to keep your employeesmdashand your bottom linemdashhealthy

Colorado Small Business Enrollment Guide

2016 | SMALL BUSINESS HEALTH

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

Itrsquos time for A BET TER WAY

Choose a clear path to

healthier people and a

healthier business

You face big challenges Costs keep going up You have a critical business decision to make every yearmdashhow to select high-quality health care for your employees at a time when the cost of care continues to accelerate at an impossible rate Since 2001 premiums for employer-sponsored health coverage have increased 113 percent1

Employees are getting sicker Many employers think of health care as just another line itemmdasha necessary expense But on average 90 percent of your employees have at least one chronic condition2 So a healthier workforce can be an investment in the future of your business

To successfully manage your costs and improve business performance you need a healthcare partner who addresses the health of your employees before costs escalate

WHATrsquoS INSIDE

A BETTER WAY to manage costs 3

A BETTER WAY to keep your employees healthier 4

Your partner for better health Virtual Care Innovations 5 Employee Health and Wellness 6 Enhancing the Employee Experience 7

It starts with a plan Accessing care in DenverBoulder 8 Accessing care in Mountain Communities 11 Accessing care in Northern Colorado 12 HMO plans 14 Accessing care in Southern Colorado 16 KP Select 17 KP Select plans 20 Medicare Coverage 21 Adult amp Pediatric Dental Plans 21 2016 Resources 22

2

Colorado Small Business Enrollment Guide

A BETTER WAY to manage costs

BET TER OUTCOMES SATISFIED MEMBERS

BET TER ACCOUNTABILIT Y

LOWER COSTS HIGHER QUALIT Y

After caring for employees for more than 65 years wersquore recognized as todayrsquos gold standard in high-quality cost-effective care mdash delivering value that other health care organizations just canrsquot match

Kaiser Permanente Colorado ranked ldquoHighest Member Satisfaction among Commercial Health Plans in Coloradordquo for the 8th year in a row in the JD Power 2015 Member Satisfaction Study3

With our health plan Kaiser Permanente physicians and affiliated provider partners work together to keep costs low while improving quality to keep your employees healthy at an affordable price

National Committee for Quality Assurance ranks Kaiser Permanente Coloradorsquos 1 Private Health Plan and 1 Medicare Plan in Colorado for the 6th year in a row4

We keep costs in line while achieving high standards of care and wersquore 1 in the nation on 17 out of 28 care measures many of which target preventable conditions5

For the 6th year in a row Aon Hewitt reports Kaiser Permanente offers the most cost-effective plan and outperforms other plans in clinical quality6

3

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

- -

-

ndash

D ID YOU KNOW

Weight management is an important factor

in controlling lost productivity health

care costs and chronic conditions And obesity is the second most prevalent

condition affecting productivity at work

On average it costs an employer $1500 more to insure an obese employee

than a normal weight employee9

Health care costs for patients with chronic conditions such

as diabetes or congestive heart failure were 30 50 percent higher when the

patient was obese 10

Obesity costs an estimated $64 billion in direct medical

costs and $59 billion in indirect costs such as lost

productivity11

$140000 in total annual

costs for 100 obese employees

A BETTER WAY to keep your employees healthier We give you a better way to invest in your employeesrsquo health They get more effective support from our top doctors clinical and hospital partners leading workforce health programs and award-winning disease management The result is healthier more engaged and more productive employees

Healthy and engaged employeesmdash Healthy employees offer a higher return on investment We make it easy and convenient for them to get better care in fewer office visits so they have fewer sick days and emergency visitsmdashkeeping them at work and more productive Theyrsquoll have access to tools and resources to actively participate in their health at home online with their smartphone and at our one-stop Kaiser Permanente facilities

Raising the bar for healthcaremdash Kaiser Permanente is one of the largest health and research systems in the world Our size and scale combined with the industryrsquos leading electronic health information system allows us to deliver better care faster than most other organizations Wersquore a national and international model for cost-effective high-quality and innovative care and wersquore quickly advancing new best practices and saving lives

Award-winning chronic caremdash Eighty-five percent of health care costs are due to chronic conditions and nine out of ten employees in the US have chronic conditions78 Your employees will benefit from the latest thinking in disease management reducing health emergencies sick days disability time and overall costs

Top physiciansmdash Better doctors provide better care and thatrsquos a smarter way to invest in employee health Kaiser Permanente has world-class doctors from schools like Yale Johns Hopkins and Harvard Additionally year over year 5280 Magazine recognizes many Kaiser Permanente Colorado physicians in its ldquoTop Doctorsrdquo issue

4

Colorado Small Business Enrollment Guide

mdash

Virtual Care Innovations Enhancing Physician e-Visit consultationsmdash For years members have been able to email their Kaiser Permanente physicians through My Health Manager Now though they can also attach photos and have virtual email consultations With our new store-and-forward functionality a photo is taken uploaded to their medical record and viewed by a Kaiser Permanente specialist who responds later with advice

Adding New RN e-Visit capabilitymdash In addition to our 247 telephone nurse advice line your employees have 247 access to online medical consultations with our Advice Call Center Registered Nurses This new feature is available within our secure patient portal on kporg

IN Q1 2015

442433

TIME -SAVING ALTERNATIVES TO OFFICE VIS ITS

Kaiser Permanente Colorado members were seen in an office visit

317595 members accessed care through secure email consultations

79806 members took advantage of telephone consultations with their primary care providers

D ID YOU KNOW

BRINGING THE DOCTORrsquoS OFFICE TO YOUR WORKFORCE

This year wersquore launching another convenient care option for your

employees video visits

Instead of seeing their Kaiser Permanente

provider in person they can have secure

convenient and personalized video consultations

through a computer smart phone or tablet

This feature is available when you get care at Kaiser Permanente facilities or with Kaiser Permanente doctors

5

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

Employee Health amp Wellness

DID YOU KNOW

Proactive Care

We help your employees stay healthy not just

treat them when they are sick Preventive screenings

help keep you and your employees healthy by

providing an early alert for many health conditions That way they can be

treated before they become serious Under health care reform many are available at no charge

For a complete list of our preventive care services visit

kporgprevention

Total Health Assessmentmdash Your employees can take a confidential online health assessment on kporgsucceed and receive a personalized report along with their results to share with their healthcare team

Healthy Lifestyle Programsmdash We offer a complementary suite of online intervention programs to help your employees achieve their health and wellness goals and thrive Some of the topics include Balancetrade for weight management Breathetrade for tobacco cessation and Care for Your Healthtrade for living with chronic conditions To get started visit kporghealthylifestyles

Wellness Coachingmdash Whether your employees are trying to eat better lose weight get active or manage stress getting started and staying motivated can be a challenge With Kaiser Permanente they can access free wellness coaching by phone to get the extra support they need to make healthy changes and stick with them

Wellness Webinarsmdash With our convenient live or recorded webinars your workforce can take an active role in improving their health and fit wellness into their schedule no matter how busy the day is View free programs and register at kpwebinarorg

Complementary Medicinemdash Kaiser Permanentersquos Center for Complementary Medicine offers chiropractic acupuncture massage and mindbody medicine services for your employees Visit kporgcam or kpccmorg to learn more about network providers and complementary medicine services

ChooseHealthytrade Discountsmdash Employees can find savings on many services including preferred membership rates at select health clubs 25 off regular rates for massage therapy chiropractic care and acupuncture Our ChooseHealthytrade online store offers 15-40 off suggested retail prices on hundreds of health products and at FitnessCoachcom there are many tools to help them achieve their health and fitness goals Providers and services are detailed on kporgchoosehealthy

6

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

Itrsquos time for A BET TER WAY

Choose a clear path to

healthier people and a

healthier business

You face big challenges Costs keep going up You have a critical business decision to make every yearmdashhow to select high-quality health care for your employees at a time when the cost of care continues to accelerate at an impossible rate Since 2001 premiums for employer-sponsored health coverage have increased 113 percent1

Employees are getting sicker Many employers think of health care as just another line itemmdasha necessary expense But on average 90 percent of your employees have at least one chronic condition2 So a healthier workforce can be an investment in the future of your business

To successfully manage your costs and improve business performance you need a healthcare partner who addresses the health of your employees before costs escalate

WHATrsquoS INSIDE

A BETTER WAY to manage costs 3

A BETTER WAY to keep your employees healthier 4

Your partner for better health Virtual Care Innovations 5 Employee Health and Wellness 6 Enhancing the Employee Experience 7

It starts with a plan Accessing care in DenverBoulder 8 Accessing care in Mountain Communities 11 Accessing care in Northern Colorado 12 HMO plans 14 Accessing care in Southern Colorado 16 KP Select 17 KP Select plans 20 Medicare Coverage 21 Adult amp Pediatric Dental Plans 21 2016 Resources 22

2

Colorado Small Business Enrollment Guide

A BETTER WAY to manage costs

BET TER OUTCOMES SATISFIED MEMBERS

BET TER ACCOUNTABILIT Y

LOWER COSTS HIGHER QUALIT Y

After caring for employees for more than 65 years wersquore recognized as todayrsquos gold standard in high-quality cost-effective care mdash delivering value that other health care organizations just canrsquot match

Kaiser Permanente Colorado ranked ldquoHighest Member Satisfaction among Commercial Health Plans in Coloradordquo for the 8th year in a row in the JD Power 2015 Member Satisfaction Study3

With our health plan Kaiser Permanente physicians and affiliated provider partners work together to keep costs low while improving quality to keep your employees healthy at an affordable price

National Committee for Quality Assurance ranks Kaiser Permanente Coloradorsquos 1 Private Health Plan and 1 Medicare Plan in Colorado for the 6th year in a row4

We keep costs in line while achieving high standards of care and wersquore 1 in the nation on 17 out of 28 care measures many of which target preventable conditions5

For the 6th year in a row Aon Hewitt reports Kaiser Permanente offers the most cost-effective plan and outperforms other plans in clinical quality6

3

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

- -

-

ndash

D ID YOU KNOW

Weight management is an important factor

in controlling lost productivity health

care costs and chronic conditions And obesity is the second most prevalent

condition affecting productivity at work

On average it costs an employer $1500 more to insure an obese employee

than a normal weight employee9

Health care costs for patients with chronic conditions such

as diabetes or congestive heart failure were 30 50 percent higher when the

patient was obese 10

Obesity costs an estimated $64 billion in direct medical

costs and $59 billion in indirect costs such as lost

productivity11

$140000 in total annual

costs for 100 obese employees

A BETTER WAY to keep your employees healthier We give you a better way to invest in your employeesrsquo health They get more effective support from our top doctors clinical and hospital partners leading workforce health programs and award-winning disease management The result is healthier more engaged and more productive employees

Healthy and engaged employeesmdash Healthy employees offer a higher return on investment We make it easy and convenient for them to get better care in fewer office visits so they have fewer sick days and emergency visitsmdashkeeping them at work and more productive Theyrsquoll have access to tools and resources to actively participate in their health at home online with their smartphone and at our one-stop Kaiser Permanente facilities

Raising the bar for healthcaremdash Kaiser Permanente is one of the largest health and research systems in the world Our size and scale combined with the industryrsquos leading electronic health information system allows us to deliver better care faster than most other organizations Wersquore a national and international model for cost-effective high-quality and innovative care and wersquore quickly advancing new best practices and saving lives

Award-winning chronic caremdash Eighty-five percent of health care costs are due to chronic conditions and nine out of ten employees in the US have chronic conditions78 Your employees will benefit from the latest thinking in disease management reducing health emergencies sick days disability time and overall costs

Top physiciansmdash Better doctors provide better care and thatrsquos a smarter way to invest in employee health Kaiser Permanente has world-class doctors from schools like Yale Johns Hopkins and Harvard Additionally year over year 5280 Magazine recognizes many Kaiser Permanente Colorado physicians in its ldquoTop Doctorsrdquo issue

4

Colorado Small Business Enrollment Guide

mdash

Virtual Care Innovations Enhancing Physician e-Visit consultationsmdash For years members have been able to email their Kaiser Permanente physicians through My Health Manager Now though they can also attach photos and have virtual email consultations With our new store-and-forward functionality a photo is taken uploaded to their medical record and viewed by a Kaiser Permanente specialist who responds later with advice

Adding New RN e-Visit capabilitymdash In addition to our 247 telephone nurse advice line your employees have 247 access to online medical consultations with our Advice Call Center Registered Nurses This new feature is available within our secure patient portal on kporg

IN Q1 2015

442433

TIME -SAVING ALTERNATIVES TO OFFICE VIS ITS

Kaiser Permanente Colorado members were seen in an office visit

317595 members accessed care through secure email consultations

79806 members took advantage of telephone consultations with their primary care providers

D ID YOU KNOW

BRINGING THE DOCTORrsquoS OFFICE TO YOUR WORKFORCE

This year wersquore launching another convenient care option for your

employees video visits

Instead of seeing their Kaiser Permanente

provider in person they can have secure

convenient and personalized video consultations

through a computer smart phone or tablet

This feature is available when you get care at Kaiser Permanente facilities or with Kaiser Permanente doctors

5

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

Employee Health amp Wellness

DID YOU KNOW

Proactive Care

We help your employees stay healthy not just

treat them when they are sick Preventive screenings

help keep you and your employees healthy by

providing an early alert for many health conditions That way they can be

treated before they become serious Under health care reform many are available at no charge

For a complete list of our preventive care services visit

kporgprevention

Total Health Assessmentmdash Your employees can take a confidential online health assessment on kporgsucceed and receive a personalized report along with their results to share with their healthcare team

Healthy Lifestyle Programsmdash We offer a complementary suite of online intervention programs to help your employees achieve their health and wellness goals and thrive Some of the topics include Balancetrade for weight management Breathetrade for tobacco cessation and Care for Your Healthtrade for living with chronic conditions To get started visit kporghealthylifestyles

Wellness Coachingmdash Whether your employees are trying to eat better lose weight get active or manage stress getting started and staying motivated can be a challenge With Kaiser Permanente they can access free wellness coaching by phone to get the extra support they need to make healthy changes and stick with them

Wellness Webinarsmdash With our convenient live or recorded webinars your workforce can take an active role in improving their health and fit wellness into their schedule no matter how busy the day is View free programs and register at kpwebinarorg

Complementary Medicinemdash Kaiser Permanentersquos Center for Complementary Medicine offers chiropractic acupuncture massage and mindbody medicine services for your employees Visit kporgcam or kpccmorg to learn more about network providers and complementary medicine services

ChooseHealthytrade Discountsmdash Employees can find savings on many services including preferred membership rates at select health clubs 25 off regular rates for massage therapy chiropractic care and acupuncture Our ChooseHealthytrade online store offers 15-40 off suggested retail prices on hundreds of health products and at FitnessCoachcom there are many tools to help them achieve their health and fitness goals Providers and services are detailed on kporgchoosehealthy

6

Colorado Small Business Enrollment Guide

A BETTER WAY to manage costs

BET TER OUTCOMES SATISFIED MEMBERS

BET TER ACCOUNTABILIT Y

LOWER COSTS HIGHER QUALIT Y

After caring for employees for more than 65 years wersquore recognized as todayrsquos gold standard in high-quality cost-effective care mdash delivering value that other health care organizations just canrsquot match

Kaiser Permanente Colorado ranked ldquoHighest Member Satisfaction among Commercial Health Plans in Coloradordquo for the 8th year in a row in the JD Power 2015 Member Satisfaction Study3

With our health plan Kaiser Permanente physicians and affiliated provider partners work together to keep costs low while improving quality to keep your employees healthy at an affordable price

National Committee for Quality Assurance ranks Kaiser Permanente Coloradorsquos 1 Private Health Plan and 1 Medicare Plan in Colorado for the 6th year in a row4

We keep costs in line while achieving high standards of care and wersquore 1 in the nation on 17 out of 28 care measures many of which target preventable conditions5

For the 6th year in a row Aon Hewitt reports Kaiser Permanente offers the most cost-effective plan and outperforms other plans in clinical quality6

3

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

- -

-

ndash

D ID YOU KNOW

Weight management is an important factor

in controlling lost productivity health

care costs and chronic conditions And obesity is the second most prevalent

condition affecting productivity at work

On average it costs an employer $1500 more to insure an obese employee

than a normal weight employee9

Health care costs for patients with chronic conditions such

as diabetes or congestive heart failure were 30 50 percent higher when the

patient was obese 10

Obesity costs an estimated $64 billion in direct medical

costs and $59 billion in indirect costs such as lost

productivity11

$140000 in total annual

costs for 100 obese employees

A BETTER WAY to keep your employees healthier We give you a better way to invest in your employeesrsquo health They get more effective support from our top doctors clinical and hospital partners leading workforce health programs and award-winning disease management The result is healthier more engaged and more productive employees

Healthy and engaged employeesmdash Healthy employees offer a higher return on investment We make it easy and convenient for them to get better care in fewer office visits so they have fewer sick days and emergency visitsmdashkeeping them at work and more productive Theyrsquoll have access to tools and resources to actively participate in their health at home online with their smartphone and at our one-stop Kaiser Permanente facilities

Raising the bar for healthcaremdash Kaiser Permanente is one of the largest health and research systems in the world Our size and scale combined with the industryrsquos leading electronic health information system allows us to deliver better care faster than most other organizations Wersquore a national and international model for cost-effective high-quality and innovative care and wersquore quickly advancing new best practices and saving lives

Award-winning chronic caremdash Eighty-five percent of health care costs are due to chronic conditions and nine out of ten employees in the US have chronic conditions78 Your employees will benefit from the latest thinking in disease management reducing health emergencies sick days disability time and overall costs

Top physiciansmdash Better doctors provide better care and thatrsquos a smarter way to invest in employee health Kaiser Permanente has world-class doctors from schools like Yale Johns Hopkins and Harvard Additionally year over year 5280 Magazine recognizes many Kaiser Permanente Colorado physicians in its ldquoTop Doctorsrdquo issue

4

Colorado Small Business Enrollment Guide

mdash

Virtual Care Innovations Enhancing Physician e-Visit consultationsmdash For years members have been able to email their Kaiser Permanente physicians through My Health Manager Now though they can also attach photos and have virtual email consultations With our new store-and-forward functionality a photo is taken uploaded to their medical record and viewed by a Kaiser Permanente specialist who responds later with advice

Adding New RN e-Visit capabilitymdash In addition to our 247 telephone nurse advice line your employees have 247 access to online medical consultations with our Advice Call Center Registered Nurses This new feature is available within our secure patient portal on kporg

IN Q1 2015

442433

TIME -SAVING ALTERNATIVES TO OFFICE VIS ITS

Kaiser Permanente Colorado members were seen in an office visit

317595 members accessed care through secure email consultations

79806 members took advantage of telephone consultations with their primary care providers

D ID YOU KNOW

BRINGING THE DOCTORrsquoS OFFICE TO YOUR WORKFORCE

This year wersquore launching another convenient care option for your

employees video visits

Instead of seeing their Kaiser Permanente

provider in person they can have secure

convenient and personalized video consultations

through a computer smart phone or tablet

This feature is available when you get care at Kaiser Permanente facilities or with Kaiser Permanente doctors

5

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

Employee Health amp Wellness

DID YOU KNOW

Proactive Care

We help your employees stay healthy not just

treat them when they are sick Preventive screenings

help keep you and your employees healthy by

providing an early alert for many health conditions That way they can be

treated before they become serious Under health care reform many are available at no charge

For a complete list of our preventive care services visit

kporgprevention

Total Health Assessmentmdash Your employees can take a confidential online health assessment on kporgsucceed and receive a personalized report along with their results to share with their healthcare team

Healthy Lifestyle Programsmdash We offer a complementary suite of online intervention programs to help your employees achieve their health and wellness goals and thrive Some of the topics include Balancetrade for weight management Breathetrade for tobacco cessation and Care for Your Healthtrade for living with chronic conditions To get started visit kporghealthylifestyles

Wellness Coachingmdash Whether your employees are trying to eat better lose weight get active or manage stress getting started and staying motivated can be a challenge With Kaiser Permanente they can access free wellness coaching by phone to get the extra support they need to make healthy changes and stick with them

Wellness Webinarsmdash With our convenient live or recorded webinars your workforce can take an active role in improving their health and fit wellness into their schedule no matter how busy the day is View free programs and register at kpwebinarorg

Complementary Medicinemdash Kaiser Permanentersquos Center for Complementary Medicine offers chiropractic acupuncture massage and mindbody medicine services for your employees Visit kporgcam or kpccmorg to learn more about network providers and complementary medicine services

ChooseHealthytrade Discountsmdash Employees can find savings on many services including preferred membership rates at select health clubs 25 off regular rates for massage therapy chiropractic care and acupuncture Our ChooseHealthytrade online store offers 15-40 off suggested retail prices on hundreds of health products and at FitnessCoachcom there are many tools to help them achieve their health and fitness goals Providers and services are detailed on kporgchoosehealthy

6

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

- -

-

ndash

D ID YOU KNOW

Weight management is an important factor

in controlling lost productivity health

care costs and chronic conditions And obesity is the second most prevalent

condition affecting productivity at work

On average it costs an employer $1500 more to insure an obese employee

than a normal weight employee9

Health care costs for patients with chronic conditions such

as diabetes or congestive heart failure were 30 50 percent higher when the

patient was obese 10

Obesity costs an estimated $64 billion in direct medical

costs and $59 billion in indirect costs such as lost

productivity11

$140000 in total annual

costs for 100 obese employees

A BETTER WAY to keep your employees healthier We give you a better way to invest in your employeesrsquo health They get more effective support from our top doctors clinical and hospital partners leading workforce health programs and award-winning disease management The result is healthier more engaged and more productive employees

Healthy and engaged employeesmdash Healthy employees offer a higher return on investment We make it easy and convenient for them to get better care in fewer office visits so they have fewer sick days and emergency visitsmdashkeeping them at work and more productive Theyrsquoll have access to tools and resources to actively participate in their health at home online with their smartphone and at our one-stop Kaiser Permanente facilities

Raising the bar for healthcaremdash Kaiser Permanente is one of the largest health and research systems in the world Our size and scale combined with the industryrsquos leading electronic health information system allows us to deliver better care faster than most other organizations Wersquore a national and international model for cost-effective high-quality and innovative care and wersquore quickly advancing new best practices and saving lives

Award-winning chronic caremdash Eighty-five percent of health care costs are due to chronic conditions and nine out of ten employees in the US have chronic conditions78 Your employees will benefit from the latest thinking in disease management reducing health emergencies sick days disability time and overall costs

Top physiciansmdash Better doctors provide better care and thatrsquos a smarter way to invest in employee health Kaiser Permanente has world-class doctors from schools like Yale Johns Hopkins and Harvard Additionally year over year 5280 Magazine recognizes many Kaiser Permanente Colorado physicians in its ldquoTop Doctorsrdquo issue

4

Colorado Small Business Enrollment Guide

mdash

Virtual Care Innovations Enhancing Physician e-Visit consultationsmdash For years members have been able to email their Kaiser Permanente physicians through My Health Manager Now though they can also attach photos and have virtual email consultations With our new store-and-forward functionality a photo is taken uploaded to their medical record and viewed by a Kaiser Permanente specialist who responds later with advice

Adding New RN e-Visit capabilitymdash In addition to our 247 telephone nurse advice line your employees have 247 access to online medical consultations with our Advice Call Center Registered Nurses This new feature is available within our secure patient portal on kporg

IN Q1 2015

442433

TIME -SAVING ALTERNATIVES TO OFFICE VIS ITS

Kaiser Permanente Colorado members were seen in an office visit

317595 members accessed care through secure email consultations

79806 members took advantage of telephone consultations with their primary care providers

D ID YOU KNOW

BRINGING THE DOCTORrsquoS OFFICE TO YOUR WORKFORCE

This year wersquore launching another convenient care option for your

employees video visits

Instead of seeing their Kaiser Permanente

provider in person they can have secure

convenient and personalized video consultations

through a computer smart phone or tablet

This feature is available when you get care at Kaiser Permanente facilities or with Kaiser Permanente doctors

5

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

Employee Health amp Wellness

DID YOU KNOW

Proactive Care

We help your employees stay healthy not just

treat them when they are sick Preventive screenings

help keep you and your employees healthy by

providing an early alert for many health conditions That way they can be

treated before they become serious Under health care reform many are available at no charge

For a complete list of our preventive care services visit

kporgprevention

Total Health Assessmentmdash Your employees can take a confidential online health assessment on kporgsucceed and receive a personalized report along with their results to share with their healthcare team

Healthy Lifestyle Programsmdash We offer a complementary suite of online intervention programs to help your employees achieve their health and wellness goals and thrive Some of the topics include Balancetrade for weight management Breathetrade for tobacco cessation and Care for Your Healthtrade for living with chronic conditions To get started visit kporghealthylifestyles

Wellness Coachingmdash Whether your employees are trying to eat better lose weight get active or manage stress getting started and staying motivated can be a challenge With Kaiser Permanente they can access free wellness coaching by phone to get the extra support they need to make healthy changes and stick with them

Wellness Webinarsmdash With our convenient live or recorded webinars your workforce can take an active role in improving their health and fit wellness into their schedule no matter how busy the day is View free programs and register at kpwebinarorg

Complementary Medicinemdash Kaiser Permanentersquos Center for Complementary Medicine offers chiropractic acupuncture massage and mindbody medicine services for your employees Visit kporgcam or kpccmorg to learn more about network providers and complementary medicine services

ChooseHealthytrade Discountsmdash Employees can find savings on many services including preferred membership rates at select health clubs 25 off regular rates for massage therapy chiropractic care and acupuncture Our ChooseHealthytrade online store offers 15-40 off suggested retail prices on hundreds of health products and at FitnessCoachcom there are many tools to help them achieve their health and fitness goals Providers and services are detailed on kporgchoosehealthy

6

Colorado Small Business Enrollment Guide

mdash

Virtual Care Innovations Enhancing Physician e-Visit consultationsmdash For years members have been able to email their Kaiser Permanente physicians through My Health Manager Now though they can also attach photos and have virtual email consultations With our new store-and-forward functionality a photo is taken uploaded to their medical record and viewed by a Kaiser Permanente specialist who responds later with advice

Adding New RN e-Visit capabilitymdash In addition to our 247 telephone nurse advice line your employees have 247 access to online medical consultations with our Advice Call Center Registered Nurses This new feature is available within our secure patient portal on kporg

IN Q1 2015

442433

TIME -SAVING ALTERNATIVES TO OFFICE VIS ITS

Kaiser Permanente Colorado members were seen in an office visit

317595 members accessed care through secure email consultations

79806 members took advantage of telephone consultations with their primary care providers

D ID YOU KNOW

BRINGING THE DOCTORrsquoS OFFICE TO YOUR WORKFORCE

This year wersquore launching another convenient care option for your

employees video visits

Instead of seeing their Kaiser Permanente

provider in person they can have secure

convenient and personalized video consultations

through a computer smart phone or tablet

This feature is available when you get care at Kaiser Permanente facilities or with Kaiser Permanente doctors

5

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

Employee Health amp Wellness

DID YOU KNOW

Proactive Care

We help your employees stay healthy not just

treat them when they are sick Preventive screenings

help keep you and your employees healthy by

providing an early alert for many health conditions That way they can be

treated before they become serious Under health care reform many are available at no charge

For a complete list of our preventive care services visit

kporgprevention

Total Health Assessmentmdash Your employees can take a confidential online health assessment on kporgsucceed and receive a personalized report along with their results to share with their healthcare team

Healthy Lifestyle Programsmdash We offer a complementary suite of online intervention programs to help your employees achieve their health and wellness goals and thrive Some of the topics include Balancetrade for weight management Breathetrade for tobacco cessation and Care for Your Healthtrade for living with chronic conditions To get started visit kporghealthylifestyles

Wellness Coachingmdash Whether your employees are trying to eat better lose weight get active or manage stress getting started and staying motivated can be a challenge With Kaiser Permanente they can access free wellness coaching by phone to get the extra support they need to make healthy changes and stick with them

Wellness Webinarsmdash With our convenient live or recorded webinars your workforce can take an active role in improving their health and fit wellness into their schedule no matter how busy the day is View free programs and register at kpwebinarorg

Complementary Medicinemdash Kaiser Permanentersquos Center for Complementary Medicine offers chiropractic acupuncture massage and mindbody medicine services for your employees Visit kporgcam or kpccmorg to learn more about network providers and complementary medicine services

ChooseHealthytrade Discountsmdash Employees can find savings on many services including preferred membership rates at select health clubs 25 off regular rates for massage therapy chiropractic care and acupuncture Our ChooseHealthytrade online store offers 15-40 off suggested retail prices on hundreds of health products and at FitnessCoachcom there are many tools to help them achieve their health and fitness goals Providers and services are detailed on kporgchoosehealthy

6

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

Employee Health amp Wellness

DID YOU KNOW

Proactive Care

We help your employees stay healthy not just

treat them when they are sick Preventive screenings

help keep you and your employees healthy by

providing an early alert for many health conditions That way they can be

treated before they become serious Under health care reform many are available at no charge

For a complete list of our preventive care services visit

kporgprevention

Total Health Assessmentmdash Your employees can take a confidential online health assessment on kporgsucceed and receive a personalized report along with their results to share with their healthcare team

Healthy Lifestyle Programsmdash We offer a complementary suite of online intervention programs to help your employees achieve their health and wellness goals and thrive Some of the topics include Balancetrade for weight management Breathetrade for tobacco cessation and Care for Your Healthtrade for living with chronic conditions To get started visit kporghealthylifestyles

Wellness Coachingmdash Whether your employees are trying to eat better lose weight get active or manage stress getting started and staying motivated can be a challenge With Kaiser Permanente they can access free wellness coaching by phone to get the extra support they need to make healthy changes and stick with them

Wellness Webinarsmdash With our convenient live or recorded webinars your workforce can take an active role in improving their health and fit wellness into their schedule no matter how busy the day is View free programs and register at kpwebinarorg

Complementary Medicinemdash Kaiser Permanentersquos Center for Complementary Medicine offers chiropractic acupuncture massage and mindbody medicine services for your employees Visit kporgcam or kpccmorg to learn more about network providers and complementary medicine services

ChooseHealthytrade Discountsmdash Employees can find savings on many services including preferred membership rates at select health clubs 25 off regular rates for massage therapy chiropractic care and acupuncture Our ChooseHealthytrade online store offers 15-40 off suggested retail prices on hundreds of health products and at FitnessCoachcom there are many tools to help them achieve their health and fitness goals Providers and services are detailed on kporgchoosehealthy

6

Colorado Small Business Enrollment Guide

Enhancing the Employee Experience

New Online Treatment Cost Estimator Calculatormdash To help your employees make more informed decisions about their health they can now visit kporgcostestimates to get personalized estimates for out-of-pocket costs for some of the most common exams tests procedures or treatment plans they may be discussing with their Kaiser Permanente physicians They can continue to also call our financial counselors

An even Better Pharmacymdash As the second largest purchaser of pharmaceuticals in the nation your employees will typically pay significantly lower costs for their generic and non-generic medications when using Kaiser Permanente pharmacies and partners We leverage our organizational purchasing power to manage costs from the start negotiating prescription drug prices buying drugs in bulk and operating our own pharmacies and warehouses With our newest pharmacy management system prescriptions are still filled accurately just in less time Employee wait times have decreased 97 of mail orders are shipped in less than 4 days and member satisfaction is at 94

Upgraded Call Centers Each year we assist millions of member calls so we upgraded capabilities for our Appointment and Advice Call Center and Clinical Pharmacy Call Centers With new speech voice recognition your employees can quickly talk with a representative or utilize self-serve options such as scheduling appointments or refilling prescriptions

DID YOU KNOW

NEW MEMBER CONNECT DEPARTMENT

Whether itrsquos finding a physician transitioning

prescriptions understanding plan benefits or

understanding kporg our newest service helps your employees navigate their plan and connect to

the care they need

7

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

Accessing Care in DenverBoulder Employees have a choice of more than 1000 primary care physicians and specialists at any Kaiser Permanente medical office in Colorado With many locations to choose from and most offering multiple services under one roof they can see their doctor get a lab test or an X-ray and pick up medications mdash all without leaving the building

