2020 kpsa advantage plus brochure - kaiser permanente...advantage plus get dental, hearing, extra...

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Advantage Plus Get dental, hearing, extra vision, and ftness benefts Kaiser Permanente Senior Advantage (HMO) Georgia Enroll now for 2020 H1170_019_11_M

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  • Advantage Plus Get dental, hearing, extra vision, and fitness benefits

    Kaiser Permanente Senior Advantage (HMO) Georgia

    Enroll now for 2020

    H1170_019_11_M

  • Be healthy.

    Be vibrant.

    Now you have the option to add dental, hearing, extra vision, and fitness benefits to your Kaiser Permanente Senior Advantage plan. And even better, it’s affordable.

  • 1

    Get started here

    Our Quick Start Guide below will give you a good overview of Advantage Plus. To learn more, turn to the table of contents on page 3.

    Quick Start Guide

    A Go to page 4 for a quick look at how Advantage Plus makes it easy to expand your health care coverage.

    B Turn to Benefits at a Glance on page 5 for a summary of the dental, hearing aid, and additional vision benefits of Advantage Plus.

    C Ready to sign up? Apply for coverage by filling out the Advantage Plus enrollment form.

    For more information, visit us online at kp.org/advantageplus.

  • Take advantage of extra benefits today.

    To learn more or to enroll, call one of our Kaiser Permanente Medicare specialists toll-free at 1-877-471-1064 TTY 711 (for the deaf, hard of hearing, or speech impaired), seven days a week, 8 a.m. to 8 p.m.

    Or visit us online at kp.org/advantageplus.

    2

  • 3

    1

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    4

    5

    6

    Table of contents

    Benefits at a glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

    Dental coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Frequently asked questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Plan features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

    Hearing aid coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Frequently asked questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Kaiser Permanente Contracted Hearing Aid Centers . . . . . . . . . . . . . . . . . . 12

    Vision coverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Frequently asked questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Kaiser Permanente Vision Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

    Enroll in Advantage Plus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

    Important information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

  • Advantage Plus

    A BENEFITS PACKAGE FOR A HEALTHIER, MORE VIBRANT YOU

    As a Kaiser Permanente Senior Advantage member, having your Medicare coverage combined with your Kaiser Permanente coverage in a single plan could make life easier. Now, with Advantage Plus, you can get valuable dental, hearing aid, and additional vision benefits added to your plan. So you get the total health care coverage you need. And all of your health benefits are in one convenient package.

    Get more health coverage. More value.

    • More benefits Only $15 a month premium adds Advantage Plus coverage to your Kaiser Permanente Senior Advantage plan. You’ll get dental, hearing aid, and additional vision benefits.

    • The convenience of one simple bill You’ll get one bill that includes both your Kaiser Permanente Senior Advantage and Advantage Plus coverage — so taking care of your health is easier than ever. If you like, you can pay your bill through monthly electronic bank payments.

    Advantage Plus gives you the choice to add more benefits to your Kaiser Permanente Senior Advantage plan. The Advantage Plus package is optional, so if you want to add these benefits, be sure to fill out the Advantage Plus enrollment form.

    Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. You must continue to pay applicable Kaiser Permanente Senior Advantage premiums. You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll. You must be a Kaiser Permanente Senior Advantage (HMO) Basic, SNP, or Enhanced plan member to be eligible for Advantage Plus.

    Out-of-network/non-contracted providers are under no obligation to treat members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

    4 For more information, visit kp.org/advantageplus

  • Benefits at a g

    lance

    1 Benefits at a glance Take a look at the key dental, hearing aid, and additional vision benefits you receive when you add Advantage Plus to your Kaiser Permanente Senior Advantage Plan. You pay a $15 monthly premium for all three benefits which is added to your monthly Kaiser Permanente Senior Advantage Plan premium. To learn more about how to enroll, please see Enroll in Advantage Plus on page 19.

    DENTAL

    * See your Evidence of Coverage for information about dental, hearing, and vision services provided under the Kaiser Permanente Senior Advantage Plan. You must also continue to pay applicable Kaiser Permanente Senior Advantage premiums.

