Benefits Book 2014 by SEIU 775 Benefits Group

YOUR BENEFITS 2013-2014

2013-2014 GUIDE TO TRAINING AND HEALTH BENEFITS

THIRD EDITION

2013-2014 BENEFITS BOOK

WELCOME Welcome to the third “Your Benefits” book from the SEIU Healthcare NW Training Partnership and Health Benefits Trust. This book is designed to serve as a complete guide to your training and health benefits. It features resources and information to make it easier to get the support you need. As a Home Care Aide, your training and health benefits are a critical part of the compensation you receive. Quality training and affordable health benefits provide the foundational skills and personal stability needed to help you deliver excellent care to your consumers and create future career pathways. You are the key to quality care in Washington’s long-term care system. Thank you for all you do to promote excellence in home care. Charissa Raynor Executive Director, Training Partnership and Health Benefits Trust

David Rolf Board Chair, Training Partnership and Health Benefits Trust President, SEIU Healthcare 775NW

MANAGE TRAINING / BENEFITS ONLINE www.myseiubenefits.org Enter your Username and Password below for easy reference USERNAME

PASSWORD

PRIMARY CARE PROVIDER (DOCTOR) / URGENT CARE CENTER Write your Doctor and nearest Urgent Care Center here for reference PRIMARY CARE DOCTOR NAME PHONE

URGENT CARE CENTER NAME AND ADDRESS

YOUR HEALTH PLAN Write your Health Benefits Plan here PLAN NAME

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HEALTH BENEFITS 4

Affordable Health Benefits for You

If You Need Assistance

Participating Employers

Quick Start

Eligibility and Enrollment

Access myseiubenefits.org

Benefits Basics

Introducing Portal 2.0

2013-2014 Medical Plan Highlights

Update Preferences

Group Health Urgent Care Centers

2013-2014 Benefit Highlights

Dental Benefits

Get Online

Vision Benefits

Online Continuing Education

TRAINING BASICS

WELLNESS Your Wellness

Health Benefits Quick Start

Quality Training, Quality Care

How to Get the Most from Your Training

DOH Certification: Follow These Steps for Success

Frequently Asked Questions

Benefits Summaries

Interpretation 26

Group Health Options

Help Improve Future Classes

Kaiser Permanente Health

WDS Delta Dental Pro Plan

TRAINING STANDARDS

HEALTH BENEFITS POLICIES

Questions and Appeals

Training Standards Chart

Notices 91

Who to Contact for Training and Support 32

Glossary 92

Safety and Orientation

Home Care Definitions

Frequently Asked Questions

Training Standards Chart

WELLNESS

Willamette Dental

Training Standards

HEALTH BENEFITS

TRAINING POLICIES

Magazine 17

TRAINING STANDARDS

Your Benefits Book

TRAINING POLICIES Classroom Policies

Reasonable Accommodation Policy

2013-2014 BENEFITS BOOK

BENEFITS POLICIES

ONTENTS

TRAINING BASICS

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One-Stop Resource for Training, Health Benefits To make it easier to understand your training and health benefits, the Training Partnership and Health Benefits Trust put together this “Your Benefits” book to help guide you. These benefits are effective Aug. 1, 2013 through July 31, 2014. This Benefits Book will be in effect until July 31, 2014.

YOUR BENEFITS 2013-2014

2013- 2014 GUIDE TO TRAIN

ING AND HEALT H BENEF

ITS

THIRD EDITION

Inside, you will find important benefits information, including: Training Benefits • Training standards • Classroom policies • Glossary • Student resources 2013-2014 BENEFITS

BOOK

Health Benefits (For eligible Individual Providers or Home Care Aides covered through their employers) • Eligibility • Benefit summaries • Wellness guide

Where to Find Updates If there are changes to training standards or other information after the book is released, we will update this “Your Benefits” book the following ways:

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ONLINE - Updates will be available online at www.myseiubenefits.org/benefits YOUR MAGAZINE - Updates will also be in Home Care InSight, the magazine for Home Care Aides. The next issue comes out in September 2013. COLOR CODED - Throughout the book, you will see information for both Individual Providers (IPs) and Agency Providers (APs). To help keep them straight, look for these colors:

n Individual Providers

n Agency Providers

DID YOU KNOW? Did you know there is an online version of the Benefits Book? The online version of the Benefits Book is a useful tool if you misplace your book or want to view your benefits information from anywhere. You can view the online Benefits Book at www.myseiubenefits.org/benefits 4

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RENCE GUIDE IF YOU NEED ASSISTANCE

General Training and Health Benefits Support Fill out a Contact Form at www.myseiubenefits.org/contact Member Resource Center (MRC) 1-866-371-3200 Mon.-Fri., 8 a.m.-6 p.m. The MRC is closed the following holidays: New Year’s Day Martin Luther King, Jr. Day Presidents’ Day Memorial Day Independence Day Labor Day Thanksgiving

Day after Thanksgiving Christmas Eve Day Christmas Day Check www.myseiubenefits.org/MRC for office closures and the most updated hours

n Individual Providers: If you need information about your training or benefits eligibility, log in to www.myseiubenefits.org first. If you cannot find the answer to your question, contact help.

n Agency Providers: Contact your employer for support.

Specific Training Support

Specific Health Benefits Support For answers to medical or dental plan questions, contact: Medical Plan Support Group Health 1-888-901-4636 Mon.-Fri., 8 a.m.-5 p.m. www.ghc.org Kaiser Permanente 1-800-813-2000 www.kp.org

Dental Plan Support Delta Dental (Dental) 1-800-554-1907 www.deltadentalwa.com Willamette Dental 1-800-359-6019 www.willamettedental.com

2013-2014 BENEFITS BOOK

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See chart on Page 32 for who to contact for specific training-related questions.

QUICK REFER IF YOU NEED ASSISTANCE For Assistance Comuníquese con el Centro de Recursos para Miembros al 1-866-371-3200 si necesita asistencia para registrarse en su entrenameinto o para saber cuál es su elegibilidad para los beneficios de salud.

Hãy gọi Trung Tâm Nguồn Lực Thành Viên theo số 1-866-371-3200 nếu quý vị cần được trợ giúp trong việc lên lịch đào tạo hoặc tìm hiểu về điều kiện để nhận phúc lợi y tế. 훈련일정을 잡거나 건강혜택 자격 확인을 위해 도움이 필요하시면 회원지원센터 1-866-371-3200로 전화주세요. 如需在安排培训日程或了解您是否有资格获取保健福利方面获取协助，请致电 1-866-371-3200 联系会员资源中心。

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Если у Вас есть вопросы, связанные с определением расписания занятий, или относительно получения Вами пособия по нетрудоспособности, обращайтесь в Учебнометодический центр по телефону 1-866-371-3200.

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RENCE GUIDE QUICK START

Training Quick Start 1. Find Your Training Standards n Individual Providers: • •

There are different training standards depending on what type of care you provide. Use the online Training Wizard – a tool to help you know which category applies to you – to find your individual training standards. Go to: www.myseiubenefits.org/wizard to complete the Wizard.

n Agency Providers: •

Your employer can help you understand your training standards. Contact your employer to get your training standard information.

2. Watch the Safety and Orientation DVDs - If Required •

Look at the training grid on Page 30 to see your requirement.

3. Schedule Training Early Schedule within first two weeks of hire to ensure the best choices.

n Individual Providers: • •

Create your Username and Password to log in to the training portal at www.myseiubenefits.org. Go online to www.myseiubenefits.org to log in to register for training or call the Member Resource Center at 1-866-371-3200.

n Agency Providers: •

Check with your employer on the best way to register. Your employer has policies on scheduling for training.

1. Check your eligibility for health insurance benefits and enroll

n Individual Providers: Go online to www.myseiubenefits.org to log in to see your eligibility and enroll online, or call the Member Resource Center at 1-866-371-3200. Your eligibility for health insurance depends on the number of hours you work.

n Agency Providers: Contact your employer to see if you are eligible for health benefits through your employer. 2. Make an appointment with your primary care doctor Go to your health insurance provider’s website or contact them by phone (see contact info on Page 5) to find available doctors and other providers. See the Health Benefits section for more details. 2013-2014 BENEFITS BOOK

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Health Benefits Quick Start

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Manage Training and Benefits Easily Online The best way to manage your training and find your eligibility for benefits is through the www.myseiubenefits.org website. Through the new Portal 2.0, you can more easily update your information and stay on top of your training.

How to Log In to the Website

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1. Sign up to log in to Portal 2.0

Enter your first name and last name. • If you know your Student ID enter it in the Student ID Field. • If you don’t know your Student ID, enter the last four digits of your Social Security number along with your birthdate (mm/dd/yyyy). (Note: If you work for DSHS, you must use your Student ID instead of your birthdate and last four digits of your Social Security Number.)

2. Fill out the basic student information

Fill out the information and click Next.

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3. View your student profile page

This screen is to verify your information. You will be asked to verify your information regularly. Make any necessary changes and click Save.

4. Email confirmation

If you have provided your email address (recommended), you will receive an email notification.

Remember, your username is your Student ID and your password is what you set when you signed in. Please put your username and password on Page 2 of this book.

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Now Youâ&#x20AC;&#x2122;re Ready to Log in to the Website!

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The SEIU Healthcare NW Training Partnership and Health Benefits Trust are pleased to announce the launch of Portal 2.0, the new and improved learning management and benefits portal for Home Care Aide students and health insurance beneficiaries. The new portal launched at www.myseiubenefits.org on July 29, 2013. Portal 2.0 is an improvement to the current portal system used by students and their employers to register for classes, take online Continuing Education, check their training requirements and enroll for health benefits. The new Portal 2.0 will benefit workers and their employers through:

Better Communication Portal 2.0 will allow for better communication and tracking so workers can follow how their issue or concern is being addressed.

Better Navigation and Usability Portal 2.0’s improved navigation and structure creates an easier and more efficient system to save time for students and employers.

More Accurate Contact Information

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Portal 2.0 will enhance the students’ and employers’ ability to update contact information, allowing students to be contacted by their preferred methods and provide the most recent language preferences for classes.

Stable, Smart Platform Portal 2.0 will be powered by Salesforce.com, the largest vendor of customer relationship management software, and the online learning platform CyberU. This will allow the Training Partnership and Health Benefits Trust to more easily and efficiently add features to the platform.

Multi-language Capability Portal 2.0 will make it easier in the future for the Training Partnership and Health Benefits Trust to provide training and health information in multiple languages.

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Student Home Page Easily access important sections

Student Dashboard Get support, find training, view training history, print certificates

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Student Support View and manage support requests

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Update Your Preferences for a Better Student Experience

Keeping your language and contact preferences updated is an important way to help the Training Partnership provide you with the best possible training experience. Make sure to update your preferences as soon as possible so we can reach you effectively. 1. Log in.

2. Click the “View Your Profile” link on the left side of the screen:

3. Click the “Edit Profile” link on the middle of the screen:

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4. Modify the settings and update other information and click the “Save” button.

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RENCE GUIDE 2013-2014 BENEFIT HIGHLIGHTS

What’s New and Improved? TRAINING Portal 2.0

The existing training and benefits portal has been upgraded. The new system, called Portal 2.0, improves students’ ability to track their training and monitor their support. It launched July 29, 2013. For more on Portal 2.0, see Page 10.

Refresher Courses As another way to help students achieve success with the DOH Certification Exam, the Training Partnership is offering a free, 2-hour, zero credit Skills Refresher course. Any student who has completed the 70-hour Basic Training series is welcome to sign up and attend. Not available in all areas. Register through the Member Resource Center at 1-866-371-3200 or www.myseiubenefits.org/contact

New Languages Beginning in July 2013, the Training Partnership will start offering training in three new languages – Cambodian/Khmer, Laotian and Somali. This adds to the six existing languages available for students – Korean, Vietnamese, Spanish, Russian, Chinese and English. In January 2014, four additional languages will be added: Samoan, Ukrainian, Tagalog and Arabic.

HEALTH BENEFITS $100 Cash Incentive for Using Health Benefits Wisely

You can earn $100 by doing all three of the following things:

H H H

Register Online: Register online at www.MyGroupHealth.org or www.kp.org. See Page 55 for instructions. Health Risk Assessment: Complete a Health Profile (Group Health) or Total Health Assessment (Kaiser). See Page 55 for instructions. Preventive Office Visit: Complete a preventive office visit with a Primary Care Provider (PCP).

Same Low Cost for Members Health Benefits Trust members still pay only $25 a month for health, dental and vision benefits. 2013-2014 BENEFITS BOOK

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The Health Benefits Trust has a new incentive program to encourage you to use your benefits in the best way to stay healthy. You will see activities that contribute to the incentive marked with a throughout the health section of this book.

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Your easy online source for Online CE, training standards and class registration Once you get your online username and password, you’re ready to go online to manage and take training! Over the past year, the Training Partnership has worked to increase the quantity and depth of the resources available on the website www.myseiubenefits.org In addition to the ability to register online and find training standards and other resources, students can take a robust number of Online Continuing Education courses – right from their computer.

www.myseiubenefits.o

WHY GO ONLINE? Online Training Wizard The online Training Wizard will give you a customized understanding of the training you need. The easy online Training Wizard is found at

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www.myseiubenefits.org/wizard

Manage and Register for Training If you are an Individual Provider, you can register for training online. You can view available courses and pick times that work for you.

Online Continuing Education Students can take their Continuing Education conveniently online – anytime, anywhere! See the following page for details on Online Continuing Education.