Integrated Care In our integrated model care teams are united for a single purposemdashbetter health Your employees receive better care thatrsquos more efficientmdashwhich means healthier outcomes for them and lower costs for you Look at the advantages built into our care approach within our Kaiser Permanente medical offices

Fewer office visitsmdashemployees save time and money by getting primary care specialty care lab pharmacy and many other services at a Kaiser Permanente medical office

Fewer sick daysmdashour team approach puts your employees at the center and helps them proactively manage their care so theyrsquore healthier at work and more productive

Satisfied workersmdashconsumers say we outperform all other health insurers in delivering high-quality customer service and making it easy to access care 12

Dependable access to great doctorsmdashevery one of our physicians goes through a rigorous selection process before we allow them to care for your employees In Colorado that means we only hire 11 of the physicians who apply

Built-in health advice and programsmdashdisease management programs health education and nurse advice are part of your plan so employees get consistent health information from one source

Ensuring consistent caremdashour doctors have created one of the worldrsquos largest most inclusive electronic medical libraries available only to our caregivers

Healthier employeesmdashprimary care physicians and specialists can view each otherrsquos treatment notes in real time via an employeersquos electronic medical record This allows for a thorough and accurate exchange of information which can help keep your employees healthier

SAVING LIVES AND DOLL ARS

89 Reduction in heart attack deaths in Colorado avoiding related medical costs and productivity losses13

8

Colorado Small Business Enrollment Guide

9

Kaiser Permanente Medical Offices

To make an appointment at any medical office call 303-338-4545 (TTY 711) weekdays 7 am to 6 pm

1 Arapahoe Medical Offices 5555 E Arapahoe Rd Centennial CO 80122

2 Aurora Centrepoint Medical Offices

14701 E Exposition Ave Aurora CO 80012

3 Baseline Medical Offices 580 Mohawk Dr Boulder CO 80303

4 Brighton Medical Offices 859 S 4th Ave Brighton CO 80601

5 Castle Rock Medical Offices 4318 Trail Boss Dr Castle Rock CO 80104

6 East Denver Medical Offices 10400 E Alameda Ave Denver CO 80247

7 Englewood Medical Offices 2955 S Broadway Englewood CO 80113

8 Evergreen Medical Offices 2942 Evergreen Pkwy Evergreen CO 80439

9 Franklin Medical Offices 2045 Franklin St Denver CO 80205

10 Hidden Lake Medical Offices 7701 Sheridan Blvd Arvada CO 80003

11 Highlands Ranch Medical Offices 9285 Hepburn St Highlands Ranch CO 80129

12 Ken Caryl Medical Offices 7600 Shaffer Pkwy Littleton CO 80127

13 Lakewood Medical Offices 8383 W Alameda Ave Lakewood CO 80226

Hospitals for scheduledinpatient care emergency care hospitalsdepartments and urgent care facilities

H E U

Behavioral Health offices (mental health chemical dependency and eating disorders)

25

25

25

270

7

7

74

52

119

119

287

85

85

85

285

76

85

36

7

13

12

11 14

22

5

20

8

1

2

H1

H2

H3

19

10

21

174

3

15

16

918

6

E4

E3

E5E2

E1

B3

B1

B2

Ken Caryl Ave

Hampden

Evergreen Pkwy

Evergreen

Boulder

Castle Rock

Longmont

C 470 E 470E 470

E 470

C 470 C 470

County Line Rd

Quincy Ave

Arapahoe Rd

Belleview Ave

Alameda Ave6th Ave

Colfax Ave

Founders Pkwy

TrD

sso

B lia

r

E Inspiration Dr

88th Ave

56th Ave

Evans Ave

64th Ave58th Ave

104th Ave

Colorado Blvd

Sable BlvdS 4th

Washington St

Pecos StHuron St

Indiana St

N 95th St

Garrison St

Sheridan

University Blvd

Chambers Rd

Airport Rd

Sable

Colorado Blvd

Wadsworth

Simm

s St

Federal Blvd S Broadway

Holly St

Pentildea BlvdPeoria St

T ower Rd

County Hwy 25112th Ave120th Ave

E 160th Ave

E 152nd AveE Bromley LnNorthwest Pkwy

E 470

S Boulder RdBaseline RdArapahoe Rd

Nelson Rd

Valmont Rd

72nd Ave

80th Ave

Mississippi Ave

Parker RdN Jordon Rd

NiP

rD

en

Smoky Hill Rd

E Main St

Lincoln Ave

287

42

Autumn Ridge Blvd

Exempla Cir

Maple Rd

Empire Rd

Campus DrS Pointe Dr

36to

17H2

P

PP

P

Humboldt St

Franklin St

Gilpin St

William

s Stg

Lafayette St

Marion St

Downing St

Ogden St

Emerson St

Clarkson St

Washington St

Pearl St

Pennsylvania S

Logan St

Park Ave

24th St

22nd St 20th Ave20th Ave

22nd Ave

23rd Ave

24th Ave

19th Ave

18th Ave

21st AveP

PConstruction

P

9

H3 U2E1

18

Medical offices Pharmacy

Medical Imaging

Audiologyhearing

Opticaloptometry

Laboratory

U1

U2

U3

H4

Map is not to scale

Medical offices Hospitals for scheduledinpatient care emergency care hospitalsdepartments and Urgent Care facilities

Behavioral Health offices (mental health chemical dependency and eating disorders)

H E U

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

10

14 Lone Tree Medical Offices 10240 Park Meadows DrLone Tree CO 80124

15 Longmont Medical Offices 2345 Bent Way Longmont CO 80503

16 Parker Medical Offices 10168 Parkglenn Way Parker CO 80138

17 Rock Creek Medical Offices 280 Exempla Cir Lafayette CO 80026

18 Skyline Medical Offices 1375 E 20th Ave Denver CO 80205

19 Smoky Hill Medical Offices 16290 E Quincy Ave Aurora CO 80015

20 Southwest Medical Offices 5257 S Wadsworth Blvd Littleton CO 80123

21 Westminster Medical Offices 11245 Huron St Westminster CO 80234

22 Wheat Ridge Medical Offices 4803 Ward Rd Wheat Ridge CO 80033

After-Hours Care

Hours and locations for after-hours care are subject to change Please call 303-338-4545 (TTY 711) at the time of need to confirm current hours and locations

1 Arapahoe Medical Offices 6 pmndash10 pm Mon - Fri 8 amndash9 pm Sat 9 amndash9 pm Sun

6 East Denver Medical Offices 8 amndash4 pm Sat 9 amndash4 pm Sun

13 Lakewood Medical Offices 8 amndash4 pm Sat 9 amndash4 pm Sun

21 Westminster Medical Offices 8 amndash4 pm Sat 9 amndash4 pm Sun

Pediatric Urgent Care

U1 Childrenrsquos Hospital Colorado Urgent Care North Campus Broomfield

469 West Highway 7 Broomfield CO 80023

U2 Childrenrsquos Hospital Colorado Urgent Care Uptown Denver

1835 Franklin Street Denver CO 80218

U3 Childrenrsquos Hospital Colorado Urgent Care Wheat Ridge

3455 Lutheran Parkway Suite 230 Wheat Ridge CO 80033

Emergency Care

If you have an emergency medical condition call 911 or go to the nearest hospital Or if time and safety permit you can go to the Emergency Department at one of the following hospitals

H3 Saint Joseph Hospital1375 East 19th Avenue Denver CO 80218

H2 Good Samaritan Medical Center

200 Exempla Circle Lafayette CO 80026

H3 Senior ER at Saint Joseph Hospital

1375 East 19th Avenue Denver CO 80218

H1 Childrenrsquos Hospital Colorado on Anschutz Medical Campus

13123 E 16th Ave Aurora CO 80045

H4 Childrenrsquos Hospital Colorado North Campus Broomfield

469 West Highway 7 Broomfield CO 80023

E1 Childrenrsquos Hospital Colorado at Saint Joseph Hospital

1835 Franklin St Denver CO 80218

H3 Rocky Mountain Hospital for Children

1719 E 19th Ave Denver CO 80218

E3 HealthONE Sky Ridge Medical Center

10101 Ridgegate Pkwy Lone Tree CO 80124

E4 HealthONE Swedish Medical Center

501 E Hampden Ave Englewood CO 80110

E5 HealthONE Swedish Southwest ER

6196 S Ammons Way Littleton CO 80123

E2 HealthONE Centennial Medical Plaza

14200 E Arapahoe Rd Centennial CO 80112

Behavioral Health Offices

For appointments call 303-471-7700 B1 Hidden Lake

Behavioral Health 7701 Sheridan Blvd Arvada CO 80003

B2 Highline Behavioral Health 10350 E Dakota Ave Denver CO 80247 Entrance located on East side of building

B3 Ridgeline Behavioral Health Center

9139 S Ridgeline Blvd Highlands Ranch CO 80129

Additional locations and access

In addition to the locations shown on this map you have access to all Kaiser Permanente medical offices in Northern and Southern Colorado

Colorado Small Business Enrollment Guide

11

Accessing Care in Mountain CommunitiesAt Kaiser Permanente we believe therersquos no better choice than choosing good health Thatrsquos why wersquore expanding our mission to provide high-quality affordable health care services into Mountain communities for the first time opening our Frisco medical office in Summit County in early 2016 and a second location in Eagle County

Integrated Care

Your employees can access care at our locations in the mountains and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

Kaiser Permanente Medical Offices

1 Kaiser Permanente Frisco Medical Offices

226 Lusher Court Frisco CO 80443

2 Eagle County location opening in 2016

Mea

dow

Driv

e

Dillon Reservoir

Lusher Ct

9

6Map is notto scale

1

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

12

Accessing Care Northern Colorado

In Northern Colorado we offer comprehensive health services and health care coverage to Loveland Fort Collins Greeley and surrounding areas Currently more than 27000 Northern Colorado members use Kaiser Permanente as their partner in health Take a look and yoursquoll see why Kaiser Permanente is a better choice

Integrated Care

Your employees can access care at any of our locations in Northern Colorado and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care pharmacy laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

The Power to Choose

We also offer your employees and additional choice in Northern Colorado they can visit a Kaiser Permanente medical office or see one of the 400+ network physicians from Banner Health and other community providers Our network in Northern Colorado works collaboratively with Kaiser Permanente care teams to ensure quality patient-centered care

Colorado Small Business Enrollment Guide

13

Kaiser Permanente Medical Offices

1 Fort Collins Medical Offices2950 E Harmony Road Suite 190 Fort Collins CO 80528 970-207-7171

2 Loveland Medical Offices4901 Thompson Parkway Loveland CO 80534-6426 970-207-7171

3 Greeley Medical Offices2429 35th Avenue Greeley CO 80634 970-207-7171

Emergency Care

E1 Estes Park Medical Center555 Prospect Avenue Estes Park CO 80517 970-586-2317

E2 McKee Medical Center2000 Boise Avenue Loveland CO 80538 970-669-4640

E3 North Colorado Medical Center1801 16th Street Greeley CO 80631 970-352-4121

E4 Banner Fort Collins Medical Center

4700 Lady Moon DriveFort Collins CO 80528970-229-4000

Urgent Care

U1 Banner Health Clinic ndash Skyline Urgent Care

2555 E 13th Street Suite 110 Loveland CO 80537 970-461-6140

U2 Banner Health Clinic ndash Summit View Urgent Care

2001 70th Ave Suite 110 Greeley CO 80634 970-378-4155

U3 Banner Health Clinic ndash Windsor Urgent Care

1300 Main Street Windsor CO 80550 970-686-5646

U4 The Healthcare Clinic of Fort Collins

1721 W Harmony Road 102 Fort Collins CO 80526 970-223-1999

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Southern Colorado

Estes Park25

25

25

85

85

87

8587

87

34

34

34

3434

34

287

287

287

257

402

392392

257

257

1414

60

6060

256 256

Fort Collins

GreeleyLoveland

2

E3

1

3

E2

E Harmony Rd CO Rd 74CO Rd 74

E Mulberry St

E Prospect Rd

TdR

lli H

tfa

W 29th StE Eisenhower Blvd

W 1st St esi

oBvAe

Zieg

ler R

d

ywkP

arr

etne

C

4th St

W 20th St

W 37th St

16th St

N 8th Ave

ht 9

5vAe

dr 3

2vAe

Medical offices

Hospitals for scheduled inpatient care H

U1

U4E4

U3

34

3434

60

3434

34

Moccasin Cir Dir

Prospect Ave

Highland Ln

Ponderosa Dr

Stanley

Cir Dir

St Vrain Av

Stanley Ave

MacGregor Ave

W Elkhorn Ave

Aspen Ave

Birch Ave

Driftwood Ave

U2

H E

Medical offices

Map is not to scale

34 36

High St

7

E1

25

25

25

85

85

87

8587

87

34

34

34

3434

34

287

287

287

257

402

392392

257

257

1414

60

6060

256 256

Fort Collins

GreeleyLoveland

2

E3

1

3

E2

E Harmony Rd CO Rd 74CO Rd 74

E Mulberry St

E Prospect Rd

TdR

lli H

tfa

W 29th StE Eisenhower Blvd

W 1st St esi

oBvAe

Zieg

ler R

d

ywkP

arr

etne

C

4th St

W 20th St

W 37th St

16th St

N 8th Ave

ht 9

5vAe

dr 3

2vAe

Medical offices

Hospitals for scheduled inpatient care H

U1

U4E4

U3

34

3434

60

3434

34

Moccasin Cir Dir

Prospect Ave

Highland Ln

Ponderosa Dr

Stanley

Cir Dir

St Vrain Av

Stanley Ave

MacGregor Ave

W Elkhorn Ave

Aspen Ave

Birch Ave

Driftwood Ave

U2

H E

Medical offices

Map is not to scale

34 36

High St

7

E1

Estes Park

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

14

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP CO Silver 050

Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a separate $250 prescription

drug deductible

-18

KP CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -33

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Plans Offered in Colorado

Colorado Small Business Enrollment Guide

15

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP CO Silver 050

Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a separate $250 prescription

drug deductible

-18

KP CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -33

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

16

Accessing Care in Southern Colorado

In Southern Colorado more than 61000 people turn to us as their trusted partner in total health We offer comprehensive health services and health care coverage to Colorado Springs Pueblo Cantildeon City and surrounding areas Take a look and yoursquoll see why Kaiser Permanente is a better partner in health

Integrated Care

Wersquove expanded to bring good health closer to our Southern Colorado members We opened a new Kaiser Permanente medical office in central Colorado Springs launched new affordable health insurance plans expanded specialty services at our Briargate location where patients of all ages can be seen

Your employees can access care at any of our locations in Southern Colorado and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care pharmacy laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

The Power to Choose

We also offer your employees an additional choice in Southern Colorado they can visit any Kaiser Permanente medical office in Colorado or choose from a comprehensive network of local physicians in their plan

Colorado Small Business Enrollment Guide

17

Collaborative Care

Wersquore partnering in new ways with network providers to bring best practices to your employees through innovative personalized care programs A care team thatrsquos informed and focused on your employees can lead to better health

Kaiser Permanente Care Connection is a team of local Kaiser Permanente nurses and health professionals who work with our network providers and your employees to manage their health help with care coordination preventative care wellness coaching educational resources and medication management

Pay for Value We identify nationally recognized quality metrics that align with best practices for certain preventive measures and disease states such as hypertension and diabetes Through this program wersquore seeing great results and showing improvements in quality of care for patients with chronic conditions such as Type 2 diabetes and hypertension as well as improving rates of prevention screenings (breast colorectal and cervical cancer)

Kaiser Permanente Select

An affordable high-quality health care plan for Colorado Springs and surrounding areas

Kaiser Permanente Select (KP Select) is all about keeping your employees healthy and keeping your health care costs down Employees who choose the KP Select plan will benefit from the same high-quality care from Kaiser Permanente at an affordable price while following a few guidelines Employees can receive care at any Kaiser Permanente medical office in Colorado with three located in Southern Colorado and have access to more than 400 KP Select providers in the Colorado Springs area Scheduled inpatient hospital care and outpatient care is available at select facilities and refills for maintenance medications must be filled at a Kaiser Permanente medical office pharmacy or through mail order

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

18

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Select Plans Offered in Colorado Springs

Colorado Small Business Enrollment Guide

19

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

20

Kaiser Permanente Medical Offices

1 Briargate Medical Offices 4105 Briargate Pkwy Suite 125 Colorado Springs CO 80920 719-282-2533

2 Parkside Medical Offices215 Parkside Drive Colorado Springs CO 80910 719-327-6540

3 Pueblo North Medical Offices 3670 Parker Boulevard Suite 200 Pueblo CO 81008 719-595-5755

Emergency Care

COLORADO SPRINGS

H1 Childrenrsquos Hospital at Memorial Hospital

1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H1 Memorial Hospital Central 1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H2 Memorial Hospital North 4050 Briargate Parkway Colorado Springs CO 80920 719-364-5000

H3 Penrose Hospital 2222 North Nevada Avenue Colorado Springs CO 80907 719-776-5000

H4 St Francis Medical Center 6001 East Woodmen Road Colorado Springs CO 80920 719-571-5000

PUEBLO

H5 Parkview Medical Center 400 West 16th Street Pueblo CO 81003 719-584-4000

H6 St Mary-Corwin Medical Center1008 Minnequa Avenue Pueblo CO 81004 719-557-4000

CANtildeON CITY

H7 St Thomas More Hospital 1338 Phay Avenue Cantildeon City CO 81212 719-285-2000

WOODLAND PARK

H8 Pikes Peak Regional Hospital16420 US Highway 24 Woodland Park CO 80863 719-687-9999

KP Select members have access to these hospitals for scheduled inpatient care

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Northern Colorado

Map is not to scale

50

50

50

5050

25

25

25

25

85

115

115115

9

67

96

231

96

96

47

78

45

24

85

24

24

2485

85

85

115

94

21

83

21

H7

H8

H1

H3

H4

1 H2

H5

H6

3

2

N Powers Blvd

E Woodmen Rd

E 4th St

E Platte Ave

Marksheffel Rd

Squirrel Creek Rd

Briargate Pkwy

W Northern Ave

Central Ave

State Hwy 120Co R

d 17

Doyle Rd

Co Rd 5013 M

eridian Rd

Hanover Rd

S Peyton Hwy

Falcon Hwy

Curtis Rd

Black Forest Rd

Meridian Rd

Peyton Hwy

Pueblo

Colorado Springs

Woodland Park

Cantildeon City

Colorado Small Business Enrollment Guide

21

Medicare Coverage

Kaiser Permanente offers group and individual Medicare Advantage and Prescription Drug Plans

For information on our individual plans contact a licensed sales specialist toll free at 1-855-843-8396 (TTY 711) seven days a week 8 a m to 8 p m or visit kporgmedicare

Adult and Pediatric Dental Care

Kaiser Permanente and Delta Dental of Colorado know good oral health is an important component of overall health so wersquove partnered to provide small group employers pediatric dental benefits and adult-only dental plans to complement Kaiser Permanentersquos medical plans

NEW 2016 Embedded Pediatric Dental Benefit

Separate Annual Deductible (applies to all services)

$50

Diagnostic amp Preventive Services

Oral Exams amp Cleanings (Limited to 2 per calendar year)

Covered 100 after Deductible

Fluoride Treatments (Limited to 2 per calendar year)

Covered 100 after Deductible

Sealants (1 per lifetime per tooth per year) Covered 100 after Deductible

Bitewing X-rays (1 set per calendar year) Covered 100 after Deductible

Basic Services (limited to 2 basic procedures per year)

Fillings Oral Surgery Endodontics Covered 50 after Deductible

Major Services (limited to 1 major procedure per year)

Crowns Covered 50 after Deductible

Embedded Pediatric

Employeersquos children (up through the month they turn 19) can receive any of the procedures listed below each calendar year

Adult Dental

Our adult-only plans complement the embedded pediatric dental coverage and are not tied to medical The lowest-cost plan starts at $13month These plans also offer

bull No waiting period

bull Dual option choices

bull $2000 benefit maximum on the high plan

For more information email Delta Dental directly at salesteamddpcocom Monday-Friday 8 am-5 pm

Important The pediatric dental benefit is embedded in all Small Group plans EXCEPT the KP CO Silver PPO 150040 plan The KP CO Silver PPO 1500-40 plan does not include pediatric dental coverage

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

22

2016 Resources Kaiser Permanente is committed to supporting you and your business Below yoursquoll find important contact information and business resources to save you time

Calling the right person should beEASY

Our goal is to have one-call resolution whenever possible Communicating with the right department is the first step With that in mind wersquove set up ONE Number Easy 303-306-2727 (866-710-2727)

If your question is about You need to talk to

Group Billing and Invoicing Account ReconciliationAdds Drops Cancels or Changes

Consolidated Service CenterOption 1

SG Contracts Brochures Forms New Employee Packets Group Cancellation

Small Group Sales amp ServiceOption 2

Benefits Eligibility Service Resolution Escalated Issues Employee-level Claims

Client Services Unit (CSU)Option 4

Customer Experience Department

Wersquore here to help you transition to Kaiser Permanente Our Customer Experience Team will visit your employees on-site and help them

bull Understand new plans amp benefits

bull Find amp choose physicians

bull Connect to the care they need

bull Transition prescriptions

To reach our Customer Experience team email welcomekporg or call 303-338-3990

Customer Account Services

An easy-to-use web site link that provides online account management for you and your broker You can view group eligibility and billing information update employee data or pay your invoices

If you would like to set up an account please contact your Account Executive or Associate Account Manager for assistance

Colorado Small Business Enrollment Guide

23

2016 Reference

1 Employer Health Benefits 2011 Annual Survey Kaiser Family Foundation and Health Research amp Educational Trust September 2011 Kaiser Family Foundation is a nonprofit private organization not affiliated with Kaiser Permanente

2 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

3 Kaiser Foundation Health Plan of Colorado Inc received the highest numerical score among commercial health plans in the Colorado region in the proprietary JD Power 2008-2015 US Member Health Plan Studiessm Study based on 31543 total member responses measuring four plans in Colorado (excludes Medicare and Medicaid) Proprietary study results are based on experiences and perceptions of members surveyed November-December 2014 Your experiences may vary Visit jdpowercom

4 Please refer to ldquoNCQArsquos Private Health Insurance Plan Rankings 2013-2014rdquo posted online at wwwncqaorg

5 Kaiser Permanente 2012 HEDISreg scores Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compassreg and represent all non- PPO lines of business Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA Quality Compass 2012 includes certain CAHPSreg data Any data display analysis interpretation or conclusion based on these data is solely that of the authors and NCQA specifically disclaims responsibility for any such display analysis interpretation or conclusion Quality Compassreg and HEDISreg are registered trademarks of NCQA CAHPSreg is a registered trademark of the Agency for Healthcare Research and Quality

6 The 2014 Hewitt Health Value InitiativeTM showed Kaiser Permanente is the most cost-efficient plan across all markets served for the sixth year in a rowmdash12 more cost-effective than the average HMO and 17 more cost-effective than the all-plan average Kaiser Permanente also outperformed other plans in clinical quality scoring 49 better than the average HMO and 209 better than the all-plan average Hewitt Health Value InitiativeTM benchmarking study mdash Kaiser Foundation Health Plan Inc Aon Hewitt April 3 2014 To get a copy of the Hewitt Health Value Initiative report for your region contact your account manager

7 Chronic Care Making the Case for Ongoing Care Robert Wood Johnson Foundation 2010

8 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

9 ldquoWorksite Wellnessrdquo Preventdiseasecom httppreventdiseasecomworksite_wellnessworksite_wellnesshtml accessed November 2 2009

10 See Note 9 11 ldquoObesity by the Numbersrdquo obesityinamericaorg accessed March 24 200812 See Note 313 Thomas Delate PhD et al ldquoReduced Health Care Expenditures After Enrollment

in a Collaborative Cardiac Care Servicerdquo Pharmacotherapy November 2010 Results from our cardiac rehabilitation program in Colorado

Kaiser Foundation Health Plan Inc of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Coloradoreg marketplace copy2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questionsCall us at 1-866-331-2091 bull Or contact your agent or broker

• WHATrsquoS INSIDE
• A BETTER WAY to manage costs
• A BETTER WAY to keep youremployees healthier
• Virtual Care Innovations
• Employee Health amp Wellness
• Enhancing the Employee Experience
• Accessing Care in DenverBoulder
• Accessing Care in Mountain Communities
• Accessing Care Northern Colorado
• KP Plans Offered in Colorado
• Accessing Care in Southern Colorado
• KP Select Plans Offered in Colorado Springs
• Medicare Coverage
• Adult and Pediatric Dental Care
• 2016 Resources

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

Accessing Care in DenverBoulder Employees have a choice of more than 1000 primary care physicians and specialists at any Kaiser Permanente medical office in Colorado With many locations to choose from and most offering multiple services under one roof they can see their doctor get a lab test or an X-ray and pick up medications mdash all without leaving the building

Integrated Care In our integrated model care teams are united for a single purposemdashbetter health Your employees receive better care thatrsquos more efficientmdashwhich means healthier outcomes for them and lower costs for you Look at the advantages built into our care approach within our Kaiser Permanente medical offices

Fewer office visitsmdashemployees save time and money by getting primary care specialty care lab pharmacy and many other services at a Kaiser Permanente medical office

Fewer sick daysmdashour team approach puts your employees at the center and helps them proactively manage their care so theyrsquore healthier at work and more productive

Satisfied workersmdashconsumers say we outperform all other health insurers in delivering high-quality customer service and making it easy to access care 12

Dependable access to great doctorsmdashevery one of our physicians goes through a rigorous selection process before we allow them to care for your employees In Colorado that means we only hire 11 of the physicians who apply

Built-in health advice and programsmdashdisease management programs health education and nurse advice are part of your plan so employees get consistent health information from one source

Ensuring consistent caremdashour doctors have created one of the worldrsquos largest most inclusive electronic medical libraries available only to our caregivers

Healthier employeesmdashprimary care physicians and specialists can view each otherrsquos treatment notes in real time via an employeersquos electronic medical record This allows for a thorough and accurate exchange of information which can help keep your employees healthier

SAVING LIVES AND DOLL ARS

89 Reduction in heart attack deaths in Colorado avoiding related medical costs and productivity losses13

8

Colorado Small Business Enrollment Guide

9

Kaiser Permanente Medical Offices

To make an appointment at any medical office call 303-338-4545 (TTY 711) weekdays 7 am to 6 pm

1 Arapahoe Medical Offices 5555 E Arapahoe Rd Centennial CO 80122

2 Aurora Centrepoint Medical Offices

14701 E Exposition Ave Aurora CO 80012

3 Baseline Medical Offices 580 Mohawk Dr Boulder CO 80303

4 Brighton Medical Offices 859 S 4th Ave Brighton CO 80601

5 Castle Rock Medical Offices 4318 Trail Boss Dr Castle Rock CO 80104

6 East Denver Medical Offices 10400 E Alameda Ave Denver CO 80247

7 Englewood Medical Offices 2955 S Broadway Englewood CO 80113

8 Evergreen Medical Offices 2942 Evergreen Pkwy Evergreen CO 80439

9 Franklin Medical Offices 2045 Franklin St Denver CO 80205

10 Hidden Lake Medical Offices 7701 Sheridan Blvd Arvada CO 80003

11 Highlands Ranch Medical Offices 9285 Hepburn St Highlands Ranch CO 80129

12 Ken Caryl Medical Offices 7600 Shaffer Pkwy Littleton CO 80127

13 Lakewood Medical Offices 8383 W Alameda Ave Lakewood CO 80226

Hospitals for scheduledinpatient care emergency care hospitalsdepartments and urgent care facilities

H E U

Behavioral Health offices (mental health chemical dependency and eating disorders)

25

25

25

270

7

7

74

52

119

119

287

85

85

85

285

76

85

36

7

13

12

11 14

22

5

20

8

1

2

H1

H2

H3

19

10

21

174

3

15

16

918

6

E4

E3

E5E2

E1

B3

B1

B2

Ken Caryl Ave

Hampden

Evergreen Pkwy

Evergreen

Boulder

Castle Rock

Longmont

C 470 E 470E 470

E 470

C 470 C 470

County Line Rd

Quincy Ave

Arapahoe Rd

Belleview Ave

Alameda Ave6th Ave

Colfax Ave

Founders Pkwy

TrD

sso

B lia

r

E Inspiration Dr

88th Ave

56th Ave

Evans Ave

64th Ave58th Ave

104th Ave

Colorado Blvd

Sable BlvdS 4th

Washington St

Pecos StHuron St

Indiana St

N 95th St

Garrison St

Sheridan

University Blvd

Chambers Rd

Airport Rd

Sable

Colorado Blvd

Wadsworth

Simm

s St

Federal Blvd S Broadway

Holly St

Pentildea BlvdPeoria St

T ower Rd

County Hwy 25112th Ave120th Ave

E 160th Ave

E 152nd AveE Bromley LnNorthwest Pkwy

E 470

S Boulder RdBaseline RdArapahoe Rd

Nelson Rd

Valmont Rd

72nd Ave

80th Ave

Mississippi Ave

Parker RdN Jordon Rd

NiP

rD

en

Smoky Hill Rd

E Main St

Lincoln Ave

287

42

Autumn Ridge Blvd

Exempla Cir

Maple Rd

Empire Rd

Campus DrS Pointe Dr

36to

17H2

P

PP

P

Humboldt St

Franklin St

Gilpin St

William

s Stg

Lafayette St

Marion St

Downing St

Ogden St

Emerson St

Clarkson St

Washington St

Pearl St

Pennsylvania S

Logan St

Park Ave

24th St

22nd St 20th Ave20th Ave

22nd Ave

23rd Ave

24th Ave

19th Ave

18th Ave

21st AveP

PConstruction

P

9

H3 U2E1

18

Medical offices Pharmacy

Medical Imaging

Audiologyhearing

Opticaloptometry

Laboratory

U1

U2

U3

H4

Map is not to scale

Medical offices Hospitals for scheduledinpatient care emergency care hospitalsdepartments and Urgent Care facilities

Behavioral Health offices (mental health chemical dependency and eating disorders)

H E U

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

10

14 Lone Tree Medical Offices 10240 Park Meadows DrLone Tree CO 80124

15 Longmont Medical Offices 2345 Bent Way Longmont CO 80503

16 Parker Medical Offices 10168 Parkglenn Way Parker CO 80138

17 Rock Creek Medical Offices 280 Exempla Cir Lafayette CO 80026

18 Skyline Medical Offices 1375 E 20th Ave Denver CO 80205

19 Smoky Hill Medical Offices 16290 E Quincy Ave Aurora CO 80015

20 Southwest Medical Offices 5257 S Wadsworth Blvd Littleton CO 80123

21 Westminster Medical Offices 11245 Huron St Westminster CO 80234

22 Wheat Ridge Medical Offices 4803 Ward Rd Wheat Ridge CO 80033

After-Hours Care

Hours and locations for after-hours care are subject to change Please call 303-338-4545 (TTY 711) at the time of need to confirm current hours and locations

1 Arapahoe Medical Offices 6 pmndash10 pm Mon - Fri 8 amndash9 pm Sat 9 amndash9 pm Sun

6 East Denver Medical Offices 8 amndash4 pm Sat 9 amndash4 pm Sun

13 Lakewood Medical Offices 8 amndash4 pm Sat 9 amndash4 pm Sun

21 Westminster Medical Offices 8 amndash4 pm Sat 9 amndash4 pm Sun

Pediatric Urgent Care

U1 Childrenrsquos Hospital Colorado Urgent Care North Campus Broomfield

469 West Highway 7 Broomfield CO 80023

U2 Childrenrsquos Hospital Colorado Urgent Care Uptown Denver

1835 Franklin Street Denver CO 80218

U3 Childrenrsquos Hospital Colorado Urgent Care Wheat Ridge

3455 Lutheran Parkway Suite 230 Wheat Ridge CO 80033

Emergency Care

If you have an emergency medical condition call 911 or go to the nearest hospital Or if time and safety permit you can go to the Emergency Department at one of the following hospitals