    Dental services are generally not covered except for the dental services covered by Medicare.*

    Key dental benefits:*

    $10 per office visit that includes the following: • Oral examinations: Preventive X-rays and

    cleanings covered twice a year. • Nonroutine services: From $0 to $580

    (in addition to office visit copay). • Restorative services: From $18 to $580

    (in addition to office visit copay). • Endodontics, periodontics, extractions: From $0 to

    $400 (in addition to office visit copay). • Prosthodontics, Oral/Maxillofacial Surgery: From $18

    to $580 (in addition to office visit copay).

    HEARING AIDS

    Hearing aids are generally not covered except for certain implanted hearing devices covered by Medicare, which are provided at no additional charge.*

    $500 allowance per hearing aid, per ear, every three years. Certain implanted hearing devices covered by Medicare are provided at no additional charge.

    VISION HARDWARE

    Vision hardware is generally not covered except for post-cataract surgery eyewear covered by Medicare.*

    $500 allowance every two years.

    Kaiser Permanente Senior Advantage coverage only

    Advantage Plus coverage combined with Kaiser Permanente Senior Advantage

    For more information, visit kp.org/advantageplus 5

  • 2 Enjoy the power of a healthy smile Your dental health is key to your overall health. Healthy teeth and gums allow you

    to eat better and feel better—in body and mind. And nothing attracts the people

    around you like a bright smile.

    Preventing and treating dental problems are important at any stage of life. You may

    feel more tooth sensitivity or have dental problems as a result of certain medications

    or health conditions. Regular oral exams not only keep your mouth healthy; they can

    also help spot medical problems.

    Advantage Plus makes it easy to smile because you know you’re getting the dental

    care you need.

    Brushing and flossing are important for healthy teeth and gums. They also help reduce the risk of infection. With proper oral health, including brushing, flossing, and regular check-ups and cleanings, you can help keep your whole body healthy.

    Reduce your risk of infection

    HEALTH TIP:

    6 For more information, visit kp.org/advantageplus

  • For more information, visit kp.org/advantageplus 7

    Dental co

    verage

    Frequently asked questions

    Advantage Plus dental benefits are provided through DeltaCare® USA Program offered by Delta Dental Insurance Company (Delta Dental).

    Q: What is the DeltaCare USA Program?

    A: The DeltaCare USA Program, offered by Delta Dental, provides dental care through the DeltaCare USA network of dentists. When you enroll, Delta Dental will assign you to a contract dentist. The DeltaCare USA network consists of private practice dental facilities that have been carefully screened for quality. You can contact Delta Dental to change your contract dentist.

    Q: When can I begin to use my dental benefits?

    A: Once you receive confirmation of your enrollment in Advantage Plus, you can begin using your dental benefits on your effective date at your assigned facility. You will also receive a dental identification card from Delta Dental.

    Q: How do I choose my dentist? A: When you enroll in Advantage Plus, Delta Dental will assign you to a contract dentist based on your home ZIP code. If you would like to change your assigned dentist, you can do so at any time. Call Delta Dental’s Customer Service Department toll free at 1-844-519-8693 (TTY 711), Monday through Friday, 8 a.m. to 9 p.m. Delta Dental is always expanding its network and adding new dentists and areas. For the most up-to-date list of dentists, visit deltadentalins.com and select DeltaCare USA under the Find a Dentist section.

    Q: How do I make an appointment? A: To make an appointment, simply call your assigned dentist’s facility and identify yourself as a DeltaCare USA Program enrollee. To get covered services, you must go to your assigned Delta dentist. Services provided by a specialist pre-approved by Delta Dental or emergency services are exceptions. Any other treatment is not covered under this dental program.

    Q: What happens if I have an emergency?

    A: If emergency services are needed, you should get in touch with your contract dentist whenever possible. If you are a new member and do not have an assigned contract dentist yet, and you need emergency services, you should contact Delta Dental’s Customer Service department toll free at 1-844-519-8693 (TTY: 711 for the hearing/speech impaired), Monday through Friday, 8 a.m. to 9 p.m., Eastern time. For more information about emergency benefits, see your Kaiser Permanente Senior Advantage Evidence of Coverage.

    http:deltadentalins.com

  • 8 For more information, visit kp.org/advantageplus

    Q: Can I get a second opinion? A: You may ask for a second opinion if you disagree with or question your contract dentist’s diagnosis and/or treatment plan. Delta Dental may also ask you to get a second opinion to confirm that your contract dentist’s treatment or your use of benefits is necessary and appropriate. For more information, see your Kaiser Permanente Senior Advantage Evidence of Coverage.