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RENCE GUIDE ONLINE CONTINUING EDUCATION As of July 2013, there are 28 English Continuing Education (CE) classes you can take online by going to www.myseiubenefits.org In addition, there are 14 online CE courses in Russian and Spanish available as well. New courses will be coming online throughout the year. With online classes you pick the times and topics that work for you. You can see the available courses, register for and access courses, receive credit, and navigate help information – all online and all 24 hours a day!

take the Multiple Sclerosis module online. I learned a lot and I could do it at home! – Abdul, Training Partnership Student

to complete, which may vary depending on learning style, material covered and Internet connection speed.

2013-2014 BENEFITS BOOK

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Each online course takes about one hour

‘‘

I loved being able to

QUICK REFER Online Continuing Education Classes as of July 2013 ENGLISH

Infection Control and Workplace Safety

An Introduction to Dementia

Multiple Sclerosis

An Introduction to Physical Disabilities

Oral Health Basics

Arthritis & Acute Mental Status Changes

Promoting Creativity

Best Practices for the Professional HCA

Relationships between Consumers

Better Health through Nutritious Cooking

Respiratory Conditions

Body Mechanics

Skin Care Basics

Cultural Competency: Nutrition

Supporting Consumer Independence

Cultural Competency: Pain Management and Assumptions

Supporting Behavior Changes in Consumers Part 1

Cultural Competency: Pain Management and Health Literacy

Supporting Behavior Changes in Consumers Part 2

Denture Care and Cleaning

The Faces of Down Syndrome

Dispelling Disability Myths

Traumatic Brain Injury

Gaining Consumer Cooperation for Oral Care

Using Household Cleaning Chemicals Safely

Green Cleaning

More new courses coming soon!

Hearing and Vision Conditions

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Home Care Aides Make a Difference

SPANISH & RUSSIAN

Body Mechanics

Important Note: The following courses were available in early 2011 for a short time, so if you took them at that time, you cannot take them again. If you did not take them then, they are available to take online.

Infection Control and Workplace Safety

Relationships Between Consumers

Better Health through Nutritious Cooking

Home Care Aides Make a Difference

An Intro to Physical Disabilities

Supporting Consumer Independence

An Introduction to Dementia

The Faces of Down Syndrome

Best Practices for the Professional HCA Multiple Sclerosis Traumatic Brain Injury

Dispelling Disability Myths Promoting Creativity

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RENCE GUIDE MAGAZINE

September 2013 - Next Issue of InSight Magazine As a community of Home Care Aides, you do important work and you have an important story to tell. You can help raise understanding of common challenges and experiences for Home Care Aides to help improve the profession. To share knowledge and skills with the Home Care Aide community, a new magazine will be published to focus on you and your work. Look for the next issue in September 2013.

Magazine Highlights Training and Health Training standards updates

•

Best practices for Home Care Aides

•

Knowledge and skills builders

•

Student participation policies and news

•

Health benefits policies and news

•

Your safety at work

Important Updates to the “Your Benefits” Book • Updates to the “Your Benefits” book will be printed in the magazine as well as posted online; be sure to check your magazine for updates.

SEND US YOUR STORY IDEAS! Do you have an interesting story to share of your successes or challenges as a Home Care Aide? Do you have a story about personal health and wellness? Do you have suggestions for stories or profiles you would like to see in the magazine? Send them to us! Go to www.myseiubenefits.org/stories to submit your story idea.

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•

TRAINING BASICS 18

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TRAINING BASICS

QUALITY TRAINING, QUALITY CARE The Training Partnership understands that adult learners bring a broad set of life experiences, education levels, and English language proficiency to the classroom. To meet that diversity, learning experiences are designed for you, adult students who bring previous knowledge and a passion

VISION Our vision is that every long-term care worker is a professional who has been trained rigorously, whose work is well respected and well compensated, who has meaningful opportunities for professional development and career growth, and who provides high quality care.

for their work to class. The focus is on practical skill development that will help you to do your job.

What Can You Expect from Basic Training Courses? •

As a student, you can expect to meet an instructor with direct care experience who is passionate about supporting Home Care Aides in their professional growth.

•

You can expect opportunities to learn using different methods like watching video clips, completing written activities, and presenting to others.

•

You can expect to learn specific skills, see them demonstrated and then have a chance to demonstrate the skill yourself.

•

You can expect to use a student guide during class which you can keep as a future resource.

‘‘

•

You can expect to be asked what you think, to share what you know, to contribute to discussion, and to answer questions.

The classes were very helpful and they gave me new, healthier ways to deal with challenges at work. – Jasmine, Training Partnership Student 2013-2014 BENEFITS BOOK

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TRAINING BASICS

What Can You Expect from Continuing Education Courses? •

You can expect options in course formats, including in-person and online learning choices.

•

In person instructor-led courses let you ask questions of the

MISSION Our mission is to train and develop professional long-term care workers to deliver high quality care.

instructor, learn from and interact with other Home Care Aides, and have hands-on practice with any skills covered. •

Online courses let you learn at your own pace whenever it is convenient for you.

•

You can expect variety in subjects, from broad overviews to in-depth explorations on specific topics.

•

You can expect to have online courses in multiple languages available to take 24 hours a day, seven days a week.

•

You can expect online learning courses that present information and ask you to apply what you have learned through interactive activities.

What Characterizes the Work of the Training Partnership? There are several themes you will find in the courses, actions, and work of the Training Partnership. They are: •

Dignity of the work and the Home Care Aides who do the work;

•

Dignity of the Consumer whose preferences, rights, individuality, and needs must be respected;

•

Empowerment of the Home Care Aide to improve their lives and the lives of Consumers;

•

Professionalism of the workforce; and

•

Cultural competency and inclusiveness to honor differences.

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Use the Training Wizard Start with the easy online Training Wizard to find the training you need. Go to: www.myseiubenefits.org/wizard to complete the Training Wizard.

Understand DOH Certification Requirements If you are required to receive certification, do not delay â&#x20AC;&#x201C; begin the process as soon as possible. Follow the instructions on the following pages to ensure you successfully complete certification.

Register Early for Training If you need Basic Training, we encourage you to register for your classes within the first two weeks of hire to get the best choice of class options. If you want to take Instructor-Led Continuing Education (CE) classes, register as early as possible to get the best choice of class options before your deadline.

Take Online Learning for Continuing Education Credits Online Continuing Education courses are an easy and convenient way to get the CE hours you need as a Home Care Aide. You can view available courses, take classes and view your credits all from your computer â&#x20AC;&#x201C; 24/7.

Go Online for Convenient Service and Support The www.myseiubenefits.org web portal is your comprehensive resource for available classes, your current training status, benefits eligibility and much more. Log in to the portal first to get the answers you need. Instructions for getting a username and password are on Page 8.

Update Your Contact Info Ensure you are receiving the most current information about your training by updating your contact information with your employer. If you are an Individual Provider, update your information in the portal at www.myseiubenefits.org

Sign Up for News and Alerts Help make sure you get all the latest news and information you need on training standards, deadlines and new online Continuation Course courses. Sign up to receive news and alerts through email.

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TRAINING BASICS

HOW TO GET THE MOST FROM YOUR TRAINING

TRAINING BASICS

ONLY FOR WORKERS WHO REQUIRE CERTIFICATION

DOH Certification: Follow These Steps for Success The Department of Health (DOH) is responsible for the certification process. This is the WA State agency responsible to issue the Home Care Aide Credential (HCA). DOH contracts with a testing company call Prometric to implement the HCA written and skills test. In an effort to help workers be successful through the process, partner organizations such as the Department of Social and Health Services and the Training Partnership are working to help share information about the DOH exam with workers. If you are required to become certified, the Training Partnership is currently recommending the following timeline to allow ample time to work through the certification steps. The steps below outline the SUGGESTED timeline for the process. Prior to Providing Care: Take Safety & Orientation Watch the Safety & Orientation DVD that was provided to you at time of hire. Call to confirm completion 1-866483-1397. You will need your confirmation number and the last 4 digits of your Social Security number. Complete prior to providing care. All workers are required to complete a name and date of birth background check before you can begin work. You will work with the contracting staff to 24

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complete this. After the name and date of birth background check is complete you are required to schedule a fingerprint appointment. Talk with your employer for directions on how to complete this. STEP 1: Submit DOH Certification Application DOH requires that you submit your application to become a Home Care Aide within 14 days of hire. If you are limited English proficient you must indicate this on your initial application. This means if your ability to read, write or speak English is limited you may be issued a provisional certification allowing up to 60 additional days to become a certified HCA. You can submit your application before the training begins. Once you have completed training you will send your Training Certificate to DOH. This is your 75 hour certificate that you will be issued when you are complete with training. Read the DOH application carefully for the mailing address to send the Training Certificate. Download the Certification Application Packet under “Applications and Forms” at www. doh.wa.gov/hsqa/HCAides/ STEP 2: Register for Training Individual Providers • Create your username and password to log in to the portal at www.myseiubenefits.org • Go to www.myseiuben-

efits.org to register for training or call the Member Resource Center at 1-866-371-3200 Agency Providers • Check with your employer on the best way to register STEP 3: Submit Candidate Exam Application Immediately upon registering for training, download and read the Candidate Information Booklet and the Sample Candidate Application Form. Download the Candidate Application Form and submit the application form and fee to Prometric to be scheduled for a Home Care Aide Exam. You do not need to have completed training at the time you apply for testing. On the application form you will attest that you are in training and to the estimated date you will complete the required 75 hours. You should allow four weeks for your application to be processed. Download the forms at www.prometric.com/WADOH STEP 4: Target Completion of Basic Training Take your training as soon as possible to ensure best access to classes in your area and your preferred language. STEP 5: Self Study and Prepare for the Exam To prepare for the exam, review the “Exam Preparation Materials” found on the

Prometric website for the Home Care Aide Exam. There you will find practice questions, skills checklists and instructions that will help you be successful in the exam. In addition, review the Practice Exam. www.prometric.com/ WADOH

STEP 6. TAKE EXAM

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*If you are a limited-English speaker, you may have additional days to receive certification.

STEP 5. SELF STUDY; PREPARE FOR EXAM

DEADLINE FOR COMPLETION STEP 4. TARGET COMPLETION OF BASIC TRAINING

STEP 3. SUBMIT CANDIDATE EXAM APPLICATION

STEP 2. REGISTER FOR TRAINING

STEP 1. SUBMIT DOH CERTIFICATION APPLICATION

PRIOR TO PROVIDING CARE TAKE SAFETY & ORIENTATION

STEP 7. GET CERTIFIED

200 120 90 60 30 14 1

DAYS

STEP 7. Get Certified Your results are reported to DOH and they will send you a letter confirming you are officially certified. You can check the DOH website listed in Step 2 to see if your certification is Active. If you are Pending it means that DOH does not have all the information they need to complete certification. Make sure you have fully completed the application, completed the back ground check, fully explained any personal history that could effect your ability to get certified and you have successful passed your written and skills examination through Prometric.

SUGGESTED TIMELINE FOR TRAINING AND CERTIFICATION

STEP 6. Take Exam Report to test location prepared to follow testing guidelines in the Candidate Information Booklet and General Instructions. www.prometric.com/ WADOH

DAY 200: STANDARD HOME CARE AIDES ARE REQUIRED TO RECEIVE CERTIFICATION

INTERPRETATION Individual Providers and Agency Providers who work with Coastal CAP, Concerned Citizens, Full Life Care, Lower Columbia CAP, Oly CAP, Senior Life Resources, and Visiting Nurses, the community interpretation option is available to you when you register for classes. Please see instructions below. Agency providers who work with AAA Residential, Addus, Amicable, Catholic Community Services (CCS), CDM, Chesterfield, KWA, ResCare, and SeaMar, the community interpreter option is available to you. Indicate to the person who registers you for class that you will be bringing a community interpreter.

Community Interpretation The Training Partnership values the diversity of Home Care Aides. Basic Training and instructor-led CE courses are offered in English, Cantonese, Spanish, Russian, Korean, Vietnamese and, new for 2013, Cambodian/Khmer, Laotian and Somali. In January 2014, four additional languages will be offered: Arabic, Tagalog, Ukrainian and Samoan. For those students who speak another primary language and are unable to take courses in English, we offer a Community Interpretation option.

Steps to Register for Community Interpretation 1. Notify the Training Partnership: At the time of course registration, tell us either using the online portal or the Member Resource Center if you will be bringing someone with you to serve as your interpreter. If you are bringing someone to interpret, you are responsible for telling them when and where the class will be held and for reserving space for them. 2. Orientation: Online Orientation Video: You and your Community Interpreter should watch a helpful online Orientation before their first Community Interpretation session. This Orientation will help prepare your Community Interpreter and you for the class. It is very important that your interpreter watches this Orientation before your first class, especially if they do not have training in interpreting. Tip Sheet: If you have a friend or family member interpret for you, we offer a tip sheet and other information that will help prepare your interpreter to assist you in class. View orientation info and tip sheet here: www.myseiubenefits.org/training/using-community-interpreter

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TRAINING BASICS

HELP IMPROVE FUTURE CLASSES Participate in strengthening future classes – a call to action

Course Survey All Home Care Aides are encouraged to complete a course survey online. The Training Partnership Customer Service Team would like your feedback to provide the best possible training for our students. These surveys are short and feedback is taken seriously. The surveys will help us do the following: • Help improve our classes • Make sure your opinions are heard • Help us better meet your needs as a student How do you submit a course survey? After you complete a course, you will see a “Take Survey” link on your student home page. Simply follow that link to review the course.