H3 Saint Joseph Hospital1375 East 19th Avenue Denver CO 80218

H2 Good Samaritan Medical Center

200 Exempla Circle Lafayette CO 80026

H3 Senior ER at Saint Joseph Hospital

1375 East 19th Avenue Denver CO 80218

H1 Childrenrsquos Hospital Colorado on Anschutz Medical Campus

13123 E 16th Ave Aurora CO 80045

H4 Childrenrsquos Hospital Colorado North Campus Broomfield

469 West Highway 7 Broomfield CO 80023

E1 Childrenrsquos Hospital Colorado at Saint Joseph Hospital

1835 Franklin St Denver CO 80218

H3 Rocky Mountain Hospital for Children

1719 E 19th Ave Denver CO 80218

E3 HealthONE Sky Ridge Medical Center

10101 Ridgegate Pkwy Lone Tree CO 80124

E4 HealthONE Swedish Medical Center

501 E Hampden Ave Englewood CO 80110

E5 HealthONE Swedish Southwest ER

6196 S Ammons Way Littleton CO 80123

E2 HealthONE Centennial Medical Plaza

14200 E Arapahoe Rd Centennial CO 80112

Behavioral Health Offices

For appointments call 303-471-7700 B1 Hidden Lake

Behavioral Health 7701 Sheridan Blvd Arvada CO 80003

B2 Highline Behavioral Health 10350 E Dakota Ave Denver CO 80247 Entrance located on East side of building

B3 Ridgeline Behavioral Health Center

9139 S Ridgeline Blvd Highlands Ranch CO 80129

Additional locations and access

In addition to the locations shown on this map you have access to all Kaiser Permanente medical offices in Northern and Southern Colorado

Colorado Small Business Enrollment Guide

11

Accessing Care in Mountain CommunitiesAt Kaiser Permanente we believe therersquos no better choice than choosing good health Thatrsquos why wersquore expanding our mission to provide high-quality affordable health care services into Mountain communities for the first time opening our Frisco medical office in Summit County in early 2016 and a second location in Eagle County

Integrated Care

Your employees can access care at our locations in the mountains and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

Kaiser Permanente Medical Offices

1 Kaiser Permanente Frisco Medical Offices

226 Lusher Court Frisco CO 80443

2 Eagle County location opening in 2016

Mea

dow

Driv

e

Dillon Reservoir

Lusher Ct

9

6Map is notto scale

1

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

12

Accessing Care Northern Colorado

In Northern Colorado we offer comprehensive health services and health care coverage to Loveland Fort Collins Greeley and surrounding areas Currently more than 27000 Northern Colorado members use Kaiser Permanente as their partner in health Take a look and yoursquoll see why Kaiser Permanente is a better choice

Integrated Care

Your employees can access care at any of our locations in Northern Colorado and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care pharmacy laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

The Power to Choose

We also offer your employees and additional choice in Northern Colorado they can visit a Kaiser Permanente medical office or see one of the 400+ network physicians from Banner Health and other community providers Our network in Northern Colorado works collaboratively with Kaiser Permanente care teams to ensure quality patient-centered care

Colorado Small Business Enrollment Guide

13

Kaiser Permanente Medical Offices

1 Fort Collins Medical Offices2950 E Harmony Road Suite 190 Fort Collins CO 80528 970-207-7171

2 Loveland Medical Offices4901 Thompson Parkway Loveland CO 80534-6426 970-207-7171

3 Greeley Medical Offices2429 35th Avenue Greeley CO 80634 970-207-7171

Emergency Care

E1 Estes Park Medical Center555 Prospect Avenue Estes Park CO 80517 970-586-2317

E2 McKee Medical Center2000 Boise Avenue Loveland CO 80538 970-669-4640

E3 North Colorado Medical Center1801 16th Street Greeley CO 80631 970-352-4121

E4 Banner Fort Collins Medical Center

4700 Lady Moon DriveFort Collins CO 80528970-229-4000

Urgent Care

U1 Banner Health Clinic ndash Skyline Urgent Care

2555 E 13th Street Suite 110 Loveland CO 80537 970-461-6140

U2 Banner Health Clinic ndash Summit View Urgent Care

2001 70th Ave Suite 110 Greeley CO 80634 970-378-4155

U3 Banner Health Clinic ndash Windsor Urgent Care

1300 Main Street Windsor CO 80550 970-686-5646

U4 The Healthcare Clinic of Fort Collins

1721 W Harmony Road 102 Fort Collins CO 80526 970-223-1999

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Southern Colorado

Estes Park25

25

25

85

85

87

8587

87

34

34

34

3434

34

287

287

287

257

402

392392

257

257

1414

60

6060

256 256

Fort Collins

GreeleyLoveland

2

E3

1

3

E2

E Harmony Rd CO Rd 74CO Rd 74

E Mulberry St

E Prospect Rd

TdR

lli H

tfa

W 29th StE Eisenhower Blvd

W 1st St esi

oBvAe

Zieg

ler R

d

ywkP

arr

etne

C

4th St

W 20th St

W 37th St

16th St

N 8th Ave

ht 9

5vAe

dr 3

2vAe

Medical offices

Hospitals for scheduled inpatient care H

U1

U4E4

U3

34

3434

60

3434

34

Moccasin Cir Dir

Prospect Ave

Highland Ln

Ponderosa Dr

Stanley

Cir Dir

St Vrain Av

Stanley Ave

MacGregor Ave

W Elkhorn Ave

Aspen Ave

Birch Ave

Driftwood Ave

U2

H E

Medical offices

Map is not to scale

34 36

High St

7

E1

25

25

25

85

85

87

8587

87

34

34

34

3434

34

287

287

287

257

402

392392

257

257

1414

60

6060

256 256

Fort Collins

GreeleyLoveland

2

E3

1

3

E2

E Harmony Rd CO Rd 74CO Rd 74

E Mulberry St

E Prospect Rd

TdR

lli H

tfa

W 29th StE Eisenhower Blvd

W 1st St esi

oBvAe

Zieg

ler R

d

ywkP

arr

etne

C

4th St

W 20th St

W 37th St

16th St

N 8th Ave

ht 9

5vAe

dr 3

2vAe

Medical offices

Hospitals for scheduled inpatient care H

U1

U4E4

U3

34

3434

60

3434

34

Moccasin Cir Dir

Prospect Ave

Highland Ln

Ponderosa Dr

Stanley

Cir Dir

St Vrain Av

Stanley Ave

MacGregor Ave

W Elkhorn Ave

Aspen Ave

Birch Ave

Driftwood Ave

U2

H E

Medical offices

Map is not to scale

34 36

High St

7

E1

Estes Park

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

14

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP CO Silver 050

Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a separate $250 prescription

drug deductible

-18

KP CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -33

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Plans Offered in Colorado

Colorado Small Business Enrollment Guide

15

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP CO Silver 050

Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a separate $250 prescription

drug deductible

-18

KP CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -33

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

16

Accessing Care in Southern Colorado

In Southern Colorado more than 61000 people turn to us as their trusted partner in total health We offer comprehensive health services and health care coverage to Colorado Springs Pueblo Cantildeon City and surrounding areas Take a look and yoursquoll see why Kaiser Permanente is a better partner in health

Integrated Care

Wersquove expanded to bring good health closer to our Southern Colorado members We opened a new Kaiser Permanente medical office in central Colorado Springs launched new affordable health insurance plans expanded specialty services at our Briargate location where patients of all ages can be seen

Your employees can access care at any of our locations in Southern Colorado and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care pharmacy laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

The Power to Choose

We also offer your employees an additional choice in Southern Colorado they can visit any Kaiser Permanente medical office in Colorado or choose from a comprehensive network of local physicians in their plan

Colorado Small Business Enrollment Guide

17

Collaborative Care

Wersquore partnering in new ways with network providers to bring best practices to your employees through innovative personalized care programs A care team thatrsquos informed and focused on your employees can lead to better health

Kaiser Permanente Care Connection is a team of local Kaiser Permanente nurses and health professionals who work with our network providers and your employees to manage their health help with care coordination preventative care wellness coaching educational resources and medication management

Pay for Value We identify nationally recognized quality metrics that align with best practices for certain preventive measures and disease states such as hypertension and diabetes Through this program wersquore seeing great results and showing improvements in quality of care for patients with chronic conditions such as Type 2 diabetes and hypertension as well as improving rates of prevention screenings (breast colorectal and cervical cancer)

Kaiser Permanente Select

An affordable high-quality health care plan for Colorado Springs and surrounding areas

Kaiser Permanente Select (KP Select) is all about keeping your employees healthy and keeping your health care costs down Employees who choose the KP Select plan will benefit from the same high-quality care from Kaiser Permanente at an affordable price while following a few guidelines Employees can receive care at any Kaiser Permanente medical office in Colorado with three located in Southern Colorado and have access to more than 400 KP Select providers in the Colorado Springs area Scheduled inpatient hospital care and outpatient care is available at select facilities and refills for maintenance medications must be filled at a Kaiser Permanente medical office pharmacy or through mail order

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

18

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Select Plans Offered in Colorado Springs

Colorado Small Business Enrollment Guide

19

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

20

Kaiser Permanente Medical Offices

1 Briargate Medical Offices 4105 Briargate Pkwy Suite 125 Colorado Springs CO 80920 719-282-2533

2 Parkside Medical Offices215 Parkside Drive Colorado Springs CO 80910 719-327-6540

3 Pueblo North Medical Offices 3670 Parker Boulevard Suite 200 Pueblo CO 81008 719-595-5755

Emergency Care

COLORADO SPRINGS

H1 Childrenrsquos Hospital at Memorial Hospital

1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H1 Memorial Hospital Central 1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H2 Memorial Hospital North 4050 Briargate Parkway Colorado Springs CO 80920 719-364-5000

H3 Penrose Hospital 2222 North Nevada Avenue Colorado Springs CO 80907 719-776-5000

H4 St Francis Medical Center 6001 East Woodmen Road Colorado Springs CO 80920 719-571-5000

PUEBLO

H5 Parkview Medical Center 400 West 16th Street Pueblo CO 81003 719-584-4000

H6 St Mary-Corwin Medical Center1008 Minnequa Avenue Pueblo CO 81004 719-557-4000

CANtildeON CITY

H7 St Thomas More Hospital 1338 Phay Avenue Cantildeon City CO 81212 719-285-2000

WOODLAND PARK

H8 Pikes Peak Regional Hospital16420 US Highway 24 Woodland Park CO 80863 719-687-9999

KP Select members have access to these hospitals for scheduled inpatient care

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Northern Colorado

Map is not to scale

50

50

50

5050

25

25

25

25

85

115

115115

9

67

96

231

96

96

47

78

45

24

85

24

24

2485

85

85

115

94

21

83

21

H7

H8

H1

H3

H4

1 H2

H5

H6

3

2

N Powers Blvd

E Woodmen Rd

E 4th St

E Platte Ave

Marksheffel Rd

Squirrel Creek Rd

Briargate Pkwy

W Northern Ave

Central Ave

State Hwy 120Co R

d 17

Doyle Rd

Co Rd 5013 M

eridian Rd

Hanover Rd

S Peyton Hwy

Falcon Hwy

Curtis Rd

Black Forest Rd

Meridian Rd

Peyton Hwy

Pueblo

Colorado Springs

Woodland Park

Cantildeon City

Colorado Small Business Enrollment Guide

21

Medicare Coverage

Kaiser Permanente offers group and individual Medicare Advantage and Prescription Drug Plans

For information on our individual plans contact a licensed sales specialist toll free at 1-855-843-8396 (TTY 711) seven days a week 8 a m to 8 p m or visit kporgmedicare

Adult and Pediatric Dental Care

Kaiser Permanente and Delta Dental of Colorado know good oral health is an important component of overall health so wersquove partnered to provide small group employers pediatric dental benefits and adult-only dental plans to complement Kaiser Permanentersquos medical plans

NEW 2016 Embedded Pediatric Dental Benefit

Separate Annual Deductible (applies to all services)

$50

Diagnostic amp Preventive Services

Oral Exams amp Cleanings (Limited to 2 per calendar year)

Covered 100 after Deductible

Fluoride Treatments (Limited to 2 per calendar year)

Covered 100 after Deductible

Sealants (1 per lifetime per tooth per year) Covered 100 after Deductible

Bitewing X-rays (1 set per calendar year) Covered 100 after Deductible

Basic Services (limited to 2 basic procedures per year)

Fillings Oral Surgery Endodontics Covered 50 after Deductible

Major Services (limited to 1 major procedure per year)

Crowns Covered 50 after Deductible

Embedded Pediatric

Employeersquos children (up through the month they turn 19) can receive any of the procedures listed below each calendar year

Adult Dental

Our adult-only plans complement the embedded pediatric dental coverage and are not tied to medical The lowest-cost plan starts at $13month These plans also offer

bull No waiting period

bull Dual option choices

bull $2000 benefit maximum on the high plan

For more information email Delta Dental directly at salesteamddpcocom Monday-Friday 8 am-5 pm

Important The pediatric dental benefit is embedded in all Small Group plans EXCEPT the KP CO Silver PPO 150040 plan The KP CO Silver PPO 1500-40 plan does not include pediatric dental coverage

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

22

2016 Resources Kaiser Permanente is committed to supporting you and your business Below yoursquoll find important contact information and business resources to save you time

Calling the right person should beEASY

Our goal is to have one-call resolution whenever possible Communicating with the right department is the first step With that in mind wersquove set up ONE Number Easy 303-306-2727 (866-710-2727)

If your question is about You need to talk to

Group Billing and Invoicing Account ReconciliationAdds Drops Cancels or Changes

Consolidated Service CenterOption 1

SG Contracts Brochures Forms New Employee Packets Group Cancellation

Small Group Sales amp ServiceOption 2

Benefits Eligibility Service Resolution Escalated Issues Employee-level Claims

Client Services Unit (CSU)Option 4

Customer Experience Department

Wersquore here to help you transition to Kaiser Permanente Our Customer Experience Team will visit your employees on-site and help them

bull Understand new plans amp benefits

bull Find amp choose physicians

bull Connect to the care they need

bull Transition prescriptions

To reach our Customer Experience team email welcomekporg or call 303-338-3990

Customer Account Services

An easy-to-use web site link that provides online account management for you and your broker You can view group eligibility and billing information update employee data or pay your invoices

If you would like to set up an account please contact your Account Executive or Associate Account Manager for assistance

Colorado Small Business Enrollment Guide

23

2016 Reference

1 Employer Health Benefits 2011 Annual Survey Kaiser Family Foundation and Health Research amp Educational Trust September 2011 Kaiser Family Foundation is a nonprofit private organization not affiliated with Kaiser Permanente

2 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

3 Kaiser Foundation Health Plan of Colorado Inc received the highest numerical score among commercial health plans in the Colorado region in the proprietary JD Power 2008-2015 US Member Health Plan Studiessm Study based on 31543 total member responses measuring four plans in Colorado (excludes Medicare and Medicaid) Proprietary study results are based on experiences and perceptions of members surveyed November-December 2014 Your experiences may vary Visit jdpowercom

4 Please refer to ldquoNCQArsquos Private Health Insurance Plan Rankings 2013-2014rdquo posted online at wwwncqaorg

5 Kaiser Permanente 2012 HEDISreg scores Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compassreg and represent all non- PPO lines of business Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA Quality Compass 2012 includes certain CAHPSreg data Any data display analysis interpretation or conclusion based on these data is solely that of the authors and NCQA specifically disclaims responsibility for any such display analysis interpretation or conclusion Quality Compassreg and HEDISreg are registered trademarks of NCQA CAHPSreg is a registered trademark of the Agency for Healthcare Research and Quality

6 The 2014 Hewitt Health Value InitiativeTM showed Kaiser Permanente is the most cost-efficient plan across all markets served for the sixth year in a rowmdash12 more cost-effective than the average HMO and 17 more cost-effective than the all-plan average Kaiser Permanente also outperformed other plans in clinical quality scoring 49 better than the average HMO and 209 better than the all-plan average Hewitt Health Value InitiativeTM benchmarking study mdash Kaiser Foundation Health Plan Inc Aon Hewitt April 3 2014 To get a copy of the Hewitt Health Value Initiative report for your region contact your account manager

7 Chronic Care Making the Case for Ongoing Care Robert Wood Johnson Foundation 2010

8 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

9 ldquoWorksite Wellnessrdquo Preventdiseasecom httppreventdiseasecomworksite_wellnessworksite_wellnesshtml accessed November 2 2009

10 See Note 9 11 ldquoObesity by the Numbersrdquo obesityinamericaorg accessed March 24 200812 See Note 313 Thomas Delate PhD et al ldquoReduced Health Care Expenditures After Enrollment

in a Collaborative Cardiac Care Servicerdquo Pharmacotherapy November 2010 Results from our cardiac rehabilitation program in Colorado

Kaiser Foundation Health Plan Inc of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Coloradoreg marketplace copy2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questionsCall us at 1-866-331-2091 bull Or contact your agent or broker

• WHATrsquoS INSIDE
• A BETTER WAY to manage costs
• A BETTER WAY to keep youremployees healthier
• Virtual Care Innovations
• Employee Health amp Wellness
• Enhancing the Employee Experience
• Accessing Care in DenverBoulder
• Accessing Care in Mountain Communities
• Accessing Care Northern Colorado
• KP Plans Offered in Colorado
• Accessing Care in Southern Colorado
• KP Select Plans Offered in Colorado Springs
• Medicare Coverage
• Adult and Pediatric Dental Care
• 2016 Resources

Colorado Small Business Enrollment Guide

9

Kaiser Permanente Medical Offices

To make an appointment at any medical office call 303-338-4545 (TTY 711) weekdays 7 am to 6 pm

1 Arapahoe Medical Offices 5555 E Arapahoe Rd Centennial CO 80122

2 Aurora Centrepoint Medical Offices

14701 E Exposition Ave Aurora CO 80012

3 Baseline Medical Offices 580 Mohawk Dr Boulder CO 80303

4 Brighton Medical Offices 859 S 4th Ave Brighton CO 80601

5 Castle Rock Medical Offices 4318 Trail Boss Dr Castle Rock CO 80104

6 East Denver Medical Offices 10400 E Alameda Ave Denver CO 80247

7 Englewood Medical Offices 2955 S Broadway Englewood CO 80113

8 Evergreen Medical Offices 2942 Evergreen Pkwy Evergreen CO 80439

9 Franklin Medical Offices 2045 Franklin St Denver CO 80205

10 Hidden Lake Medical Offices 7701 Sheridan Blvd Arvada CO 80003

11 Highlands Ranch Medical Offices 9285 Hepburn St Highlands Ranch CO 80129

12 Ken Caryl Medical Offices 7600 Shaffer Pkwy Littleton CO 80127

13 Lakewood Medical Offices 8383 W Alameda Ave Lakewood CO 80226

Hospitals for scheduledinpatient care emergency care hospitalsdepartments and urgent care facilities

H E U

Behavioral Health offices (mental health chemical dependency and eating disorders)

25

25

25

270

7

7

74

52

119

119

287

85

85

85

285

76

85

36

7

13

12

11 14

22

5

20

8

1

2

H1

H2

H3

19

10

21

174

3

15

16

918

6

E4

E3

E5E2

E1

B3

B1

B2

Ken Caryl Ave

Hampden

Evergreen Pkwy

Evergreen

Boulder

Castle Rock

Longmont

C 470 E 470E 470

E 470

C 470 C 470

County Line Rd

Quincy Ave

Arapahoe Rd

Belleview Ave

Alameda Ave6th Ave

Colfax Ave

Founders Pkwy

TrD

sso

B lia

r

E Inspiration Dr

88th Ave

56th Ave

Evans Ave

64th Ave58th Ave

104th Ave

Colorado Blvd

Sable BlvdS 4th

Washington St

Pecos StHuron St

Indiana St

N 95th St

Garrison St

Sheridan

University Blvd

Chambers Rd

Airport Rd

Sable

Colorado Blvd

Wadsworth

Simm

s St

Federal Blvd S Broadway

Holly St

Pentildea BlvdPeoria St

T ower Rd

County Hwy 25112th Ave120th Ave

E 160th Ave

E 152nd AveE Bromley LnNorthwest Pkwy

E 470

S Boulder RdBaseline RdArapahoe Rd

Nelson Rd

Valmont Rd

72nd Ave

80th Ave

Mississippi Ave

Parker RdN Jordon Rd

NiP

rD

en

Smoky Hill Rd

E Main St

Lincoln Ave

287

42

Autumn Ridge Blvd

Exempla Cir

Maple Rd

Empire Rd

Campus DrS Pointe Dr

36to

17H2

P

PP

P

Humboldt St

Franklin St

Gilpin St

William

s Stg

Lafayette St

Marion St

Downing St

Ogden St

Emerson St

Clarkson St

Washington St

Pearl St

Pennsylvania S

Logan St

Park Ave

24th St

22nd St 20th Ave20th Ave

22nd Ave

23rd Ave

24th Ave

19th Ave

18th Ave

21st AveP

PConstruction

P

9

H3 U2E1

18

Medical offices Pharmacy

Medical Imaging

Audiologyhearing

Opticaloptometry

Laboratory

U1

U2

U3

H4

Map is not to scale

Medical offices Hospitals for scheduledinpatient care emergency care hospitalsdepartments and Urgent Care facilities

Behavioral Health offices (mental health chemical dependency and eating disorders)

H E U

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

10

14 Lone Tree Medical Offices 10240 Park Meadows DrLone Tree CO 80124

15 Longmont Medical Offices 2345 Bent Way Longmont CO 80503

16 Parker Medical Offices 10168 Parkglenn Way Parker CO 80138

17 Rock Creek Medical Offices 280 Exempla Cir Lafayette CO 80026

18 Skyline Medical Offices 1375 E 20th Ave Denver CO 80205

19 Smoky Hill Medical Offices 16290 E Quincy Ave Aurora CO 80015

20 Southwest Medical Offices 5257 S Wadsworth Blvd Littleton CO 80123

21 Westminster Medical Offices 11245 Huron St Westminster CO 80234

22 Wheat Ridge Medical Offices 4803 Ward Rd Wheat Ridge CO 80033

After-Hours Care

Hours and locations for after-hours care are subject to change Please call 303-338-4545 (TTY 711) at the time of need to confirm current hours and locations

1 Arapahoe Medical Offices 6 pmndash10 pm Mon - Fri 8 amndash9 pm Sat 9 amndash9 pm Sun

6 East Denver Medical Offices 8 amndash4 pm Sat 9 amndash4 pm Sun

13 Lakewood Medical Offices 8 amndash4 pm Sat 9 amndash4 pm Sun

21 Westminster Medical Offices 8 amndash4 pm Sat 9 amndash4 pm Sun

Pediatric Urgent Care

U1 Childrenrsquos Hospital Colorado Urgent Care North Campus Broomfield

469 West Highway 7 Broomfield CO 80023

U2 Childrenrsquos Hospital Colorado Urgent Care Uptown Denver

1835 Franklin Street Denver CO 80218

U3 Childrenrsquos Hospital Colorado Urgent Care Wheat Ridge

3455 Lutheran Parkway Suite 230 Wheat Ridge CO 80033

Emergency Care

If you have an emergency medical condition call 911 or go to the nearest hospital Or if time and safety permit you can go to the Emergency Department at one of the following hospitals

H3 Saint Joseph Hospital1375 East 19th Avenue Denver CO 80218

H2 Good Samaritan Medical Center

200 Exempla Circle Lafayette CO 80026

H3 Senior ER at Saint Joseph Hospital

1375 East 19th Avenue Denver CO 80218

H1 Childrenrsquos Hospital Colorado on Anschutz Medical Campus

13123 E 16th Ave Aurora CO 80045

H4 Childrenrsquos Hospital Colorado North Campus Broomfield

469 West Highway 7 Broomfield CO 80023

E1 Childrenrsquos Hospital Colorado at Saint Joseph Hospital

1835 Franklin St Denver CO 80218

H3 Rocky Mountain Hospital for Children

1719 E 19th Ave Denver CO 80218

E3 HealthONE Sky Ridge Medical Center

10101 Ridgegate Pkwy Lone Tree CO 80124

E4 HealthONE Swedish Medical Center

501 E Hampden Ave Englewood CO 80110

E5 HealthONE Swedish Southwest ER

6196 S Ammons Way Littleton CO 80123

E2 HealthONE Centennial Medical Plaza

14200 E Arapahoe Rd Centennial CO 80112

Behavioral Health Offices

For appointments call 303-471-7700 B1 Hidden Lake

Behavioral Health 7701 Sheridan Blvd Arvada CO 80003

B2 Highline Behavioral Health 10350 E Dakota Ave Denver CO 80247 Entrance located on East side of building

B3 Ridgeline Behavioral Health Center

9139 S Ridgeline Blvd Highlands Ranch CO 80129

Additional locations and access

In addition to the locations shown on this map you have access to all Kaiser Permanente medical offices in Northern and Southern Colorado

Colorado Small Business Enrollment Guide

11

Accessing Care in Mountain CommunitiesAt Kaiser Permanente we believe therersquos no better choice than choosing good health Thatrsquos why wersquore expanding our mission to provide high-quality affordable health care services into Mountain communities for the first time opening our Frisco medical office in Summit County in early 2016 and a second location in Eagle County

Integrated Care

Your employees can access care at our locations in the mountains and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

Kaiser Permanente Medical Offices

1 Kaiser Permanente Frisco Medical Offices

226 Lusher Court Frisco CO 80443

2 Eagle County location opening in 2016

Mea

dow

Driv

e

Dillon Reservoir

Lusher Ct

9

6Map is notto scale

1

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

12

Accessing Care Northern Colorado

In Northern Colorado we offer comprehensive health services and health care coverage to Loveland Fort Collins Greeley and surrounding areas Currently more than 27000 Northern Colorado members use Kaiser Permanente as their partner in health Take a look and yoursquoll see why Kaiser Permanente is a better choice

Integrated Care

Your employees can access care at any of our locations in Northern Colorado and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care pharmacy laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

The Power to Choose

We also offer your employees and additional choice in Northern Colorado they can visit a Kaiser Permanente medical office or see one of the 400+ network physicians from Banner Health and other community providers Our network in Northern Colorado works collaboratively with Kaiser Permanente care teams to ensure quality patient-centered care

Colorado Small Business Enrollment Guide

13

Kaiser Permanente Medical Offices

1 Fort Collins Medical Offices2950 E Harmony Road Suite 190 Fort Collins CO 80528 970-207-7171

2 Loveland Medical Offices4901 Thompson Parkway Loveland CO 80534-6426 970-207-7171

3 Greeley Medical Offices2429 35th Avenue Greeley CO 80634 970-207-7171

Emergency Care

E1 Estes Park Medical Center555 Prospect Avenue Estes Park CO 80517 970-586-2317

E2 McKee Medical Center2000 Boise Avenue Loveland CO 80538 970-669-4640

E3 North Colorado Medical Center1801 16th Street Greeley CO 80631 970-352-4121

E4 Banner Fort Collins Medical Center

4700 Lady Moon DriveFort Collins CO 80528970-229-4000

Urgent Care

U1 Banner Health Clinic ndash Skyline Urgent Care

2555 E 13th Street Suite 110 Loveland CO 80537 970-461-6140

U2 Banner Health Clinic ndash Summit View Urgent Care

2001 70th Ave Suite 110 Greeley CO 80634 970-378-4155

U3 Banner Health Clinic ndash Windsor Urgent Care

1300 Main Street Windsor CO 80550 970-686-5646

U4 The Healthcare Clinic of Fort Collins

1721 W Harmony Road 102 Fort Collins CO 80526 970-223-1999

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Southern Colorado

Estes Park25

25

25

85

85

87

8587

87

34

34

34

3434

34

287

287

287

257

402

392392

257

257

1414

60

6060

256 256

Fort Collins

GreeleyLoveland

2

E3

1

3

E2

E Harmony Rd CO Rd 74CO Rd 74

E Mulberry St

E Prospect Rd

TdR

lli H

tfa

W 29th StE Eisenhower Blvd

W 1st St esi

oBvAe

Zieg

ler R

d

ywkP

arr

etne

C

4th St

W 20th St

W 37th St

16th St

N 8th Ave

ht 9

5vAe

dr 3

2vAe

Medical offices

Hospitals for scheduled inpatient care H

U1

U4E4

U3

34

3434

60

3434

34

Moccasin Cir Dir

Prospect Ave

Highland Ln

Ponderosa Dr

Stanley

Cir Dir

St Vrain Av

Stanley Ave

MacGregor Ave

W Elkhorn Ave

Aspen Ave

Birch Ave

Driftwood Ave

U2

H E

Medical offices

Map is not to scale

34 36

High St

7

E1

25

25

25

85

85

87

8587

87

34

34

34

3434

34

287

287

287

257

402

392392

257

257

1414

60

6060

256 256

Fort Collins

GreeleyLoveland

2

E3

1

3

E2

E Harmony Rd CO Rd 74CO Rd 74

E Mulberry St

E Prospect Rd

TdR

lli H

tfa

W 29th StE Eisenhower Blvd

W 1st St esi

oBvAe

Zieg

ler R

d

ywkP

arr

etne

C

4th St

W 20th St

W 37th St

16th St

N 8th Ave

ht 9

5vAe

dr 3

2vAe

Medical offices

Hospitals for scheduled inpatient care H

U1

U4E4

U3

34

3434

60

3434

34

Moccasin Cir Dir

Prospect Ave

Highland Ln

Ponderosa Dr

Stanley

Cir Dir

St Vrain Av

Stanley Ave

MacGregor Ave

W Elkhorn Ave

Aspen Ave

Birch Ave

Driftwood Ave

U2

H E

Medical offices

Map is not to scale

34 36

High St

7

E1

Estes Park

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

14

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP CO Silver 050

Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a separate $250 prescription

drug deductible

-18

KP CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -33

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Plans Offered in Colorado

Colorado Small Business Enrollment Guide

15

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP CO Silver 050

Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a separate $250 prescription

drug deductible

-18

KP CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -33

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

16

Accessing Care in Southern Colorado

In Southern Colorado more than 61000 people turn to us as their trusted partner in total health We offer comprehensive health services and health care coverage to Colorado Springs Pueblo Cantildeon City and surrounding areas Take a look and yoursquoll see why Kaiser Permanente is a better partner in health

Integrated Care

Wersquove expanded to bring good health closer to our Southern Colorado members We opened a new Kaiser Permanente medical office in central Colorado Springs launched new affordable health insurance plans expanded specialty services at our Briargate location where patients of all ages can be seen

Your employees can access care at any of our locations in Southern Colorado and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care pharmacy laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

The Power to Choose

We also offer your employees an additional choice in Southern Colorado they can visit any Kaiser Permanente medical office in Colorado or choose from a comprehensive network of local physicians in their plan

Colorado Small Business Enrollment Guide

17

Collaborative Care

Wersquore partnering in new ways with network providers to bring best practices to your employees through innovative personalized care programs A care team thatrsquos informed and focused on your employees can lead to better health

Kaiser Permanente Care Connection is a team of local Kaiser Permanente nurses and health professionals who work with our network providers and your employees to manage their health help with care coordination preventative care wellness coaching educational resources and medication management

Pay for Value We identify nationally recognized quality metrics that align with best practices for certain preventive measures and disease states such as hypertension and diabetes Through this program wersquore seeing great results and showing improvements in quality of care for patients with chronic conditions such as Type 2 diabetes and hypertension as well as improving rates of prevention screenings (breast colorectal and cervical cancer)

Kaiser Permanente Select

An affordable high-quality health care plan for Colorado Springs and surrounding areas