    Q: What if I need to change my Delta dentist?

    A: You may change your dentist at any time by calling Delta Dental’s Customer Service department toll free at 1-844-519-8693 (TTY 711), Monday through Friday, 8 a.m. to 9 p.m. You must make your request for a contract dentist change before the 21st of the month for the change to be effective the first day of the next month.

    Before you can change your contract dentist, you must also complete any treatment in progress, such as (a) partial or full dentures for which final impressions have been taken, (b) completion of root canals, or (c) delivery of crowns when teeth have been prepared.

    DeltaCare USA Plan With enrollment in Advantage Plus, you will receive dental coverage for comprehensive services through the DeltaCare USA Program. You must visit a dentist in the DeltaCare USA network to receive benefits. Services provided by out-of-network dentists will not be covered.

    Please refer to your Evidence of Coverage for more information on benefits, limitations, and exclusions. For more information regarding your medical plan benefits, please refer to your Summary of Benefits. For full information on Kaiser Permanente Senior Advantage benefits, call our Member Services department toll free at 1-800-232-4404, seven days a week, 8 a.m. to 8 p.m. TTY users should call 711.

  • Dental co

    verage

    How your plan works

    Features DeltaCare USA Program

    Cost to patient Coverage is included in your $15 Advantage Plus monthly premium.

    Covered services Comprehensive dental services provided by your assigned contract dentist.

    Copays Out-of-pocket costs are clearly defined.

    Dentist network advantages

    When you enroll, Delta Dental will assign you to a contract dentist. You can contact Delta Dental to change your contract dentist. The DeltaCare USA network consists of private practice dental facilities that have been carefully screened for quality.

    • Services provided by out-of-network dentists will not be covered.

    Out-of-area coverage Services provided by out-of-network dentists will not be covered. You must receive services from your assigned DeltaCare USA provider.

    Deductibles/maximums No deductible or maximums on covered procedures.

    Additional advantages Claims convenience — DeltaCare USA providers file all claims for you and process all referrals to specialty care.

    Contact us

    DeltaCare USA

    Customer Service (includes automated voice attendant) Call toll free: 1-844-519-8693 TDD & TTY: 711

    8 a.m. – 9 p.m. Monday – Friday

    Dentist Search, Online Eligibility, Benefits, and Claims Status

    deltadentalins.com

    Claims Submission Delta Dental Insurance Company P.O. Box 1809 Alpharetta, GA 30023-1809

    For more information, visit kp.org/advantageplus 9

    http:deltadentalins.com

  • Hear well. Live well. 3 Good hearing allows you to participate in life more fully. You’re more confident, more secure, and more connected to your world.

    Millions of Americans experience some degree of hearing loss. Among people over 50, it’s the third most common ailment, behind heart disease and arthritis. But now, more than ever, hearing loss doesn’t mean that your quality of life has to change. Today’s hearing products are smaller, more effective, and more comfortable.

    Hearing benefits from Advantage Plus can help make sure you’re not missing the sounds and conversations that make life more fulfilling.

    • Do you often ask people to speak up or repeat themselves? • Do you have trouble following conversations in a noisy room or

    understanding speech on the phone? • Do you have trouble hearing the sound of your telephone, alarm clock,

    or doorbell? • Do others complain that your TV or stereo is too loud?

    Quick hearing self-check

    HEALTH TIP:

    10 For more information, visit kp.org/advantageplus

  • For more information, visit kp.org/advantageplus 11

    Hearing

    aid co

    verage

    Frequently asked questions

    The hearing aids that Advantage Plus covers are provided at select Kaiser Permanente facilities and by referral at designated contracted providers.

    Q: If I have a hearing loss, are hearing aids covered?

    A: As a Kaiser Permanente member with the Advantage Plus package, you will receive a $500 allowance toward the purchase of a hearing aid in each ear (maximum $1,000 for both ears). This credit is available once every three years. You will be responsible for the difference between the $500 allowance and the price of the hearing aid.

    Q: Where can I obtain my hearing aids? A: You may use your hearing aid benefit at our core Kaiser Permanente audiology facilities and by referral at designated contracted providers.