In-person Feedback and Focus Groups In addition to surveys, the Training Partnership collects input from students through in-person feedback and focus groups. These opportunities allow students to share their ideas and feedback to improve classes. If you are interested in participating, email feedback@myseiubenefits.org and provide your full name and date of birth in the email. We will contact you in the future for feedback opportunities.

2013-2014 BENEFITS BOOK

TRAINING STANDARDS 28

MYSEIUBENEFITS.ORG

TRAINING STANDARDS

TRAINING STANDARDS Training standards vary for different types of workers. Be sure to check your own training standards through the online Wizard and see the training standards chart on Page 30.

Basic Training Curriculum Different types of workers have different Basic Training standards. Basic Training is the introductory training you take to understand the fundamentals of Home Care Aide work.

Continuing Education Different types of workers have different Continuing Education standards. The Training Partnership

TRAINING WIZARD As training standards change, you may wonder: “How do I know what my training standards are?” The Training Partnership has a convenient and easy online Training Wizard to help. The Wizard – in addition to the training standards chart on Page 30 - will help you understand the training you need. Go to www.myseiubenefits.org/wizard to get started!

provides quality instructor-led and online Continuing Education (CE) classes across the state. Continuing Education covers a broad range of subjects. You choose the ones that are best suited to your interests and the Consumers you serve.

2013-2014 BENEFITS BOOK

MYSEIUBENEFITS.ORG

Not applicable

Completed prior to providing care

Standard HCA IP or AP hired after 1/7/2012 renewed certification

Standard HCA IP or AP hired before 1/7/2012

Parent Individual Provider (HCS/AAA)*

Parent DD Individual Provider (DDD)*

Limited Service Provider*

Adult Child Individual Provider*

Completed prior to providing care

Not applicable

Completed prior to providing care

Safety Training 3 Hours

Not required

Within 120 days of starting to provide care Within 120 days of starting to provide care

Not required

Within 120 days of starting to provide care Not required

Not applicable

Within 120 days of starting to provide care

Not applicable

Not required

Basic Training 70 Hours

BASIC TRAINING

Not required

Within 120 days of starting to provide care Not required

Yes

HCA Credential Required?

Not required

Not applicable

Not required

Parent Provider (DDD Only) Class 7 Hours

CREDENTIAL

By your birthday in next calendar year after completing Accelerated Basic Training

Not required, unless you voluntarily obtain your HCA credential

By your birthday in next calendar year after completing Basic Training

By your birthday following your last HCA credential renewal date

By your second birthday following your HCA credential issuance date**

Continuing Education 12 Hours

INITIAL CONTINUING EDUCATION (CE)

*NOTE: If you work for multiple employers, have multiple roles or multiple consumers, you may have different training standards than the chart indicates below. ** If you are credentialed on your birthday then your CE is due on your first birthday following your non-HCA Credential issuance date.

Completed prior to providing care

Standard HCA Individual Provider (IP) & Agency Provider (AP) hired after 1/7/2012 in process or Newly Issued HCA credential

Orientation 2 Hours

Accelerated Basic Training 30 Hours

UPDATED JULY 2013

ORIENTATION AND SAFETY

TRAINING STANDARDS

By your birthday

Not required, unless you voluntarily obtain your HCA credential

By your birthday

Continuing Education 12 Hours

ONGOING CE

Not required

Provider with a Newly Issued Non-HCA Credential

Not required

By your birthday

If CE is required in table above, then your CE is due by your first birthday after you start working as an HCA IP or AP. If CE is required in the table above, then your CE is due by your second birthday following you non-HCA Credential issuance date.**

Provides care to a consumer living in his or her home. Employed by a private, Medicaid homecare agency or DSHS.

A worker who has successfully passed a test and been credentialed by Department of Health as a Home Care Aide.

Home Care Aide (HCA) employed by a private, Medicaid homecare agency.

Home Care Aide (HCA) whose employer of record is DSHS.

Home Care Aide who does not work with their own parent or child. Works more than 20 hours a month or has more than one consumer.

This is an IP who provides care to his/her own adult child and is contracted through Home and Community Services (HCS) and/or an Area Agency on Aging (AAA). This is often referred to as a non-DDD Parent Provider.

This is an IP who provides care to his/her own adult child with a developmental disability and is contracted through the Developmental Disability Administration.

This is any IP who provides care 20 hours a month or less for one consumer.

An adult child providing care for his/her biological, step or adoptive parent.

This is an HCA with a current healthcare credential, such as a Registered Nurse (RN), Licensed Practical Nurse (LPN) or Nursing Assistant Certified (NAC).

HCA Credentialed

Agency Provider (AP)

Individual Provider (IP)

Standard HCA

Parent Individual Provider (HCS/AAA)

Parent DD Individual Provider (DDA)

Limited Service Provider

Adult Child Individual Provider

Non-HCA Credentialed

A provider may fall into more than one of these definitions.

Home Care Aide (HCA)

HOME CARE AIDE DEFINITIONS

***If you are currently certified as an LPN or RN, CE is not required for your role as an Individual Provider (IP) or Agency Provider (AP). You must maintain your LPN or RN credential and be in good standing with the state of Washington.

Not required

Provider with a Renewed Non-HCA Credential

For Workers Who Have a Current Non-HCA Credential, the Chart Below Applies (Not LPN or RN)***

TRAINING STANDARDS

2013-2014 BENEFITS BOOK

WHO TO CONTACT FOR TRAINING SUPPORT AGENCY PROVIDERS INDIVIDUAL PROVIDERS

Class registration and rescheduling

(Visiting Nurse Home Care, Senior Life Resources, OlyCAP, CoastalCAP, Concerned Citizens, Full Life)

AGENCY PROVIDERS

(Addus, Chesterfield, KWA, ResCare, SeaMar, Amicable)

(Catholic Community Services , CDM, AAA Residential)

Website or MRC

Your Employer

How to complete your Website or MRC training

Website or MRC

Your Employer

Username and Website or MRC password assistance

Website or MRC

Website, MRC or Employer

Your Employer

Confirmation Code

Website or MRC

MRC

Your Employer

Confirming class schedule

Website or MRC

Website, MRC or Employer

Your Employer

Training requirement Primary DSHS Contact Your Employer and deadlines

Your Employer

Questions about payment

Primary DSHS Contact Your Employer

Your Employer

Change of address

Primary DSHS Contact Your Employer

Your Employer

Change in training standards due to change in employment status

Primary DSHS Contact Your Employer

Your Employer

Requesting a certificate

See Next Page

MYSEIUBENEFITS.ORG

See Next Page

SAFETY AND ORIENTATION If you are in aSEIcategory that requires U HEALTHCAR E NW TRAININ G

The Training PARTNERSH Partnership trains and deve IP care workers lops professi to deliver high onal long-term quality care and people and support with disabiliti to older adul es. ts

either the Training Partnership’s Safety or Orientation training (or both) you should or contracting. The kit contains the following:

TRAINING STANDARDS

SAFETY & ORIENTATIO N

have received a kit at the time of hiring

1. Instructions on “How to Complete and Receive Credit

D HELP? CON

TACT THE MEM

for Safety and/or Orientation.”

BER RESOUR

1-866-371-32

CE CENTER

WWW.MYSEIUBE NEFIT

S.ORG

2. Three DVDs: Orientation, 635 ANDOVER

PARK WEST

SUITE 200, TUKW

ILA, WA 98188

SEI U H E A L TR AI NI NG TPAH C A R E N W RT NE RS HI P

Safety Training Part 1, and Safety Training Part 2.

3. Supplemental information titled, “Orientation and Safety – A Reference Tool for Individual Providers.” Agencies may supplement this training with an agency-specific orientation program. If you did not receive the Safety and Orientation Kit, please contact your employer. Safety and Orientation Verification Line: 1-866-483-1397

CERTIFICATES

Students (and Agency employers and DSHS staff) can print their own certificates. Once you have completed your training, log in to your account and go to Training History. From there, click the “Certificate” link and print from the browser.

That’s it, you’re done! It’s fast and easy and you can do it from home.

2013-2014 BENEFITS BOOK

FREQUENTLY ASKED QUESTIONS 1. What is www.myseiubenefits.org? At www.myseiubenefits.org you can read important announcements from the Training Partnership, learn about our different programs and ask questions. On the website, you can register for classes, see your training history and track your progress.

Have a question about wages for training? Contact your employer or your DSHS case manager. The Training Partnership cannot answer questions regarding wages.

You can also take online Continuing Education classes by going to this website. 2. How do I log in to www.myseiubenefits.org? Logging in to your account is an easy process from the website. Follow the instructions on Page 8 to log in. 3. How do I check in for classes? You just need a state-issued picture ID to check in for your classes. That can be a driverâ&#x20AC;&#x2122;s license, an ID card or a passport. 4. How do I update my contact information with the Training Partnership? You can update your contact info and set your preferred contact and language preferences in your student record by logging in at www.myseiubenefits.org or you can call the Member Resource Center at 1-866-371-3200. 5. How do I ensure the Training Partnership knows I need classes in another language? Make sure you update your language preferences in the Portal 2.0 or call the Member Resource Center for help in multiple languages at 1-866-371-3200.

MYSEIUBENEFITS.ORG

FREQUENTLY ASKED QUESTIONS 6. I arrived to class and I am not on the roster. What do I do? If your name is not on the roster and you decide to stay in the class, you will need to fill out an attestation form. Please note that filling out an attestation form does not guarantee that credit will be granted. 7. How do I provide feedback about a class? Your feedback is very important to us and we want to know about your class experience with the Training Partnership. You can complete a course survey after attending a class by going to www.myseiubenefits.org. For more information on submitting feedback, see Page 27.

TRAINING POLICIES

8. How do I get my training certificate? You now have access to printing your own certificate at any time. Once you’ve completed all your training requirements, you can log on to see your record at www.myseiubenefits.org and get your certificate of completion at your convenience. Refer to the Certificates section on Page 33 if you need assistance. 9. I have a question about wages for training. Contact your employer or your DSHS contact. The Training Partnership cannot answer questions regarding wages.

‘‘

The class on mental health really helped me understand the issue better and gave me tools. I feel more prepared to help my client with mental health issues now. – Marcos, Training Partnership Student

2013-2014 BENEFITS BOOK

CLASSROOM POLICIES At the Training Partnership we know you have taken your valuable time to come to class. We created the following policies to ensure a successful learning environment in which everyone can support each other and get the most out of each class.

Class Registration •

Students need to be registered for class and on the class roster in order to take a class.

•

If you have not previously registered for a class, you will not be able to take the class.

•

If your name is not on the roster, you will need to fill out an attestation form if you decide to stay in the class. Please note that filling out an attestation form does not guarantee that credit will be granted.

Only Registered Students and Interpreters are Allowed in Class •

The only people allowed in class are registered students and registered interpreters.

•

Students may not bring Consumers, children, or any other visitors to class.

Classes Start on Time •

If you arrive to class after the start time, you will be considered late and you will need to reschedule your class.

•

You should arrive to class 15 minutes before the start time to avoid being late.

Bring Picture ID •

Students are expected to show a state-issued picture ID to sign in for class. It can be a state ID, a driver’s license or a passport.

MYSEIUBENEFITS.ORG

CLASSROOM POLICIES Student Participation •

Students are expected to fully participate in the learning experience.

•

Personal phone calls or other personal matters should be taken care of during breaks.

Class Cancellation A student will need to cancel class registration at least 72 hours in advance of the class time.

•

If the Training Partnership has to cancel a class, a notification of the class cancellation will be sent to you based on the communication preference in your online profile. The Training Partnership will work with you to reschedule the class.

TRAINING POLICIES

•

Inclement Weather •

If the Training Partnership has to cancel a class due to inclement weather, a notification of the class cancellation will be sent based on the communication preference in your profile. The Training Partnership will work with you to reschedule the class.

2013-2014 BENEFITS BOOK

REASONABLE ACCOMMODATION POLICY Policy on Reasonable Accommodation of Students with Disabilities The SEIU Healthcare NW Training Partnership (“Training Partnership”) admits students regardless of race, color, national origin, ethnic origin, gender, age, disability and sexual orientation to all the rights, privileges, programs, and activities generally accorded or made available to students by the Training Partnership. It does not discriminate on the basis of race, color, national origin, ethnic origin, gender, age, disability and sexual orientation in administration of its training and educational policies, admissions policies, scholarship and loan programs, and other Training Partnership administered programs.

What is Reasonable Accommodation? Reasonable accommodation means modifying or adjusting practices, procedures, policies, educational services and delivery, or the training environment so that a student with a disability can enjoy equal educational opportunity, so long as (1) there is sufficient medical evidence establishing a relationship between the disability and the need addressed by the specific accommodation; and (2) it does not impose an undue hardship on the Training Partnership.

Students with disabilities have the right to request and receive reasonable accommodation so that students may have the opportunity to take full advantage of the Training Partnership’s programs and activities.

When is a person regarded as having a disability? For purposes of accommodation, a person is regarded as having a disability if he or she has a sensory, mental, or physical impairment that is medically cognizable or diagnosable or exists as a record or history or is perceived to exist.

MYSEIUBENEFITS.ORG

REASONABLE ACCOMMODATION POLICY What is Undue Hardship? Undue hardship means, among other things, an excessively costly, extensive, substantial or disruptive modification or one that would fundamentally alter the nature or operations of the Training Partnership or its programs.