Kaiser Permanente Select (KP Select) is all about keeping your employees healthy and keeping your health care costs down Employees who choose the KP Select plan will benefit from the same high-quality care from Kaiser Permanente at an affordable price while following a few guidelines Employees can receive care at any Kaiser Permanente medical office in Colorado with three located in Southern Colorado and have access to more than 400 KP Select providers in the Colorado Springs area Scheduled inpatient hospital care and outpatient care is available at select facilities and refills for maintenance medications must be filled at a Kaiser Permanente medical office pharmacy or through mail order

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

18

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Select Plans Offered in Colorado Springs

Colorado Small Business Enrollment Guide

19

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

20

Kaiser Permanente Medical Offices

1 Briargate Medical Offices 4105 Briargate Pkwy Suite 125 Colorado Springs CO 80920 719-282-2533

2 Parkside Medical Offices215 Parkside Drive Colorado Springs CO 80910 719-327-6540

3 Pueblo North Medical Offices 3670 Parker Boulevard Suite 200 Pueblo CO 81008 719-595-5755

Emergency Care

COLORADO SPRINGS

H1 Childrenrsquos Hospital at Memorial Hospital

1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H1 Memorial Hospital Central 1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H2 Memorial Hospital North 4050 Briargate Parkway Colorado Springs CO 80920 719-364-5000

H3 Penrose Hospital 2222 North Nevada Avenue Colorado Springs CO 80907 719-776-5000

H4 St Francis Medical Center 6001 East Woodmen Road Colorado Springs CO 80920 719-571-5000

PUEBLO

H5 Parkview Medical Center 400 West 16th Street Pueblo CO 81003 719-584-4000

H6 St Mary-Corwin Medical Center1008 Minnequa Avenue Pueblo CO 81004 719-557-4000

CANtildeON CITY

H7 St Thomas More Hospital 1338 Phay Avenue Cantildeon City CO 81212 719-285-2000

WOODLAND PARK

H8 Pikes Peak Regional Hospital16420 US Highway 24 Woodland Park CO 80863 719-687-9999

KP Select members have access to these hospitals for scheduled inpatient care

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Northern Colorado

Map is not to scale

50

50

50

5050

25

25

25

25

85

115

115115

9

67

96

231

96

96

47

78

45

24

85

24

24

2485

85

85

115

94

21

83

21

H7

H8

H1

H3

H4

1 H2

H5

H6

3

2

N Powers Blvd

E Woodmen Rd

E 4th St

E Platte Ave

Marksheffel Rd

Squirrel Creek Rd

Briargate Pkwy

W Northern Ave

Central Ave

State Hwy 120Co R

d 17

Doyle Rd

Co Rd 5013 M

eridian Rd

Hanover Rd

S Peyton Hwy

Falcon Hwy

Curtis Rd

Black Forest Rd

Meridian Rd

Peyton Hwy

Pueblo

Colorado Springs

Woodland Park

Cantildeon City

Colorado Small Business Enrollment Guide

21

Medicare Coverage

Kaiser Permanente offers group and individual Medicare Advantage and Prescription Drug Plans

For information on our individual plans contact a licensed sales specialist toll free at 1-855-843-8396 (TTY 711) seven days a week 8 a m to 8 p m or visit kporgmedicare

Adult and Pediatric Dental Care

Kaiser Permanente and Delta Dental of Colorado know good oral health is an important component of overall health so wersquove partnered to provide small group employers pediatric dental benefits and adult-only dental plans to complement Kaiser Permanentersquos medical plans

NEW 2016 Embedded Pediatric Dental Benefit

Separate Annual Deductible (applies to all services)

$50

Diagnostic amp Preventive Services

Oral Exams amp Cleanings (Limited to 2 per calendar year)

Covered 100 after Deductible

Fluoride Treatments (Limited to 2 per calendar year)

Covered 100 after Deductible

Sealants (1 per lifetime per tooth per year) Covered 100 after Deductible

Bitewing X-rays (1 set per calendar year) Covered 100 after Deductible

Basic Services (limited to 2 basic procedures per year)

Fillings Oral Surgery Endodontics Covered 50 after Deductible

Major Services (limited to 1 major procedure per year)

Crowns Covered 50 after Deductible

Embedded Pediatric

Employeersquos children (up through the month they turn 19) can receive any of the procedures listed below each calendar year

Adult Dental

Our adult-only plans complement the embedded pediatric dental coverage and are not tied to medical The lowest-cost plan starts at $13month These plans also offer

bull No waiting period

bull Dual option choices

bull $2000 benefit maximum on the high plan

For more information email Delta Dental directly at salesteamddpcocom Monday-Friday 8 am-5 pm

Important The pediatric dental benefit is embedded in all Small Group plans EXCEPT the KP CO Silver PPO 150040 plan The KP CO Silver PPO 1500-40 plan does not include pediatric dental coverage

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

22

2016 Resources Kaiser Permanente is committed to supporting you and your business Below yoursquoll find important contact information and business resources to save you time

Calling the right person should beEASY

Our goal is to have one-call resolution whenever possible Communicating with the right department is the first step With that in mind wersquove set up ONE Number Easy 303-306-2727 (866-710-2727)

If your question is about You need to talk to

Group Billing and Invoicing Account ReconciliationAdds Drops Cancels or Changes

Consolidated Service CenterOption 1

SG Contracts Brochures Forms New Employee Packets Group Cancellation

Small Group Sales amp ServiceOption 2

Benefits Eligibility Service Resolution Escalated Issues Employee-level Claims

Client Services Unit (CSU)Option 4

Customer Experience Department

Wersquore here to help you transition to Kaiser Permanente Our Customer Experience Team will visit your employees on-site and help them

bull Understand new plans amp benefits

bull Find amp choose physicians

bull Connect to the care they need

bull Transition prescriptions

To reach our Customer Experience team email welcomekporg or call 303-338-3990

Customer Account Services

An easy-to-use web site link that provides online account management for you and your broker You can view group eligibility and billing information update employee data or pay your invoices

If you would like to set up an account please contact your Account Executive or Associate Account Manager for assistance

Colorado Small Business Enrollment Guide

23

2016 Reference

1 Employer Health Benefits 2011 Annual Survey Kaiser Family Foundation and Health Research amp Educational Trust September 2011 Kaiser Family Foundation is a nonprofit private organization not affiliated with Kaiser Permanente

2 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

3 Kaiser Foundation Health Plan of Colorado Inc received the highest numerical score among commercial health plans in the Colorado region in the proprietary JD Power 2008-2015 US Member Health Plan Studiessm Study based on 31543 total member responses measuring four plans in Colorado (excludes Medicare and Medicaid) Proprietary study results are based on experiences and perceptions of members surveyed November-December 2014 Your experiences may vary Visit jdpowercom

4 Please refer to ldquoNCQArsquos Private Health Insurance Plan Rankings 2013-2014rdquo posted online at wwwncqaorg

5 Kaiser Permanente 2012 HEDISreg scores Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compassreg and represent all non- PPO lines of business Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA Quality Compass 2012 includes certain CAHPSreg data Any data display analysis interpretation or conclusion based on these data is solely that of the authors and NCQA specifically disclaims responsibility for any such display analysis interpretation or conclusion Quality Compassreg and HEDISreg are registered trademarks of NCQA CAHPSreg is a registered trademark of the Agency for Healthcare Research and Quality

6 The 2014 Hewitt Health Value InitiativeTM showed Kaiser Permanente is the most cost-efficient plan across all markets served for the sixth year in a rowmdash12 more cost-effective than the average HMO and 17 more cost-effective than the all-plan average Kaiser Permanente also outperformed other plans in clinical quality scoring 49 better than the average HMO and 209 better than the all-plan average Hewitt Health Value InitiativeTM benchmarking study mdash Kaiser Foundation Health Plan Inc Aon Hewitt April 3 2014 To get a copy of the Hewitt Health Value Initiative report for your region contact your account manager

7 Chronic Care Making the Case for Ongoing Care Robert Wood Johnson Foundation 2010

8 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

9 ldquoWorksite Wellnessrdquo Preventdiseasecom httppreventdiseasecomworksite_wellnessworksite_wellnesshtml accessed November 2 2009

10 See Note 9 11 ldquoObesity by the Numbersrdquo obesityinamericaorg accessed March 24 200812 See Note 313 Thomas Delate PhD et al ldquoReduced Health Care Expenditures After Enrollment

in a Collaborative Cardiac Care Servicerdquo Pharmacotherapy November 2010 Results from our cardiac rehabilitation program in Colorado

Kaiser Foundation Health Plan Inc of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Coloradoreg marketplace copy2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questionsCall us at 1-866-331-2091 bull Or contact your agent or broker

• WHATrsquoS INSIDE
• A BETTER WAY to manage costs
• A BETTER WAY to keep youremployees healthier
• Virtual Care Innovations
• Employee Health amp Wellness
• Enhancing the Employee Experience
• Accessing Care in DenverBoulder
• Accessing Care in Mountain Communities
• Accessing Care Northern Colorado
• KP Plans Offered in Colorado
• Accessing Care in Southern Colorado
• KP Select Plans Offered in Colorado Springs
• Medicare Coverage
• Adult and Pediatric Dental Care
• 2016 Resources

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

10

14 Lone Tree Medical Offices 10240 Park Meadows DrLone Tree CO 80124

15 Longmont Medical Offices 2345 Bent Way Longmont CO 80503

16 Parker Medical Offices 10168 Parkglenn Way Parker CO 80138

17 Rock Creek Medical Offices 280 Exempla Cir Lafayette CO 80026

18 Skyline Medical Offices 1375 E 20th Ave Denver CO 80205

19 Smoky Hill Medical Offices 16290 E Quincy Ave Aurora CO 80015

20 Southwest Medical Offices 5257 S Wadsworth Blvd Littleton CO 80123

21 Westminster Medical Offices 11245 Huron St Westminster CO 80234

22 Wheat Ridge Medical Offices 4803 Ward Rd Wheat Ridge CO 80033

After-Hours Care

Hours and locations for after-hours care are subject to change Please call 303-338-4545 (TTY 711) at the time of need to confirm current hours and locations

1 Arapahoe Medical Offices 6 pmndash10 pm Mon - Fri 8 amndash9 pm Sat 9 amndash9 pm Sun

6 East Denver Medical Offices 8 amndash4 pm Sat 9 amndash4 pm Sun

13 Lakewood Medical Offices 8 amndash4 pm Sat 9 amndash4 pm Sun

21 Westminster Medical Offices 8 amndash4 pm Sat 9 amndash4 pm Sun

Pediatric Urgent Care

U1 Childrenrsquos Hospital Colorado Urgent Care North Campus Broomfield

469 West Highway 7 Broomfield CO 80023

U2 Childrenrsquos Hospital Colorado Urgent Care Uptown Denver

1835 Franklin Street Denver CO 80218

U3 Childrenrsquos Hospital Colorado Urgent Care Wheat Ridge

3455 Lutheran Parkway Suite 230 Wheat Ridge CO 80033

Emergency Care

If you have an emergency medical condition call 911 or go to the nearest hospital Or if time and safety permit you can go to the Emergency Department at one of the following hospitals

H3 Saint Joseph Hospital1375 East 19th Avenue Denver CO 80218

H2 Good Samaritan Medical Center

200 Exempla Circle Lafayette CO 80026

H3 Senior ER at Saint Joseph Hospital

1375 East 19th Avenue Denver CO 80218

H1 Childrenrsquos Hospital Colorado on Anschutz Medical Campus

13123 E 16th Ave Aurora CO 80045

H4 Childrenrsquos Hospital Colorado North Campus Broomfield

469 West Highway 7 Broomfield CO 80023

E1 Childrenrsquos Hospital Colorado at Saint Joseph Hospital

1835 Franklin St Denver CO 80218

H3 Rocky Mountain Hospital for Children

1719 E 19th Ave Denver CO 80218

E3 HealthONE Sky Ridge Medical Center

10101 Ridgegate Pkwy Lone Tree CO 80124

E4 HealthONE Swedish Medical Center

501 E Hampden Ave Englewood CO 80110

E5 HealthONE Swedish Southwest ER

6196 S Ammons Way Littleton CO 80123

E2 HealthONE Centennial Medical Plaza

14200 E Arapahoe Rd Centennial CO 80112

Behavioral Health Offices

For appointments call 303-471-7700 B1 Hidden Lake

Behavioral Health 7701 Sheridan Blvd Arvada CO 80003

B2 Highline Behavioral Health 10350 E Dakota Ave Denver CO 80247 Entrance located on East side of building

B3 Ridgeline Behavioral Health Center

9139 S Ridgeline Blvd Highlands Ranch CO 80129

Additional locations and access

In addition to the locations shown on this map you have access to all Kaiser Permanente medical offices in Northern and Southern Colorado

Colorado Small Business Enrollment Guide

11

Accessing Care in Mountain CommunitiesAt Kaiser Permanente we believe therersquos no better choice than choosing good health Thatrsquos why wersquore expanding our mission to provide high-quality affordable health care services into Mountain communities for the first time opening our Frisco medical office in Summit County in early 2016 and a second location in Eagle County

Integrated Care

Your employees can access care at our locations in the mountains and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

Kaiser Permanente Medical Offices

1 Kaiser Permanente Frisco Medical Offices

226 Lusher Court Frisco CO 80443

2 Eagle County location opening in 2016

Mea

dow

Driv

e

Dillon Reservoir

Lusher Ct

9

6Map is notto scale

1

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

12

Accessing Care Northern Colorado

In Northern Colorado we offer comprehensive health services and health care coverage to Loveland Fort Collins Greeley and surrounding areas Currently more than 27000 Northern Colorado members use Kaiser Permanente as their partner in health Take a look and yoursquoll see why Kaiser Permanente is a better choice

Integrated Care

Your employees can access care at any of our locations in Northern Colorado and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care pharmacy laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

The Power to Choose

We also offer your employees and additional choice in Northern Colorado they can visit a Kaiser Permanente medical office or see one of the 400+ network physicians from Banner Health and other community providers Our network in Northern Colorado works collaboratively with Kaiser Permanente care teams to ensure quality patient-centered care

Colorado Small Business Enrollment Guide

13

Kaiser Permanente Medical Offices

1 Fort Collins Medical Offices2950 E Harmony Road Suite 190 Fort Collins CO 80528 970-207-7171

2 Loveland Medical Offices4901 Thompson Parkway Loveland CO 80534-6426 970-207-7171

3 Greeley Medical Offices2429 35th Avenue Greeley CO 80634 970-207-7171

Emergency Care

E1 Estes Park Medical Center555 Prospect Avenue Estes Park CO 80517 970-586-2317

E2 McKee Medical Center2000 Boise Avenue Loveland CO 80538 970-669-4640

E3 North Colorado Medical Center1801 16th Street Greeley CO 80631 970-352-4121

E4 Banner Fort Collins Medical Center

4700 Lady Moon DriveFort Collins CO 80528970-229-4000

Urgent Care

U1 Banner Health Clinic ndash Skyline Urgent Care

2555 E 13th Street Suite 110 Loveland CO 80537 970-461-6140

U2 Banner Health Clinic ndash Summit View Urgent Care

2001 70th Ave Suite 110 Greeley CO 80634 970-378-4155

U3 Banner Health Clinic ndash Windsor Urgent Care

1300 Main Street Windsor CO 80550 970-686-5646

U4 The Healthcare Clinic of Fort Collins

1721 W Harmony Road 102 Fort Collins CO 80526 970-223-1999

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Southern Colorado

Estes Park25

25

25

85

85

87

8587

87

34

34

34

3434

34

287

287

287

257

402

392392

257

257

1414

60

6060

256 256

Fort Collins

GreeleyLoveland

2

E3

1

3

E2

E Harmony Rd CO Rd 74CO Rd 74

E Mulberry St

E Prospect Rd

TdR

lli H

tfa

W 29th StE Eisenhower Blvd

W 1st St esi

oBvAe

Zieg

ler R

d

ywkP

arr

etne

C

4th St

W 20th St

W 37th St

16th St

N 8th Ave

ht 9

5vAe

dr 3

2vAe

Medical offices

Hospitals for scheduled inpatient care H

U1

U4E4

U3

34

3434

60

3434

34

Moccasin Cir Dir

Prospect Ave

Highland Ln

Ponderosa Dr

Stanley

Cir Dir

St Vrain Av

Stanley Ave

MacGregor Ave

W Elkhorn Ave

Aspen Ave

Birch Ave

Driftwood Ave

U2

H E

Medical offices

Map is not to scale

34 36

High St

7

E1

25

25

25

85

85

87

8587

87

34

34

34

3434

34

287

287

287

257

402

392392

257

257

1414

60

6060

256 256

Fort Collins

GreeleyLoveland

2

E3

1

3

E2

E Harmony Rd CO Rd 74CO Rd 74

E Mulberry St

E Prospect Rd

TdR

lli H

tfa

W 29th StE Eisenhower Blvd

W 1st St esi

oBvAe

Zieg

ler R

d

ywkP

arr

etne

C

4th St

W 20th St

W 37th St

16th St

N 8th Ave

ht 9

5vAe

dr 3

2vAe

Medical offices

Hospitals for scheduled inpatient care H

U1

U4E4

U3

34

3434

60

3434

34

Moccasin Cir Dir

Prospect Ave

Highland Ln

Ponderosa Dr

Stanley

Cir Dir

St Vrain Av

Stanley Ave

MacGregor Ave

W Elkhorn Ave

Aspen Ave

Birch Ave

Driftwood Ave

U2

H E

Medical offices

Map is not to scale

34 36

High St

7

E1

Estes Park

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

14

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP CO Silver 050

Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a separate $250 prescription

drug deductible

-18

KP CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -33

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Plans Offered in Colorado

Colorado Small Business Enrollment Guide

15

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP CO Silver 050

Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a separate $250 prescription

drug deductible

-18

KP CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -33

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

16

Accessing Care in Southern Colorado

In Southern Colorado more than 61000 people turn to us as their trusted partner in total health We offer comprehensive health services and health care coverage to Colorado Springs Pueblo Cantildeon City and surrounding areas Take a look and yoursquoll see why Kaiser Permanente is a better partner in health

Integrated Care

Wersquove expanded to bring good health closer to our Southern Colorado members We opened a new Kaiser Permanente medical office in central Colorado Springs launched new affordable health insurance plans expanded specialty services at our Briargate location where patients of all ages can be seen

Your employees can access care at any of our locations in Southern Colorado and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care pharmacy laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

The Power to Choose

We also offer your employees an additional choice in Southern Colorado they can visit any Kaiser Permanente medical office in Colorado or choose from a comprehensive network of local physicians in their plan

Colorado Small Business Enrollment Guide

17

Collaborative Care

Wersquore partnering in new ways with network providers to bring best practices to your employees through innovative personalized care programs A care team thatrsquos informed and focused on your employees can lead to better health

Kaiser Permanente Care Connection is a team of local Kaiser Permanente nurses and health professionals who work with our network providers and your employees to manage their health help with care coordination preventative care wellness coaching educational resources and medication management

Pay for Value We identify nationally recognized quality metrics that align with best practices for certain preventive measures and disease states such as hypertension and diabetes Through this program wersquore seeing great results and showing improvements in quality of care for patients with chronic conditions such as Type 2 diabetes and hypertension as well as improving rates of prevention screenings (breast colorectal and cervical cancer)

Kaiser Permanente Select

An affordable high-quality health care plan for Colorado Springs and surrounding areas

Kaiser Permanente Select (KP Select) is all about keeping your employees healthy and keeping your health care costs down Employees who choose the KP Select plan will benefit from the same high-quality care from Kaiser Permanente at an affordable price while following a few guidelines Employees can receive care at any Kaiser Permanente medical office in Colorado with three located in Southern Colorado and have access to more than 400 KP Select providers in the Colorado Springs area Scheduled inpatient hospital care and outpatient care is available at select facilities and refills for maintenance medications must be filled at a Kaiser Permanente medical office pharmacy or through mail order

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

18

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Select Plans Offered in Colorado Springs

Colorado Small Business Enrollment Guide

19

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

20

Kaiser Permanente Medical Offices

1 Briargate Medical Offices 4105 Briargate Pkwy Suite 125 Colorado Springs CO 80920 719-282-2533

2 Parkside Medical Offices215 Parkside Drive Colorado Springs CO 80910 719-327-6540

3 Pueblo North Medical Offices 3670 Parker Boulevard Suite 200 Pueblo CO 81008 719-595-5755

Emergency Care

COLORADO SPRINGS

H1 Childrenrsquos Hospital at Memorial Hospital

1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H1 Memorial Hospital Central 1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H2 Memorial Hospital North 4050 Briargate Parkway Colorado Springs CO 80920 719-364-5000

H3 Penrose Hospital 2222 North Nevada Avenue Colorado Springs CO 80907 719-776-5000

H4 St Francis Medical Center 6001 East Woodmen Road Colorado Springs CO 80920 719-571-5000

PUEBLO

H5 Parkview Medical Center 400 West 16th Street Pueblo CO 81003 719-584-4000

H6 St Mary-Corwin Medical Center1008 Minnequa Avenue Pueblo CO 81004 719-557-4000

CANtildeON CITY

H7 St Thomas More Hospital 1338 Phay Avenue Cantildeon City CO 81212 719-285-2000

WOODLAND PARK

H8 Pikes Peak Regional Hospital16420 US Highway 24 Woodland Park CO 80863 719-687-9999

KP Select members have access to these hospitals for scheduled inpatient care

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Northern Colorado

Map is not to scale

50

50

50

5050

25

25

25

25

85

115

115115

9

67

96

231

96

96

47

78

45

24

85

24

24

2485

85

85

115

94

21

83

21

H7

H8

H1

H3

H4

1 H2

H5

H6

3

2

N Powers Blvd

E Woodmen Rd

E 4th St

E Platte Ave

Marksheffel Rd

Squirrel Creek Rd

Briargate Pkwy

W Northern Ave

Central Ave

State Hwy 120Co R

d 17

Doyle Rd

Co Rd 5013 M

eridian Rd

Hanover Rd

S Peyton Hwy

Falcon Hwy

Curtis Rd

Black Forest Rd

Meridian Rd

Peyton Hwy

Pueblo

Colorado Springs

Woodland Park

Cantildeon City

Colorado Small Business Enrollment Guide

21

Medicare Coverage

Kaiser Permanente offers group and individual Medicare Advantage and Prescription Drug Plans

For information on our individual plans contact a licensed sales specialist toll free at 1-855-843-8396 (TTY 711) seven days a week 8 a m to 8 p m or visit kporgmedicare

Adult and Pediatric Dental Care

Kaiser Permanente and Delta Dental of Colorado know good oral health is an important component of overall health so wersquove partnered to provide small group employers pediatric dental benefits and adult-only dental plans to complement Kaiser Permanentersquos medical plans

NEW 2016 Embedded Pediatric Dental Benefit

Separate Annual Deductible (applies to all services)

$50

Diagnostic amp Preventive Services

Oral Exams amp Cleanings (Limited to 2 per calendar year)

Covered 100 after Deductible

Fluoride Treatments (Limited to 2 per calendar year)

Covered 100 after Deductible

Sealants (1 per lifetime per tooth per year) Covered 100 after Deductible

Bitewing X-rays (1 set per calendar year) Covered 100 after Deductible

Basic Services (limited to 2 basic procedures per year)

Fillings Oral Surgery Endodontics Covered 50 after Deductible

Major Services (limited to 1 major procedure per year)

Crowns Covered 50 after Deductible

Embedded Pediatric

Employeersquos children (up through the month they turn 19) can receive any of the procedures listed below each calendar year

Adult Dental

Our adult-only plans complement the embedded pediatric dental coverage and are not tied to medical The lowest-cost plan starts at $13month These plans also offer

bull No waiting period

bull Dual option choices

bull $2000 benefit maximum on the high plan

For more information email Delta Dental directly at salesteamddpcocom Monday-Friday 8 am-5 pm

Important The pediatric dental benefit is embedded in all Small Group plans EXCEPT the KP CO Silver PPO 150040 plan The KP CO Silver PPO 1500-40 plan does not include pediatric dental coverage

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

22

2016 Resources Kaiser Permanente is committed to supporting you and your business Below yoursquoll find important contact information and business resources to save you time

Calling the right person should beEASY

Our goal is to have one-call resolution whenever possible Communicating with the right department is the first step With that in mind wersquove set up ONE Number Easy 303-306-2727 (866-710-2727)

If your question is about You need to talk to

Group Billing and Invoicing Account ReconciliationAdds Drops Cancels or Changes

Consolidated Service CenterOption 1

SG Contracts Brochures Forms New Employee Packets Group Cancellation

Small Group Sales amp ServiceOption 2

Benefits Eligibility Service Resolution Escalated Issues Employee-level Claims

Client Services Unit (CSU)Option 4

Customer Experience Department

Wersquore here to help you transition to Kaiser Permanente Our Customer Experience Team will visit your employees on-site and help them

bull Understand new plans amp benefits

bull Find amp choose physicians

bull Connect to the care they need

bull Transition prescriptions

To reach our Customer Experience team email welcomekporg or call 303-338-3990

Customer Account Services

An easy-to-use web site link that provides online account management for you and your broker You can view group eligibility and billing information update employee data or pay your invoices

If you would like to set up an account please contact your Account Executive or Associate Account Manager for assistance

Colorado Small Business Enrollment Guide

23

2016 Reference

1 Employer Health Benefits 2011 Annual Survey Kaiser Family Foundation and Health Research amp Educational Trust September 2011 Kaiser Family Foundation is a nonprofit private organization not affiliated with Kaiser Permanente

2 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

3 Kaiser Foundation Health Plan of Colorado Inc received the highest numerical score among commercial health plans in the Colorado region in the proprietary JD Power 2008-2015 US Member Health Plan Studiessm Study based on 31543 total member responses measuring four plans in Colorado (excludes Medicare and Medicaid) Proprietary study results are based on experiences and perceptions of members surveyed November-December 2014 Your experiences may vary Visit jdpowercom

4 Please refer to ldquoNCQArsquos Private Health Insurance Plan Rankings 2013-2014rdquo posted online at wwwncqaorg

5 Kaiser Permanente 2012 HEDISreg scores Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compassreg and represent all non- PPO lines of business Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA Quality Compass 2012 includes certain CAHPSreg data Any data display analysis interpretation or conclusion based on these data is solely that of the authors and NCQA specifically disclaims responsibility for any such display analysis interpretation or conclusion Quality Compassreg and HEDISreg are registered trademarks of NCQA CAHPSreg is a registered trademark of the Agency for Healthcare Research and Quality

6 The 2014 Hewitt Health Value InitiativeTM showed Kaiser Permanente is the most cost-efficient plan across all markets served for the sixth year in a rowmdash12 more cost-effective than the average HMO and 17 more cost-effective than the all-plan average Kaiser Permanente also outperformed other plans in clinical quality scoring 49 better than the average HMO and 209 better than the all-plan average Hewitt Health Value InitiativeTM benchmarking study mdash Kaiser Foundation Health Plan Inc Aon Hewitt April 3 2014 To get a copy of the Hewitt Health Value Initiative report for your region contact your account manager

7 Chronic Care Making the Case for Ongoing Care Robert Wood Johnson Foundation 2010

8 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

9 ldquoWorksite Wellnessrdquo Preventdiseasecom httppreventdiseasecomworksite_wellnessworksite_wellnesshtml accessed November 2 2009

10 See Note 9 11 ldquoObesity by the Numbersrdquo obesityinamericaorg accessed March 24 200812 See Note 313 Thomas Delate PhD et al ldquoReduced Health Care Expenditures After Enrollment

in a Collaborative Cardiac Care Servicerdquo Pharmacotherapy November 2010 Results from our cardiac rehabilitation program in Colorado

Kaiser Foundation Health Plan Inc of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Coloradoreg marketplace copy2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questionsCall us at 1-866-331-2091 bull Or contact your agent or broker

• WHATrsquoS INSIDE
• A BETTER WAY to manage costs
• A BETTER WAY to keep youremployees healthier
• Virtual Care Innovations
• Employee Health amp Wellness
• Enhancing the Employee Experience
• Accessing Care in DenverBoulder
• Accessing Care in Mountain Communities
• Accessing Care Northern Colorado
• KP Plans Offered in Colorado
• Accessing Care in Southern Colorado
• KP Select Plans Offered in Colorado Springs
• Medicare Coverage
• Adult and Pediatric Dental Care
• 2016 Resources

Colorado Small Business Enrollment Guide

11

Accessing Care in Mountain CommunitiesAt Kaiser Permanente we believe therersquos no better choice than choosing good health Thatrsquos why wersquore expanding our mission to provide high-quality affordable health care services into Mountain communities for the first time opening our Frisco medical office in Summit County in early 2016 and a second location in Eagle County

Integrated Care

Your employees can access care at our locations in the mountains and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

Kaiser Permanente Medical Offices

1 Kaiser Permanente Frisco Medical Offices

226 Lusher Court Frisco CO 80443

2 Eagle County location opening in 2016

Mea

dow

Driv

e

Dillon Reservoir

Lusher Ct

9

6Map is notto scale

1

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

12

Accessing Care Northern Colorado

In Northern Colorado we offer comprehensive health services and health care coverage to Loveland Fort Collins Greeley and surrounding areas Currently more than 27000 Northern Colorado members use Kaiser Permanente as their partner in health Take a look and yoursquoll see why Kaiser Permanente is a better choice

Integrated Care

Your employees can access care at any of our locations in Northern Colorado and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care pharmacy laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

The Power to Choose

We also offer your employees and additional choice in Northern Colorado they can visit a Kaiser Permanente medical office or see one of the 400+ network physicians from Banner Health and other community providers Our network in Northern Colorado works collaboratively with Kaiser Permanente care teams to ensure quality patient-centered care

Colorado Small Business Enrollment Guide

13

Kaiser Permanente Medical Offices

1 Fort Collins Medical Offices2950 E Harmony Road Suite 190 Fort Collins CO 80528 970-207-7171

2 Loveland Medical Offices4901 Thompson Parkway Loveland CO 80534-6426 970-207-7171

3 Greeley Medical Offices2429 35th Avenue Greeley CO 80634 970-207-7171

Emergency Care

E1 Estes Park Medical Center555 Prospect Avenue Estes Park CO 80517 970-586-2317

E2 McKee Medical Center2000 Boise Avenue Loveland CO 80538 970-669-4640

E3 North Colorado Medical Center1801 16th Street Greeley CO 80631 970-352-4121

E4 Banner Fort Collins Medical Center

4700 Lady Moon DriveFort Collins CO 80528970-229-4000

Urgent Care

U1 Banner Health Clinic ndash Skyline Urgent Care

2555 E 13th Street Suite 110 Loveland CO 80537 970-461-6140

U2 Banner Health Clinic ndash Summit View Urgent Care

2001 70th Ave Suite 110 Greeley CO 80634 970-378-4155

U3 Banner Health Clinic ndash Windsor Urgent Care

1300 Main Street Windsor CO 80550 970-686-5646

U4 The Healthcare Clinic of Fort Collins

1721 W Harmony Road 102 Fort Collins CO 80526 970-223-1999

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Southern Colorado

Estes Park25

25

25

85

85

87

8587

87

34

34

34

3434

34

287

287

287

257

402

392392

257

257

1414

60

6060

256 256

Fort Collins

GreeleyLoveland

2

E3

1

3

E2

E Harmony Rd CO Rd 74CO Rd 74

E Mulberry St

E Prospect Rd

TdR

lli H

tfa

W 29th StE Eisenhower Blvd

W 1st St esi

oBvAe

Zieg

ler R

d

ywkP

arr

etne

C

4th St

W 20th St

W 37th St

16th St

N 8th Ave

ht 9

5vAe

dr 3

2vAe

Medical offices

Hospitals for scheduled inpatient care H

U1

U4E4

U3

34

3434

60

3434

34

Moccasin Cir Dir

Prospect Ave

Highland Ln

Ponderosa Dr

Stanley

Cir Dir

St Vrain Av

Stanley Ave

MacGregor Ave

W Elkhorn Ave

Aspen Ave

Birch Ave

Driftwood Ave

U2

H E

Medical offices

Map is not to scale

34 36

High St

7

E1

25

25

25

85

85

87

8587

87

34

34

34

3434

34

287

287

287

257

402

392392

257

257

1414

60

6060

256 256

Fort Collins

GreeleyLoveland

2

E3

1

3

E2

E Harmony Rd CO Rd 74CO Rd 74

E Mulberry St

E Prospect Rd

TdR

lli H

tfa

W 29th StE Eisenhower Blvd

W 1st St esi

oBvAe

Zieg

ler R

d

ywkP

arr

etne

C

4th St

W 20th St

W 37th St

16th St

N 8th Ave

ht 9

5vAe

dr 3

2vAe

Medical offices

Hospitals for scheduled inpatient care H

U1

U4E4

U3

34

3434

60

3434

34

Moccasin Cir Dir

Prospect Ave

Highland Ln

Ponderosa Dr

Stanley

Cir Dir

St Vrain Av

Stanley Ave

MacGregor Ave

W Elkhorn Ave

Aspen Ave

Birch Ave

Driftwood Ave

U2

H E

Medical offices

Map is not to scale

34 36

High St

7

E1

Estes Park

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

14

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP CO Silver 050

Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a separate $250 prescription

drug deductible

-18

KP CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -33

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Plans Offered in Colorado

Colorado Small Business Enrollment Guide

15

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP CO Silver 050

Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a separate $250 prescription

drug deductible

-18

KP CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -33

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

16

Accessing Care in Southern Colorado

In Southern Colorado more than 61000 people turn to us as their trusted partner in total health We offer comprehensive health services and health care coverage to Colorado Springs Pueblo Cantildeon City and surrounding areas Take a look and yoursquoll see why Kaiser Permanente is a better partner in health

