Benefits Overview

The Southeast Permanente Medical Group “Benefits Overview”
Health Benefits:

KP HMO Plan I	High Deductible Health Plan (HDHP) and Health Savings Account (HSA)	Wellness
KP HMO Plan II	Supplemental Medical
Multi-Choice Select PPO	Dental Plan

Kaiser Permanente HMO Plan I
	The Kaiser Foundation Health Plan (KFHP) HMO coverage is provided at a nominal cost to all full-time physicians. KFHP HMO is comprehensive and includes basic and major medical care, such as hospitalization, surgery, maternity care, X-ray and laboratory medical equipment and emergency care. Covered services must be received directly at a Kaiser Permanente medical facility.
		Doctor Office Visits
		There is no co-payment for doctor office visits.
		Prescription Drugs
		There is no co-payment for prescriptions that have been prescribed by a TSPMG physician. In addition, counter drugs can be purchased at a discount from a Kaiser Permanente pharmacy.
		Vision Care
		There is no charge for one eye exam every 12 months at an approved provider. There is a $150 allowance every 24 months for frames and lenses or contact lenses in lieu of eyeglasses.
		Behavioral Health Care
		Behavioral Health benefits are provided at Kaiser Permanente facilities with no co-payment.
		Emergency Services
		Emergency care and urgent care are available from Kaiser Permanente Plan facilities.
	HMO coverage becomes effective on your date of hire. The benefit is provided to you, your spouse/ domestic partner, and unmarried children under 19 years of age (up to age 25 if full time student). Physicians working on a part-time basis will incur a payroll deduction based on the number of hours worked weekly and the number of family members enrolled in the plan.
Kaiser Permanente HMO Plan II
	The KP HMO Plan II mirrors the KP HMO Plan I with the exception of a $5 per prescription co-payment.
Multi-Choice Select PPO
	The Kaiser Permanente Multi-Choice Select PPO is available to all benefits eligible physicians. Those enrolled in this plan will incur a payroll deduction based on the number of hours worked weekly and the number of family members enrolled in the plan. Those enrolled in the Multi-Choice Select PPO plan may choose to use in-network or out-of-network providers each time health care is needed. When using in-network providers, there are no deductibles. When using out-of-network providers, a deductible must first be met and then there is a co-insurance amount which is generally 30%. Physicians are eligible for this plan from their date of hire.
High Deductible Health Plan (HDHP) and Health Savings Account (HSA)
	The High Deductible Health Plan coverage is provided at no cost to all full-time physicians and offers the ability to use a tax-favored Health Savings Account. Under this plan you have a high deductible to satisfy, but if you need a high level of medical care for catastrophic events, you have the peace of mind knowing that there is a limit on your out-of-pocket expenses.
	You can only elect an HSA if you enroll in the HDHP. HSA's offer the following advantages: You can make tax-free contributions to an HSA, within annual limits established under federal law. Unused HSA dollars carry over from year to year. Neither your contributions nor any investment earnings generated by the account are taxable when used for qualified medical expenses.
Supplemental Medical
	The Supplemental Medical Coverage is provided to all physicians enrolled in the HMO Plans (not available to those enrolled in the Multi-Choice Select PPO or the High Deductible Health Plan) from their date of hire. Supplemental Medical provides additional coverage to the medical benefits provided by KFHP HMO coverage. This benefit reimburses physicians for certain medical expenses not covered by KFHP HMO or those with coverage limits. Physicians share the cost of covered Supplemental Medical expenses through deductibles and co-payments. The deductible is $100 per covered individual, up to $200 per family maximum. Covered services include, but are not limited to, acupuncture; alcohol and chemical dependency; chiropractic services; custodial care services; durable medical equipment; infertility services; mental health services; and physical, occupational, respiratory, speech or radiation therapy. Most services are covered at 80%.
Dental Plan
	The Southeast Permanente Medical Group provides dental coverage for you, your spouse/domestic partner, and family.
		Corporate paid premium
		Coverage begins on your date of hire
		Diagnostic and preventive services are paid at 100% of usual, customary and reasonable charges (UCR)
		The plan provides for routine exams once every six months
		Basic Services benefit coverage pays:
		20% UCR for fillings, root canals, oral surgery, gum disease treatment
		Major Services benefit coverage pays:
		50% UCR for crowns, bridges, dentures, prosthodontic replacement (every five years)
		Orthodontia coverage pays:
		50% UCR of eligible charges for covered dependents up to age 19
		Maximum lifetime benefit of $1,500
		There is a $50 deductible per person or $150 deductible per family annually for basic and/or major services.
		Maximum annual benefit of $1,500 per covered dependent each calendar year
	*UCR- Usual, customary and reasonable
Wellness
	The Southeast Permanente Medical Group is dedicated to promoting the well being of our practitioners. It’s important to ensure that you have the resources and support necessary for you to seek treatment for stress or other difficulty in any area of your life. That’s why TSPMG offers the Kaiser Permanente Assistance Program (KPAP) and a Supplemental Mental Health Program.
	Kaiser Permanente Assistance Program
	The Kaiser Permanente Assistance Program (KPAP) is a confidential resource and referral service that exists to help you, your eligible dependents, and anyone else living in your household cope with a variety of life challenges. There is no charge to use the KPAP, and specially trained customer service representatives and professional counselors are available 24-hours a day.
	The KPAP offers programs and resources that can help in the following areas:
		Parenting concerns;
		Family and relationship issues;
		Alcohol and drug abuse;
		Emotional difficulties;
		Stress-related problems;
		Conflicts at work or home; and
		Other personal concerns
	That plan may include short-term counseling within the KPAP or referral to a specialist or other resources within your community.
	Supplemental Mental Health
	Another option available to you and your dependents (those you have covered under TSPMG-sponsored medical plan) is a $3,000 annual behavioral health benefit that can be used for treatment with a licensed practitioner outside of TSPMG for a DSM-IV diagnosis.