Overview of Accommodation Process To request reasonable accommodation, a student with a disability should request accommodation from the Training Partnership by completing the â&#x20AC;&#x153;ADA Request Formâ&#x20AC;? found at www.myseiubenefits.org/ADA_policy or by calling the Member Resource Center. Once the request is received by the Training Partnership, the Accommodation Process will start, during which the student

TRAINING POLICIES

will be asked to provide current documentation of his or her disability, the functional limitations resulting from the disability, and recommendations for specific accommodations. As part of the Accommodation Process, the Training Partnership will confer with the student to identify appropriate and reasonable accommodations that may be warranted under the particular circumstances. The Training Partnership has the right to establish qualifications and other essential standards and requirements for its courses, programs, activities and services. All students are expected to meet these essential qualifications, standards, and requirements with or without reasonable accommodations. More detailed information on the Accommodation Process can be found at www.myseiubenefits.org/ADA_policy

2013-2014 BENEFITS BOOK

HEALTH BENEFITS 40

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AFFORDABLE HEALTH BENEFITS FOR YOU For eligible Individual Providers and Agency Providers, the Health Benefits Trust is a nonprofit organization providing affordable health coverage focused on keeping you healthy. The health care benefits offered by the Health Benefits Trust are part of a community of care that starts with the wellness of you, the Home Care Aide.

2013-2014 Benefits Plan The Health Benefits Trust designed the 2013-2014 benefits, which took effect on Aug. 1, 2013, to fulfill the following goals: • • • •

Lowering out-of-pocket costs for Home Care Aides Emphasizing preventive care to encourage wellness Increasing participation in health risk assessments Increasing use of urgent care facilities in urgent situations that don’t require emergency room care

• •

Encouraging convenient, lower-cost prescriptions through mail order

HEALTH BENEFITS BASICS

•

Making mail prescriptions for some chronic conditions free Encouraging use of in-network providers

The 2013-2014 benefits plan accomplishes those goals and allows for the continuation of affordable, quality benefits for all eligible Home Care Aides. You may be eligible if you worked 86 hours in each of the previous three months. Once enrolled in health coverage, your coverage will continue as long as you work at least 86 hours every month and pay your monthly co-premium.

How to Enroll n Individual Providers: You can enroll by logging in to www.myseiubenefits.org and filling out the enrollment form online (first time applicants only). Call the Member Resource Center toll-free at 1-866-371-3200 to get answers to your questions about eligibility for benefits, and also to request an enrollment application if your coverage lapsed more than a year ago.

n Agency Providers: Contact your employer for assistance and enrollment information.

2013-2014 BENEFITS BOOK

PARTICIPATING EMPLOYERS Washington employers whose employees are eligible for benefits through the Health Benefits Trust. NOTE: This list may change, check with your employer to verify participation. AAA Residential Services Addus Healthcare Amicable Healthcare Catholic Community Services CDM Chesterfield Concerned Citizens Home Care Services of Montana Korean Womenâ&#x20AC;&#x2122;s Association

Lower Columbia Community Action Council Olympic Community Action Council Coastal Community Action Council ResCare Senior Life Resources Northwest State of Washington (employer of record) Visiting Nurse Home Care

ELIGIBILITY AND ENROLLMENT How many hours do I have to work for continuing coverage? After your coverage begins, you must work at least 86 hours each month to have continuous coverage.

How do I enroll? n Individual Provider: Log on to www.myseiubenefits.org to complete enrollment or call the Member Resource Center at 1-866-371-3200.

n Agency Provider: Contact your employer to coordinate your enrollment.

MYSEIUBENEFITS.ORG

BENEFITS BASICS Home Care Aides get the following comprehensive benefits through the Health Benefits Trust:

Medical Nobody ever plans to get sick, but the Health Benefits Trust has you covered. Depending on where you live, your medical, vision and prescription drug coverage will be provided by Group Health or Kaiser Permanente. You pay very little out-of-pocket for the following services: • • • • • • •

Acupuncture Allergy shots and other injections Chiropractor visits Doctor’s office visits Hearing exams In-patient hospitalization Laboratory services

• • • • • •

Mammograms Maternity services Mental health Rehabilitative therapies Routine immunizations X-rays and diagnostic imaging

Vision •

Hardware, such as glasses and contacts

HEALTH BENEFITS BASICS

•

Routine exams

Prescription Drugs • •

Generic drugs Brand-name drugs

Dental The Health Benefits Trust helps with routine dental care as well as dental emergencies. Dental benefits are provided by Delta Dental and Willamette Dental. Preventive care: There is no annual deductible for preventive procedures. Covered procedures include check-ups, cleanings and X-rays. Basic procedures: Covered procedures include fillings, oral surgery, periodontics (gum disease) and endodontics (root canals).

HOW MUCH DOES IT COST? The Health Benefits Trust works hard to keep your out-of-pocket costs low. You pay $25 per month toward the premium for medical/prescription/vision and dental coverage. You cannot enroll for only medical or only dental coverage.

Major procedures: Covered procedures include crowns, dentures and bridges. 2013-2014 BENEFITS BOOK

2013-2014 MEDICAL PLAN HIGHLIGHTS New Incentives The 2013-2014 Health Benefits Trust plans include a new incentive program. Incentive activities are marked by a throughout this book. IMPORTANT NOTE: For Group Health, the incentive will come automatically up to 6-8 weeks after you complete all three incentive activities. If you are with Kaiser, please contact the Health Benefits Trust after completing all three steps. If you have already registered online, you can still receive the incentive for doing the other two activities between 8/1/2013 and 7/31/2014.

MONTHLY COST SHARE UNCHANGED The monthly cost share for Home Care Aides will remain the same at $25 per month.

You can earn $100 by doing all three of the following things each year:

H H H

Register Online: Register online at www.MyGroupHealth.org or www.kp.org. See page 55 for instructions. If you have already registered, you do not need to again. Health Risk Assessment: Complete a Health Profile (Group Health) or Total Health Assessment (Kaiser). See Page 55 for instructions. Preventive Office Visit: Complete a preventive office visit with a Primary Care Provider (PCP). A preventive office visit gives you and your doctor a chance to talk about topics that can help prevent disease and improve your health. Recommended tests and immunizations can be given during your preventive visits or at appointments between those visits.

Group Health: No Cost for Value-Based Prescriptions by Mail The Rx co-pay is lower for value-based drugs that treat diabetes, high blood pressure, high cholesterol and heart failure. The co-pay is also lower for other generic drugs, and formulary brand-name drugs.

PRESCRIPTION/RX CO-PAY GRID Rx Co-pay (In-network) for 30 day supply Formulary Contraceptives Group Health

Kaiser

$25

Kaiser

$25

$50

Kaiser (requires approval)

$50

Value Based Drugs* Group Health Generic drugs Group Health Formulary brand name drugs Group Health Non-formulary brand name drugs Group Health

MYSEIUBENEFITS.ORG

Value-Based Drugs are for Diabetes: metformin, glipizide, glyburide, insulin NPH High Cholesterol: simvastatin, lovastatin, pravastatin Heart Failure: carvedilol, metoprolol XL, spironolactone High Blood Pressure: hydrochlorothiazide, chlorthalidone, lisinopril, enalapril, captopril, ramipril, lisinopril/HCTZ, amlodipine, verapamil, diltiazem, metoprololIR, atenolol

NEW INCENTIVES = $100 Complete the following three actions and you will receive a check for $100!

Group Health Pharmacy Costs Less You will have the lowest co-pay, or no co-pay, by using mail order prescription drugs through the Group Health pharmacy.

Hearing Benefits

H H H

Sign up for MyGroupHealth.org or KP.org Fill out a Health Profile or Total Health Assessment Complete a preventive office visit with a Primary Care Provider

Your 2013-2014 plan includes benefits for hearing services.

Your Current Insurance Plan If you are currently enrolled in the Health Benefits Trust, you are enrolled in one of the following plans depending on your ZIP code: Group Health POS – You live within 30 miles of a Group Health Medical Center or contracted facility. Group Health PPO – You live more than 30 miles from Group Health Medical Center or contracted facility.

HEALTH BENEFITS BASICS

Group Health Cooperative HMO – You live within 30 miles of a Group Health Medical Center or contracted facility and enrolled in the Trust effective 8/1/2012 or later. This plan only has coverage in-network. There are no out-ofnetwork benefits. Kaiser Permanente HMO – You live within the Kaiser Permanente service area (southwest Washington/Portland, OR only).

UNDERSTANDING HEALTH INSURANCE TERMS Co-pay The amount you will pay at the time of your visit. Deductible The amount that you pay for covered services before the plan begins paying in a given year. You need only to satisfy your deductible once in a calendar year.

In-network You don’t have to pay as much when you use this group of providers. HMO: You only have coverage in-network. Out-of-network A bigger group of providers where you may access care but your outof-pocket expenses will be higher than with in-network providers.

2013-2014 BENEFITS BOOK

PLAN AND NETWORK GRID

WHICH PLAN AND NETWORK APPLIES TO ME? Group Health Cooperative – HMO Plan

Group Health “Options Select” – POS Plan

for members who enroll 8/1/2012 or later

if you have been previously enrolled prior to 8/1/2012 and are re-enrolling:

Your network is called: “Group Health Cooperative”

Your network is called: “Group Health Options Select” If you are enrolling effective 8/1/2012 or later, you will be automatically enrolled in this plan if you live within 30 miles of a Group Health Facility or Contracted Provider.

If you are enrolling effective 8/1/2012 or later, you will be automatically enrolled in this plan if you live within 30 miles of a Group Health Facility or Contracted Provider.

Group Health “Options” – PPO Plan

Your in-network is called: “Options” You will be automatically enrolled in this plan if you live farther than 30 miles from a Group Health Facility or Contracted Provider or live in Montana.

Your in-network is called: “Options Select”

All care is provided at Group Health Medical Centers and from other Group Health contracted providers

In-Network care is provided at Group Health Medical Centers and from other Group Health contracted providers.

No out-of-network coverage is available.

Out-of-Network care is provided by First Choice Health Network Providers. The First Choice Health Network has an extensive panel of preferred providers in WA, OR, ID, AK and MT.

In-Network care is provided by Group Health Medical Centers; other Group Health contracted providers; First Choice Health Network Providers and First Health Network Providers The First Choice Health Network has an extensive panel of preferred providers in WA, OR, ID, AK and MT. Out-of-Network care is any other licensed provider

Link to look up Group Health Providers http://myseiu.be/imSCSp

Group Health PHARMACY HMO Plan

POS Plan

PPO Plan

Any Group Health Medical Center or contracted community pharmacy.

In-Network: Any Group Health Medical Center or contracted Community Pharmacy

In-Network: Group Health Medical Centers and Med Impact Pharmacies Out-of-Network: All other pharmacies

Out-of-Network: Med Impact Pharmacies

KAISER PERMANENTE If you live in the Kaiser Permanente Service Area (please see FAQ #30) you will be automatically enrolled in this plan. You must access a Kaiser Permanente provider/facility for your care. There is no out-of-network coverage under this plan. Link to look up Kaiser Permanente Providers http://myseiu.be/mTdBBa

DENTAL PLANS You have a choice of dental plans, however you would only choose Willamette Dental if you lived near a Willamette Dental Clinic.

Delta Dental (Washington Dental Service) PPO Plan

Willamette Dental

In-network: You will have the highest level of coverage by using a Delta Dental PPO dentist. You can find a Delta Dental PPO network dentist by visiting their at www.DeltaDentalWA. com. Click on the Patients tab and then on the Find a Dentist tab at the top of the screen to begin your search. Choose the “Delta Dental PPO” option for participating dentists under the In a Certain Plan or Network. Be sure to check the Delta Dental PPO network.

Coverage for this plan is only offered at Willamette Dental Clinics. You can find the locations of Willamette Dental clinics by visiting www. willamettedental.com. Click on the Locations tab for your state.

For dentists outside of Washington state, click on the green “search the national Delta Dental directory” link. This will take you to the national directory.

MYSEIUBENEFITS.ORG

MEDICAL PLAN HIGHLIGHTS 2013-2014 BENEFIT

IN-NETWORK

OUT-OF-NETWORK POS PLAN ONLY

Preventive Care

Covered In Full

Covered in full up to $300; 80% covered

Covered In Full

$500 deduct, 80% Covered

Group Health

$15

$15 co-pay, deductible and coinsurance apply

Kaiser

$30

No out-of-network allowed

$200 co-pay

Group Health

$500 and services may not be covered depending on your plan

Kaiser

Not allowed

Mammograms

NOTES

Routine mammograms

Urgent Care

Emergency Room

Waived if admitted

Out-of-Network Deductible

No out-of-network allowed

HEALTH BENEFITS BASICS

2013-2014 BENEFITS BOOK

MYSEIUBENEFITS.ORG

GROUP HEALTH URGENT CARE CENTERS Six Group Health medical centers have Urgent Care Centers, most with evening, weekend, and holiday hours. Group Health also contracts with many community Urgent Care Centers throughout the state of Washington. Use the Group Health Provider Directory at www.ghc.org to find urgent care providers in other areas. You can also find urgent care locations, hours and wait times from the Group Health iPhone and Android App. For more on when to go to Urgent Care, see Page 56. For additional Urgent Care Centers, call the Consulting Nurse Line at 1-800-297-6877 for the nearest location.