Integrated Care

Wersquove expanded to bring good health closer to our Southern Colorado members We opened a new Kaiser Permanente medical office in central Colorado Springs launched new affordable health insurance plans expanded specialty services at our Briargate location where patients of all ages can be seen

Your employees can access care at any of our locations in Southern Colorado and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care pharmacy laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

The Power to Choose

We also offer your employees an additional choice in Southern Colorado they can visit any Kaiser Permanente medical office in Colorado or choose from a comprehensive network of local physicians in their plan

Colorado Small Business Enrollment Guide

17

Collaborative Care

Wersquore partnering in new ways with network providers to bring best practices to your employees through innovative personalized care programs A care team thatrsquos informed and focused on your employees can lead to better health

Kaiser Permanente Care Connection is a team of local Kaiser Permanente nurses and health professionals who work with our network providers and your employees to manage their health help with care coordination preventative care wellness coaching educational resources and medication management

Pay for Value We identify nationally recognized quality metrics that align with best practices for certain preventive measures and disease states such as hypertension and diabetes Through this program wersquore seeing great results and showing improvements in quality of care for patients with chronic conditions such as Type 2 diabetes and hypertension as well as improving rates of prevention screenings (breast colorectal and cervical cancer)

Kaiser Permanente Select

An affordable high-quality health care plan for Colorado Springs and surrounding areas

Kaiser Permanente Select (KP Select) is all about keeping your employees healthy and keeping your health care costs down Employees who choose the KP Select plan will benefit from the same high-quality care from Kaiser Permanente at an affordable price while following a few guidelines Employees can receive care at any Kaiser Permanente medical office in Colorado with three located in Southern Colorado and have access to more than 400 KP Select providers in the Colorado Springs area Scheduled inpatient hospital care and outpatient care is available at select facilities and refills for maintenance medications must be filled at a Kaiser Permanente medical office pharmacy or through mail order

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

18

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Select Plans Offered in Colorado Springs

Colorado Small Business Enrollment Guide

19

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

20

Kaiser Permanente Medical Offices

1 Briargate Medical Offices 4105 Briargate Pkwy Suite 125 Colorado Springs CO 80920 719-282-2533

2 Parkside Medical Offices215 Parkside Drive Colorado Springs CO 80910 719-327-6540

3 Pueblo North Medical Offices 3670 Parker Boulevard Suite 200 Pueblo CO 81008 719-595-5755

Emergency Care

COLORADO SPRINGS

H1 Childrenrsquos Hospital at Memorial Hospital

1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H1 Memorial Hospital Central 1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H2 Memorial Hospital North 4050 Briargate Parkway Colorado Springs CO 80920 719-364-5000

H3 Penrose Hospital 2222 North Nevada Avenue Colorado Springs CO 80907 719-776-5000

H4 St Francis Medical Center 6001 East Woodmen Road Colorado Springs CO 80920 719-571-5000

PUEBLO

H5 Parkview Medical Center 400 West 16th Street Pueblo CO 81003 719-584-4000

H6 St Mary-Corwin Medical Center1008 Minnequa Avenue Pueblo CO 81004 719-557-4000

CANtildeON CITY

H7 St Thomas More Hospital 1338 Phay Avenue Cantildeon City CO 81212 719-285-2000

WOODLAND PARK

H8 Pikes Peak Regional Hospital16420 US Highway 24 Woodland Park CO 80863 719-687-9999

KP Select members have access to these hospitals for scheduled inpatient care

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Northern Colorado

Map is not to scale

50

50

50

5050

25

25

25

25

85

115

115115

9

67

96

231

96

96

47

78

45

24

85

24

24

2485

85

85

115

94

21

83

21

H7

H8

H1

H3

H4

1 H2

H5

H6

3

2

N Powers Blvd

E Woodmen Rd

E 4th St

E Platte Ave

Marksheffel Rd

Squirrel Creek Rd

Briargate Pkwy

W Northern Ave

Central Ave

State Hwy 120Co R

d 17

Doyle Rd

Co Rd 5013 M

eridian Rd

Hanover Rd

S Peyton Hwy

Falcon Hwy

Curtis Rd

Black Forest Rd

Meridian Rd

Peyton Hwy

Pueblo

Colorado Springs

Woodland Park

Cantildeon City

Colorado Small Business Enrollment Guide

21

Medicare Coverage

Kaiser Permanente offers group and individual Medicare Advantage and Prescription Drug Plans

For information on our individual plans contact a licensed sales specialist toll free at 1-855-843-8396 (TTY 711) seven days a week 8 a m to 8 p m or visit kporgmedicare

Adult and Pediatric Dental Care

Kaiser Permanente and Delta Dental of Colorado know good oral health is an important component of overall health so wersquove partnered to provide small group employers pediatric dental benefits and adult-only dental plans to complement Kaiser Permanentersquos medical plans

NEW 2016 Embedded Pediatric Dental Benefit

Separate Annual Deductible (applies to all services)

$50

Diagnostic amp Preventive Services

Oral Exams amp Cleanings (Limited to 2 per calendar year)

Covered 100 after Deductible

Fluoride Treatments (Limited to 2 per calendar year)

Covered 100 after Deductible

Sealants (1 per lifetime per tooth per year) Covered 100 after Deductible

Bitewing X-rays (1 set per calendar year) Covered 100 after Deductible

Basic Services (limited to 2 basic procedures per year)

Fillings Oral Surgery Endodontics Covered 50 after Deductible

Major Services (limited to 1 major procedure per year)

Crowns Covered 50 after Deductible

Embedded Pediatric

Employeersquos children (up through the month they turn 19) can receive any of the procedures listed below each calendar year

Adult Dental

Our adult-only plans complement the embedded pediatric dental coverage and are not tied to medical The lowest-cost plan starts at $13month These plans also offer

bull No waiting period

bull Dual option choices

bull $2000 benefit maximum on the high plan

For more information email Delta Dental directly at salesteamddpcocom Monday-Friday 8 am-5 pm

Important The pediatric dental benefit is embedded in all Small Group plans EXCEPT the KP CO Silver PPO 150040 plan The KP CO Silver PPO 1500-40 plan does not include pediatric dental coverage

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

22

2016 Resources Kaiser Permanente is committed to supporting you and your business Below yoursquoll find important contact information and business resources to save you time

Calling the right person should beEASY

Our goal is to have one-call resolution whenever possible Communicating with the right department is the first step With that in mind wersquove set up ONE Number Easy 303-306-2727 (866-710-2727)

If your question is about You need to talk to

Group Billing and Invoicing Account ReconciliationAdds Drops Cancels or Changes

Consolidated Service CenterOption 1

SG Contracts Brochures Forms New Employee Packets Group Cancellation

Small Group Sales amp ServiceOption 2

Benefits Eligibility Service Resolution Escalated Issues Employee-level Claims

Client Services Unit (CSU)Option 4

Customer Experience Department

Wersquore here to help you transition to Kaiser Permanente Our Customer Experience Team will visit your employees on-site and help them

bull Understand new plans amp benefits

bull Find amp choose physicians

bull Connect to the care they need

bull Transition prescriptions

To reach our Customer Experience team email welcomekporg or call 303-338-3990

Customer Account Services

An easy-to-use web site link that provides online account management for you and your broker You can view group eligibility and billing information update employee data or pay your invoices

If you would like to set up an account please contact your Account Executive or Associate Account Manager for assistance

Colorado Small Business Enrollment Guide

23

2016 Reference

1 Employer Health Benefits 2011 Annual Survey Kaiser Family Foundation and Health Research amp Educational Trust September 2011 Kaiser Family Foundation is a nonprofit private organization not affiliated with Kaiser Permanente

2 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

3 Kaiser Foundation Health Plan of Colorado Inc received the highest numerical score among commercial health plans in the Colorado region in the proprietary JD Power 2008-2015 US Member Health Plan Studiessm Study based on 31543 total member responses measuring four plans in Colorado (excludes Medicare and Medicaid) Proprietary study results are based on experiences and perceptions of members surveyed November-December 2014 Your experiences may vary Visit jdpowercom

4 Please refer to ldquoNCQArsquos Private Health Insurance Plan Rankings 2013-2014rdquo posted online at wwwncqaorg

5 Kaiser Permanente 2012 HEDISreg scores Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compassreg and represent all non- PPO lines of business Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA Quality Compass 2012 includes certain CAHPSreg data Any data display analysis interpretation or conclusion based on these data is solely that of the authors and NCQA specifically disclaims responsibility for any such display analysis interpretation or conclusion Quality Compassreg and HEDISreg are registered trademarks of NCQA CAHPSreg is a registered trademark of the Agency for Healthcare Research and Quality

6 The 2014 Hewitt Health Value InitiativeTM showed Kaiser Permanente is the most cost-efficient plan across all markets served for the sixth year in a rowmdash12 more cost-effective than the average HMO and 17 more cost-effective than the all-plan average Kaiser Permanente also outperformed other plans in clinical quality scoring 49 better than the average HMO and 209 better than the all-plan average Hewitt Health Value InitiativeTM benchmarking study mdash Kaiser Foundation Health Plan Inc Aon Hewitt April 3 2014 To get a copy of the Hewitt Health Value Initiative report for your region contact your account manager

7 Chronic Care Making the Case for Ongoing Care Robert Wood Johnson Foundation 2010

8 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

9 ldquoWorksite Wellnessrdquo Preventdiseasecom httppreventdiseasecomworksite_wellnessworksite_wellnesshtml accessed November 2 2009

10 See Note 9 11 ldquoObesity by the Numbersrdquo obesityinamericaorg accessed March 24 200812 See Note 313 Thomas Delate PhD et al ldquoReduced Health Care Expenditures After Enrollment

in a Collaborative Cardiac Care Servicerdquo Pharmacotherapy November 2010 Results from our cardiac rehabilitation program in Colorado

Kaiser Foundation Health Plan Inc of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Coloradoreg marketplace copy2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questionsCall us at 1-866-331-2091 bull Or contact your agent or broker

• WHATrsquoS INSIDE
• A BETTER WAY to manage costs
• A BETTER WAY to keep youremployees healthier
• Virtual Care Innovations
• Employee Health amp Wellness
• Enhancing the Employee Experience
• Accessing Care in DenverBoulder
• Accessing Care in Mountain Communities
• Accessing Care Northern Colorado
• KP Plans Offered in Colorado
• Accessing Care in Southern Colorado
• KP Select Plans Offered in Colorado Springs
• Medicare Coverage
• Adult and Pediatric Dental Care
• 2016 Resources

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

12

Accessing Care Northern Colorado

In Northern Colorado we offer comprehensive health services and health care coverage to Loveland Fort Collins Greeley and surrounding areas Currently more than 27000 Northern Colorado members use Kaiser Permanente as their partner in health Take a look and yoursquoll see why Kaiser Permanente is a better choice

Integrated Care

Your employees can access care at any of our locations in Northern Colorado and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care pharmacy laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

The Power to Choose

We also offer your employees and additional choice in Northern Colorado they can visit a Kaiser Permanente medical office or see one of the 400+ network physicians from Banner Health and other community providers Our network in Northern Colorado works collaboratively with Kaiser Permanente care teams to ensure quality patient-centered care

Colorado Small Business Enrollment Guide

13

Kaiser Permanente Medical Offices

1 Fort Collins Medical Offices2950 E Harmony Road Suite 190 Fort Collins CO 80528 970-207-7171

2 Loveland Medical Offices4901 Thompson Parkway Loveland CO 80534-6426 970-207-7171

3 Greeley Medical Offices2429 35th Avenue Greeley CO 80634 970-207-7171

Emergency Care

E1 Estes Park Medical Center555 Prospect Avenue Estes Park CO 80517 970-586-2317

E2 McKee Medical Center2000 Boise Avenue Loveland CO 80538 970-669-4640

E3 North Colorado Medical Center1801 16th Street Greeley CO 80631 970-352-4121

E4 Banner Fort Collins Medical Center

4700 Lady Moon DriveFort Collins CO 80528970-229-4000

Urgent Care

U1 Banner Health Clinic ndash Skyline Urgent Care

2555 E 13th Street Suite 110 Loveland CO 80537 970-461-6140

U2 Banner Health Clinic ndash Summit View Urgent Care

2001 70th Ave Suite 110 Greeley CO 80634 970-378-4155

U3 Banner Health Clinic ndash Windsor Urgent Care

1300 Main Street Windsor CO 80550 970-686-5646

U4 The Healthcare Clinic of Fort Collins

1721 W Harmony Road 102 Fort Collins CO 80526 970-223-1999

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Southern Colorado

Estes Park25

25

25

85

85

87

8587

87

34

34

34

3434

34

287

287

287

257

402

392392

257

257

1414

60

6060

256 256

Fort Collins

GreeleyLoveland

2

E3

1

3

E2

E Harmony Rd CO Rd 74CO Rd 74

E Mulberry St

E Prospect Rd

TdR

lli H

tfa

W 29th StE Eisenhower Blvd

W 1st St esi

oBvAe

Zieg

ler R

d

ywkP

arr

etne

C

4th St

W 20th St

W 37th St

16th St

N 8th Ave

ht 9

5vAe

dr 3

2vAe

Medical offices

Hospitals for scheduled inpatient care H

U1

U4E4

U3

34

3434

60

3434

34

Moccasin Cir Dir

Prospect Ave

Highland Ln

Ponderosa Dr

Stanley

Cir Dir

St Vrain Av

Stanley Ave

MacGregor Ave

W Elkhorn Ave

Aspen Ave

Birch Ave

Driftwood Ave

U2

H E

Medical offices

Map is not to scale

34 36

High St

7

E1

25

25

25

85

85

87

8587

87

34

34

34

3434

34

287

287

287

257

402

392392

257

257

1414

60

6060

256 256

Fort Collins

GreeleyLoveland

2

E3

1

3

E2

E Harmony Rd CO Rd 74CO Rd 74

E Mulberry St

E Prospect Rd

TdR

lli H

tfa

W 29th StE Eisenhower Blvd

W 1st St esi

oBvAe

Zieg

ler R

d

ywkP

arr

etne

C

4th St

W 20th St

W 37th St

16th St

N 8th Ave

ht 9

5vAe

dr 3

2vAe

Medical offices

Hospitals for scheduled inpatient care H

U1

U4E4

U3

34

3434

60

3434

34

Moccasin Cir Dir

Prospect Ave

Highland Ln

Ponderosa Dr

Stanley

Cir Dir

St Vrain Av

Stanley Ave

MacGregor Ave

W Elkhorn Ave

Aspen Ave

Birch Ave

Driftwood Ave

U2

H E

Medical offices

Map is not to scale

34 36

High St

7

E1

Estes Park

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

14

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP CO Silver 050

Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a separate $250 prescription

drug deductible

-18

KP CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -33

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Plans Offered in Colorado

Colorado Small Business Enrollment Guide

15

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP CO Silver 050

Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a separate $250 prescription

drug deductible

-18

KP CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -33

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

16

Accessing Care in Southern Colorado

In Southern Colorado more than 61000 people turn to us as their trusted partner in total health We offer comprehensive health services and health care coverage to Colorado Springs Pueblo Cantildeon City and surrounding areas Take a look and yoursquoll see why Kaiser Permanente is a better partner in health

Integrated Care

Wersquove expanded to bring good health closer to our Southern Colorado members We opened a new Kaiser Permanente medical office in central Colorado Springs launched new affordable health insurance plans expanded specialty services at our Briargate location where patients of all ages can be seen

Your employees can access care at any of our locations in Southern Colorado and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care pharmacy laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

The Power to Choose

We also offer your employees an additional choice in Southern Colorado they can visit any Kaiser Permanente medical office in Colorado or choose from a comprehensive network of local physicians in their plan

Colorado Small Business Enrollment Guide

17

Collaborative Care

Wersquore partnering in new ways with network providers to bring best practices to your employees through innovative personalized care programs A care team thatrsquos informed and focused on your employees can lead to better health

Kaiser Permanente Care Connection is a team of local Kaiser Permanente nurses and health professionals who work with our network providers and your employees to manage their health help with care coordination preventative care wellness coaching educational resources and medication management

Pay for Value We identify nationally recognized quality metrics that align with best practices for certain preventive measures and disease states such as hypertension and diabetes Through this program wersquore seeing great results and showing improvements in quality of care for patients with chronic conditions such as Type 2 diabetes and hypertension as well as improving rates of prevention screenings (breast colorectal and cervical cancer)

Kaiser Permanente Select

An affordable high-quality health care plan for Colorado Springs and surrounding areas

Kaiser Permanente Select (KP Select) is all about keeping your employees healthy and keeping your health care costs down Employees who choose the KP Select plan will benefit from the same high-quality care from Kaiser Permanente at an affordable price while following a few guidelines Employees can receive care at any Kaiser Permanente medical office in Colorado with three located in Southern Colorado and have access to more than 400 KP Select providers in the Colorado Springs area Scheduled inpatient hospital care and outpatient care is available at select facilities and refills for maintenance medications must be filled at a Kaiser Permanente medical office pharmacy or through mail order

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

18

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Select Plans Offered in Colorado Springs

Colorado Small Business Enrollment Guide

19

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

20

Kaiser Permanente Medical Offices

1 Briargate Medical Offices 4105 Briargate Pkwy Suite 125 Colorado Springs CO 80920 719-282-2533

2 Parkside Medical Offices215 Parkside Drive Colorado Springs CO 80910 719-327-6540

3 Pueblo North Medical Offices 3670 Parker Boulevard Suite 200 Pueblo CO 81008 719-595-5755

Emergency Care

COLORADO SPRINGS

H1 Childrenrsquos Hospital at Memorial Hospital

1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H1 Memorial Hospital Central 1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H2 Memorial Hospital North 4050 Briargate Parkway Colorado Springs CO 80920 719-364-5000

H3 Penrose Hospital 2222 North Nevada Avenue Colorado Springs CO 80907 719-776-5000

H4 St Francis Medical Center 6001 East Woodmen Road Colorado Springs CO 80920 719-571-5000

PUEBLO

H5 Parkview Medical Center 400 West 16th Street Pueblo CO 81003 719-584-4000

H6 St Mary-Corwin Medical Center1008 Minnequa Avenue Pueblo CO 81004 719-557-4000

CANtildeON CITY

H7 St Thomas More Hospital 1338 Phay Avenue Cantildeon City CO 81212 719-285-2000

WOODLAND PARK

H8 Pikes Peak Regional Hospital16420 US Highway 24 Woodland Park CO 80863 719-687-9999

KP Select members have access to these hospitals for scheduled inpatient care

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Northern Colorado

Map is not to scale

50

50

50

5050

25

25

25

25

85

115

115115

9

67

96

231

96

96

47

78

45

24

85

24

24

2485

85

85

115

94

21

83

21

H7

H8

H1

H3

H4

1 H2

H5

H6

3

2

N Powers Blvd

E Woodmen Rd

E 4th St

E Platte Ave

Marksheffel Rd

Squirrel Creek Rd

Briargate Pkwy

W Northern Ave

Central Ave

State Hwy 120Co R

d 17

Doyle Rd

Co Rd 5013 M

eridian Rd

Hanover Rd

S Peyton Hwy

Falcon Hwy

Curtis Rd

Black Forest Rd

Meridian Rd

Peyton Hwy

Pueblo

Colorado Springs

Woodland Park

Cantildeon City

Colorado Small Business Enrollment Guide

21

Medicare Coverage

Kaiser Permanente offers group and individual Medicare Advantage and Prescription Drug Plans

For information on our individual plans contact a licensed sales specialist toll free at 1-855-843-8396 (TTY 711) seven days a week 8 a m to 8 p m or visit kporgmedicare

Adult and Pediatric Dental Care

Kaiser Permanente and Delta Dental of Colorado know good oral health is an important component of overall health so wersquove partnered to provide small group employers pediatric dental benefits and adult-only dental plans to complement Kaiser Permanentersquos medical plans

NEW 2016 Embedded Pediatric Dental Benefit

Separate Annual Deductible (applies to all services)

$50

Diagnostic amp Preventive Services

Oral Exams amp Cleanings (Limited to 2 per calendar year)

Covered 100 after Deductible

Fluoride Treatments (Limited to 2 per calendar year)

Covered 100 after Deductible

Sealants (1 per lifetime per tooth per year) Covered 100 after Deductible

Bitewing X-rays (1 set per calendar year) Covered 100 after Deductible

Basic Services (limited to 2 basic procedures per year)

Fillings Oral Surgery Endodontics Covered 50 after Deductible

Major Services (limited to 1 major procedure per year)

Crowns Covered 50 after Deductible

Embedded Pediatric

Employeersquos children (up through the month they turn 19) can receive any of the procedures listed below each calendar year

Adult Dental

Our adult-only plans complement the embedded pediatric dental coverage and are not tied to medical The lowest-cost plan starts at $13month These plans also offer

bull No waiting period

bull Dual option choices

bull $2000 benefit maximum on the high plan

For more information email Delta Dental directly at salesteamddpcocom Monday-Friday 8 am-5 pm

Important The pediatric dental benefit is embedded in all Small Group plans EXCEPT the KP CO Silver PPO 150040 plan The KP CO Silver PPO 1500-40 plan does not include pediatric dental coverage

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

22

2016 Resources Kaiser Permanente is committed to supporting you and your business Below yoursquoll find important contact information and business resources to save you time

Calling the right person should beEASY

Our goal is to have one-call resolution whenever possible Communicating with the right department is the first step With that in mind wersquove set up ONE Number Easy 303-306-2727 (866-710-2727)

If your question is about You need to talk to

Group Billing and Invoicing Account ReconciliationAdds Drops Cancels or Changes

Consolidated Service CenterOption 1

SG Contracts Brochures Forms New Employee Packets Group Cancellation

Small Group Sales amp ServiceOption 2

Benefits Eligibility Service Resolution Escalated Issues Employee-level Claims

Client Services Unit (CSU)Option 4

Customer Experience Department

Wersquore here to help you transition to Kaiser Permanente Our Customer Experience Team will visit your employees on-site and help them

bull Understand new plans amp benefits

bull Find amp choose physicians

bull Connect to the care they need

bull Transition prescriptions

To reach our Customer Experience team email welcomekporg or call 303-338-3990

Customer Account Services

An easy-to-use web site link that provides online account management for you and your broker You can view group eligibility and billing information update employee data or pay your invoices

If you would like to set up an account please contact your Account Executive or Associate Account Manager for assistance

Colorado Small Business Enrollment Guide

23

2016 Reference

1 Employer Health Benefits 2011 Annual Survey Kaiser Family Foundation and Health Research amp Educational Trust September 2011 Kaiser Family Foundation is a nonprofit private organization not affiliated with Kaiser Permanente

2 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

3 Kaiser Foundation Health Plan of Colorado Inc received the highest numerical score among commercial health plans in the Colorado region in the proprietary JD Power 2008-2015 US Member Health Plan Studiessm Study based on 31543 total member responses measuring four plans in Colorado (excludes Medicare and Medicaid) Proprietary study results are based on experiences and perceptions of members surveyed November-December 2014 Your experiences may vary Visit jdpowercom

4 Please refer to ldquoNCQArsquos Private Health Insurance Plan Rankings 2013-2014rdquo posted online at wwwncqaorg

5 Kaiser Permanente 2012 HEDISreg scores Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compassreg and represent all non- PPO lines of business Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA Quality Compass 2012 includes certain CAHPSreg data Any data display analysis interpretation or conclusion based on these data is solely that of the authors and NCQA specifically disclaims responsibility for any such display analysis interpretation or conclusion Quality Compassreg and HEDISreg are registered trademarks of NCQA CAHPSreg is a registered trademark of the Agency for Healthcare Research and Quality

6 The 2014 Hewitt Health Value InitiativeTM showed Kaiser Permanente is the most cost-efficient plan across all markets served for the sixth year in a rowmdash12 more cost-effective than the average HMO and 17 more cost-effective than the all-plan average Kaiser Permanente also outperformed other plans in clinical quality scoring 49 better than the average HMO and 209 better than the all-plan average Hewitt Health Value InitiativeTM benchmarking study mdash Kaiser Foundation Health Plan Inc Aon Hewitt April 3 2014 To get a copy of the Hewitt Health Value Initiative report for your region contact your account manager

7 Chronic Care Making the Case for Ongoing Care Robert Wood Johnson Foundation 2010

8 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

9 ldquoWorksite Wellnessrdquo Preventdiseasecom httppreventdiseasecomworksite_wellnessworksite_wellnesshtml accessed November 2 2009

10 See Note 9 11 ldquoObesity by the Numbersrdquo obesityinamericaorg accessed March 24 200812 See Note 313 Thomas Delate PhD et al ldquoReduced Health Care Expenditures After Enrollment

in a Collaborative Cardiac Care Servicerdquo Pharmacotherapy November 2010 Results from our cardiac rehabilitation program in Colorado

Kaiser Foundation Health Plan Inc of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Coloradoreg marketplace copy2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questionsCall us at 1-866-331-2091 bull Or contact your agent or broker

• WHATrsquoS INSIDE
• A BETTER WAY to manage costs
• A BETTER WAY to keep youremployees healthier
• Virtual Care Innovations
• Employee Health amp Wellness
• Enhancing the Employee Experience
• Accessing Care in DenverBoulder
• Accessing Care in Mountain Communities
• Accessing Care Northern Colorado
• KP Plans Offered in Colorado
• Accessing Care in Southern Colorado
• KP Select Plans Offered in Colorado Springs
• Medicare Coverage
• Adult and Pediatric Dental Care
• 2016 Resources

Colorado Small Business Enrollment Guide

13

Kaiser Permanente Medical Offices

1 Fort Collins Medical Offices2950 E Harmony Road Suite 190 Fort Collins CO 80528 970-207-7171

2 Loveland Medical Offices4901 Thompson Parkway Loveland CO 80534-6426 970-207-7171

3 Greeley Medical Offices2429 35th Avenue Greeley CO 80634 970-207-7171

Emergency Care

E1 Estes Park Medical Center555 Prospect Avenue Estes Park CO 80517 970-586-2317

E2 McKee Medical Center2000 Boise Avenue Loveland CO 80538 970-669-4640

E3 North Colorado Medical Center1801 16th Street Greeley CO 80631 970-352-4121

E4 Banner Fort Collins Medical Center

4700 Lady Moon DriveFort Collins CO 80528970-229-4000

Urgent Care

U1 Banner Health Clinic ndash Skyline Urgent Care

2555 E 13th Street Suite 110 Loveland CO 80537 970-461-6140

U2 Banner Health Clinic ndash Summit View Urgent Care

2001 70th Ave Suite 110 Greeley CO 80634 970-378-4155

U3 Banner Health Clinic ndash Windsor Urgent Care

1300 Main Street Windsor CO 80550 970-686-5646

U4 The Healthcare Clinic of Fort Collins

1721 W Harmony Road 102 Fort Collins CO 80526 970-223-1999

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Southern Colorado

Estes Park25

25

25

85

85

87

8587

87

34

34

34

3434

34

287

287

287

257

402

392392

257

257

1414

60

6060

256 256

Fort Collins

GreeleyLoveland

2

E3

1

3

E2

E Harmony Rd CO Rd 74CO Rd 74

E Mulberry St

E Prospect Rd

TdR

lli H

tfa

W 29th StE Eisenhower Blvd

W 1st St esi

oBvAe

Zieg

ler R

d

ywkP

arr

etne

C

4th St

W 20th St

W 37th St

16th St

N 8th Ave

ht 9

5vAe

dr 3

2vAe

Medical offices

Hospitals for scheduled inpatient care H

U1

U4E4

U3

34

3434

60

3434

34

Moccasin Cir Dir

Prospect Ave

Highland Ln

Ponderosa Dr

Stanley

Cir Dir

St Vrain Av

Stanley Ave

MacGregor Ave

W Elkhorn Ave

Aspen Ave

Birch Ave

Driftwood Ave

U2

H E

Medical offices

Map is not to scale

34 36

High St

7

E1

25

25

25

85

85

87

8587

87

34

34

34

3434

34

287

287

287

257

402

392392

257

257

1414

60

6060

256 256

Fort Collins

GreeleyLoveland

2

E3

1

3

E2

E Harmony Rd CO Rd 74CO Rd 74

E Mulberry St

E Prospect Rd

TdR

lli H

tfa

W 29th StE Eisenhower Blvd

W 1st St esi

oBvAe

Zieg

ler R

d

ywkP

arr

etne

C

4th St

W 20th St

W 37th St

16th St

N 8th Ave

ht 9

5vAe

dr 3

2vAe

Medical offices

Hospitals for scheduled inpatient care H

U1

U4E4

U3

34

3434

60

3434

34

Moccasin Cir Dir

Prospect Ave

Highland Ln

Ponderosa Dr

Stanley

Cir Dir

St Vrain Av

Stanley Ave

MacGregor Ave

W Elkhorn Ave

Aspen Ave

Birch Ave

Driftwood Ave

U2

H E

Medical offices

Map is not to scale

34 36

High St

7

E1

Estes Park

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

14

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP CO Silver 050

Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a separate $250 prescription

drug deductible

-18

KP CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -33

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Plans Offered in Colorado

Colorado Small Business Enrollment Guide

15

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP CO Silver 050

Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a separate $250 prescription

drug deductible

-18

KP CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -33

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

16

Accessing Care in Southern Colorado

In Southern Colorado more than 61000 people turn to us as their trusted partner in total health We offer comprehensive health services and health care coverage to Colorado Springs Pueblo Cantildeon City and surrounding areas Take a look and yoursquoll see why Kaiser Permanente is a better partner in health

Integrated Care

Wersquove expanded to bring good health closer to our Southern Colorado members We opened a new Kaiser Permanente medical office in central Colorado Springs launched new affordable health insurance plans expanded specialty services at our Briargate location where patients of all ages can be seen

Your employees can access care at any of our locations in Southern Colorado and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care pharmacy laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

The Power to Choose

We also offer your employees an additional choice in Southern Colorado they can visit any Kaiser Permanente medical office in Colorado or choose from a comprehensive network of local physicians in their plan

Colorado Small Business Enrollment Guide

17

Collaborative Care

Wersquore partnering in new ways with network providers to bring best practices to your employees through innovative personalized care programs A care team thatrsquos informed and focused on your employees can lead to better health