    Q: How does my hearing aid benefit work?

    A: If a hearing aid is prescribed, you may use your hearing aid benefit at our core Kaiser Permanente audiology facilities and by referral at designated contracted providers.

    Q: Are there any limitations to the type or style of hearing aid that is covered?

    A: You may purchase your hearing aid at our core Kaiser Permanente audiology facilities and by referral at designated contracted providers. The audiologist will assist you in selecting the hearing aids that best meet your needs. A complete range of technologies and styles is available, and you will receive a thorough explanation of your test results and recommended treatment options.

    Q: What if I have a medical problem with my hearing?

    A: If a medical problem is identified during the hearing examination, the audiologist will notify your primary care physician of the results and assist you in obtaining the appropriate medical follow-up.

    Q: What if I need service or repairs on my hearing aid?

    A: The hearing aid you purchase at our core Kaiser Permanente audiology facilities and by referral at designated contracted providers may be covered by the manufacturer’s warranty. The warranty details will be explained at the time of purchase. Batteries and accessories are not covered under this hearing aid benefit.

  • Kaiser Permanente Audiology and Core Facilities

    CLAYTON COUNTY

    Jonesboro

    Southwood Comprehensive Medical Center 2400 Mount Zion Pkwy. Jonesboro, GA 30326 770-603-3649

    FULTON COUNTY

    Atlanta

    Glenlake Comprehensive Medical Center 20 Glenlake Pkwy. Atlanta, GA 30328 770-677-6075

    GWINNETT COUNTY

    Duluth

    Gwinnett Comprehensive Medical Center 3650 Steve Reynolds Blvd. Duluth, GA 30096 770-931-6012

    Designated Contracted Providers— Kaiser Permanente Referral Required

    DEKALB COUNTY

    Decatur

    Atlanta Hearing Aid Services of Decatur 2655-D North Decatur Rd. Decatur, GA 30033 404-373-2411

    12 For more information, visit kp.org/advantageplus

  • 4 Focus on a healthier you Here’s an immediate way to enhance your life: improve your vision. It’s possible that your vision has changed—but you haven’t noticed. When you see clearly, your daily activities, such as driving and reading, become noticeably easier.

    It’s important to have your eyes checked regularly to identify minor as well as more serious eye problems. Advantage Plus adds a material eyewear allowance to your Senior Advantage plan. So you’ll have more choices to help you see a brighter, more vibrant world.

    Keep these helpful nighttime-driving guidelines in mind:

    • Drive more slowly so that you have more time to react.

    • Keep your windshield, as well as all the lights on your car, clean.

    • Ask your eye care professional about getting anti-reflective coating on your eyeglass lenses to cut down on glare.

    • Check with your doctor to find out if any medications you are taking can affect your night vision.

    Better night vision

    HEALTH TIP:

    Visio

    n coverag

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    For more information, visit kp.org/advantageplus 13

  • 14 For more information, visit kp.org/advantageplus

    Frequently asked questions

    The vision hardware benefits covered by Advantage Plus are provided at our core Kaiser Permanente facilities and vision partners in the Atlanta metro area. For information about vision services (including limitations and exclusions) covered by Senior Advantage and Advantage Plus, see your Kaiser Permanente Senior Advantage Evidence of Coverage.

    Q: What is my coverage for eyeglasses and contact lenses?

    A: As a Kaiser Permanente member with the Advantage Plus package, you will receive a credit of $500 to use toward the purchase of eyeglasses and contact lenses every two years. If you do not use the entire $500 credit at the initial point of sale, you cannot use it later. If the eyewear you purchase costs more than $500, you will be responsible for paying the difference.

    Q: After I first use my Advantage Plus vision benefit, when can I use it again?

    A: You are eligible to use your Advantage Plus vision benefit two years from the date that you last obtained your eyeglasses or contact lenses using this benefit.

    Q: Where can I obtain my eyeglasses and contact lenses?

    A: You may use your vision benefit for contacts and eyeglasses at our vision partner locations listed below. You can also find out more information about your vision benefit by calling our Member Services department at 1-800-232-4404 (TTY: 711).