WESTERN WASHINGTON BELLEVUE MEDICAL CENTER 425-502-3000 11511 N.E. 10th St. Bellevue, WA 98004 URGENT CARE | 425-502-4120

EASTERN WASHINGTON RIVERFRONT MEDICAL CENTER 509-324-6464 322 W. North River Dr. Spokane, WA 99201 EXTENDED HOURS | 509-324-6464

HEALTH BENEFITS BASICS

CAPITOL HILL CAMPUS, SEATTLE 206-326-3000 201 16th Ave. E. Seattle, WA 98112 URGENT CARE | 206-326-3175

TACOMA MEDICAL CENTER 253-596-3300 209 Martin Luther King Jr. Way Tacoma, WA 98405 URGENT CARE | 253-596-3300

EVERETT MEDICAL CENTER 425-261-1500 2930 Maple St. Everett, WA 98201 URGENT CARE | 425-261-1660 OLYMPIA MEDICAL CENTER 360-923-7000 700 Lilly Rd. N.E. Olympia, WA 98506 URGENT CARE | 360-923-7740 SILVERDALE MEDICAL CENTER 360-307-7300 10452 Silverdale Way N.W. Silverdale, WA 98383 URGENT CARE | 360-307-7300

URGENT CARE SAVES MONEY $200 vs. $15 The out-of-pocket cost for a trip to the emergency room is $200 (waived if you are admitted to the hospital) vs. just $15 for a trip to Urgent Care with Group Health and $30 with Kaiser.

2013-2014 BENEFITS BOOK

MYSEIUBENEFITS.ORG

DENTAL BENEFITS Healthy teeth and gums are a critical part of your overall health. That’s why comprehensive dental benefits are included in the coverage you receive through the Health Benefits Trust. To keep your teeth healthy, your dental benefits include at no additional cost to you for in-network services: •

Routine exams

•

Regular cleanings

•

X-rays

•

Gum care

•

Fillings

DID YOU KNOW? The American Dental Association says healthy gums are linked to a healthy heart. Another reason to visit your dentist regularly.

Depending on your plan, some of the cost of the following procedures may also be covered: Crowns, inlays

•

Dentures

•

Implants

HEALTH BENEFITS BASICS

•

To take the best care of your teeth, gums and overall health, you should see your dentist every six months for a complete exam and cleaning.

VISION BENEFITS Keeping your eyes healthy and regularly updating optical prescriptions are important to your overall health and well being. Vision benefits through the Health Benefits Trust are an affordable way to ensure your sight is protected.

DID YOU KNOW? As part of a complete wellness plan, everyone should have regular eye exams, even if you’re not having problems with your vision.

• For a $15 co-pay per visit, you receive routine vision care. • Every two years you receive $200 worth of optical supplies, including contact lenses and frames.

2013-2014 BENEFITS BOOK

WELLNESS 52

MYSEIUBENEFITS.ORG

YOUR WELLNESS Working Together to Keep You Healthy As a Home Care Aide, you know how important it is to stay healthy. With the benefits you receive from the Health Benefits Trust, you have excellent health care, dental and vision benefits at a low cost. There are some key things you can do to ensure that health care for Home Care Aides continues for years to come: •

Have a preventive care visit

•

Understand the importance of using urgent care vs. the emergency room

•

Use mail order pharmacy and generic drugs

Four Steps to Better Health There are several key ways you can maximize your benefits for better health:

•

Complete your Preventive Care Visit

•

Complete a Health Profile or Total Health Assessment

•

Use urgent care vs. the emergency room when appropriate

•

Manage prescriptions to your provider; use mail order

H H

Follow the steps below and on the following pages to get started.

HEALTHY HOME CARE AIDE WELLNESS

URGENT CARE

URGENT CARE See a Primary Care Provider

Find a doctor; set up your first visit

Find Your Closest Urgent Care Centers

Locate the centers near you

Manage Your URGENT CARE Prescriptions Transfer prescriptions to your health plan, use mail order

2013-2014 BENEFITS BOOK

Have a Preventive Care Visit

One of the most important things for you to do is to select a Primary Care Provider and set up your first preventive care visit. A strong relationship with your Primary Care Provider is at the heart of your care, and helping you stay healthy.

How to Select Your Primary Care Provider Go Online: Use the provider directory at www.ghc.org URGENT CAREor www.kp.org to find a personal physician who’s a good match for you. or Call: Group Health Customer Service at 1-888-901-4636 Kaiser Permanente Customer Service at 1-800-813-2000

H Make a Preventive Care Appointment Establishing a relationship with your Primary Care Provider (PCP) is important to your health. Make a preventive care appointment so your PCP can best help you to be or stay healthy.

What’s a Primary Care Provider? A Primary Care Provider is a family practice, general practice, internal medicine, or pediatrics physician who provides most of a member’s primary care. A PCP helps coordinate a member’s specialty care.

MYSEIUBENEFITS.ORG

DID YOU KNOW? Your out-of-pocket expenses are much less when you use in-network providers. Assuming you have four office visits this year, your out-of-pocket expenses using a Group Health provider would be $60 vs. $500 or more with an out-of-network provider.

Registering at MyGroupHealth.org or KP.org will help get you connected to the most convenient care. At MyGroupHealth you can make appointments online, order prescriptions and email your doctor. Once you register, you will be able to complete your Health Risk Assessment or Total Health Assessment.

MyGroupHealth CARE H Register forURGENT To access the Health Profile, you need to upgrade your MyGroupHealth account so you have access to online services. To register, visit MyGroupHealth.org or call Website Customer Service at 1-888-874-1620.

H Register for Kaiser Online Access Using Kaiser online access, you can fill out your Total Health Assessment. Register at www.kp.org

WELLNESS

H Take a Health Profile or Total Health Assessment Filling out an easy quiz called a Health Profile or Health Risk Assessment will help you find out how healthy you are. •

What are your daily eating habits?

•

How often do you exercise?

•

How often do you drink alcohol?

Find out how the answers to questions like these affect your health. Your Health Profile (Group Health) or Total Health Assessment (Kaiser) are online quizzes to help you and your doctor take better control of your health.

2013-2014 BENEFITS BOOK

Locate Closest Urgent Care Center

It is important to locate your Urgent Care Center in

URGENT CARE

advance because in the event you need urgent care, it is often a difficult time to look for an Urgent Care Center.

When to Use Urgent Care vs. Emergency Room Here are some examples of when to use urgent care or the emergency room. This is not intended to be a complete list. URGENT CARE - $15 per visit Allergies Asthma Attack (Minor) Cold, Flu, Fever Cough Dizziness Fractures Nausea Minor Burns Minor Cuts/Lacerations Sore Throat Sprains Stitches

DID YOU KNOW? Urgent care is a much more affordable option for Home Care Aides through the Health Benefits Trust. The out-of-pocket cost for a trip to the emergency room is $200 (waived if you are admitted to the hospital) vs. just $15 for a trip to Urgent Care with Group Health and $30 with Kaiser. 56

MYSEIUBENEFITS.ORG

EMERGENCY ROOM - $200 per visit (waived if admitted) Chest Pain Compound Fractures (Bone Visible) High Fever Ingestion of Poison Major Head Injury Seizures Severe Asthma Attack Severe Burns Shock Uncontrollable Bleeding

Where to Find Urgent Care GROUP HEALTH: Many Group Health medical clinics have Urgent Care Centers, most with evening, weekend, and holiday hours. Use the Provider Directory online to find urgent care providers in other areas. Find an Urgent Care Center at www.ghc.org or call 1-888-901-4636. KAISER: Find an Urgent Care Center at www.kp.org or call 1-800-813-2000.

Manage Your Prescriptions

Your prescriptions are a big part of your health benefits. Make the most of them by managing them wisely.

Transfer Prescriptions If you have existing prescriptions, have them transferred to Group Health or Kaiser Permanente to receive the best benefit from your coverage.

URGENT CARE

Mail-Order Prescriptions

Getting your prescriptions by mail does not cost any more than the co-pays. Group Health members get a co-pay discount of up to $5 vs. filling your prescription at the pharmacy. Kaiser members can obtain a three months supply for only two co-pays vs. three co-pays at the pharmacy.

Value-Based Prescriptions Free for You For some Value-Based prescriptions through Group Health, there is no co-pay when you have drugs mailed to you through convenient mail order services. See Page 44 for a list of the prescriptions available for this benefit.

WELLNESS

HOW TO TRANSFER YOUR PRESCRIPTION Group Health: Go online to www.ghc.org to transfer your prescription or call Customer Service at 1-888-901-4636. Kaiser Permanente: Go online to www.kp.org or call Customer Service at 1-800-813-2000.

How to Set Up Mail-Order Prescriptions Group Health: After setting up an online account you can order refills online or by phone and have them mailed to you – free of charge. Kaiser Permanente: After setting up an online account you can order refills online and have them mailed to you – free of charge. 2013-2014 BENEFITS BOOK

MYSEIUBENEFITS.ORG

HEALTH BENEFITS QUICK START Check Your Eligibility for Health Benefits You must work at least 86 hours per month for three consecutive months to be eligible to apply for these benefits. You do not need to wait until you are eligible to apply, you can complete the enrollment form after youâ&#x20AC;&#x2122;re hired.

Enroll n Individual Providers: You can enroll by logging in to

URGENT CARE

www.myseiubenefits.org and filling out the enrollment form.

n Agency Providers: Talk with your employer about enrollment.

Look for Your ID Card After you are eligible and enroll you should receive an ID card in the mail. You will need the ID card number to access your benefits. If you do not receive the card by the 10th of the month that your coverage starts, call the MRC at 1-866-371-3200 if you are an Individual Provider or, if you are an Agency Provider, talk with your employer. Look for and write down your nearest Urgent Care Center and keep it with your card for reference.

H and Fill Out Your Health Profile H

Register online at www.MyGroupHealth.org or www.KP.org to get the best care from your health provider. Once you are registered, complete the online Health Profile. The Profile is an online quiz and report to help you manage your health.

Make a Preventive Care Appointment H

URGENT CARE

Use the online provider directory at www.ghc.org or www.kp.org to find a primary care doctor whoâ&#x20AC;&#x2122;s a good match for you. Then make a preventive care appointment.

URGENT CARE

Locate Your Nearest Urgent Care Center As soon as possible, you should identify the closest Urgent Care Center to you in case of an emergency. You can find Urgent Care Centers online at www.ghc.org or www.kp.org

Manage Your Prescriptions If you have existing prescriptions, have them transferred to Group Health or Kaiser Permanente. Next, set up mail-order prescription refills online or through customer service to save money and time.

URGENT CARE Complete Three Activities Marked with a Star and Receive $100!

If you have 1) registered online for MyGroupHealth.org or KP.org; 2) completed your Health Assessment; and 3) had a preventive care appointment, you will receive a check for $100. 2013-2014 BENEFITS BOOK

WELLNESS

URGENT CARE

FREQUENTLY ASKED QUESTIONS COVERAGE BASICS 1. When I am outside Washington state or the United States am I covered by the plan? Yes, but you must contact the health insurance provider for specific benefits and claim submission procedures at: Group Health 1-888-901-4636 Kaiser 1-800-813-2000 Delta Dental 1-800-554-1907 Willamette (contact the clinic where the services were provided) 2. Can I add dependents to my plan?

n Individual Provider: Dependents are not covered. The Individual Provider benefits do not allow coverage for dependents under this plan.

n Agency Provider: If you are covered by the Health Benefits Trust, you can cover dependents by paying the full premium for them through payroll deduction. Dependents can only be added when they are initially eligible or during the annual open enrollment period. Check with your employer for information. 3. How do I cancel my coverage and the corresponding paycheck deductions? The request must be made in writing and sent to the Health Benefits Trust via fax or U.S. Mail. Fax to 206-859-2637 or mail to SEIU Healthcare NW Health Benefits Trust PO Box 6, Mukilteo, WA 98275. Requests in writing received before the 15th of the month will stop further payroll deductions. 4. If I havenâ&#x20AC;&#x2122;t received an ID card, who do I call? Allow up to 10 days after your coverage begins for processing and mailing your ID cards. After you enroll and are eligible you should receive an ID card in the mail. You will need the ID card number to access your benefits. If you do not receive the card by the 10th of the month that your coverage starts, call the Member Resource Center at 1-866-371-3200 if you are an Individual Provider, or if you are an Agency Provider, talk with your employer. 5. Is dental or vision coverage included with this plan? Yes. Vision coverage is part of your medical plan administered by your medical health insurance provider â&#x20AC;&#x201C; Group Health or Kaiser. You have the choice of dental coverage either through Delta Dental or Willamette. 6. Is there a pre-existing condition waiting period? No.

MYSEIUBENEFITS.ORG

FREQUENTLY ASKED QUESTIONS ELIGIBILITY 7. Can I use authorized, unclaimed hours from a previous month to satisfy my hour requirement in a subsequent month? No. For the purpose of health care insurance eligibility, hours are only applicable to the month in which they are authorized, not when they are claimed or paid. 8. How do I enroll for coverage?

n Individual Provider: Log on to www.myseiubenefits.org to complete enrollment or call the Member Resource Center at 1-866-371-3200.