Kaiser Permanente Care Connection is a team of local Kaiser Permanente nurses and health professionals who work with our network providers and your employees to manage their health help with care coordination preventative care wellness coaching educational resources and medication management

Pay for Value We identify nationally recognized quality metrics that align with best practices for certain preventive measures and disease states such as hypertension and diabetes Through this program wersquore seeing great results and showing improvements in quality of care for patients with chronic conditions such as Type 2 diabetes and hypertension as well as improving rates of prevention screenings (breast colorectal and cervical cancer)

Kaiser Permanente Select

An affordable high-quality health care plan for Colorado Springs and surrounding areas

Kaiser Permanente Select (KP Select) is all about keeping your employees healthy and keeping your health care costs down Employees who choose the KP Select plan will benefit from the same high-quality care from Kaiser Permanente at an affordable price while following a few guidelines Employees can receive care at any Kaiser Permanente medical office in Colorado with three located in Southern Colorado and have access to more than 400 KP Select providers in the Colorado Springs area Scheduled inpatient hospital care and outpatient care is available at select facilities and refills for maintenance medications must be filled at a Kaiser Permanente medical office pharmacy or through mail order

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

18

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Select Plans Offered in Colorado Springs

Colorado Small Business Enrollment Guide

19

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

20

Kaiser Permanente Medical Offices

1 Briargate Medical Offices 4105 Briargate Pkwy Suite 125 Colorado Springs CO 80920 719-282-2533

2 Parkside Medical Offices215 Parkside Drive Colorado Springs CO 80910 719-327-6540

3 Pueblo North Medical Offices 3670 Parker Boulevard Suite 200 Pueblo CO 81008 719-595-5755

Emergency Care

COLORADO SPRINGS

H1 Childrenrsquos Hospital at Memorial Hospital

1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H1 Memorial Hospital Central 1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H2 Memorial Hospital North 4050 Briargate Parkway Colorado Springs CO 80920 719-364-5000

H3 Penrose Hospital 2222 North Nevada Avenue Colorado Springs CO 80907 719-776-5000

H4 St Francis Medical Center 6001 East Woodmen Road Colorado Springs CO 80920 719-571-5000

PUEBLO

H5 Parkview Medical Center 400 West 16th Street Pueblo CO 81003 719-584-4000

H6 St Mary-Corwin Medical Center1008 Minnequa Avenue Pueblo CO 81004 719-557-4000

CANtildeON CITY

H7 St Thomas More Hospital 1338 Phay Avenue Cantildeon City CO 81212 719-285-2000

WOODLAND PARK

H8 Pikes Peak Regional Hospital16420 US Highway 24 Woodland Park CO 80863 719-687-9999

KP Select members have access to these hospitals for scheduled inpatient care

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Northern Colorado

Map is not to scale

50

50

50

5050

25

25

25

25

85

115

115115

9

67

96

231

96

96

47

78

45

24

85

24

24

2485

85

85

115

94

21

83

21

H7

H8

H1

H3

H4

1 H2

H5

H6

3

2

N Powers Blvd

E Woodmen Rd

E 4th St

E Platte Ave

Marksheffel Rd

Squirrel Creek Rd

Briargate Pkwy

W Northern Ave

Central Ave

State Hwy 120Co R

d 17

Doyle Rd

Co Rd 5013 M

eridian Rd

Hanover Rd

S Peyton Hwy

Falcon Hwy

Curtis Rd

Black Forest Rd

Meridian Rd

Peyton Hwy

Pueblo

Colorado Springs

Woodland Park

Cantildeon City

Colorado Small Business Enrollment Guide

21

Medicare Coverage

Kaiser Permanente offers group and individual Medicare Advantage and Prescription Drug Plans

For information on our individual plans contact a licensed sales specialist toll free at 1-855-843-8396 (TTY 711) seven days a week 8 a m to 8 p m or visit kporgmedicare

Adult and Pediatric Dental Care

Kaiser Permanente and Delta Dental of Colorado know good oral health is an important component of overall health so wersquove partnered to provide small group employers pediatric dental benefits and adult-only dental plans to complement Kaiser Permanentersquos medical plans

NEW 2016 Embedded Pediatric Dental Benefit

Separate Annual Deductible (applies to all services)

$50

Diagnostic amp Preventive Services

Oral Exams amp Cleanings (Limited to 2 per calendar year)

Covered 100 after Deductible

Fluoride Treatments (Limited to 2 per calendar year)

Covered 100 after Deductible

Sealants (1 per lifetime per tooth per year) Covered 100 after Deductible

Bitewing X-rays (1 set per calendar year) Covered 100 after Deductible

Basic Services (limited to 2 basic procedures per year)

Fillings Oral Surgery Endodontics Covered 50 after Deductible

Major Services (limited to 1 major procedure per year)

Crowns Covered 50 after Deductible

Embedded Pediatric

Employeersquos children (up through the month they turn 19) can receive any of the procedures listed below each calendar year

Adult Dental

Our adult-only plans complement the embedded pediatric dental coverage and are not tied to medical The lowest-cost plan starts at $13month These plans also offer

bull No waiting period

bull Dual option choices

bull $2000 benefit maximum on the high plan

For more information email Delta Dental directly at salesteamddpcocom Monday-Friday 8 am-5 pm

Important The pediatric dental benefit is embedded in all Small Group plans EXCEPT the KP CO Silver PPO 150040 plan The KP CO Silver PPO 1500-40 plan does not include pediatric dental coverage

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

22

2016 Resources Kaiser Permanente is committed to supporting you and your business Below yoursquoll find important contact information and business resources to save you time

Calling the right person should beEASY

Our goal is to have one-call resolution whenever possible Communicating with the right department is the first step With that in mind wersquove set up ONE Number Easy 303-306-2727 (866-710-2727)

If your question is about You need to talk to

Group Billing and Invoicing Account ReconciliationAdds Drops Cancels or Changes

Consolidated Service CenterOption 1

SG Contracts Brochures Forms New Employee Packets Group Cancellation

Small Group Sales amp ServiceOption 2

Benefits Eligibility Service Resolution Escalated Issues Employee-level Claims

Client Services Unit (CSU)Option 4

Customer Experience Department

Wersquore here to help you transition to Kaiser Permanente Our Customer Experience Team will visit your employees on-site and help them

bull Understand new plans amp benefits

bull Find amp choose physicians

bull Connect to the care they need

bull Transition prescriptions

To reach our Customer Experience team email welcomekporg or call 303-338-3990

Customer Account Services

An easy-to-use web site link that provides online account management for you and your broker You can view group eligibility and billing information update employee data or pay your invoices

If you would like to set up an account please contact your Account Executive or Associate Account Manager for assistance

Colorado Small Business Enrollment Guide

23

2016 Reference

1 Employer Health Benefits 2011 Annual Survey Kaiser Family Foundation and Health Research amp Educational Trust September 2011 Kaiser Family Foundation is a nonprofit private organization not affiliated with Kaiser Permanente

2 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

3 Kaiser Foundation Health Plan of Colorado Inc received the highest numerical score among commercial health plans in the Colorado region in the proprietary JD Power 2008-2015 US Member Health Plan Studiessm Study based on 31543 total member responses measuring four plans in Colorado (excludes Medicare and Medicaid) Proprietary study results are based on experiences and perceptions of members surveyed November-December 2014 Your experiences may vary Visit jdpowercom

4 Please refer to ldquoNCQArsquos Private Health Insurance Plan Rankings 2013-2014rdquo posted online at wwwncqaorg

5 Kaiser Permanente 2012 HEDISreg scores Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compassreg and represent all non- PPO lines of business Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA Quality Compass 2012 includes certain CAHPSreg data Any data display analysis interpretation or conclusion based on these data is solely that of the authors and NCQA specifically disclaims responsibility for any such display analysis interpretation or conclusion Quality Compassreg and HEDISreg are registered trademarks of NCQA CAHPSreg is a registered trademark of the Agency for Healthcare Research and Quality

6 The 2014 Hewitt Health Value InitiativeTM showed Kaiser Permanente is the most cost-efficient plan across all markets served for the sixth year in a rowmdash12 more cost-effective than the average HMO and 17 more cost-effective than the all-plan average Kaiser Permanente also outperformed other plans in clinical quality scoring 49 better than the average HMO and 209 better than the all-plan average Hewitt Health Value InitiativeTM benchmarking study mdash Kaiser Foundation Health Plan Inc Aon Hewitt April 3 2014 To get a copy of the Hewitt Health Value Initiative report for your region contact your account manager

7 Chronic Care Making the Case for Ongoing Care Robert Wood Johnson Foundation 2010

8 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

9 ldquoWorksite Wellnessrdquo Preventdiseasecom httppreventdiseasecomworksite_wellnessworksite_wellnesshtml accessed November 2 2009

10 See Note 9 11 ldquoObesity by the Numbersrdquo obesityinamericaorg accessed March 24 200812 See Note 313 Thomas Delate PhD et al ldquoReduced Health Care Expenditures After Enrollment

in a Collaborative Cardiac Care Servicerdquo Pharmacotherapy November 2010 Results from our cardiac rehabilitation program in Colorado

Kaiser Foundation Health Plan Inc of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Coloradoreg marketplace copy2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questionsCall us at 1-866-331-2091 bull Or contact your agent or broker

• WHATrsquoS INSIDE
• A BETTER WAY to manage costs
• A BETTER WAY to keep youremployees healthier
• Virtual Care Innovations
• Employee Health amp Wellness
• Enhancing the Employee Experience
• Accessing Care in DenverBoulder
• Accessing Care in Mountain Communities
• Accessing Care Northern Colorado
• KP Plans Offered in Colorado
• Accessing Care in Southern Colorado
• KP Select Plans Offered in Colorado Springs
• Medicare Coverage
• Adult and Pediatric Dental Care
• 2016 Resources

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

14

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP CO Silver 050

Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a separate $250 prescription

drug deductible

-18

KP CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -33

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Plans Offered in Colorado

Colorado Small Business Enrollment Guide

15

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP CO Silver 050

Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a separate $250 prescription

drug deductible

-18

KP CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -33

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

16

Accessing Care in Southern Colorado

In Southern Colorado more than 61000 people turn to us as their trusted partner in total health We offer comprehensive health services and health care coverage to Colorado Springs Pueblo Cantildeon City and surrounding areas Take a look and yoursquoll see why Kaiser Permanente is a better partner in health

Integrated Care

Wersquove expanded to bring good health closer to our Southern Colorado members We opened a new Kaiser Permanente medical office in central Colorado Springs launched new affordable health insurance plans expanded specialty services at our Briargate location where patients of all ages can be seen

Your employees can access care at any of our locations in Southern Colorado and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care pharmacy laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

The Power to Choose

We also offer your employees an additional choice in Southern Colorado they can visit any Kaiser Permanente medical office in Colorado or choose from a comprehensive network of local physicians in their plan

Colorado Small Business Enrollment Guide

17

Collaborative Care

Wersquore partnering in new ways with network providers to bring best practices to your employees through innovative personalized care programs A care team thatrsquos informed and focused on your employees can lead to better health

Kaiser Permanente Care Connection is a team of local Kaiser Permanente nurses and health professionals who work with our network providers and your employees to manage their health help with care coordination preventative care wellness coaching educational resources and medication management

Pay for Value We identify nationally recognized quality metrics that align with best practices for certain preventive measures and disease states such as hypertension and diabetes Through this program wersquore seeing great results and showing improvements in quality of care for patients with chronic conditions such as Type 2 diabetes and hypertension as well as improving rates of prevention screenings (breast colorectal and cervical cancer)

Kaiser Permanente Select

An affordable high-quality health care plan for Colorado Springs and surrounding areas

Kaiser Permanente Select (KP Select) is all about keeping your employees healthy and keeping your health care costs down Employees who choose the KP Select plan will benefit from the same high-quality care from Kaiser Permanente at an affordable price while following a few guidelines Employees can receive care at any Kaiser Permanente medical office in Colorado with three located in Southern Colorado and have access to more than 400 KP Select providers in the Colorado Springs area Scheduled inpatient hospital care and outpatient care is available at select facilities and refills for maintenance medications must be filled at a Kaiser Permanente medical office pharmacy or through mail order

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

18

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Select Plans Offered in Colorado Springs

Colorado Small Business Enrollment Guide

19

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

20

Kaiser Permanente Medical Offices

1 Briargate Medical Offices 4105 Briargate Pkwy Suite 125 Colorado Springs CO 80920 719-282-2533

2 Parkside Medical Offices215 Parkside Drive Colorado Springs CO 80910 719-327-6540

3 Pueblo North Medical Offices 3670 Parker Boulevard Suite 200 Pueblo CO 81008 719-595-5755

Emergency Care

COLORADO SPRINGS

H1 Childrenrsquos Hospital at Memorial Hospital

1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H1 Memorial Hospital Central 1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H2 Memorial Hospital North 4050 Briargate Parkway Colorado Springs CO 80920 719-364-5000

H3 Penrose Hospital 2222 North Nevada Avenue Colorado Springs CO 80907 719-776-5000

H4 St Francis Medical Center 6001 East Woodmen Road Colorado Springs CO 80920 719-571-5000

PUEBLO

H5 Parkview Medical Center 400 West 16th Street Pueblo CO 81003 719-584-4000

H6 St Mary-Corwin Medical Center1008 Minnequa Avenue Pueblo CO 81004 719-557-4000

CANtildeON CITY

H7 St Thomas More Hospital 1338 Phay Avenue Cantildeon City CO 81212 719-285-2000

WOODLAND PARK

H8 Pikes Peak Regional Hospital16420 US Highway 24 Woodland Park CO 80863 719-687-9999

KP Select members have access to these hospitals for scheduled inpatient care

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Northern Colorado

Map is not to scale

50

50

50

5050

25

25

25

25

85

115

115115

9

67

96

231

96

96

47

78

45

24

85

24

24

2485

85

85

115

94

21

83

21

H7

H8

H1

H3

H4

1 H2

H5

H6

3

2

N Powers Blvd

E Woodmen Rd

E 4th St

E Platte Ave

Marksheffel Rd

Squirrel Creek Rd

Briargate Pkwy

W Northern Ave

Central Ave

State Hwy 120Co R

d 17

Doyle Rd

Co Rd 5013 M

eridian Rd

Hanover Rd

S Peyton Hwy

Falcon Hwy

Curtis Rd

Black Forest Rd

Meridian Rd

Peyton Hwy

Pueblo

Colorado Springs

Woodland Park

Cantildeon City

Colorado Small Business Enrollment Guide

21

Medicare Coverage

Kaiser Permanente offers group and individual Medicare Advantage and Prescription Drug Plans

For information on our individual plans contact a licensed sales specialist toll free at 1-855-843-8396 (TTY 711) seven days a week 8 a m to 8 p m or visit kporgmedicare

Adult and Pediatric Dental Care

Kaiser Permanente and Delta Dental of Colorado know good oral health is an important component of overall health so wersquove partnered to provide small group employers pediatric dental benefits and adult-only dental plans to complement Kaiser Permanentersquos medical plans

NEW 2016 Embedded Pediatric Dental Benefit

Separate Annual Deductible (applies to all services)

$50

Diagnostic amp Preventive Services

Oral Exams amp Cleanings (Limited to 2 per calendar year)

Covered 100 after Deductible

Fluoride Treatments (Limited to 2 per calendar year)

Covered 100 after Deductible

Sealants (1 per lifetime per tooth per year) Covered 100 after Deductible

Bitewing X-rays (1 set per calendar year) Covered 100 after Deductible

Basic Services (limited to 2 basic procedures per year)

Fillings Oral Surgery Endodontics Covered 50 after Deductible

Major Services (limited to 1 major procedure per year)

Crowns Covered 50 after Deductible

Embedded Pediatric

Employeersquos children (up through the month they turn 19) can receive any of the procedures listed below each calendar year

Adult Dental

Our adult-only plans complement the embedded pediatric dental coverage and are not tied to medical The lowest-cost plan starts at $13month These plans also offer

bull No waiting period

bull Dual option choices

bull $2000 benefit maximum on the high plan

For more information email Delta Dental directly at salesteamddpcocom Monday-Friday 8 am-5 pm

Important The pediatric dental benefit is embedded in all Small Group plans EXCEPT the KP CO Silver PPO 150040 plan The KP CO Silver PPO 1500-40 plan does not include pediatric dental coverage

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

22

2016 Resources Kaiser Permanente is committed to supporting you and your business Below yoursquoll find important contact information and business resources to save you time

Calling the right person should beEASY

Our goal is to have one-call resolution whenever possible Communicating with the right department is the first step With that in mind wersquove set up ONE Number Easy 303-306-2727 (866-710-2727)

If your question is about You need to talk to

Group Billing and Invoicing Account ReconciliationAdds Drops Cancels or Changes

Consolidated Service CenterOption 1

SG Contracts Brochures Forms New Employee Packets Group Cancellation

Small Group Sales amp ServiceOption 2

Benefits Eligibility Service Resolution Escalated Issues Employee-level Claims

Client Services Unit (CSU)Option 4

Customer Experience Department

Wersquore here to help you transition to Kaiser Permanente Our Customer Experience Team will visit your employees on-site and help them

bull Understand new plans amp benefits

bull Find amp choose physicians

bull Connect to the care they need

bull Transition prescriptions

To reach our Customer Experience team email welcomekporg or call 303-338-3990

Customer Account Services

An easy-to-use web site link that provides online account management for you and your broker You can view group eligibility and billing information update employee data or pay your invoices

If you would like to set up an account please contact your Account Executive or Associate Account Manager for assistance

Colorado Small Business Enrollment Guide

23

2016 Reference

1 Employer Health Benefits 2011 Annual Survey Kaiser Family Foundation and Health Research amp Educational Trust September 2011 Kaiser Family Foundation is a nonprofit private organization not affiliated with Kaiser Permanente

2 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

3 Kaiser Foundation Health Plan of Colorado Inc received the highest numerical score among commercial health plans in the Colorado region in the proprietary JD Power 2008-2015 US Member Health Plan Studiessm Study based on 31543 total member responses measuring four plans in Colorado (excludes Medicare and Medicaid) Proprietary study results are based on experiences and perceptions of members surveyed November-December 2014 Your experiences may vary Visit jdpowercom

4 Please refer to ldquoNCQArsquos Private Health Insurance Plan Rankings 2013-2014rdquo posted online at wwwncqaorg

5 Kaiser Permanente 2012 HEDISreg scores Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compassreg and represent all non- PPO lines of business Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA Quality Compass 2012 includes certain CAHPSreg data Any data display analysis interpretation or conclusion based on these data is solely that of the authors and NCQA specifically disclaims responsibility for any such display analysis interpretation or conclusion Quality Compassreg and HEDISreg are registered trademarks of NCQA CAHPSreg is a registered trademark of the Agency for Healthcare Research and Quality

6 The 2014 Hewitt Health Value InitiativeTM showed Kaiser Permanente is the most cost-efficient plan across all markets served for the sixth year in a rowmdash12 more cost-effective than the average HMO and 17 more cost-effective than the all-plan average Kaiser Permanente also outperformed other plans in clinical quality scoring 49 better than the average HMO and 209 better than the all-plan average Hewitt Health Value InitiativeTM benchmarking study mdash Kaiser Foundation Health Plan Inc Aon Hewitt April 3 2014 To get a copy of the Hewitt Health Value Initiative report for your region contact your account manager

7 Chronic Care Making the Case for Ongoing Care Robert Wood Johnson Foundation 2010

8 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

9 ldquoWorksite Wellnessrdquo Preventdiseasecom httppreventdiseasecomworksite_wellnessworksite_wellnesshtml accessed November 2 2009

10 See Note 9 11 ldquoObesity by the Numbersrdquo obesityinamericaorg accessed March 24 200812 See Note 313 Thomas Delate PhD et al ldquoReduced Health Care Expenditures After Enrollment

in a Collaborative Cardiac Care Servicerdquo Pharmacotherapy November 2010 Results from our cardiac rehabilitation program in Colorado

Kaiser Foundation Health Plan Inc of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Coloradoreg marketplace copy2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questionsCall us at 1-866-331-2091 bull Or contact your agent or broker

• WHATrsquoS INSIDE
• A BETTER WAY to manage costs
• A BETTER WAY to keep youremployees healthier
• Virtual Care Innovations
• Employee Health amp Wellness
• Enhancing the Employee Experience
• Accessing Care in DenverBoulder
• Accessing Care in Mountain Communities
• Accessing Care Northern Colorado
• KP Plans Offered in Colorado
• Accessing Care in Southern Colorado
• KP Select Plans Offered in Colorado Springs
• Medicare Coverage
• Adult and Pediatric Dental Care
• 2016 Resources

Colorado Small Business Enrollment Guide

15

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP CO Silver 050

Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a separate $250 prescription

drug deductible

-18

KP CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -33

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

16

Accessing Care in Southern Colorado

In Southern Colorado more than 61000 people turn to us as their trusted partner in total health We offer comprehensive health services and health care coverage to Colorado Springs Pueblo Cantildeon City and surrounding areas Take a look and yoursquoll see why Kaiser Permanente is a better partner in health

Integrated Care

Wersquove expanded to bring good health closer to our Southern Colorado members We opened a new Kaiser Permanente medical office in central Colorado Springs launched new affordable health insurance plans expanded specialty services at our Briargate location where patients of all ages can be seen

Your employees can access care at any of our locations in Southern Colorado and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care pharmacy laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

The Power to Choose

We also offer your employees an additional choice in Southern Colorado they can visit any Kaiser Permanente medical office in Colorado or choose from a comprehensive network of local physicians in their plan

Colorado Small Business Enrollment Guide

17

Collaborative Care

Wersquore partnering in new ways with network providers to bring best practices to your employees through innovative personalized care programs A care team thatrsquos informed and focused on your employees can lead to better health

Kaiser Permanente Care Connection is a team of local Kaiser Permanente nurses and health professionals who work with our network providers and your employees to manage their health help with care coordination preventative care wellness coaching educational resources and medication management

Pay for Value We identify nationally recognized quality metrics that align with best practices for certain preventive measures and disease states such as hypertension and diabetes Through this program wersquore seeing great results and showing improvements in quality of care for patients with chronic conditions such as Type 2 diabetes and hypertension as well as improving rates of prevention screenings (breast colorectal and cervical cancer)

Kaiser Permanente Select

An affordable high-quality health care plan for Colorado Springs and surrounding areas

Kaiser Permanente Select (KP Select) is all about keeping your employees healthy and keeping your health care costs down Employees who choose the KP Select plan will benefit from the same high-quality care from Kaiser Permanente at an affordable price while following a few guidelines Employees can receive care at any Kaiser Permanente medical office in Colorado with three located in Southern Colorado and have access to more than 400 KP Select providers in the Colorado Springs area Scheduled inpatient hospital care and outpatient care is available at select facilities and refills for maintenance medications must be filled at a Kaiser Permanente medical office pharmacy or through mail order

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

18

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Select Plans Offered in Colorado Springs

Colorado Small Business Enrollment Guide

19

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

20

Kaiser Permanente Medical Offices

1 Briargate Medical Offices 4105 Briargate Pkwy Suite 125 Colorado Springs CO 80920 719-282-2533

2 Parkside Medical Offices215 Parkside Drive Colorado Springs CO 80910 719-327-6540

3 Pueblo North Medical Offices 3670 Parker Boulevard Suite 200 Pueblo CO 81008 719-595-5755

Emergency Care

COLORADO SPRINGS

H1 Childrenrsquos Hospital at Memorial Hospital

1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H1 Memorial Hospital Central 1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H2 Memorial Hospital North 4050 Briargate Parkway Colorado Springs CO 80920 719-364-5000

H3 Penrose Hospital 2222 North Nevada Avenue Colorado Springs CO 80907 719-776-5000

H4 St Francis Medical Center 6001 East Woodmen Road Colorado Springs CO 80920 719-571-5000

PUEBLO

H5 Parkview Medical Center 400 West 16th Street Pueblo CO 81003 719-584-4000

H6 St Mary-Corwin Medical Center1008 Minnequa Avenue Pueblo CO 81004 719-557-4000

CANtildeON CITY

H7 St Thomas More Hospital 1338 Phay Avenue Cantildeon City CO 81212 719-285-2000

WOODLAND PARK

H8 Pikes Peak Regional Hospital16420 US Highway 24 Woodland Park CO 80863 719-687-9999

KP Select members have access to these hospitals for scheduled inpatient care

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Northern Colorado

Map is not to scale

50

50

50

5050

25

25

25

25

85

115

115115

9

67

96

231

96

96

47

78

45

24

85

24

24

2485

85

85

115

94

21

83

21

H7

H8

H1

H3

H4

1 H2

H5

H6

3

2

N Powers Blvd

E Woodmen Rd

E 4th St

E Platte Ave

Marksheffel Rd

Squirrel Creek Rd

Briargate Pkwy

W Northern Ave

Central Ave

State Hwy 120Co R

d 17

Doyle Rd

Co Rd 5013 M

eridian Rd

Hanover Rd

S Peyton Hwy

Falcon Hwy

Curtis Rd

Black Forest Rd

Meridian Rd

Peyton Hwy

Pueblo

Colorado Springs

Woodland Park

Cantildeon City

Colorado Small Business Enrollment Guide

21

Medicare Coverage

Kaiser Permanente offers group and individual Medicare Advantage and Prescription Drug Plans

For information on our individual plans contact a licensed sales specialist toll free at 1-855-843-8396 (TTY 711) seven days a week 8 a m to 8 p m or visit kporgmedicare

Adult and Pediatric Dental Care

Kaiser Permanente and Delta Dental of Colorado know good oral health is an important component of overall health so wersquove partnered to provide small group employers pediatric dental benefits and adult-only dental plans to complement Kaiser Permanentersquos medical plans

NEW 2016 Embedded Pediatric Dental Benefit

Separate Annual Deductible (applies to all services)

$50

Diagnostic amp Preventive Services

Oral Exams amp Cleanings (Limited to 2 per calendar year)

Covered 100 after Deductible

Fluoride Treatments (Limited to 2 per calendar year)

Covered 100 after Deductible

Sealants (1 per lifetime per tooth per year) Covered 100 after Deductible

Bitewing X-rays (1 set per calendar year) Covered 100 after Deductible

Basic Services (limited to 2 basic procedures per year)

Fillings Oral Surgery Endodontics Covered 50 after Deductible

Major Services (limited to 1 major procedure per year)

Crowns Covered 50 after Deductible

Embedded Pediatric

Employeersquos children (up through the month they turn 19) can receive any of the procedures listed below each calendar year

Adult Dental

Our adult-only plans complement the embedded pediatric dental coverage and are not tied to medical The lowest-cost plan starts at $13month These plans also offer

bull No waiting period

bull Dual option choices

bull $2000 benefit maximum on the high plan

For more information email Delta Dental directly at salesteamddpcocom Monday-Friday 8 am-5 pm

Important The pediatric dental benefit is embedded in all Small Group plans EXCEPT the KP CO Silver PPO 150040 plan The KP CO Silver PPO 1500-40 plan does not include pediatric dental coverage

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

22

2016 Resources Kaiser Permanente is committed to supporting you and your business Below yoursquoll find important contact information and business resources to save you time

Calling the right person should beEASY

Our goal is to have one-call resolution whenever possible Communicating with the right department is the first step With that in mind wersquove set up ONE Number Easy 303-306-2727 (866-710-2727)

If your question is about You need to talk to

Group Billing and Invoicing Account ReconciliationAdds Drops Cancels or Changes

Consolidated Service CenterOption 1

SG Contracts Brochures Forms New Employee Packets Group Cancellation

Small Group Sales amp ServiceOption 2

Benefits Eligibility Service Resolution Escalated Issues Employee-level Claims

Client Services Unit (CSU)Option 4

Customer Experience Department

Wersquore here to help you transition to Kaiser Permanente Our Customer Experience Team will visit your employees on-site and help them

bull Understand new plans amp benefits

bull Find amp choose physicians

bull Connect to the care they need

bull Transition prescriptions

To reach our Customer Experience team email welcomekporg or call 303-338-3990

Customer Account Services

An easy-to-use web site link that provides online account management for you and your broker You can view group eligibility and billing information update employee data or pay your invoices

If you would like to set up an account please contact your Account Executive or Associate Account Manager for assistance

Colorado Small Business Enrollment Guide

23

2016 Reference

1 Employer Health Benefits 2011 Annual Survey Kaiser Family Foundation and Health Research amp Educational Trust September 2011 Kaiser Family Foundation is a nonprofit private organization not affiliated with Kaiser Permanente

2 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

3 Kaiser Foundation Health Plan of Colorado Inc received the highest numerical score among commercial health plans in the Colorado region in the proprietary JD Power 2008-2015 US Member Health Plan Studiessm Study based on 31543 total member responses measuring four plans in Colorado (excludes Medicare and Medicaid) Proprietary study results are based on experiences and perceptions of members surveyed November-December 2014 Your experiences may vary Visit jdpowercom

4 Please refer to ldquoNCQArsquos Private Health Insurance Plan Rankings 2013-2014rdquo posted online at wwwncqaorg

5 Kaiser Permanente 2012 HEDISreg scores Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compassreg and represent all non- PPO lines of business Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA Quality Compass 2012 includes certain CAHPSreg data Any data display analysis interpretation or conclusion based on these data is solely that of the authors and NCQA specifically disclaims responsibility for any such display analysis interpretation or conclusion Quality Compassreg and HEDISreg are registered trademarks of NCQA CAHPSreg is a registered trademark of the Agency for Healthcare Research and Quality

6 The 2014 Hewitt Health Value InitiativeTM showed Kaiser Permanente is the most cost-efficient plan across all markets served for the sixth year in a rowmdash12 more cost-effective than the average HMO and 17 more cost-effective than the all-plan average Kaiser Permanente also outperformed other plans in clinical quality scoring 49 better than the average HMO and 209 better than the all-plan average Hewitt Health Value InitiativeTM benchmarking study mdash Kaiser Foundation Health Plan Inc Aon Hewitt April 3 2014 To get a copy of the Hewitt Health Value Initiative report for your region contact your account manager

7 Chronic Care Making the Case for Ongoing Care Robert Wood Johnson Foundation 2010

8 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

9 ldquoWorksite Wellnessrdquo Preventdiseasecom httppreventdiseasecomworksite_wellnessworksite_wellnesshtml accessed November 2 2009

10 See Note 9 11 ldquoObesity by the Numbersrdquo obesityinamericaorg accessed March 24 200812 See Note 313 Thomas Delate PhD et al ldquoReduced Health Care Expenditures After Enrollment

in a Collaborative Cardiac Care Servicerdquo Pharmacotherapy November 2010 Results from our cardiac rehabilitation program in Colorado

Kaiser Foundation Health Plan Inc of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Coloradoreg marketplace copy2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questionsCall us at 1-866-331-2091 bull Or contact your agent or broker

• WHATrsquoS INSIDE
• A BETTER WAY to manage costs
• A BETTER WAY to keep youremployees healthier
• Virtual Care Innovations
• Employee Health amp Wellness
• Enhancing the Employee Experience
• Accessing Care in DenverBoulder
• Accessing Care in Mountain Communities
• Accessing Care Northern Colorado
• KP Plans Offered in Colorado
• Accessing Care in Southern Colorado
• KP Select Plans Offered in Colorado Springs
• Medicare Coverage
• Adult and Pediatric Dental Care
• 2016 Resources

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

16

Accessing Care in Southern Colorado

In Southern Colorado more than 61000 people turn to us as their trusted partner in total health We offer comprehensive health services and health care coverage to Colorado Springs Pueblo Cantildeon City and surrounding areas Take a look and yoursquoll see why Kaiser Permanente is a better partner in health

Integrated Care

Wersquove expanded to bring good health closer to our Southern Colorado members We opened a new Kaiser Permanente medical office in central Colorado Springs launched new affordable health insurance plans expanded specialty services at our Briargate location where patients of all ages can be seen