    Kaiser Permanente vision partners

    CHEROKEE COUNTY Canton Woodstock

    MyEyeDr MyEyeDr 217 Riverstone Dr 12924 Hwy 92 Canton, Ga 30114 Suite 100 770-345-5220 Woodstock, Ga 30188

    678-717-9121

    MyEyeDr 9801 Hwy 92 Suite 100 Woodstock, Ga 30188 770-592-7100

    CLAYTON COUNTY Morrow

    For Eyes Optical Co. 1297 Mount Zion Rd Morrow, Ga 30260 770-960-9077

  • COBB COUNTY Acworth

    Eye Contact 1720 Mars Hill Rd NW Suite 160 Acworth, Ga 30101 770-529-1925

    Austell

    Mobley Eye Care 2345 East West Connector Suite 1010 Austell, Ga 30106 770-941-2323

    Kennesaw

    MyEyeDr 1415 Wooten Lake Rd NW Suite 100 Kennesaw, Ga 30144 770-792-3937

    Marietta

    Eye Site Optical Of Marietta 596 Cobb Pkwy S Marietta, Ga 30060 770-429-1847

    For Eyes Optical Co 4101 Roswell Rd NE Suite 905 Marietta, Ga 30062 770-565-6763

    The Eye Gallery-East Cobb 1311 Johnson Ferry Rd Marietta, Ga 30068 770-977-4139

    Smyrna

    Eye Associates Of Smyrna 2400 Herodian Way SE Suite 130 Smyrna, Ga 30080 770-953-9000

    Eye Elements 1675 Cumberland Pkwy SE Suite 103 Smyrna, GA 30080 770-438-0202

    COWETA COUNTY Sharpsburg

    Mobley B Dean, OD 3339 Hwy 34 East Sharpsburg, Ga 30277 770-304-2025

    DEKALB COUNTY Atlanta

    MyEyeDr 2184 Henderson Mill Rd NE Suite 12B Atlanta, Ga 30345 770-938-2923

    Brookhaven

    MyEyeDr 1418 Dresden Dr NE Brookhaven, Ga 30319 404-239-0272

    MyEyeDr 3369 Buford Hwy NE Brookhaven, Ga 30329 404-320-9100

    Decatur

    Belvedere Eye Center 3479 Memorial Dr Suite A & B Decatur, Ga 30032 404-534-1222

    Dunwoody

    Eye Elements

    4505 Ashford Dunwoody Rd NE

    Suite 1 Dunwoody, GA 30346 770-399-8488

    Tucker

    For Eyes Optical Co. 4104 La Vista Rd Tucker, Ga 30084 770-493-3995

    FAYETTE COUNTY Fayetteville

    A Plus Optique 1240 Hwy 54 West Suite 306 Fayetteville, Ga 30214 678-834-7411

    TJ Roberts, LLC 539 North Glynn St Fayetteville, Ga 30214 678-817-7722

    Visio

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    For more information, visit kp.org/advantageplus 1515

  • 16 For more information, visit kp.org/advantageplus

    FORSYTH COUNTY Cumming

    Complete Family Eyecare & Optique, PC 2350 Atlanta Hwy Suite 110 Cumming, Ga 30040 678-965-5558

    FULTON COUNTY Alpharetta

    For Eyes Optical Co. 5230 Windward Pkwy Ste 100 Alpharetta, Ga 30004 678-537-0002

    b.spectacled Alpharetta 50 Canton St Suite 112 Alpharetta, Ga 30009 678-894-1650

    MyEyeDr 3975 Old Milton Pkwy Suite 2 Alpharetta, Ga 30005 678-624-7766

    Eye Elements 8400 Holcomb Bridge Rd Suite 440 Alpharetta, Ga 30022 770-645-1222

    Atlanta

    For Eyes Optical Co 2385 Peachtree Rd NE Suite A2EF Atlanta, Ga 30305 404-237-4922

    Eye Center Of Atlanta PC 501 Pulliam St SW Suite 139 Atlanta, Ga 30312 404-589-8517