HOW DO I ENROLL FOR COVERAGE? n Individual Provider: Log on to www.myseiubenefits. org to complete enrollment or call the Member Resource Center at 1-866-371-3200.

n Agency Provider: Contact your employer to coordinate your enrollment.

n Agency Provider: Contact your employer to coordinate your enrollment. 9. How many hours do I have to work for continuing coverage? After your coverage begins, you must work at least 86 hours each month to have continuous coverage. 10. I don’t have enough hours some months resulting in a lapse in coverage, do I have to meet the initial eligibility requirements again? If you are not covered by the plan for 12 months in a row, you will need to requalify for the initial eligibility requirements. 11. I work for a Home Care Agency and I’m also an Individual Provider. If I’m currently enrolled in my agency employer’s plan, can I terminate that coverage and enroll in the Health Benefits Trust as an Individual Provider instead of keeping my agency plan? Yes, but please keep in mind the initial eligibility requirements when determining your cancellation date. You’ll need to keep your current plan until your coverage as an Individual Provider begins. NOTE: You cannot be covered under both the Health Benefits Trust as an Individual Provider and another employer’s plan. 12. What happens if I work less than 86 hours in a month after I am enrolled in the plan?

Your coverage will terminate the first day of the following month.

2013-2014 BENEFITS BOOK

BENEFITS POLICIES

For all Grandfathered Agency Providers - (this means you were an Agency Provider and must have had health care coverage by the Trust in the month of September 2011).

FREQUENTLY ASKED QUESTIONS Example: If you work less than 86 hours in May, your health care coverage will end that month and you will NOT have coverage starting June 1st. For all Individual Providers and all Non-Grandfathered Agency Providers Your coverage will continue for one month and end the first of day of the second month. Example: If you work less than 86 hours in May, you WILL have health care coverage in June, but you will NOT have coverage starting July 1st. If you lose coverage, you may choose to pay the full monthly (COBRA) premium out of pocket. In this case, the Health Benefits Trust will send you a COBRA notice and election form explaining your coverage option and the cost. 13. When can I submit my enrollment form for coverage?

n Individual Provider: You should enroll as soon as you have authorization to work as an Individual Provider.

n Agency Provider: Contact your employer to coordinate your enrollment.

MISCELLANEOUS 14. I am an Individual Provider. What if I report my hours to Social Service Payment System (SSPS) so late that they donâ&#x20AC;&#x2122;t make the $25 deduction from my check? You will need to notify the Health Benefits Trust and mail in a check or money order for $25 payable to SEIU Healthcare NW Benefits Trust, PO Box 6, Mukilteo, WA 98275. You will also need to send a copy of your paycheck stub (also known as your Remittance Advice) and invoice showing you claimed at least 86 hours for that month. It is very important to report your hours to SSPS in a timely manner to avoid having to make a payment by mail. Your health insurance provider may not be able to verify your eligibility and your coverage will be considered lapsed until we receive your check and supporting documentation. 15. Can I be covered by another plan at the same time that Iâ&#x20AC;&#x2122;m enrolled in the Health Benefits Trust Plan and use it as secondary coverage? Participants may not have comprehensive health care benefits or insurance through other individual, family, employment-based, military or veterans coverage or insurance. 16. How do I notify you that my address has changed? If you are an Individual Provider, request for an address change must be made to either your DSHS case worker or to Social Service Payment System (SSPS) 62

MYSEIUBENEFITS.ORG

Is dental or coverage in with this pl

r vision ncluded lan?

FREQUENTLY ASKED QUESTIONS directly. If you are an Agency Provider, contact your employer to make this change. 17. I currently have coverage, but not through the Health Benefits Trust plan. Can I enroll in the Health Benefits Trust plan if my other current coverage terminates? Yes. 18. I want to change my dental insurance provider. How can I do this?

IS DENTAL OR VISION COVERAGE INCLUDED? Yes. Vision coverage is part of your medical plan administered by your medical insurance provider â&#x20AC;&#x201C; Group Health or Kaiser. You have the choice of dental coverage either through Delta Dental or Willamette.

Typically, this is only allowed during the annual open enrollment period that takes place in July of each year and has an August 1 effective date. If you are an Agency Provider, please contact your employer about open enrollment or other location change options available. If you are an Individual Provider, please call the Member Resource Center toll-free at 1-866-371-3200 about options for changing dental insurance providers. 19. If I cancel my insurance, can I enroll again later? Yes, but if you have voluntarily cancelled your coverage, you will have to meet the initial eligibility requirements again in order to regain coverage. If you are an Agency Provider, you cannot enroll again until the next annual open enrollment. 20. If I have coverage through my spouse, can I cancel that coverage and sign up for the Health Benefits Trust plan? Yes, but please keep in mind the initial eligibility requirements when determining your cancellation date. 21. What benefit plans are offered by the Health Benefits Trust? Currently, three insurance providers provide fully insured medical and/or dental coverage and one insurance provider provides self-insured dental coverage. Providers currently include: Group Health, Kaiser Permanente, Delta Dental Self-Insured Dental, and Willamette Dental Group. Trust enrollees are automatically enrolled in the Group Health coverage unless they reside in the Kaiser Permanente service area (southwest Washington and Portland, OR areas). Health Benefits Trust enrollees have a choice of dental insurance providers. 22. What if I am currently on COBRA through another plan? Can I cancel COBRA and enroll?

2013-2014 BENEFITS BOOK

BENEFITS POLICIES

Yes. There is a place on the enrollment application to indicate the current plan termination date. Please contact the Health Benefits Trust directly with questions on the COBRA benefit at 1-866-771-7359.

FREQUENTLY ASKED QUESTIONS 23. What if I have Washington’s Basic Health Plan (BHP) coverage? Can I enroll in this plan? Only if you cancel your BHP coverage. You cannot have both. There is a place on the Health Benefit Trust’s enrollment application to indicate the termination date of the current coverage. 24. When will my coverage be effective?

n Individual Providers: Call the Member Resource Center at 1-866-371-3200 to determine.

n Agency Providers: Please contact your Human Resources department to coordinate your enrollment.

Group Health Specific Questions 26. What if I don’t want to see any doctors who practice with Group Health Medical Centers? If you are a new enrollee in the Health Benefits Trust effective 8/1/2012 or later, and you live within 30 miles of a Group Health Medical Center or contracted provider, your health care coverage is only for using Group Health Medical Centers or contracted providers. There is no out-of-network coverage. For all other enrollees, each time you seek health care services, you can choose to use your in-network providers, or not. Your highest level of benefits ($0 deductible) will be found using in-network providers: Group Health Physicians for the POS (Options) plan and First Choice Health Network of Providers for the PPO (Options PPO) plan. You will pay more out of pocket costs by using an out-of-network provider. For example, you will have a $500 deductible. 27. What does Group Health HMO vs. POS vs. PPO mean? If you live within 30 miles of a Group Health facility or contracted provider, and your coverage begins 8/1/2012 or later, you will automatically be enrolled in the HMO plan. If you are already enrolled, then your coverage is through the POS plan. If you live beyond 30 miles, you will automatically be enrolled in the PPO plan. In the POS and PPO plans, you have the choice of in-network or out-of-network providers each time you seek service. 28. How do I look for a provider available to me through Group Health? For POS plan (within 30 miles of Group Health facilities): On right hand side of www.ghc.org, under “Find a Doctor or Medical Facility” click on “Provider & Facility Directory”; then click on “Doctors and Other Providers”; then under “*Health plan provider network:” choose “Options PPO” or “Options Select” 64

MYSEIUBENEFITS.ORG

FREQUENTLY ASKED QUESTIONS (for the HMO plan) For PPO Plan (all others): On right hand side of www.ghc.org, under “Find a Doctor or Medical Facility” click on “Provider & Facility Directory,” click on “Doctors and Other Providers”; then under “*Health plan provider network:” choose Options PPO. Or call Group Health Customer Service toll free: 1-888-901-4636 • Finding a provider • Specific benefit questions • Complex medical care case management • Inpatient care case management 29. How do I pay my co-pay? Beginning in May 2013, Group Health no longer accepts cash payments at Group Health Medical Centers facilities. Group Health expects payment at time of service, and will gladly accept: • Credit cards, debit cards, and personal checks. Visa, MasterCard®, American Express, and Discover® credit and debit cards are welcome. Personal checks will be scanned, converted to electronic transactions, and immediately deducted from your checking account. • Prepaid debit cards you can purchase at large stores, including Safeway, QFC, Target, and Walmart. Look for them where gift cards are sold. • Prepaid debit cards from banks or credit unions. You can reload these cards at any time. For more info, go to ghc.org/payment, ask one of our cashiers, or call Customer Service toll-free at 1-888-901-4636.

WHO DO I CONTACT IF I HAVE QUESTIONS ABOUT MY BENEFITS? Contact your insurance provider directly for an explanation of benefits and/or questions you have about claims. Group Health (POS, POS, HMO) 1-888-901-4636 www.ghc.org Kaiser Permanente 1-800-813-2000 www.kp.org Delta Dental (Dental) 1-800-554-1907 www.deltadentalwa.com Willamette Dental 1-800-359-6019 www.willamettedental.com

n Individual Providers: Contact the Member Resource Center toll-free at 1-866-371-3200.

n Agency Providers: Contact your employer. 2013-2014 BENEFITS BOOK

BENEFITS POLICIES

WHO DO I CALL TO ENROLL OR ASK ELIGIBILITY QUESTIONS?

FREQUENTLY ASKED QUESTIONS KAISER PERMANENTE SPECIFIC QUESTIONS 30. What is Kaiser Permanente’s service area? If you live in any of the following counties/ZIP codes, your medical coverage will be provided by Kaiser Permanente’s HMO plan. Washington counties: Clark, Cowlitz, Lewis 98591 98593 98596, Skamania 98639 98648, Wahkiakum 98612 98647 Oregon counties: Multnomah, Polk, Washington, Yamhill 31. Do I have out-of-network coverage under Kaiser Permanente? No (with the exception of emergency services). To access your comprehensive coverage, you must use a Kaiser Permanente provider/facility. www.kp.org Link to find Kaiser Permanente Providers http://myseiu.be/mTdBBa 32. How do I contact Kaiser Permanente Membership Services? Call Kaiser Permanente Membership Services toll free: 1-800-813-2000 • • • • • •

Choose a primary care provider Specific benefit questions Complex medical care case management Inpatient care case management Speak to an advice nurse Ask about Kaiser Permanente facilities across the country

33. What can I do when I register for Kaiser Online Access?:

MYSEIUBENEFITS.ORG

POLICIES

• E-mail your doctor’s office • View select test results • Order prescription refills (and have them mailed to you, with free shipping) • Request or cancel routine appointments • Review recent past office visits • See a list of your recent immunizations and allergies • Act for a family member (e-mail your child’s doctor, and more) • Receive a monthly e-newsletter Register at https://members.kaiserpermanente.org/redirects/register

BENEFIT SUMMARIES The following pages are benefit summaries, only, and are not intended to replace the specifics of the individual planâ&#x20AC;&#x2122;s Certificate of Coverage, Contract, or Evidence of Insurance. If there is a contradiction, the Certificate of Coverage, Contract, or Evidence of Insurance will take precedence.

IF YOU HAVE QUESTIONS If you have questions about your planâ&#x20AC;&#x2122;s coverage, contact your health insurance provider. Group Health www.ghc.org 1-888-901-4636 Mon.-Fri., 8 a.m.-5 p.m. Kaiser Permanente 1-800-813-2000 www.kp.org Delta Dental 1-800-554-1907 www.deltadentalwa.com Willamette Dental 1-800-359-6019 www.willamettedental.com

2013-2014 BENEFITS BOOK

GROUP HEALTH OPTIONS - Benefit Summaries Questions? 1-888-901-4636 www.ghc.org NOTE: This is a benefit summary, only, and is not intended to replace the specifics of the planâ&#x20AC;&#x2122;s Certificate of Coverage, Contract, or Evidence of Insurance. If there is a contradiction, the Certificate of Coverage, Contract, or Evidence of Insurance will take precedence.

Group Health HMO Effective Date 8/1/2013

Health Plan Group Health

Ref RQ-68053

This is a brief summary of benefits. THIS IS NOT A CONTRACT OR CERTIFICATE OF COVERAGE. All benefit descriptions, including alternative care, are for medically necessary services. The Member will be charged the lesser of the cost share for the covered service or the actual charge for that service. For full coverage provisions, including limitations, please refer to your certificate of coverage. In accordance with the Patient Protection and Affordable Care Act of 2010, • The lifetime maximum on the dollar value of covered essential health benefits no longer applies. Members whose coverage ended by reason of reaching a lifetime limit under this plan are eligible to enroll in this plan. Benefits

Inside Network

Plan deductible

No annual deductible

Individual deductible carryover

Not applicable

Plan coinsurance

No plan coinsurance Individual out-of-pocket limit: $1,000 Family out-of-pocket limit: $2,000

Out-of-pocket limit

Out-of-pocket expenses for the following covered services are included in the out-of-pocket limit: Inpatient services, outpatient services, emergency services at a GHC or non-GHC facility, ambulance services.

Pre-existing condition (PEC) waiting period

No PEC

Lifetime maximum

Unlimited

Outpatient services (Office visits)

$15 copay

Hospital services

Inpatient services: $100 copay, per day for up to 5 days per admit Outpatient surgery: $50 copay

Prescription drugs (some injectable drugs may be covered under Outpatient services)

Value based/formulary generic/formulary brand $4/$8/$25 copay per 30 day supply

Prescription mail order

$5 discount per 30 day supply

Acupuncture

Covered up to 8 visits per medical diagnosis per calendar year without prior authorization; additional visits when approved by the plan $15 copay

Ambulance services

Plan pays 80%, you pay 20%

Chemical dependency

Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $15 copay

Devices, equipment and supplies • Durable medical equipment • Orthopedic appliances • Post-mastectomy bras limited to two (2) every six (6) months

Covered at 50%

• Ostomy supplies • Prosthetic devices

Covered at 50%

RQ-68053

2013-2014 BENEFITS BOOK

Group Health HMO Diabetic supplies

Diagnostic lab and X-ray services

High end radiology imaging services such as CT, MR and PET must be determined Medically Necessary and require prior authorization except when associated with Emergency care or inpatient services

Emergency services (copay waived if admitted)

$200 copay at a designated facility

Hearing exams (routine)

$15 copay

Hearing hardware

Not covered

Home health services

Covered in full. No visit limit.

