.
$325
$675
$325/$325
Kimberly visits her personal physician for a non-preventive eye exam. She pays with her HSA Health Payment Card (debit card) .
$140
$535
$465/$465
Kimberly visits Kaiser Permanente’s optical center and buys a new pair of prescription sunglasses. She pays with her HSA
Health Payment Card (debit card)
$150
$385
$465/$465

29. Using your HSA funds to pay for qualified medical expenses
Here’s how a member might be charged for a qualified medical expense:
Kimberly is a Kaiser Permanente member. She visits the optometrist, using her HSA Health Payment Card (debit card) to pay for her eye exam. The exam is a qualified medical expense, so the amount charged counts toward her deductible and out-of-pocket maximum.
Kimberly then visits Kaiser Permanente’s optical center and uses her HSA Health Payment Card (debit card) again to buy a pair of prescription sunglasses. However, the cost of the sunglasses is not covered and will therefore not count toward her deductible and out-of-pocket maximum.
Note to presenter: Select Health Payment Card if the employer is offering the HSA administered through Kaiser Permanente.
Select debit card if the employer has selected a different administrator.
The eye exam is covered as a qualified medical expense per Section 213(d) of the Internal Revenue Code.
However, the cost of the sunglasses is not covered and will therefore not count toward her deductible and out-of-pocket maximum.

30. Tools and resources to help you plan and budget
At Kaiser Permanente, we think you should be in charge of your health and your budget. You’ll find helpful information, tools, and resources at
Some resources are:
Paying for Care brochure
Preventive care services list
Estimates and Out-of-Pocket Summary tools
Sample fee list
HSA calculators
Paying for Care brochure: Helps you understand what to expect before, during, and after a visit, as well as how much and when to pay. You can also see a sample bill and Summary of Accumulation (SOA).
Preventive services list: Helps you understand which preventive services are covered even if you haven’t yet reached your deductible.
Estimates tool: Provides a personalized estimate of how much different medical services might cost based on your health plan and where you are in meeting your deductible, so you can budget for your health care needs and make informed decisions about treatment options. This tool includes estimated fees for the most common outpatient procedures, drugs, and lab tests.
Out-of-Pocket Summary tool: Can help you see how close you are to meeting your deductible and out-of-pocket maximum. That way, you’ll have a better sense of whether you’ll pay a deductible payment, copay, or coinsurance the next time you receive care.
Sample fee list: Shows estimated member charges for some commonly used medical services—such as office visits, lab tests, and X-rays—when provided at Kaiser Permanente medical centers, medical offices, and other facilities. When you receive care or services from a provider at a non–Kaiser Permanente facility, even if the provider is under contract to provide services for Kaiser Permanente members, the charges may be different. The amount of charges you pay out of your own pocket will depend on your plan coverage and on whether or not your provider is a Kaiser Permanente practitioner and other criteria. Additionally, your benefit plan may cover services at different levels of copayment or coinsurance.
Tax Savings HSA calculator: Our HSA calculators can help you estimate and manage the value, costs, and tax savings of your HSA, now and into the future.
Contact our Member Service Contact Center at to get estimates for your care or to discuss any questions you may have.

31.
Find information and resources for understanding your deductible plan on our deductible website.
Describes how Kaiser Permanente deductible plans work
Provides information about costs and billing
Links to additional resources

32. Paying for Care Brochure
Use this brochure to better understand the financial side of your health plan.
Shows how to get a cost estimate before you come in for care.
Gives details on what to expect during visits, including what you may need to pay.
Explains how to read your bills and your Summary of Accumulation (SOA).
Available at facilities and on our deductible plan website.
Review this brochure before, during, and after your visit and whenever you may have questions to better understand the financial side of your Kaiser Permanente HSA-qualified deductible HMO plan.

33. Estimates and Out-of-Pocket Summary
Get personalized cost estimates and track expenses at home.
Our online Estimates tool
Get a cost estimate of your scheduled services before you come in for care.
Go to or to use our Estimates tool.
Estimates are based on your plan benefits and how close you are to reaching your deductible and out-of- pocket maximum.
Our online Out-of-Pocket Summary tool
See a summary of how much you’ve spent, and how close you are to reaching your deductible and out-of-pocket maximum.
Go to or to use our Out-of-Pocket Summary tool.
This can give you a better idea of whether you’ll pay a copay, coinsurance, or deductible payment the next time you come in for care.
Knowing how your deductible plan works can give you a better idea of how much you’re likely to pay for the care you receive. Once you’re a member, you can register on our website to access our Estimates tool or sample fee lists. These tools help you know in advance what you can expect to pay for the services you plan to receive during scheduled visits. You’ll also be able to see how close you are to meeting your deductible, which can help you understand what types of payments you’ll need to make. 33

34. Preventive care services flier
You can get most preventive care services at little or no cost—even before you reach your deductible. See a list of common preventive care services for:
adults
women
children
View our preventive care services flier at 34

35. Sample Fee List
Note to presenter: The Sample Fee List is really for prospective members, while the Estimates and Out-of-Pocket Summary tools are better for enrolled members. The difference between the Sample Fee List and Estimates tool is that the Estimates tool shows bundled services while providing estimates according to your actual plan design.
The sample fee list PDF contains the top 100 outpatient estimated charges for commonly used medical services.
Fee lists are region specific.
In California, the fee list is translated into Chinese and Spanish. 35

36. Tax Calculators

37. Summary of Accumulation (SOA)
This document lists all of your medical charges that accumulate towards your deductible and annual out-of-pocket maximum throughout the calendar year.
Once you begin using your deductible plan, you will receive an SOA for periods when you have charges that count toward your deductible and annual out-of-pocket maximum.
Keep in mind, services take an average of 30 to 45 days to appear on your SOA.
Your SOA is not a bill.
The SOA is a monthly statement that let’s you know how close you are to meeting your deductible and out-of-pocket maximum. If you’re registered on kp.org and have internet access, you can get up to date information regarding your progress by visiting kp.org/outofpocket.
Please remember that further documentation may be required to substantiate your HSA distributions. Be sure to save your Summary of Accumulation (SOA), bills, and receipts.