    Eye Elements 867 Peachtree St NE Suite 2 Atlanta, Ga 30308 470-823-4375

    Eyecare One Vision Center 590 Cascade Rd Atlanta, Ga 30310 404-753-7777

    Eye Elements 2900 Peachtree Rd NW Suite 301 Atlanta, Ga 30305 404-869-5551

    MyEyeDr 2549 Piedmont Rd NE Suite 120 Atlanta, Ga 30324 404-467-0717

    MyEyeDr 3155 Cobb Pkwy SE Suite 110 Atlanta, Ga 30339 770-644-0012

    Southern Eye Specialists, PC 3071 Campbellton Rd SW Suite 1 Atlanta, Ga 30311 404-344-3556

    The Eye Gallery— Atlantic Station 1380 Atlantic Dr Atlanta, Ga 30363 404-593-2926

    The Eye Gallery—Buckhead 3330 Piedmont Rd NE Atlanta, Ga 30305 404-231-3772

    West End Eye Center 807 Ralph David Abernathy

    Blvd Atlanta, Ga 30310 404-755-4300

    College Park

    Leah Johnson Mcferren, OD, PC 1704 Virginia Ave College Park, Ga 30337 404-768-3500

    Duluth

    Eye 1St Vision & Laser 10080 Medlock Bridge Rd Duluth, Ga 30097 770-623-3931

    Sugarloaf Eyecare 6555 Sugarloaf Pkwy Suite 305 Duluth, Ga 30097 770-495-0937

  • Sandy Springs

    20/15 Eyecare, LLC 2090 Dunwoody Club Dr #126 Sandy Springs, Ga 30350 770-676-7848

    Eye 1St Vision Center 901 Abernathy Rd Suite 100 Sandy Springs, Ga 30328 404-252-1702

    For Eyes Optical Co 6015 Roswell Rd NE Suite B Sandy Springs, Ga 30328 404-843-8277

    MyEyeDr 5940 Roswell Rd NE Sandy Springs, Ga 30328 404-843-2020

    The Eye Gallery-Sandy Springs 5975 Roswell Rd Sandy Springs, Ga 30328 404-252-4111

    GWINNETT COUNTY Duluth

    For Eyes Optical Co 2130 Pleasant Hill Rd Duluth, Ga 30096 770-622-8883

    Grayson

    Nanston Vision—Snellville 1707 Bristol Farms Ct Grayson, Ga 30017 770-668-6693

    Lawrenceville

    Brookwood Eyecare/ Dr. Jamilah Birdsong 3370 Sugarloaf Pkwy Suite B3 Lawrenceville, Ga 30044 770-736-7774

    MyEyeDr 875 Lawrenceville

    Suwanee Rd Lawrenceville, Ga 30043 770-963-0370

    Sugarloaf Vision Center, LLC 4825 Sugarloaf Pkwy Suite F Lawrenceville, Ga 30044 770-559-9670

    Monique Batchelor, LLC 1400 Lawrenceville Hwy Lawrenceville, Ga 30044 770-682-7404

    Lilburn

    Eye Elements 4153 Lawrenceville Hwy NW Suite 5 Lilburn, Ga 30047 770-921-4707

    Clarkson Eye Care 4319 Lawrenceville Hwy NW Lilburn, GA 30047

    770-921-4707

    Norcross

    Norcross Eye Center 1560 Indian Trail Lilburn Rd Suite 108 Norcross, Ga 30093 678-580-0195

    Pure Vue Vision Care, LLC 6050 Peachtree Pkwy Suite 210 Norcross, Ga 30092 770-903-4555

    The Eye Gallery— The Forum 5165 Peachtree Pkwy Norcross, Ga 30092 770-447-4790

    Peachtree Corners

    Ferdon Family Eyecare 5270 Peachtree Pkwy Suite 109A Peachtree Corners, Ga 30092 678-271-3445

    For Eyes Optical Co 5130 Peachtree Pkwy Suite 630 Peachtree Corners, Ga 30092 770-637-1775

    Visio

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    For more information, visit kp.org/advantageplus 1717

  • 18 For more information, visit kp.org/advantageplus

    GWINNETT COUNTY HENRY COUNTY McDonough continued

    Hampton MyEyeDr Snellville

    For Eyes Optical Co. 2055 Scenic Hwy Suite B Snellville, Ga 30078 770-736-8311

    Eye Elements 2427 Heritage Village Suite 4 Snellville, Ga 30078 770-978-2020

    Suwanee

    MyEyeDr 1000 Peachtree Industrial

    Blvd Suwanee, Ga 30024 770-271-0611

    1044 Avalon Pkwy Advanced Family Eyecare McDonough, Ga 30253 of Hampton, LLC 770-898-7078990 Bear Creek Blvd Suite D Hampton, Ga 30228 770-707-0711

    Locust Grove

    Eye Associates of Locust Grove 4946 Bill Gardner Pwky Locust Grove, Ga 30248 770-957-9814

  • 5 Enroll in Advantage Plus Applying for Advantage Plus is easy! 1. Go online today! To learn more and to download an enrollment form, visit

    kp.org/advantageplus.