Hospice services

Covered in full

Infertility services

Not covered

Manipulative therapy

Covered up to 10 visits per calendar year without prior authorization $15 copay

Massage services

See Rehabilitation services

$200 copay at a non designated facility

Inpatient: $100 copay, per day for up to 5 days per admit Maternity services

Mental Health

Outpatient: $15 copay. Routine care not subject to outpatient services copay Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $15 copay

Naturopathy

Covered up to 3 visits per medical diagnosis per calendar year without prior authorization; additional visits when approved by plan $15 copay

Newborn Services

Initial hospital stay: See Hospital Services; Office visits: See Outpatient Services; Routine well care: See Preventive care. Any applicable cost share for newborn services is separate from that of the mother.

Obesity-related surgery (bariatric)

Not covered

Organ transplants Donor search & harvest applies to lifetime max Preventive care Well-care physicals, immunizations, Pap smear exams, mammograms

RQ-68053

MYSEIUBENEFITS.ORG

Unlimited, no waiting period Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $15 copay Covered in full Womenâ&#x20AC;&#x2122;s preventive care services (including contraceptive drugs and devices and sterilization) are covered in full.

Group Health HMO Rehabilitation services (Occupational, speech, physical including services for neurodevelopmentally disabled members) Rehabilitation visits are a total of combined therapy visits per calendar year Skilled nursing facility Sterilization (vasectomy, tubal ligation)

Temporomandibular Joint (TMJ) services

Inpatient: 60 days per calendar year $100 copay, per day for up to 5 days per admit Outpatient: 60 visits per calendar year $15 copay Covered in full up to 60 days per calendar year Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $15 copay Womenâ&#x20AC;&#x2122;s sterilization procedures are covered in full. $1,000 per calendar year; $5,000 lifetime max Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $15 copay

Tobacco cessation counseling

Quit for Life Program - covered in full

Routine vision care (1 visit every 12 months)

$15 copay

Optical hardware Lenses, including contact lenses and frames

$200 per 24 months

RQ-68053

2013-2014 BENEFITS BOOK

Options Effective Date 8/1/2013

Health Plan Options

Ref RQ-68054

This is a brief summary of benefits. THIS IS NOT A CONTRACT OR CERTIFICATE OF COVERAGE. All benefit descriptions, including alternative care, are for medically necessary services. The Member will be charged the lesser of the cost share for the covered service or the actual charge for that service. For full coverage provisions, including limitations, please refer to your certificate of coverage. In accordance with the Patient Protection and Affordable Care Act of 2010, â&#x20AC;˘ The lifetime maximum on the dollar value of covered essential health benefits no longer applies. Members whose coverage ended by reason of reaching a lifetime limit under this plan are eligible to enroll in this plan BENEFIT

Inside Network

Outside Network Individual deductible: $500 per calendar year Family deductible: $1,000 per calendar year 4th quarter carryover applies Plan pays 80%, you pay 20% of the Usual, Customary and Reasonable (UCR) charges.

Plan deductible

No annual deductible

Individual deductible carryover

Not applicable

Plan coinsurance

No plan coinsurance

Out-of-pocket limit

Individual out-of-pocket limit: $1,000 Family out-of-pocket limit: $2,000 Out-of-pocket expenses for the following covered services are included in the out-of-pocket limit inpatient services, outpatient services, emergency services at a Managed Health Care Network (MHCN) facility and ambulance services

Individual out-of-pocket limit: $2,000 Family out-of-pocket limit: $4,000: Out-of-pocket expenses for the following covered services are included in the out-of-pocket limit: Plan coinsurance, emergency services at a non-Managed Health Care Network (MHCN) facility.

No PEC

Same as in-network

Pre-existing condition (PEC) waiting period Lifetime maximum (Office visits)

Hospital services

Unlimited

Same as in-network maximum $15 copay, deductible and coinsurance apply Inpatient services: $100 copay, per Inpatient services: $100 copay, day for up to 5 days per admit per day for up to 5 days per admit Deductible and coinsurance apply $15 copay

Outpatient surgery: $50 copay

Prescription drugs (some injectable drugs may be covered under Outpatient services) Prescription mail order

Acupuncture

Ambulance services Chemical dependency

Value based/formulary generic/ formulary brand/non- formulary $4/$8/$25/$50 copay per 30 day supply $5 discount per 30 day supply Covered up to 8 visits per medical diagnosis per calendar year without prior authorization; additional visits when approved by the plan

MYSEIUBENEFITS.ORG

$13/$30/$55 copay per 30 day supply Not covered

$15 copay, deductible and coinsurance apply

$15 copay Plan pays 80%, you pay 20%

Same as in-network Inpatient: $100 copay, per day for Inpatient: $100 copay, per day for up to 5 days per admit up to 5 days per admit Deductible and coinsurance applt Outpatient: $15 copay

RQ-68054

Outpatient surgery: $50 copay, deductible and coinsurance apply Formulary generic/formulary brand/ non-formulary

Outpatient: $15 copay, deductible and coinsurance apply

Options BENEFIT Inside Network Devices, equipment and supplies • Durable medical equipment Orthopedic appliances Covered at 50% • Orthopedic appliances • Post-mastectcomy bras limite to two (2) every six (6) months • Ostomy supplies Covered at 50% • Prosthetic devices Insulin, needles, syringes and lancets-see Prescription drugs. External insulin pumps, blood glucose monitors, testing reagents and supplies-see Devices, equipment and supplies. When Diabetic supplies Devices, equipment and supplies or Prescription drugs are covered and have benefit limits, diabetic supplies are not subject to these limits.

Outside Network

Covered at 50%, deductible applies

Insulin, needles, syringes and lancets-see Prescription drugs. External insulin pumps, blood glucose monitors, testing reagents and supplies-see Devices, equipment and supplies. When Devices, equipment and supplies or Prescription drugs are covered and have benefit limits, diabetic supplies are not subject to these limits. Inpatient: Covered under Hospital Inpatient: Covered under Hospital services services Outpatient: Deductible and Outpatient: Covered in full coinsurance apply High end radiology imaging High end radiology imaging services Diagnostic lab and X-ray services services such as CT, MR and PET such as CT, MR and PET must be must be determined Medically determined Medically Necessary Necessary and require prior and require prior authorization authorization except when except when associated with associated with Emergency care Emergency care or inpatient or inpatient services. services. Emergency services $200 copay $200 copay (copay waived if admitted) $15 copay, deductible and $15 copay Hearing exams (routine) coinsurance apply Not covered Not covered Hearing hardware No visit limit Covered in full. No visit limit. Home health services Deductible and coinsurance apply Covered in full Deductible and coinsurance apply Hospice services

Infertility services Manipulative therapy Massage services

Maternity services

Mental Health

Not covered Covered up to 10 visits per calendar year without prior authorization $15 copay See Rehabilitation services

Visit limits shared with in-network $15 copay, deductible and coinsurance apply

See Rehabilitation services Inpatient: $100 copay, per day for Inpatient: $100 copay, per day for up to 5 days per admit up to 5 days per admit Deductible and coinsurance apply Outpatient: $15 copay. Routine care not subject to outpatient services copay

Outpatient: $15 copay, deductible and coinsurance apply. Routine care not subject to outpatient services copay. Inpatient: $100 copay, per day for Inpatient: $100 copay, per day for up to 5 days per admit Deductible up to 5 days per admit and coinsurance apply Outpatient: $15 copay

Naturopathy

Not covered

Covered up to 3 visits per medical diagnosis per calendar year without prior authorization; additional visits when approved by plan $15 copay

Outpatient: $15 copay, deductible and coinsurance apply $15 copay, deductible and coinsurance apply

RQ-68054

2013-2014 BENEFITS BOOK

Options BENEFIT

Inside Network Initial hospital stay: See Hospital Services; Office visits: See Outpatient Services; Routine well care: See Preventive care. Any Newborn Services applicable cost share for newborn services is separate from that of the mother Obesity-related surgery (bariatric) Not covered Organ transplants Donor search & harvest a pplies to lifetime max

Unlimited, no waiting period

Outside Network Initial hospital stay: See Hospital Services; Office visits: See Outpatient Services; Routine well care: See Preventive care. Any applicable cost share for newborn services is separate from that of the mother Not covered Shared with in-network

Inpatient: $100 copay, per day for Inpatient: $100 copay, per day for up to 5 days per admit Deductible up to 5 days per admit and coinsurance apply Outpatient: $15 copay

Outpatient: $15 copay, deductible and coinsurance apply $300 per person; $600 per family per calendar year Coinsurance applies

Preventive care Well-care physicals, immunizations, Pap smear exams, mammograms

Rehabilitation services (Occupational, speech, physical including services for neurodevelopmentally disabled members) Rehabilitation visits are a total of combined therapy visits per calendar year Skilled nursing facility

Sterilization (vasectomy, tubal ligation)

Temporomandibular Joint (TMJ) services

Tobacco cessation counseling Routine vision care (1 visit every 12 months) Optical hardware Lenses, including contact lenses and frames

RQ-68054

MYSEIUBENEFITS.ORG

Covered in full Women’s preventive care services (including contraceptive drugs and devices and sterilization) are covered in full.

Inpatient: 60 days per calendar year $100 copay, per day for up to 5 days per admit

Women’s preventive care services (including contraceptive drugs and devices and sterilization) are subject to the applicable Preventive Care cost share and benefit maximums Routine mammograms: Deductible and coinsurance apply Inpatient: Day limits shared with in-network $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply

Outpatient: 60 visits per calendar year $15 copay

Outpatient: Visit limits shared with in-network $15 copay, deductible and coinsurance apply Day limits shared with in-network Covered in full up to 60 days per benefit, deductible and coinsurance calendar year apply Inpatient: $100 copay, per day for up to 5 days per admit Inpatient: $100 copay, per day for Deductible and coinsurance apply up to 5 days per admit Outpatient: $15 copay, deductible and coinsurance apply Outpatient: $15 copay

Women’s sterilization procedures are covered subject to the applicable Preventive Care cost share and benefit maximums Shared with in-network $1,000 per calendar year; $5,000 Inpatient: $100 copy, per day for up lifetime max to 5 days per admit Inpatient: $100 copay, per day for Deductible and coinsurance apply up to 5 days per admit Outpatient: $15 copay, deductible Outpatient: $15 copay and coinsurance apply Quit for Life Program - covered Applicable cost shares apply in full $15 copay, deductible and $15 copay coinsurance apply Women’s sterilization procedures are covered in full.

$200 per 24 months

Shared with in-network

Options PPO Effective Date 8/1/2013

Health Plan Options PPO

Ref RQ-68044

This is a brief summary of benefits. THIS IS NOT A CONTRACT OR CERTIFICATE OF COVERAGE. All benefit descriptions, including alternative care, are for medically necessary services. The Member will be charged the lesser of the cost share for the covered service or the actual charge for that service. For full coverage provisions, including limitations, please refer to your certificate of coverage. In accordance with the Patient Protection and Affordable Care Act of 2010, The lifetime maximum on the dollar value of covered essential health benefits no longer applies. Members whose coverage ended by reason of reaching a lifetime limit under this plan are eligible to enroll in this plan.

BENEFIT

Preferred Provider Network (PPN)

Non-Preferred Provider Network Individual deductible: $500 per calendar year Family deductible: $1,000 per calendar year

Plan deductible

No annual deductible

Individual deductible carryover

Not applicable

4th quarter carryover applies

Plan coinsurance

No plan coinsurance

Plan pays 80%, you pay 20% of the Usual, Customary and Reasonable (UCR) charges.

Individual out-of-pocket limit: $1,000 Family out-of-pocket limit: $2,000 Out-of-pocket limit

Out-of-pocket expenses for the following covered services are included in the out-of-pocket limit:

Individual out-of-pocket limit: $2,000 per calendar year Family out-of-pocket limit: 2X

Inpatient services, outpatient services, emergency services at a Preferred Provider Network (PPN) facility and ambulance services. Pre-existing condition (PEC) waiting period Lifetime maximum Outpatient services (Office visits) Hospital services

No PEC

Same as preferred provider network

Unlimited

Same as preferred provider maximum $15 copay, deductible and coinsurance $15 copay apply Inpatient services: $100 copay, per day Inpatient services: $100 copay, per for up to 5 days per admit day for up to 5 days per admit Deductible and coinsurance apply Outpatient surgery: $50 copay, Outpatient surgery: $50 copay deductible and coinsurance apply

Prescription drugs (some injectable drugs may be covered under Outpatient services)

Formulary generic/formulary brand/ Formulary generic/formulary brand/ non-formulary non-formulary $4/$8/$25/$50 copay $13/$30/$55 copay services)

Prescription mail order

2 x prescription cost share per 90 day supply

Acupuncture

12 visits per calendar year $15 copay

Ambulance services

Plan pays 80%, you pay 20%

Chemical dependency

Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $15 copay

Not covered Shared with preferred provider visit limit $15 copay, deductible and coinsurance apply Same as preferred provider benefit Inpatient: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: $15 copay, deductible and coinsurance apply

RQ-68044

2013-2014 BENEFITS BOOK

Options PPO BENEFIT

Preferred Provider Network (PPN)

Devices, equipment and supplies • Durable medical Covered at 50% equipment • Orthopedic appliances • Post-mastectomy bras limited to two (2) every six (6) months

Non-Preferred Provider Network

Covered at 50%, deductible applies

• Ostomy supplies • Prosthetic devices

Covered at 50%

Covered at 50%, deductible applies

Diabetic supplies

Insulin, needles, syringes and lancetssee Prescription drugs. External insulin pumps, blood glucose monitors, testing reagents and supplies-see Devices, equipment and supplies. When Devices, equipment and supplies or Prescription drugs are covered and have benefit limits, diabetic supplies are not subject to these limits.