Your employees can access care at any of our locations in Southern Colorado and at any of our 28 Kaiser Permanente locations throughout Colorado With primary care pharmacy laboratory and medical imaging all under one roof ndash receiving care at a Kaiser Permanente Medical Office can save your employees time

Theyrsquoll also benefit from Kaiser Permanentersquos integrated approach to health care delivery when receiving care at our Kaiser Permanente medical offices My Health Manager on kporg allows them the ability to schedule appointments view most lab results order prescriptions and email their Kaiser Permanente doctors With innovative web-based tools through kporg and the recently launched app for mobile devices your employees will have access to information in their secure medical record

The Power to Choose

We also offer your employees an additional choice in Southern Colorado they can visit any Kaiser Permanente medical office in Colorado or choose from a comprehensive network of local physicians in their plan

Colorado Small Business Enrollment Guide

17

Collaborative Care

Wersquore partnering in new ways with network providers to bring best practices to your employees through innovative personalized care programs A care team thatrsquos informed and focused on your employees can lead to better health

Kaiser Permanente Care Connection is a team of local Kaiser Permanente nurses and health professionals who work with our network providers and your employees to manage their health help with care coordination preventative care wellness coaching educational resources and medication management

Pay for Value We identify nationally recognized quality metrics that align with best practices for certain preventive measures and disease states such as hypertension and diabetes Through this program wersquore seeing great results and showing improvements in quality of care for patients with chronic conditions such as Type 2 diabetes and hypertension as well as improving rates of prevention screenings (breast colorectal and cervical cancer)

Kaiser Permanente Select

An affordable high-quality health care plan for Colorado Springs and surrounding areas

Kaiser Permanente Select (KP Select) is all about keeping your employees healthy and keeping your health care costs down Employees who choose the KP Select plan will benefit from the same high-quality care from Kaiser Permanente at an affordable price while following a few guidelines Employees can receive care at any Kaiser Permanente medical office in Colorado with three located in Southern Colorado and have access to more than 400 KP Select providers in the Colorado Springs area Scheduled inpatient hospital care and outpatient care is available at select facilities and refills for maintenance medications must be filled at a Kaiser Permanente medical office pharmacy or through mail order

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

18

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Select Plans Offered in Colorado Springs

Colorado Small Business Enrollment Guide

19

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

20

Kaiser Permanente Medical Offices

1 Briargate Medical Offices 4105 Briargate Pkwy Suite 125 Colorado Springs CO 80920 719-282-2533

2 Parkside Medical Offices215 Parkside Drive Colorado Springs CO 80910 719-327-6540

3 Pueblo North Medical Offices 3670 Parker Boulevard Suite 200 Pueblo CO 81008 719-595-5755

Emergency Care

COLORADO SPRINGS

H1 Childrenrsquos Hospital at Memorial Hospital

1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H1 Memorial Hospital Central 1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H2 Memorial Hospital North 4050 Briargate Parkway Colorado Springs CO 80920 719-364-5000

H3 Penrose Hospital 2222 North Nevada Avenue Colorado Springs CO 80907 719-776-5000

H4 St Francis Medical Center 6001 East Woodmen Road Colorado Springs CO 80920 719-571-5000

PUEBLO

H5 Parkview Medical Center 400 West 16th Street Pueblo CO 81003 719-584-4000

H6 St Mary-Corwin Medical Center1008 Minnequa Avenue Pueblo CO 81004 719-557-4000

CANtildeON CITY

H7 St Thomas More Hospital 1338 Phay Avenue Cantildeon City CO 81212 719-285-2000

WOODLAND PARK

H8 Pikes Peak Regional Hospital16420 US Highway 24 Woodland Park CO 80863 719-687-9999

KP Select members have access to these hospitals for scheduled inpatient care

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Northern Colorado

Map is not to scale

50

50

50

5050

25

25

25

25

85

115

115115

9

67

96

231

96

96

47

78

45

24

85

24

24

2485

85

85

115

94

21

83

21

H7

H8

H1

H3

H4

1 H2

H5

H6

3

2

N Powers Blvd

E Woodmen Rd

E 4th St

E Platte Ave

Marksheffel Rd

Squirrel Creek Rd

Briargate Pkwy

W Northern Ave

Central Ave

State Hwy 120Co R

d 17

Doyle Rd

Co Rd 5013 M

eridian Rd

Hanover Rd

S Peyton Hwy

Falcon Hwy

Curtis Rd

Black Forest Rd

Meridian Rd

Peyton Hwy

Pueblo

Colorado Springs

Woodland Park

Cantildeon City

Colorado Small Business Enrollment Guide

21

Medicare Coverage

Kaiser Permanente offers group and individual Medicare Advantage and Prescription Drug Plans

For information on our individual plans contact a licensed sales specialist toll free at 1-855-843-8396 (TTY 711) seven days a week 8 a m to 8 p m or visit kporgmedicare

Adult and Pediatric Dental Care

Kaiser Permanente and Delta Dental of Colorado know good oral health is an important component of overall health so wersquove partnered to provide small group employers pediatric dental benefits and adult-only dental plans to complement Kaiser Permanentersquos medical plans

NEW 2016 Embedded Pediatric Dental Benefit

Separate Annual Deductible (applies to all services)

$50

Diagnostic amp Preventive Services

Oral Exams amp Cleanings (Limited to 2 per calendar year)

Covered 100 after Deductible

Fluoride Treatments (Limited to 2 per calendar year)

Covered 100 after Deductible

Sealants (1 per lifetime per tooth per year) Covered 100 after Deductible

Bitewing X-rays (1 set per calendar year) Covered 100 after Deductible

Basic Services (limited to 2 basic procedures per year)

Fillings Oral Surgery Endodontics Covered 50 after Deductible

Major Services (limited to 1 major procedure per year)

Crowns Covered 50 after Deductible

Embedded Pediatric

Employeersquos children (up through the month they turn 19) can receive any of the procedures listed below each calendar year

Adult Dental

Our adult-only plans complement the embedded pediatric dental coverage and are not tied to medical The lowest-cost plan starts at $13month These plans also offer

bull No waiting period

bull Dual option choices

bull $2000 benefit maximum on the high plan

For more information email Delta Dental directly at salesteamddpcocom Monday-Friday 8 am-5 pm

Important The pediatric dental benefit is embedded in all Small Group plans EXCEPT the KP CO Silver PPO 150040 plan The KP CO Silver PPO 1500-40 plan does not include pediatric dental coverage

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

22

2016 Resources Kaiser Permanente is committed to supporting you and your business Below yoursquoll find important contact information and business resources to save you time

Calling the right person should beEASY

Our goal is to have one-call resolution whenever possible Communicating with the right department is the first step With that in mind wersquove set up ONE Number Easy 303-306-2727 (866-710-2727)

If your question is about You need to talk to

Group Billing and Invoicing Account ReconciliationAdds Drops Cancels or Changes

Consolidated Service CenterOption 1

SG Contracts Brochures Forms New Employee Packets Group Cancellation

Small Group Sales amp ServiceOption 2

Benefits Eligibility Service Resolution Escalated Issues Employee-level Claims

Client Services Unit (CSU)Option 4

Customer Experience Department

Wersquore here to help you transition to Kaiser Permanente Our Customer Experience Team will visit your employees on-site and help them

bull Understand new plans amp benefits

bull Find amp choose physicians

bull Connect to the care they need

bull Transition prescriptions

To reach our Customer Experience team email welcomekporg or call 303-338-3990

Customer Account Services

An easy-to-use web site link that provides online account management for you and your broker You can view group eligibility and billing information update employee data or pay your invoices

If you would like to set up an account please contact your Account Executive or Associate Account Manager for assistance

Colorado Small Business Enrollment Guide

23

2016 Reference

1 Employer Health Benefits 2011 Annual Survey Kaiser Family Foundation and Health Research amp Educational Trust September 2011 Kaiser Family Foundation is a nonprofit private organization not affiliated with Kaiser Permanente

2 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

3 Kaiser Foundation Health Plan of Colorado Inc received the highest numerical score among commercial health plans in the Colorado region in the proprietary JD Power 2008-2015 US Member Health Plan Studiessm Study based on 31543 total member responses measuring four plans in Colorado (excludes Medicare and Medicaid) Proprietary study results are based on experiences and perceptions of members surveyed November-December 2014 Your experiences may vary Visit jdpowercom

4 Please refer to ldquoNCQArsquos Private Health Insurance Plan Rankings 2013-2014rdquo posted online at wwwncqaorg

5 Kaiser Permanente 2012 HEDISreg scores Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compassreg and represent all non- PPO lines of business Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA Quality Compass 2012 includes certain CAHPSreg data Any data display analysis interpretation or conclusion based on these data is solely that of the authors and NCQA specifically disclaims responsibility for any such display analysis interpretation or conclusion Quality Compassreg and HEDISreg are registered trademarks of NCQA CAHPSreg is a registered trademark of the Agency for Healthcare Research and Quality

6 The 2014 Hewitt Health Value InitiativeTM showed Kaiser Permanente is the most cost-efficient plan across all markets served for the sixth year in a rowmdash12 more cost-effective than the average HMO and 17 more cost-effective than the all-plan average Kaiser Permanente also outperformed other plans in clinical quality scoring 49 better than the average HMO and 209 better than the all-plan average Hewitt Health Value InitiativeTM benchmarking study mdash Kaiser Foundation Health Plan Inc Aon Hewitt April 3 2014 To get a copy of the Hewitt Health Value Initiative report for your region contact your account manager

7 Chronic Care Making the Case for Ongoing Care Robert Wood Johnson Foundation 2010

8 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

9 ldquoWorksite Wellnessrdquo Preventdiseasecom httppreventdiseasecomworksite_wellnessworksite_wellnesshtml accessed November 2 2009

10 See Note 9 11 ldquoObesity by the Numbersrdquo obesityinamericaorg accessed March 24 200812 See Note 313 Thomas Delate PhD et al ldquoReduced Health Care Expenditures After Enrollment

in a Collaborative Cardiac Care Servicerdquo Pharmacotherapy November 2010 Results from our cardiac rehabilitation program in Colorado

Kaiser Foundation Health Plan Inc of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Coloradoreg marketplace copy2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questionsCall us at 1-866-331-2091 bull Or contact your agent or broker

• WHATrsquoS INSIDE
• A BETTER WAY to manage costs
• A BETTER WAY to keep youremployees healthier
• Virtual Care Innovations
• Employee Health amp Wellness
• Enhancing the Employee Experience
• Accessing Care in DenverBoulder
• Accessing Care in Mountain Communities
• Accessing Care Northern Colorado
• KP Plans Offered in Colorado
• Accessing Care in Southern Colorado
• KP Select Plans Offered in Colorado Springs
• Medicare Coverage
• Adult and Pediatric Dental Care
• 2016 Resources

Colorado Small Business Enrollment Guide

17

Collaborative Care

Wersquore partnering in new ways with network providers to bring best practices to your employees through innovative personalized care programs A care team thatrsquos informed and focused on your employees can lead to better health

Kaiser Permanente Care Connection is a team of local Kaiser Permanente nurses and health professionals who work with our network providers and your employees to manage their health help with care coordination preventative care wellness coaching educational resources and medication management

Pay for Value We identify nationally recognized quality metrics that align with best practices for certain preventive measures and disease states such as hypertension and diabetes Through this program wersquore seeing great results and showing improvements in quality of care for patients with chronic conditions such as Type 2 diabetes and hypertension as well as improving rates of prevention screenings (breast colorectal and cervical cancer)

Kaiser Permanente Select

An affordable high-quality health care plan for Colorado Springs and surrounding areas

Kaiser Permanente Select (KP Select) is all about keeping your employees healthy and keeping your health care costs down Employees who choose the KP Select plan will benefit from the same high-quality care from Kaiser Permanente at an affordable price while following a few guidelines Employees can receive care at any Kaiser Permanente medical office in Colorado with three located in Southern Colorado and have access to more than 400 KP Select providers in the Colorado Springs area Scheduled inpatient hospital care and outpatient care is available at select facilities and refills for maintenance medications must be filled at a Kaiser Permanente medical office pharmacy or through mail order

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

18

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Select Plans Offered in Colorado Springs

Colorado Small Business Enrollment Guide

19

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

20

Kaiser Permanente Medical Offices

1 Briargate Medical Offices 4105 Briargate Pkwy Suite 125 Colorado Springs CO 80920 719-282-2533

2 Parkside Medical Offices215 Parkside Drive Colorado Springs CO 80910 719-327-6540

3 Pueblo North Medical Offices 3670 Parker Boulevard Suite 200 Pueblo CO 81008 719-595-5755

Emergency Care

COLORADO SPRINGS

H1 Childrenrsquos Hospital at Memorial Hospital

1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H1 Memorial Hospital Central 1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H2 Memorial Hospital North 4050 Briargate Parkway Colorado Springs CO 80920 719-364-5000

H3 Penrose Hospital 2222 North Nevada Avenue Colorado Springs CO 80907 719-776-5000

H4 St Francis Medical Center 6001 East Woodmen Road Colorado Springs CO 80920 719-571-5000

PUEBLO

H5 Parkview Medical Center 400 West 16th Street Pueblo CO 81003 719-584-4000

H6 St Mary-Corwin Medical Center1008 Minnequa Avenue Pueblo CO 81004 719-557-4000

CANtildeON CITY

H7 St Thomas More Hospital 1338 Phay Avenue Cantildeon City CO 81212 719-285-2000

WOODLAND PARK

H8 Pikes Peak Regional Hospital16420 US Highway 24 Woodland Park CO 80863 719-687-9999

KP Select members have access to these hospitals for scheduled inpatient care

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Northern Colorado

Map is not to scale

50

50

50

5050

25

25

25

25

85

115

115115

9

67

96

231

96

96

47

78

45

24

85

24

24

2485

85

85

115

94

21

83

21

H7

H8

H1

H3

H4

1 H2

H5

H6

3

2

N Powers Blvd

E Woodmen Rd

E 4th St

E Platte Ave

Marksheffel Rd

Squirrel Creek Rd

Briargate Pkwy

W Northern Ave

Central Ave

State Hwy 120Co R

d 17

Doyle Rd

Co Rd 5013 M

eridian Rd

Hanover Rd

S Peyton Hwy

Falcon Hwy

Curtis Rd

Black Forest Rd

Meridian Rd

Peyton Hwy

Pueblo

Colorado Springs

Woodland Park

Cantildeon City

Colorado Small Business Enrollment Guide

21

Medicare Coverage

Kaiser Permanente offers group and individual Medicare Advantage and Prescription Drug Plans

For information on our individual plans contact a licensed sales specialist toll free at 1-855-843-8396 (TTY 711) seven days a week 8 a m to 8 p m or visit kporgmedicare

Adult and Pediatric Dental Care

Kaiser Permanente and Delta Dental of Colorado know good oral health is an important component of overall health so wersquove partnered to provide small group employers pediatric dental benefits and adult-only dental plans to complement Kaiser Permanentersquos medical plans

NEW 2016 Embedded Pediatric Dental Benefit

Separate Annual Deductible (applies to all services)

$50

Diagnostic amp Preventive Services

Oral Exams amp Cleanings (Limited to 2 per calendar year)

Covered 100 after Deductible

Fluoride Treatments (Limited to 2 per calendar year)

Covered 100 after Deductible

Sealants (1 per lifetime per tooth per year) Covered 100 after Deductible

Bitewing X-rays (1 set per calendar year) Covered 100 after Deductible

Basic Services (limited to 2 basic procedures per year)

Fillings Oral Surgery Endodontics Covered 50 after Deductible

Major Services (limited to 1 major procedure per year)

Crowns Covered 50 after Deductible

Embedded Pediatric

Employeersquos children (up through the month they turn 19) can receive any of the procedures listed below each calendar year

Adult Dental

Our adult-only plans complement the embedded pediatric dental coverage and are not tied to medical The lowest-cost plan starts at $13month These plans also offer

bull No waiting period

bull Dual option choices

bull $2000 benefit maximum on the high plan

For more information email Delta Dental directly at salesteamddpcocom Monday-Friday 8 am-5 pm

Important The pediatric dental benefit is embedded in all Small Group plans EXCEPT the KP CO Silver PPO 150040 plan The KP CO Silver PPO 1500-40 plan does not include pediatric dental coverage

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

22

2016 Resources Kaiser Permanente is committed to supporting you and your business Below yoursquoll find important contact information and business resources to save you time

Calling the right person should beEASY

Our goal is to have one-call resolution whenever possible Communicating with the right department is the first step With that in mind wersquove set up ONE Number Easy 303-306-2727 (866-710-2727)

If your question is about You need to talk to

Group Billing and Invoicing Account ReconciliationAdds Drops Cancels or Changes

Consolidated Service CenterOption 1

SG Contracts Brochures Forms New Employee Packets Group Cancellation

Small Group Sales amp ServiceOption 2

Benefits Eligibility Service Resolution Escalated Issues Employee-level Claims

Client Services Unit (CSU)Option 4

Customer Experience Department

Wersquore here to help you transition to Kaiser Permanente Our Customer Experience Team will visit your employees on-site and help them

bull Understand new plans amp benefits

bull Find amp choose physicians

bull Connect to the care they need

bull Transition prescriptions

To reach our Customer Experience team email welcomekporg or call 303-338-3990

Customer Account Services

An easy-to-use web site link that provides online account management for you and your broker You can view group eligibility and billing information update employee data or pay your invoices

If you would like to set up an account please contact your Account Executive or Associate Account Manager for assistance

Colorado Small Business Enrollment Guide

23

2016 Reference

1 Employer Health Benefits 2011 Annual Survey Kaiser Family Foundation and Health Research amp Educational Trust September 2011 Kaiser Family Foundation is a nonprofit private organization not affiliated with Kaiser Permanente

2 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

3 Kaiser Foundation Health Plan of Colorado Inc received the highest numerical score among commercial health plans in the Colorado region in the proprietary JD Power 2008-2015 US Member Health Plan Studiessm Study based on 31543 total member responses measuring four plans in Colorado (excludes Medicare and Medicaid) Proprietary study results are based on experiences and perceptions of members surveyed November-December 2014 Your experiences may vary Visit jdpowercom

4 Please refer to ldquoNCQArsquos Private Health Insurance Plan Rankings 2013-2014rdquo posted online at wwwncqaorg

5 Kaiser Permanente 2012 HEDISreg scores Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compassreg and represent all non- PPO lines of business Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA Quality Compass 2012 includes certain CAHPSreg data Any data display analysis interpretation or conclusion based on these data is solely that of the authors and NCQA specifically disclaims responsibility for any such display analysis interpretation or conclusion Quality Compassreg and HEDISreg are registered trademarks of NCQA CAHPSreg is a registered trademark of the Agency for Healthcare Research and Quality

6 The 2014 Hewitt Health Value InitiativeTM showed Kaiser Permanente is the most cost-efficient plan across all markets served for the sixth year in a rowmdash12 more cost-effective than the average HMO and 17 more cost-effective than the all-plan average Kaiser Permanente also outperformed other plans in clinical quality scoring 49 better than the average HMO and 209 better than the all-plan average Hewitt Health Value InitiativeTM benchmarking study mdash Kaiser Foundation Health Plan Inc Aon Hewitt April 3 2014 To get a copy of the Hewitt Health Value Initiative report for your region contact your account manager

7 Chronic Care Making the Case for Ongoing Care Robert Wood Johnson Foundation 2010

8 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

9 ldquoWorksite Wellnessrdquo Preventdiseasecom httppreventdiseasecomworksite_wellnessworksite_wellnesshtml accessed November 2 2009

10 See Note 9 11 ldquoObesity by the Numbersrdquo obesityinamericaorg accessed March 24 200812 See Note 313 Thomas Delate PhD et al ldquoReduced Health Care Expenditures After Enrollment

in a Collaborative Cardiac Care Servicerdquo Pharmacotherapy November 2010 Results from our cardiac rehabilitation program in Colorado

Kaiser Foundation Health Plan Inc of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Coloradoreg marketplace copy2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questionsCall us at 1-866-331-2091 bull Or contact your agent or broker

• WHATrsquoS INSIDE
• A BETTER WAY to manage costs
• A BETTER WAY to keep youremployees healthier
• Virtual Care Innovations
• Employee Health amp Wellness
• Enhancing the Employee Experience
• Accessing Care in DenverBoulder
• Accessing Care in Mountain Communities
• Accessing Care Northern Colorado
• KP Plans Offered in Colorado
• Accessing Care in Southern Colorado
• KP Select Plans Offered in Colorado Springs
• Medicare Coverage
• Adult and Pediatric Dental Care
• 2016 Resources

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

18

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

KP Select Plans Offered in Colorado Springs

Colorado Small Business Enrollment Guide

19

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

20

Kaiser Permanente Medical Offices

1 Briargate Medical Offices 4105 Briargate Pkwy Suite 125 Colorado Springs CO 80920 719-282-2533

2 Parkside Medical Offices215 Parkside Drive Colorado Springs CO 80910 719-327-6540

3 Pueblo North Medical Offices 3670 Parker Boulevard Suite 200 Pueblo CO 81008 719-595-5755

Emergency Care

COLORADO SPRINGS

H1 Childrenrsquos Hospital at Memorial Hospital

1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H1 Memorial Hospital Central 1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H2 Memorial Hospital North 4050 Briargate Parkway Colorado Springs CO 80920 719-364-5000

H3 Penrose Hospital 2222 North Nevada Avenue Colorado Springs CO 80907 719-776-5000

H4 St Francis Medical Center 6001 East Woodmen Road Colorado Springs CO 80920 719-571-5000

PUEBLO

H5 Parkview Medical Center 400 West 16th Street Pueblo CO 81003 719-584-4000

H6 St Mary-Corwin Medical Center1008 Minnequa Avenue Pueblo CO 81004 719-557-4000

CANtildeON CITY

H7 St Thomas More Hospital 1338 Phay Avenue Cantildeon City CO 81212 719-285-2000

WOODLAND PARK

H8 Pikes Peak Regional Hospital16420 US Highway 24 Woodland Park CO 80863 719-687-9999

KP Select members have access to these hospitals for scheduled inpatient care

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Northern Colorado

Map is not to scale

50

50

50

5050

25

25

25

25

85

115

115115

9

67

96

231

96

96

47

78

45

24

85

24

24

2485

85

85

115

94

21

83

21

H7

H8

H1

H3

H4

1 H2

H5

H6

3

2

N Powers Blvd

E Woodmen Rd

E 4th St

E Platte Ave

Marksheffel Rd

Squirrel Creek Rd

Briargate Pkwy

W Northern Ave

Central Ave

State Hwy 120Co R

d 17

Doyle Rd

Co Rd 5013 M

eridian Rd

Hanover Rd

S Peyton Hwy

Falcon Hwy

Curtis Rd

Black Forest Rd

Meridian Rd

Peyton Hwy

Pueblo

Colorado Springs

Woodland Park

Cantildeon City

Colorado Small Business Enrollment Guide

21

Medicare Coverage

Kaiser Permanente offers group and individual Medicare Advantage and Prescription Drug Plans

For information on our individual plans contact a licensed sales specialist toll free at 1-855-843-8396 (TTY 711) seven days a week 8 a m to 8 p m or visit kporgmedicare

Adult and Pediatric Dental Care

Kaiser Permanente and Delta Dental of Colorado know good oral health is an important component of overall health so wersquove partnered to provide small group employers pediatric dental benefits and adult-only dental plans to complement Kaiser Permanentersquos medical plans

NEW 2016 Embedded Pediatric Dental Benefit

Separate Annual Deductible (applies to all services)

$50

Diagnostic amp Preventive Services

Oral Exams amp Cleanings (Limited to 2 per calendar year)

Covered 100 after Deductible

Fluoride Treatments (Limited to 2 per calendar year)

Covered 100 after Deductible

Sealants (1 per lifetime per tooth per year) Covered 100 after Deductible

Bitewing X-rays (1 set per calendar year) Covered 100 after Deductible

Basic Services (limited to 2 basic procedures per year)

Fillings Oral Surgery Endodontics Covered 50 after Deductible

Major Services (limited to 1 major procedure per year)

Crowns Covered 50 after Deductible

Embedded Pediatric

Employeersquos children (up through the month they turn 19) can receive any of the procedures listed below each calendar year

Adult Dental

Our adult-only plans complement the embedded pediatric dental coverage and are not tied to medical The lowest-cost plan starts at $13month These plans also offer

bull No waiting period

bull Dual option choices

bull $2000 benefit maximum on the high plan

For more information email Delta Dental directly at salesteamddpcocom Monday-Friday 8 am-5 pm

Important The pediatric dental benefit is embedded in all Small Group plans EXCEPT the KP CO Silver PPO 150040 plan The KP CO Silver PPO 1500-40 plan does not include pediatric dental coverage

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

22

2016 Resources Kaiser Permanente is committed to supporting you and your business Below yoursquoll find important contact information and business resources to save you time

Calling the right person should beEASY

Our goal is to have one-call resolution whenever possible Communicating with the right department is the first step With that in mind wersquove set up ONE Number Easy 303-306-2727 (866-710-2727)

If your question is about You need to talk to

Group Billing and Invoicing Account ReconciliationAdds Drops Cancels or Changes

Consolidated Service CenterOption 1

SG Contracts Brochures Forms New Employee Packets Group Cancellation

Small Group Sales amp ServiceOption 2

Benefits Eligibility Service Resolution Escalated Issues Employee-level Claims

Client Services Unit (CSU)Option 4

Customer Experience Department

Wersquore here to help you transition to Kaiser Permanente Our Customer Experience Team will visit your employees on-site and help them

bull Understand new plans amp benefits

bull Find amp choose physicians

bull Connect to the care they need

bull Transition prescriptions

To reach our Customer Experience team email welcomekporg or call 303-338-3990

Customer Account Services

An easy-to-use web site link that provides online account management for you and your broker You can view group eligibility and billing information update employee data or pay your invoices

If you would like to set up an account please contact your Account Executive or Associate Account Manager for assistance

Colorado Small Business Enrollment Guide

23

2016 Reference

1 Employer Health Benefits 2011 Annual Survey Kaiser Family Foundation and Health Research amp Educational Trust September 2011 Kaiser Family Foundation is a nonprofit private organization not affiliated with Kaiser Permanente

2 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

3 Kaiser Foundation Health Plan of Colorado Inc received the highest numerical score among commercial health plans in the Colorado region in the proprietary JD Power 2008-2015 US Member Health Plan Studiessm Study based on 31543 total member responses measuring four plans in Colorado (excludes Medicare and Medicaid) Proprietary study results are based on experiences and perceptions of members surveyed November-December 2014 Your experiences may vary Visit jdpowercom

4 Please refer to ldquoNCQArsquos Private Health Insurance Plan Rankings 2013-2014rdquo posted online at wwwncqaorg

5 Kaiser Permanente 2012 HEDISreg scores Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compassreg and represent all non- PPO lines of business Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA Quality Compass 2012 includes certain CAHPSreg data Any data display analysis interpretation or conclusion based on these data is solely that of the authors and NCQA specifically disclaims responsibility for any such display analysis interpretation or conclusion Quality Compassreg and HEDISreg are registered trademarks of NCQA CAHPSreg is a registered trademark of the Agency for Healthcare Research and Quality

6 The 2014 Hewitt Health Value InitiativeTM showed Kaiser Permanente is the most cost-efficient plan across all markets served for the sixth year in a rowmdash12 more cost-effective than the average HMO and 17 more cost-effective than the all-plan average Kaiser Permanente also outperformed other plans in clinical quality scoring 49 better than the average HMO and 209 better than the all-plan average Hewitt Health Value InitiativeTM benchmarking study mdash Kaiser Foundation Health Plan Inc Aon Hewitt April 3 2014 To get a copy of the Hewitt Health Value Initiative report for your region contact your account manager

7 Chronic Care Making the Case for Ongoing Care Robert Wood Johnson Foundation 2010

8 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

9 ldquoWorksite Wellnessrdquo Preventdiseasecom httppreventdiseasecomworksite_wellnessworksite_wellnesshtml accessed November 2 2009

10 See Note 9 11 ldquoObesity by the Numbersrdquo obesityinamericaorg accessed March 24 200812 See Note 313 Thomas Delate PhD et al ldquoReduced Health Care Expenditures After Enrollment

in a Collaborative Cardiac Care Servicerdquo Pharmacotherapy November 2010 Results from our cardiac rehabilitation program in Colorado

Kaiser Foundation Health Plan Inc of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Coloradoreg marketplace copy2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questionsCall us at 1-866-331-2091 bull Or contact your agent or broker

• WHATrsquoS INSIDE
• A BETTER WAY to manage costs
• A BETTER WAY to keep youremployees healthier
• Virtual Care Innovations
• Employee Health amp Wellness
• Enhancing the Employee Experience
• Accessing Care in DenverBoulder
• Accessing Care in Mountain Communities
• Accessing Care Northern Colorado
• KP Plans Offered in Colorado
• Accessing Care in Southern Colorado
• KP Select Plans Offered in Colorado Springs
• Medicare Coverage
• Adult and Pediatric Dental Care
• 2016 Resources

Colorado Small Business Enrollment Guide

19

Plan Metal Tier

Deductible Coinsurance (Members

Cost)

Out-of-Pocket Maximum

PCP Specialist After Hours

Emergency Room

Outpatient Surgery

Inpatient Hospital

Lab amp X-ray

MRI CT amp PET

Prescription DrugsGenericBrand

Non-PreferredSpecialty

Relativity to KP CO

Platinum 025

HMO (Simple and straightforward coverage for your employees)

KP Select CO Platinum 025

Platinum None 10 $3000 $25 $45 $75 $300 $500 $500 per day (up to 4 days)

10 $200 $10$35$250$250 0

KP Select CO Gold 030

Gold None 30 $4500 $30 $60 $75 $300 $1000 $1000 per day (up to 4 days)

30 $500 $15$45$375$375 -6

KP Select CO Silver 050 Silver None 40 $6850 $50 $70 $100 $500 40 $1500 per day (up to 4 days)

40 $500 $15$50$570$570 -12

Deductible HMO (Deductible-based plans designed to fit any budget)

KP Select CO Platinum 25020

Platinum $250 10 $2000 $20 $40 $75 $200 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$10$251010 2

KP Select CO Gold 50030

Gold $500 20 $4000 $30 $50 $75 $300 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$325$325 -9

KP Select CO Gold 100030

Gold $1000 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -6

KP Select CO Gold 150030

Gold $1500 10 $3500 $30 $50 $75 $300 10 after deductible

10 after deductible

10 after deductible

10 after deductible

$15$451010 -8

KP Select CO Silver 250030

Silver $2500 20 $5800 $30 $50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$452020 Non-Generic drugs are subject to a

separate $250 prescription drug deductible

-18

KP Select CO Silver 350030

Silver $3500 20 $5500 $0 for the first visit then $30 per visit

$50 $100 $350 20 after deductible

20 after deductible

20 after deductible

20 after deductible

$15$45$450$450 -19

KP Select CO Bronze 550050

Bronze $5500 40 $6850 $50 per visit for 3 visits then 40 after

deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

40 after deductible

$25$110$570$570 -36

KP Select CO Bronze 685050

Bronze $6850 0 $6850 $50 per visit for 3 visits then no charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -32

Consumer-Driven Health Plans (Empower your employees by allowing them to use health savings accounts (HSAs) to pay for routine health care expenses)

KP Select CO Silver 275030HSA

Silver $2750 15 $5500 $30 after deductible $50 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

15 after deductible

$10$301515 after deductible -26

KP Select CO Bronze 475050HSA

Bronze $4750 30 $6500 $50 after deductible $70 after deductible

30 after deductible

$500 after deductible

30 after deductible

30 after deductible

30 after deductible

30 after deductible

$20$453030 after deductible -39

KP Select CO Bronze 6500100HSA

Bronze $6500 0 $6500 No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after

deductible

No charge after deductible

No charge after

deductible

No charge after

deductible

No charge after deductible -36

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

20

Kaiser Permanente Medical Offices

1 Briargate Medical Offices 4105 Briargate Pkwy Suite 125 Colorado Springs CO 80920 719-282-2533

2 Parkside Medical Offices215 Parkside Drive Colorado Springs CO 80910 719-327-6540

3 Pueblo North Medical Offices 3670 Parker Boulevard Suite 200 Pueblo CO 81008 719-595-5755

Emergency Care

COLORADO SPRINGS

H1 Childrenrsquos Hospital at Memorial Hospital

1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H1 Memorial Hospital Central 1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H2 Memorial Hospital North 4050 Briargate Parkway Colorado Springs CO 80920 719-364-5000