    2. We’re here to help. If you’re ready to enroll or have questions, call a Kaiser Permanente Medicare specialist at 1-877-471-1064 (TTY 711), seven days a week, 8 a.m. to 8 p.m.

    Other important information about applying for Advantage Plus: • You must be a Kaiser Permanente Senior fill out a new enrollment form, you can add

    Advantage individual plan member to Advantage Plus within 30 days of enrolling enroll in the Advantage Plus package. in Kaiser Permanente Senior Advantage.

    • If you’re already a Kaiser Permanente • The premium for your Advantage Plus

    Senior Advantage member, you can dental, hearing aid, and additional

    enroll in the Advantage Plus package vision benefits is $15 per month. The

    any time from October 15, 2019 $15 monthly premium is in addition to

    through March 31, 2020. your monthly Kaiser Permanente Senior

    Advantage premium, if any, and you• If you’re a new Kaiser Permanente must also continue to pay your

    Senior Advantage member, or enrolling Medicare Part B premium.because you have moved and need to

    Thank you for taking this step toward better dental, hearing, and vision health. We’ll let you know when your enrollment form has been approved and give you more details about your coverage and start date. For more information, visit us online at kp.org/advantageplus. Or call one of our Kaiser Permanente Medicare specialists at 1-877-471-1064 (TTY 711), seven days a week, 8 a.m. to 8 p.m. We’ll be happy to help.

    Enro

    ll in Ad

    vantage P

    lus

    For more information, visit kp.org/advantageplus 1919

  • 6 Important information The Advantage Plus benefit package gives you additional dental,* hearing aid, and extra vision coverage for an additional monthly premium of $15. This is in addition to any premiums required for Kaiser Permanente Senior Advantage described in your Kaiser Permanente Senior Advantage Evidence of Coverage, and you must also continue to pay your monthly Medicare premiums.

    For more information about dental, hearing aid, and additional vision coverage through Advantage Plus, see your Kaiser Permanente Senior Advantage Evidence of Coverage.

    Enrollment and disenrollment

    Enrollment To enroll in Advantage Plus, you must complete the Advantage Plus enrollment form.

    If you are already a Kaiser Permanente Senior Advantage member, you may add Advantage Plus benefits to your Kaiser Permanente Senior Advantage individual plan coverage by sending us the enrollment form before March 31, 2020, for coverage to become effective on April 1, 2020. Coverage is effective the 1st of the month following the date we receive your completed enrollment form.

    If you are enrolling in Kaiser Permanente Senior Advantage either as a new member or because you have moved and you must complete a new Kaiser Permanente Senior Advantage enrollment form, you can add Advantage Plus within 30 days of enrolling in Kaiser Permanente Senior Advantage. Coverage is effective the 1st of the month following the date we receive your completed enrollment form.

    Disenrollment You can stop your Advantage Plus coverage anytime. Your disenrollment will be effective the first of the month following the date we receive your completed disenrollment form. To request a disenrollment form, please call our Member Service Contact Center toll free at 1-800-232-4404 (TTY 711 for the hearing/speech impaired), seven days a week, 8 a.m. to 8 p.m. For more details about disenrollment, see your Kaiser Permanente Senior Advantage Evidence of Coverage.

    For additional information about the Kaiser Permanente Senior Advantage individual plan, see your Kaiser Permanente Senior Advantage Evidence of Coverage.

    * Kaiser Permanente has an agreement with Delta Dental to provide you comprehensive dental care through a network of dentists that contract with Delta Dental’s DeltaCare® USA Dental program. For information about dental coverage, please refer to your Kaiser Permanente Senior Advantage Evidence of Coverage.

    20 For more information, visit kp.org/advantageplus

  • For more information, visit kp.org/advantageplus 21

    Inform

    ation yo

    u need to

    know

    Hearing aid and vision coverage

    For more information about hearing and vision coverage, including exclusions and limitations, please see the Kaiser Permanente Senior Advantage Evidence of Coverage (EOC).

    Dental coverage

    For more information about dental coverage including exclusions and limitations, please see your Kaiser Permanente Senior Advantage Evidence of Coverage for detailed information about dental services provided under your Senior Advantage individual plan.

  • 22 For more information, visit kp.org/advantageplus

    Notice of nondiscrimination Kaiser Permanente complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Kaiser Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. We also:

    • Provide no cost aids and services to people with disabilities to communicate effectively with us, such as: ♦ Qualified sign language interpreters. ♦ Written information in other formats, such as large print, audio, and accessible

    electronic formats. • Provide no cost language services to people whose primary language is not English,

    such as: ♦ Qualified interpreters. ♦ Information written in other languages.

    If you need these services, call Member Services at 1-800-232-4404 (TTY 711), 8 a.m. to 8 p.m., seven days a week.

    If you believe that Kaiser Permanente has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with our Civil Rights Coordinator by writing to Attention: Member Services, Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305 or calling Member Services at the number listed above. You can file a grievance by mail or phone. If you need help filing a grievance, our Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

    Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.

    61104516

    http://www.hhs.gov/ocr/office/file/index.htmlhttps://ocrportal.hhs.gov/ocr/portal/lobby.jsf

  • For more information, visit kp.org/advantageplus 23

    Multi-language Interpreter Services

    English ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-800-232-4404 (TTY: 711).

    Spanish ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-232-4404 (TTY: 711).

    Chinese注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-800-232-4404(TTY:711)。

    Vietnamese CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-232-4404 (TTY: 711).

    Korean

    주의: 한국어를 사용하시는 경우 , 언어 지원 서비스를 무료로 이용하실 수 있습니다 .

    1-800-232-4404 (TTY: 711)번으로 전화해 주십시오 .

    Russian ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-800-232-4404 (телетайп: 711).

    Japanese注意事項:日本語を話される場合、無料の言語支援をご利用いただけます。 1-800-232-4404(TTY:711)まで、お電話にてご連絡ください。

    Amharic ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-800-232-4404 (መስማት ለተሳናቸው: 711).

    H1170_016_11 accepted

    60505608

  • 24 For more information, visit kp.org/advantageplus

    Farsi

    ھمافراشمی برگ اترصوبیبانزالت یتس د، یکنی مگوفتگسیرافنازببھ راگ ی ماانیرھ : ھجوتی ریبگس اتم 1-800-232-4404 (TTY: 711) با .شداب

    Arabic

    مقربل صتا .نجابالمك لر فواتتة یوغللادة عساملات امدخن فإ، ةغللار كذاث دحتتت نكذا إ :ةظحولم.(117- 1-008-232-4044 :مكبالومالصف تھام قر(

    German ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-800-232-4404 (TTY: 711).

    French ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-800-232-4404 (ATS : 711).

    Portuguese ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-800-232-4404 (TTY: 711).

    French Creole ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-800-232-4404 (TTY: 711).

  • For a healthier, more vibrant you. Enroll in Advantage Plus today.

    Get more value from your Kaiser Permanente Medicare health plan by adding Advantage Plus. You can get extra benefits such as dental, vision, hearing, and fitness coverage for an affordable monthly premium. More health benefits, great care. Now that’s a healthy addition to your coverage.

    Want more info?

    Visit kp.org/advantageplus to enroll online today. Or call us toll free at 1-877-471-1064 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.

  • Nine Piedmont Center 3495 Piedmont Road, NE Atlanta, GA 30305

    Please recycle. 377410349 October 2019

    Advantage PlusBe healthy. Be vibrant.Quick Start GuideTake advantage of extra benefits todayTable of contentsA BENEFITS PACKAGE FOR AHEALTHIER, MORE VIBRANT YOUBenefits at a glanceDental coverageFrequently asked questionsPlan features

    Hearing aid coverageFrequently asked questionsKaiser Permanente Contracted Hearing Aid Centers

    Vision coverageFrequently asked questionsKaiser Permanente Vision Partners

    Enroll in Advantage PlusImportant information