H3 Penrose Hospital 2222 North Nevada Avenue Colorado Springs CO 80907 719-776-5000

H4 St Francis Medical Center 6001 East Woodmen Road Colorado Springs CO 80920 719-571-5000

PUEBLO

H5 Parkview Medical Center 400 West 16th Street Pueblo CO 81003 719-584-4000

H6 St Mary-Corwin Medical Center1008 Minnequa Avenue Pueblo CO 81004 719-557-4000

CANtildeON CITY

H7 St Thomas More Hospital 1338 Phay Avenue Cantildeon City CO 81212 719-285-2000

WOODLAND PARK

H8 Pikes Peak Regional Hospital16420 US Highway 24 Woodland Park CO 80863 719-687-9999

KP Select members have access to these hospitals for scheduled inpatient care

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Northern Colorado

Map is not to scale

50

50

50

5050

25

25

25

25

85

115

115115

9

67

96

231

96

96

47

78

45

24

85

24

24

2485

85

85

115

94

21

83

21

H7

H8

H1

H3

H4

1 H2

H5

H6

3

2

N Powers Blvd

E Woodmen Rd

E 4th St

E Platte Ave

Marksheffel Rd

Squirrel Creek Rd

Briargate Pkwy

W Northern Ave

Central Ave

State Hwy 120Co R

d 17

Doyle Rd

Co Rd 5013 M

eridian Rd

Hanover Rd

S Peyton Hwy

Falcon Hwy

Curtis Rd

Black Forest Rd

Meridian Rd

Peyton Hwy

Pueblo

Colorado Springs

Woodland Park

Cantildeon City

Colorado Small Business Enrollment Guide

21

Medicare Coverage

Kaiser Permanente offers group and individual Medicare Advantage and Prescription Drug Plans

For information on our individual plans contact a licensed sales specialist toll free at 1-855-843-8396 (TTY 711) seven days a week 8 a m to 8 p m or visit kporgmedicare

Adult and Pediatric Dental Care

Kaiser Permanente and Delta Dental of Colorado know good oral health is an important component of overall health so wersquove partnered to provide small group employers pediatric dental benefits and adult-only dental plans to complement Kaiser Permanentersquos medical plans

NEW 2016 Embedded Pediatric Dental Benefit

Separate Annual Deductible (applies to all services)

$50

Diagnostic amp Preventive Services

Oral Exams amp Cleanings (Limited to 2 per calendar year)

Covered 100 after Deductible

Fluoride Treatments (Limited to 2 per calendar year)

Covered 100 after Deductible

Sealants (1 per lifetime per tooth per year) Covered 100 after Deductible

Bitewing X-rays (1 set per calendar year) Covered 100 after Deductible

Basic Services (limited to 2 basic procedures per year)

Fillings Oral Surgery Endodontics Covered 50 after Deductible

Major Services (limited to 1 major procedure per year)

Crowns Covered 50 after Deductible

Embedded Pediatric

Employeersquos children (up through the month they turn 19) can receive any of the procedures listed below each calendar year

Adult Dental

Our adult-only plans complement the embedded pediatric dental coverage and are not tied to medical The lowest-cost plan starts at $13month These plans also offer

bull No waiting period

bull Dual option choices

bull $2000 benefit maximum on the high plan

For more information email Delta Dental directly at salesteamddpcocom Monday-Friday 8 am-5 pm

Important The pediatric dental benefit is embedded in all Small Group plans EXCEPT the KP CO Silver PPO 150040 plan The KP CO Silver PPO 1500-40 plan does not include pediatric dental coverage

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

22

2016 Resources Kaiser Permanente is committed to supporting you and your business Below yoursquoll find important contact information and business resources to save you time

Calling the right person should beEASY

Our goal is to have one-call resolution whenever possible Communicating with the right department is the first step With that in mind wersquove set up ONE Number Easy 303-306-2727 (866-710-2727)

If your question is about You need to talk to

Group Billing and Invoicing Account ReconciliationAdds Drops Cancels or Changes

Consolidated Service CenterOption 1

SG Contracts Brochures Forms New Employee Packets Group Cancellation

Small Group Sales amp ServiceOption 2

Benefits Eligibility Service Resolution Escalated Issues Employee-level Claims

Client Services Unit (CSU)Option 4

Customer Experience Department

Wersquore here to help you transition to Kaiser Permanente Our Customer Experience Team will visit your employees on-site and help them

bull Understand new plans amp benefits

bull Find amp choose physicians

bull Connect to the care they need

bull Transition prescriptions

To reach our Customer Experience team email welcomekporg or call 303-338-3990

Customer Account Services

An easy-to-use web site link that provides online account management for you and your broker You can view group eligibility and billing information update employee data or pay your invoices

If you would like to set up an account please contact your Account Executive or Associate Account Manager for assistance

Colorado Small Business Enrollment Guide

23

2016 Reference

1 Employer Health Benefits 2011 Annual Survey Kaiser Family Foundation and Health Research amp Educational Trust September 2011 Kaiser Family Foundation is a nonprofit private organization not affiliated with Kaiser Permanente

2 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

3 Kaiser Foundation Health Plan of Colorado Inc received the highest numerical score among commercial health plans in the Colorado region in the proprietary JD Power 2008-2015 US Member Health Plan Studiessm Study based on 31543 total member responses measuring four plans in Colorado (excludes Medicare and Medicaid) Proprietary study results are based on experiences and perceptions of members surveyed November-December 2014 Your experiences may vary Visit jdpowercom

4 Please refer to ldquoNCQArsquos Private Health Insurance Plan Rankings 2013-2014rdquo posted online at wwwncqaorg

5 Kaiser Permanente 2012 HEDISreg scores Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compassreg and represent all non- PPO lines of business Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA Quality Compass 2012 includes certain CAHPSreg data Any data display analysis interpretation or conclusion based on these data is solely that of the authors and NCQA specifically disclaims responsibility for any such display analysis interpretation or conclusion Quality Compassreg and HEDISreg are registered trademarks of NCQA CAHPSreg is a registered trademark of the Agency for Healthcare Research and Quality

6 The 2014 Hewitt Health Value InitiativeTM showed Kaiser Permanente is the most cost-efficient plan across all markets served for the sixth year in a rowmdash12 more cost-effective than the average HMO and 17 more cost-effective than the all-plan average Kaiser Permanente also outperformed other plans in clinical quality scoring 49 better than the average HMO and 209 better than the all-plan average Hewitt Health Value InitiativeTM benchmarking study mdash Kaiser Foundation Health Plan Inc Aon Hewitt April 3 2014 To get a copy of the Hewitt Health Value Initiative report for your region contact your account manager

7 Chronic Care Making the Case for Ongoing Care Robert Wood Johnson Foundation 2010

8 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

9 ldquoWorksite Wellnessrdquo Preventdiseasecom httppreventdiseasecomworksite_wellnessworksite_wellnesshtml accessed November 2 2009

10 See Note 9 11 ldquoObesity by the Numbersrdquo obesityinamericaorg accessed March 24 200812 See Note 313 Thomas Delate PhD et al ldquoReduced Health Care Expenditures After Enrollment

in a Collaborative Cardiac Care Servicerdquo Pharmacotherapy November 2010 Results from our cardiac rehabilitation program in Colorado

Kaiser Foundation Health Plan Inc of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Coloradoreg marketplace copy2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questionsCall us at 1-866-331-2091 bull Or contact your agent or broker

• WHATrsquoS INSIDE
• A BETTER WAY to manage costs
• A BETTER WAY to keep youremployees healthier
• Virtual Care Innovations
• Employee Health amp Wellness
• Enhancing the Employee Experience
• Accessing Care in DenverBoulder
• Accessing Care in Mountain Communities
• Accessing Care Northern Colorado
• KP Plans Offered in Colorado
• Accessing Care in Southern Colorado
• KP Select Plans Offered in Colorado Springs
• Medicare Coverage
• Adult and Pediatric Dental Care
• 2016 Resources

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

20

Kaiser Permanente Medical Offices

1 Briargate Medical Offices 4105 Briargate Pkwy Suite 125 Colorado Springs CO 80920 719-282-2533

2 Parkside Medical Offices215 Parkside Drive Colorado Springs CO 80910 719-327-6540

3 Pueblo North Medical Offices 3670 Parker Boulevard Suite 200 Pueblo CO 81008 719-595-5755

Emergency Care

COLORADO SPRINGS

H1 Childrenrsquos Hospital at Memorial Hospital

1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H1 Memorial Hospital Central 1400 East Boulder Street Colorado Springs CO 80909 719-365-5000

H2 Memorial Hospital North 4050 Briargate Parkway Colorado Springs CO 80920 719-364-5000

H3 Penrose Hospital 2222 North Nevada Avenue Colorado Springs CO 80907 719-776-5000

H4 St Francis Medical Center 6001 East Woodmen Road Colorado Springs CO 80920 719-571-5000

PUEBLO

H5 Parkview Medical Center 400 West 16th Street Pueblo CO 81003 719-584-4000

H6 St Mary-Corwin Medical Center1008 Minnequa Avenue Pueblo CO 81004 719-557-4000

CANtildeON CITY

H7 St Thomas More Hospital 1338 Phay Avenue Cantildeon City CO 81212 719-285-2000

WOODLAND PARK

H8 Pikes Peak Regional Hospital16420 US Highway 24 Woodland Park CO 80863 719-687-9999

KP Select members have access to these hospitals for scheduled inpatient care

Additional locations and access

In addition to the locations shown on the map you have access to hundreds of network providers throughout the service area however they are not represented on this map Network provider information and locations can be found at kporgfacilities

Additionally you have access to all Kaiser Permanente medical offices in DenverBoulder or Northern Colorado

Map is not to scale

50

50

50

5050

25

25

25

25

85

115

115115

9

67

96

231

96

96

47

78

45

24

85

24

24

2485

85

85

115

94

21

83

21

H7

H8

H1

H3

H4

1 H2

H5

H6

3

2

N Powers Blvd

E Woodmen Rd

E 4th St

E Platte Ave

Marksheffel Rd

Squirrel Creek Rd

Briargate Pkwy

W Northern Ave

Central Ave

State Hwy 120Co R

d 17

Doyle Rd

Co Rd 5013 M

eridian Rd

Hanover Rd

S Peyton Hwy

Falcon Hwy

Curtis Rd

Black Forest Rd

Meridian Rd

Peyton Hwy

Pueblo

Colorado Springs

Woodland Park

Cantildeon City

Colorado Small Business Enrollment Guide

21

Medicare Coverage

Kaiser Permanente offers group and individual Medicare Advantage and Prescription Drug Plans

For information on our individual plans contact a licensed sales specialist toll free at 1-855-843-8396 (TTY 711) seven days a week 8 a m to 8 p m or visit kporgmedicare

Adult and Pediatric Dental Care

Kaiser Permanente and Delta Dental of Colorado know good oral health is an important component of overall health so wersquove partnered to provide small group employers pediatric dental benefits and adult-only dental plans to complement Kaiser Permanentersquos medical plans

NEW 2016 Embedded Pediatric Dental Benefit

Separate Annual Deductible (applies to all services)

$50

Diagnostic amp Preventive Services

Oral Exams amp Cleanings (Limited to 2 per calendar year)

Covered 100 after Deductible

Fluoride Treatments (Limited to 2 per calendar year)

Covered 100 after Deductible

Sealants (1 per lifetime per tooth per year) Covered 100 after Deductible

Bitewing X-rays (1 set per calendar year) Covered 100 after Deductible

Basic Services (limited to 2 basic procedures per year)

Fillings Oral Surgery Endodontics Covered 50 after Deductible

Major Services (limited to 1 major procedure per year)

Crowns Covered 50 after Deductible

Embedded Pediatric

Employeersquos children (up through the month they turn 19) can receive any of the procedures listed below each calendar year

Adult Dental

Our adult-only plans complement the embedded pediatric dental coverage and are not tied to medical The lowest-cost plan starts at $13month These plans also offer

bull No waiting period

bull Dual option choices

bull $2000 benefit maximum on the high plan

For more information email Delta Dental directly at salesteamddpcocom Monday-Friday 8 am-5 pm

Important The pediatric dental benefit is embedded in all Small Group plans EXCEPT the KP CO Silver PPO 150040 plan The KP CO Silver PPO 1500-40 plan does not include pediatric dental coverage

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

22

2016 Resources Kaiser Permanente is committed to supporting you and your business Below yoursquoll find important contact information and business resources to save you time

Calling the right person should beEASY

Our goal is to have one-call resolution whenever possible Communicating with the right department is the first step With that in mind wersquove set up ONE Number Easy 303-306-2727 (866-710-2727)

If your question is about You need to talk to

Group Billing and Invoicing Account ReconciliationAdds Drops Cancels or Changes

Consolidated Service CenterOption 1

SG Contracts Brochures Forms New Employee Packets Group Cancellation

Small Group Sales amp ServiceOption 2

Benefits Eligibility Service Resolution Escalated Issues Employee-level Claims

Client Services Unit (CSU)Option 4

Customer Experience Department

Wersquore here to help you transition to Kaiser Permanente Our Customer Experience Team will visit your employees on-site and help them

bull Understand new plans amp benefits

bull Find amp choose physicians

bull Connect to the care they need

bull Transition prescriptions

To reach our Customer Experience team email welcomekporg or call 303-338-3990

Customer Account Services

An easy-to-use web site link that provides online account management for you and your broker You can view group eligibility and billing information update employee data or pay your invoices

If you would like to set up an account please contact your Account Executive or Associate Account Manager for assistance

Colorado Small Business Enrollment Guide

23

2016 Reference

1 Employer Health Benefits 2011 Annual Survey Kaiser Family Foundation and Health Research amp Educational Trust September 2011 Kaiser Family Foundation is a nonprofit private organization not affiliated with Kaiser Permanente

2 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

3 Kaiser Foundation Health Plan of Colorado Inc received the highest numerical score among commercial health plans in the Colorado region in the proprietary JD Power 2008-2015 US Member Health Plan Studiessm Study based on 31543 total member responses measuring four plans in Colorado (excludes Medicare and Medicaid) Proprietary study results are based on experiences and perceptions of members surveyed November-December 2014 Your experiences may vary Visit jdpowercom

4 Please refer to ldquoNCQArsquos Private Health Insurance Plan Rankings 2013-2014rdquo posted online at wwwncqaorg

5 Kaiser Permanente 2012 HEDISreg scores Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compassreg and represent all non- PPO lines of business Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA Quality Compass 2012 includes certain CAHPSreg data Any data display analysis interpretation or conclusion based on these data is solely that of the authors and NCQA specifically disclaims responsibility for any such display analysis interpretation or conclusion Quality Compassreg and HEDISreg are registered trademarks of NCQA CAHPSreg is a registered trademark of the Agency for Healthcare Research and Quality

6 The 2014 Hewitt Health Value InitiativeTM showed Kaiser Permanente is the most cost-efficient plan across all markets served for the sixth year in a rowmdash12 more cost-effective than the average HMO and 17 more cost-effective than the all-plan average Kaiser Permanente also outperformed other plans in clinical quality scoring 49 better than the average HMO and 209 better than the all-plan average Hewitt Health Value InitiativeTM benchmarking study mdash Kaiser Foundation Health Plan Inc Aon Hewitt April 3 2014 To get a copy of the Hewitt Health Value Initiative report for your region contact your account manager

7 Chronic Care Making the Case for Ongoing Care Robert Wood Johnson Foundation 2010

8 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

9 ldquoWorksite Wellnessrdquo Preventdiseasecom httppreventdiseasecomworksite_wellnessworksite_wellnesshtml accessed November 2 2009

10 See Note 9 11 ldquoObesity by the Numbersrdquo obesityinamericaorg accessed March 24 200812 See Note 313 Thomas Delate PhD et al ldquoReduced Health Care Expenditures After Enrollment

in a Collaborative Cardiac Care Servicerdquo Pharmacotherapy November 2010 Results from our cardiac rehabilitation program in Colorado

Kaiser Foundation Health Plan Inc of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Coloradoreg marketplace copy2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questionsCall us at 1-866-331-2091 bull Or contact your agent or broker

• WHATrsquoS INSIDE
• A BETTER WAY to manage costs
• A BETTER WAY to keep youremployees healthier
• Virtual Care Innovations
• Employee Health amp Wellness
• Enhancing the Employee Experience
• Accessing Care in DenverBoulder
• Accessing Care in Mountain Communities
• Accessing Care Northern Colorado
• KP Plans Offered in Colorado
• Accessing Care in Southern Colorado
• KP Select Plans Offered in Colorado Springs
• Medicare Coverage
• Adult and Pediatric Dental Care
• 2016 Resources

Colorado Small Business Enrollment Guide

21

Medicare Coverage

Kaiser Permanente offers group and individual Medicare Advantage and Prescription Drug Plans

For information on our individual plans contact a licensed sales specialist toll free at 1-855-843-8396 (TTY 711) seven days a week 8 a m to 8 p m or visit kporgmedicare

Adult and Pediatric Dental Care

Kaiser Permanente and Delta Dental of Colorado know good oral health is an important component of overall health so wersquove partnered to provide small group employers pediatric dental benefits and adult-only dental plans to complement Kaiser Permanentersquos medical plans

NEW 2016 Embedded Pediatric Dental Benefit

Separate Annual Deductible (applies to all services)

$50

Diagnostic amp Preventive Services

Oral Exams amp Cleanings (Limited to 2 per calendar year)

Covered 100 after Deductible

Fluoride Treatments (Limited to 2 per calendar year)

Covered 100 after Deductible

Sealants (1 per lifetime per tooth per year) Covered 100 after Deductible

Bitewing X-rays (1 set per calendar year) Covered 100 after Deductible

Basic Services (limited to 2 basic procedures per year)

Fillings Oral Surgery Endodontics Covered 50 after Deductible

Major Services (limited to 1 major procedure per year)

Crowns Covered 50 after Deductible

Embedded Pediatric

Employeersquos children (up through the month they turn 19) can receive any of the procedures listed below each calendar year

Adult Dental

Our adult-only plans complement the embedded pediatric dental coverage and are not tied to medical The lowest-cost plan starts at $13month These plans also offer

bull No waiting period

bull Dual option choices

bull $2000 benefit maximum on the high plan

For more information email Delta Dental directly at salesteamddpcocom Monday-Friday 8 am-5 pm

Important The pediatric dental benefit is embedded in all Small Group plans EXCEPT the KP CO Silver PPO 150040 plan The KP CO Silver PPO 1500-40 plan does not include pediatric dental coverage

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

22

2016 Resources Kaiser Permanente is committed to supporting you and your business Below yoursquoll find important contact information and business resources to save you time

Calling the right person should beEASY

Our goal is to have one-call resolution whenever possible Communicating with the right department is the first step With that in mind wersquove set up ONE Number Easy 303-306-2727 (866-710-2727)

If your question is about You need to talk to

Group Billing and Invoicing Account ReconciliationAdds Drops Cancels or Changes

Consolidated Service CenterOption 1

SG Contracts Brochures Forms New Employee Packets Group Cancellation

Small Group Sales amp ServiceOption 2

Benefits Eligibility Service Resolution Escalated Issues Employee-level Claims

Client Services Unit (CSU)Option 4

Customer Experience Department

Wersquore here to help you transition to Kaiser Permanente Our Customer Experience Team will visit your employees on-site and help them

bull Understand new plans amp benefits

bull Find amp choose physicians

bull Connect to the care they need

bull Transition prescriptions

To reach our Customer Experience team email welcomekporg or call 303-338-3990

Customer Account Services

An easy-to-use web site link that provides online account management for you and your broker You can view group eligibility and billing information update employee data or pay your invoices

If you would like to set up an account please contact your Account Executive or Associate Account Manager for assistance

Colorado Small Business Enrollment Guide

23

2016 Reference

1 Employer Health Benefits 2011 Annual Survey Kaiser Family Foundation and Health Research amp Educational Trust September 2011 Kaiser Family Foundation is a nonprofit private organization not affiliated with Kaiser Permanente

2 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

3 Kaiser Foundation Health Plan of Colorado Inc received the highest numerical score among commercial health plans in the Colorado region in the proprietary JD Power 2008-2015 US Member Health Plan Studiessm Study based on 31543 total member responses measuring four plans in Colorado (excludes Medicare and Medicaid) Proprietary study results are based on experiences and perceptions of members surveyed November-December 2014 Your experiences may vary Visit jdpowercom

4 Please refer to ldquoNCQArsquos Private Health Insurance Plan Rankings 2013-2014rdquo posted online at wwwncqaorg

5 Kaiser Permanente 2012 HEDISreg scores Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compassreg and represent all non- PPO lines of business Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA Quality Compass 2012 includes certain CAHPSreg data Any data display analysis interpretation or conclusion based on these data is solely that of the authors and NCQA specifically disclaims responsibility for any such display analysis interpretation or conclusion Quality Compassreg and HEDISreg are registered trademarks of NCQA CAHPSreg is a registered trademark of the Agency for Healthcare Research and Quality

6 The 2014 Hewitt Health Value InitiativeTM showed Kaiser Permanente is the most cost-efficient plan across all markets served for the sixth year in a rowmdash12 more cost-effective than the average HMO and 17 more cost-effective than the all-plan average Kaiser Permanente also outperformed other plans in clinical quality scoring 49 better than the average HMO and 209 better than the all-plan average Hewitt Health Value InitiativeTM benchmarking study mdash Kaiser Foundation Health Plan Inc Aon Hewitt April 3 2014 To get a copy of the Hewitt Health Value Initiative report for your region contact your account manager

7 Chronic Care Making the Case for Ongoing Care Robert Wood Johnson Foundation 2010

8 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

9 ldquoWorksite Wellnessrdquo Preventdiseasecom httppreventdiseasecomworksite_wellnessworksite_wellnesshtml accessed November 2 2009

10 See Note 9 11 ldquoObesity by the Numbersrdquo obesityinamericaorg accessed March 24 200812 See Note 313 Thomas Delate PhD et al ldquoReduced Health Care Expenditures After Enrollment

in a Collaborative Cardiac Care Servicerdquo Pharmacotherapy November 2010 Results from our cardiac rehabilitation program in Colorado

Kaiser Foundation Health Plan Inc of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Coloradoreg marketplace copy2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questionsCall us at 1-866-331-2091 bull Or contact your agent or broker

• WHATrsquoS INSIDE
• A BETTER WAY to manage costs
• A BETTER WAY to keep youremployees healthier
• Virtual Care Innovations
• Employee Health amp Wellness
• Enhancing the Employee Experience
• Accessing Care in DenverBoulder
• Accessing Care in Mountain Communities
• Accessing Care Northern Colorado
• KP Plans Offered in Colorado
• Accessing Care in Southern Colorado
• KP Select Plans Offered in Colorado Springs
• Medicare Coverage
• Adult and Pediatric Dental Care
• 2016 Resources

to keep your employeesmdashand your bottom linemdashhealthy

Have questions Call us at 1-866-331-2091 bull Or contact your agent or broker

22

2016 Resources Kaiser Permanente is committed to supporting you and your business Below yoursquoll find important contact information and business resources to save you time

Calling the right person should beEASY

Our goal is to have one-call resolution whenever possible Communicating with the right department is the first step With that in mind wersquove set up ONE Number Easy 303-306-2727 (866-710-2727)

If your question is about You need to talk to

Group Billing and Invoicing Account ReconciliationAdds Drops Cancels or Changes

Consolidated Service CenterOption 1

SG Contracts Brochures Forms New Employee Packets Group Cancellation

Small Group Sales amp ServiceOption 2

Benefits Eligibility Service Resolution Escalated Issues Employee-level Claims

Client Services Unit (CSU)Option 4

Customer Experience Department

Wersquore here to help you transition to Kaiser Permanente Our Customer Experience Team will visit your employees on-site and help them

bull Understand new plans amp benefits

bull Find amp choose physicians

bull Connect to the care they need

bull Transition prescriptions

To reach our Customer Experience team email welcomekporg or call 303-338-3990

Customer Account Services

An easy-to-use web site link that provides online account management for you and your broker You can view group eligibility and billing information update employee data or pay your invoices

If you would like to set up an account please contact your Account Executive or Associate Account Manager for assistance

Colorado Small Business Enrollment Guide

23

2016 Reference

1 Employer Health Benefits 2011 Annual Survey Kaiser Family Foundation and Health Research amp Educational Trust September 2011 Kaiser Family Foundation is a nonprofit private organization not affiliated with Kaiser Permanente

2 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

3 Kaiser Foundation Health Plan of Colorado Inc received the highest numerical score among commercial health plans in the Colorado region in the proprietary JD Power 2008-2015 US Member Health Plan Studiessm Study based on 31543 total member responses measuring four plans in Colorado (excludes Medicare and Medicaid) Proprietary study results are based on experiences and perceptions of members surveyed November-December 2014 Your experiences may vary Visit jdpowercom

4 Please refer to ldquoNCQArsquos Private Health Insurance Plan Rankings 2013-2014rdquo posted online at wwwncqaorg

5 Kaiser Permanente 2012 HEDISreg scores Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compassreg and represent all non- PPO lines of business Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA Quality Compass 2012 includes certain CAHPSreg data Any data display analysis interpretation or conclusion based on these data is solely that of the authors and NCQA specifically disclaims responsibility for any such display analysis interpretation or conclusion Quality Compassreg and HEDISreg are registered trademarks of NCQA CAHPSreg is a registered trademark of the Agency for Healthcare Research and Quality

6 The 2014 Hewitt Health Value InitiativeTM showed Kaiser Permanente is the most cost-efficient plan across all markets served for the sixth year in a rowmdash12 more cost-effective than the average HMO and 17 more cost-effective than the all-plan average Kaiser Permanente also outperformed other plans in clinical quality scoring 49 better than the average HMO and 209 better than the all-plan average Hewitt Health Value InitiativeTM benchmarking study mdash Kaiser Foundation Health Plan Inc Aon Hewitt April 3 2014 To get a copy of the Hewitt Health Value Initiative report for your region contact your account manager

7 Chronic Care Making the Case for Ongoing Care Robert Wood Johnson Foundation 2010

8 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

9 ldquoWorksite Wellnessrdquo Preventdiseasecom httppreventdiseasecomworksite_wellnessworksite_wellnesshtml accessed November 2 2009

10 See Note 9 11 ldquoObesity by the Numbersrdquo obesityinamericaorg accessed March 24 200812 See Note 313 Thomas Delate PhD et al ldquoReduced Health Care Expenditures After Enrollment

in a Collaborative Cardiac Care Servicerdquo Pharmacotherapy November 2010 Results from our cardiac rehabilitation program in Colorado

Kaiser Foundation Health Plan Inc of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Coloradoreg marketplace copy2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questionsCall us at 1-866-331-2091 bull Or contact your agent or broker

• WHATrsquoS INSIDE
• A BETTER WAY to manage costs
• A BETTER WAY to keep youremployees healthier
• Virtual Care Innovations
• Employee Health amp Wellness
• Enhancing the Employee Experience
• Accessing Care in DenverBoulder
• Accessing Care in Mountain Communities
• Accessing Care Northern Colorado
• KP Plans Offered in Colorado
• Accessing Care in Southern Colorado
• KP Select Plans Offered in Colorado Springs
• Medicare Coverage
• Adult and Pediatric Dental Care
• 2016 Resources

Colorado Small Business Enrollment Guide

23

2016 Reference

1 Employer Health Benefits 2011 Annual Survey Kaiser Family Foundation and Health Research amp Educational Trust September 2011 Kaiser Family Foundation is a nonprofit private organization not affiliated with Kaiser Permanente

2 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

3 Kaiser Foundation Health Plan of Colorado Inc received the highest numerical score among commercial health plans in the Colorado region in the proprietary JD Power 2008-2015 US Member Health Plan Studiessm Study based on 31543 total member responses measuring four plans in Colorado (excludes Medicare and Medicaid) Proprietary study results are based on experiences and perceptions of members surveyed November-December 2014 Your experiences may vary Visit jdpowercom

4 Please refer to ldquoNCQArsquos Private Health Insurance Plan Rankings 2013-2014rdquo posted online at wwwncqaorg

5 Kaiser Permanente 2012 HEDISreg scores Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compassreg and represent all non- PPO lines of business Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA Quality Compass 2012 includes certain CAHPSreg data Any data display analysis interpretation or conclusion based on these data is solely that of the authors and NCQA specifically disclaims responsibility for any such display analysis interpretation or conclusion Quality Compassreg and HEDISreg are registered trademarks of NCQA CAHPSreg is a registered trademark of the Agency for Healthcare Research and Quality

6 The 2014 Hewitt Health Value InitiativeTM showed Kaiser Permanente is the most cost-efficient plan across all markets served for the sixth year in a rowmdash12 more cost-effective than the average HMO and 17 more cost-effective than the all-plan average Kaiser Permanente also outperformed other plans in clinical quality scoring 49 better than the average HMO and 209 better than the all-plan average Hewitt Health Value InitiativeTM benchmarking study mdash Kaiser Foundation Health Plan Inc Aon Hewitt April 3 2014 To get a copy of the Hewitt Health Value Initiative report for your region contact your account manager

7 Chronic Care Making the Case for Ongoing Care Robert Wood Johnson Foundation 2010

8 Dan Witters and Sangeeta Agrawal ldquoUnhealthy US Workers Absenteeism Costs $153 Billionrdquo Gallup-Healthways Well-Being Index January 2ndashOctober 2 2011 wwwgallupcompoll150026Unhealthy-Workers-Absenteeism-Costs-153-Billionaspx

9 ldquoWorksite Wellnessrdquo Preventdiseasecom httppreventdiseasecomworksite_wellnessworksite_wellnesshtml accessed November 2 2009

10 See Note 9 11 ldquoObesity by the Numbersrdquo obesityinamericaorg accessed March 24 200812 See Note 313 Thomas Delate PhD et al ldquoReduced Health Care Expenditures After Enrollment

in a Collaborative Cardiac Care Servicerdquo Pharmacotherapy November 2010 Results from our cardiac rehabilitation program in Colorado

Kaiser Foundation Health Plan Inc of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Coloradoreg marketplace copy2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questionsCall us at 1-866-331-2091 bull Or contact your agent or broker

• WHATrsquoS INSIDE
• A BETTER WAY to manage costs
• A BETTER WAY to keep youremployees healthier
• Virtual Care Innovations
• Employee Health amp Wellness
• Enhancing the Employee Experience
• Accessing Care in DenverBoulder
• Accessing Care in Mountain Communities
• Accessing Care Northern Colorado
• KP Plans Offered in Colorado
• Accessing Care in Southern Colorado
• KP Select Plans Offered in Colorado Springs
• Medicare Coverage
• Adult and Pediatric Dental Care
• 2016 Resources

Kaiser Foundation Health Plan Inc of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Coloradoreg marketplace copy2014 Kaiser Permanente 60347119_15_SBEnrollmentGuide_CO

Have questionsCall us at 1-866-331-2091 bull Or contact your agent or broker

• WHATrsquoS INSIDE
• A BETTER WAY to manage costs
• A BETTER WAY to keep youremployees healthier
• Virtual Care Innovations
• Employee Health amp Wellness
• Enhancing the Employee Experience
• Accessing Care in DenverBoulder
• Accessing Care in Mountain Communities
• Accessing Care Northern Colorado
• KP Plans Offered in Colorado
• Accessing Care in Southern Colorado
• KP Select Plans Offered in Colorado Springs
• Medicare Coverage
• Adult and Pediatric Dental Care
• 2016 Resources