Inpatient: Covered under Hospital Diagnostic lab and X-ray services services Outpatient: Covered in full Emergency services (copay waived if admitted)

$200 copay

Inpatient: Covered under Hospital services Outpatient: Deductible and coinsurance apply $200 copay

Hearing exams (routine) $15 copay

$15 copay, deductible and coinsurance apply

Hearing hardware

Not covered

Covered in full up to 130 visits total per calendar year Covered in full Not covered Covered up to 12 visits per calendar year without prior authorization $15 copay

Shared with preferred provider visit limit Deductible and coinsurance apply Deductible and coinsurance apply Not covered Shared with preferred provider visit limit $15 copay, deductible and coinsurance appl Shared with preferred provider visit limit $15 copay, deductible and coinsurance apply Inpatient: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply

Home health services Hospice services Infertility services Manipulative therapy Massage services

12 visits per calendar year $15 copay Inpatient: $100 copay, per day for up to 5 days per admit

Maternity services

Mental Health

Outpatient: $15 copay. Routine care Outpatient: $15 copay, deductible and not subject to outpatient services coinsurance apply. Routine care not copay. subject to outpatient services copay Inpatient: $100 copay, per day for up Inpatient: $100 copay, per day for to 5 days per admit Deductible and up to 5 days per admit coinsurance apply Outpatient: $15 copay

Naturopathy

12 visits per calendar year $15 copay

RQ-68044

MYSEIUBENEFITS.ORG

Outpatient: $15 copay, deductible and coinsurance apply Shared with preferred provider visit limit $15 copay, deductible and coinsurance apply

Options PPO BENEFIT

Newborn Services

Obesity-related surgery (bariatric)

Preferred Provider Non-Preferred Provider Network (PPN) Network Initial hospital stay: See Hospital Services; Office visits: See Outpatient Services; Routine well care: See Initial hospital stay: See Hospital Preventive care. Any applicable Services; Office visits: See cost share for newborn services is separate from that of the mother Not covered

Unlimited, no waiting period Organ transplants Inpatient: $100 copay, per day for Donor search & harvest up to 5 days per admit applies to lifetime max Outpatient: $15 copay

Not covered

Not covered Not covered Women’s preventive care services (including contraceptive drugs and devices and sterilization) are subject to the applicable Preventive Care cost share and benefit maximums

Preventive care Well-care physicals, immunizations, Pap smear exams, mammograms

Covered in full

Rehabilitation services (Occupational, speech, physical including services for neurodevelopmentally disabled members) Rehabilitation visits are a total $15 copay of combined therapy visits per calendar year

Inpatient: Day limits shared with preferred provider benefit limit $100 Inpatient: 60 days per calendar year copay, per day for up to 5 days per $100 copay, per day for up to 5 admit Deductible and coinsurance days per admit apply

Skilled nursing facility

Sterilization (vasectomy, tubal ligation)

Women’s preventive care services (including contraceptive drugs and devices and sterilization) are covered in full

Outpatient: 60 visits per calendar year

Covered in full up to 60 days per calendar year

Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $15 copay Women’s sterilization procedures are covered in full

$1,000 per calendar year; $5,000 lifetime max

Temporomandibular Joint Inpatient: $100 copay, per day for (TMJ) services up to 5 days per admit Outpatient: $15 copay Tobacco cessation Quit for Life Program - covered in counseling full Routine vision care $15 copay (1 visit every 12 months) Optical hardware Lenses, including contact $200 per 24 months lenses and frames

Routine mammograms: Deductible and coinsurance apply

Outpatient: Visit limits shared with preferred provider benefit limit $15 copay, deductible and coinsurance apply Day limits shared with preferred provider benefit, deductible and coinsurance apply Inpatient: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: $15 copay, deductible and coinsurance apply Women’s sterilization procedures are covered subject to the applicable Preventive Care cost share and benefit maximums Shared with preferred provider benefit Inpatient: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: $15 copay, deductible and coinsurance apply Applicable cost shares apply $15 copay, deductible and coinsurance apply Shared with preferred provider benefit

RQ-68044

2013-2014 BENEFITS BOOK

KAISER PERMANENTE HEALTH Benefit Summaries Questions? 1-800-813-2000 or (503) 813-2000 Member Services Weekday Hours 8am-6pm Member Services Weekend Hours Closed www.kp.org NOTE: This is a benefit summary, only, and is not intended to replace the specifics of the planâ&#x20AC;&#x2122;s Certificate of Coverage, Contract, or Evidence of Insurance. If there is a contradiction, the Certificate of Coverage, Contract, or Evidence of Insurance will take precedence.

MYSEIUBENEFITS.ORG

Plan B Washington Traditional Copayment Plan C13B SEIU Healthcare NW Health Benefits Trust 12420-001 PLAN B Washington Traditional Copayment Plan C13B August 1, 2013 through July 31, 2014 Out-of-Pocket Maximum (Not all services apply to the maximum.) For one Member

$750 per Calendar Year

For an entire Family

$2,250 per Calendar Year

Preventive Care Services

You pay

Routine preventive physical exam (includes adult, well baby, and well child)

Scheduled prenatal care and first postpartum visit

Immunizations

Preventive tests

Outpatient Services Primary care visit

$15

Specialty care visit

$15

Urgent care visit

$30

Emergency department visit

$200 (Waived if admitted)

Outpatient surgery visit

$50

Chemotherapy/radiation therapy visit

$15

Laboratory, X-ray, imaging, and special diagnostic procedures

CT, MRI, PET scans

$50

Administered medications (all outpatient settings)

Routine eye exam

$10

Injection visit provided in nurse treatment area

Durable medical equipment, external prosthetic devices, and orthotic devices

20% Coinsurance

Physical, speech, and occupational therapies (up to 20 visits per therapy per Calendar Year)

$15

Physician-referred acupuncture and naturopathy visit

$15

Spinal and extremity manipulation therapy visit (after 12 visits, prior authorization needed)

$15

Inpatient Hospital Services

$100 per admission

Ambulance Services (per transport)

$75

Skilled Nursing Facility Services (up to 100 days per Calendar Year)

$0 Continued next pate

2013-2014 BENEFITS BOOK

Plan B Washington Traditional Copayment Plan C13B Optional Benefits Alternative care ( self-referred)

Not covered

Hearing aids (for Members age 18 and over)

Not covered

Outpatient prescription drugs

$5 generic/$25 brand/$50 approved nonformulary brand. $0 for formulary contraceptives. You get up to a 30-day supply. When you use mail delivery, you get up to a 90-day supply of maintenance drugs for two Copayments.

Vision hardware and optical Services

Balance after $200 allowance every 24 months

Travel Services

Not covered

Chemical Dependency Services Outpatient Services

$15

Inpatient hospital & residential Services

$100 per admission

Mental Health Services Outpatient Services

$15

Inpatient hospital & residential Services

$100 per admission

Exclusions and Limitations The Services listed below are either completely excluded from coverage or partially limited. This applies to all Services that would otherwise be covered and is in addition to the exclusions and limitations that apply only to a particular Service as listed in the description of that Service in the Evidence of Coverage. Certain exams and Services; Cosmetic Services; Custodial Services; Dental Services. Except when Medically Necessary for Members who have a medical condition that would place undue risk if performed in a dental office. The procedure is subject to Utilization Review.; Designated blood donations; Detained or confined members; Employer responsibility; Experimental or investigational Services; Eye surgery; Family Services. Services provided by a member of your immediate family.; Genetic testing; Government agency responsibility; Hearing aids. Unless the Hearing Aid rider has been purchased.; Hypnotherapy; Non-Medically Necessary Services; Nonreusable medical supplies; Outpatient Prescription Drugs. Unless the Outpatient Prescription Drug rider has been purchased. Kaiser Permanente formulary applies. We cover non-formulary drugs only when you meet exception criteria unless specifically covered by your prescription drug plan.; Services performed by unlicensed people; Services that are not health care Services, supplies, or items; Services related to a noncovered Service; Sexual reassignment surgery; Supportive care and other Services; Travel and lodging. Limited to: (a) Medically Necessary â&#x20AC;&#x153;ambulance Servicesâ&#x20AC;?, and (b) certain expenses that we preauthorize.; Travel Services. All travel-related Services including travel-only immunizations (such as yellow fever, typhoid, and Japanese encephalitis), unless the Travel Services rider has been purchased.; Vision hardware and optical Services. Unless the Vision Hardware and Optical Services rider has been purchased.; Vision therapy and orthoptics or eye exercises; Professional Services for fitting and follow-up Services for contact lenses; Low-visionaids. Questions? Call Membership Services (M-F, 8 am-6 pm) or visit kp.org Portland area..503-813-2000. All other areas..1-800-813-2000. TTY..1-800-735-2900. Language Interpretation Services, all areas..1-800-324-8010 This is not a contract. This benefit summary does not fully describe your benefit coverage with Kaiser Foundation Health Plan of the Northwest. For more details on benefit coverage, claims review, and adjudication procedures, please see your Evidence of Coverage (EOC) or call Membership Services. In the case of conflict between this summary and the EOC, the EOC will prevail.

MYSEIUBENEFITS.ORG

WDS Delta Dental Pro

WDS Delta Dental Pro Plan Benefit Summaries Questions? Customer Service toll-free (800) 554-1907, Monday â&#x20AC;&#x201C; Friday 8 a.m. to 5 p.m., Pacific Time

Please Note: This is a brief summary of benefits only and does not constitute a contract. You will receive a benefits booklet that completely details your Delta Dental PPO dental benefits. Please feel free to call our customer service department if you have any questions.

2013-2014 BENEFITS BOOK

WDS Delta Dental Pro SEIU – Individual Providers – Plan A Plan #: 00018

Name: Delta Dental PPO

Plan Summary

Effective Date: January 1, 2013 Payment Levels

Delta Dental PPO Dentist

Delta Dental Premier or Nonparticipating Dentist

Out-of-State Dentist

Class I – Diagnostic & Preventive Exams, Prophys, X-rays, Fluoride, Fissure sealants

100%

80%

Class II – Restorative Restorations, Endodontics, Periodontics, Oral Surgery

100%

60%

Class III – Major Crowns, Dentures, Partials, Bridges, Implants

80%

40%

Annual Maximum Per Person Benefit Period: (January 1 – December 31)

$1,000

Annual Plan Deductible Waived for Class I covered dental benefits

$50

MySmile® personal benefits center, available on Washington Dental Service’s Web site at DeltaDentalWA.com, is customized to your individual needs and provides you with answers to your most pressing questions about your dental coverage. Please Note: This is a brief summary of benefits only and does not constitute a contract. You will receive a benefits booklet that completely details your Delta Dental PPO dental benefits. Please feel free to call our customer service department if you have any questions. Washington Dental Service PO Box 75983 Seattle, WA 98175-0983 Customer Service toll-free (800) 554-1907, Monday – Friday 8 a.m. to 5 p.m., Pacific Time

ACCESSING CARE How to use your Delta Dental PPO plan The dental plan offered to your group is Delta Dental PPO, a preferred provider plan. You can choose any dentist — in or out of the PPO network — at the time of treatment. However, if you select a dentist who is part of the Delta Dental PPO network, your benefits will likely be paid at a higher level and your out-of-pocket expenses may be lower. Washington Dental Service will handle all customer service and claims processing for your plan. Tell your dentist you are covered by Washington Dental Service and give him or her your member identification number, the plan name and plan number. Delta Dental PPO dentists Delta Dental PPO dentists complete claim forms and submit them directly to Washington Dental Service. PPO dentists receive payment based on their pre-approved, discounted PPO fees and they cannot charge you more than these fees. You are responsible only for your stated deductibles, coinsurance and/or amounts in excess of the plan maximums.

MYSEIUBENEFITS.ORG

WDS Delta Dental Pro Delta Dental Premier® dentists — (non-PPO) Delta Dental Premier dentists are members of our traditional fee-for-service plan, but they are not part of the PPO network; therefore, your out-of-pocket costs may be higher. Delta Dental Premier dentists will still submit claims for you and receive payment directly from Washington Dental Service. Their payment will be based upon their pre-approved fees with Washington Dental Service. They also cannot charge you more than these fees. You are responsible only for your stated deductibles, coinsurance and/or amounts in excess of the program maximums. Finding a dentist You can find a participating dentist in your area by visiting the Washington Dental Service Web site at DeltaDentalWA.com. Click on the Patients tab and then on the Find A Dentist tab to begin your search. Be sure to select the appropriate plan — Delta Dental PPO or Delta Dental Premier — and follow the prompts. Nonparticipating dentists You are not limited to visiting a Washington Dental Service dentist. If you choose a nonparticipating dentist, you will be responsible for having the dentist complete and sign claim forms. It will also be up to you to ensure that the claims are sent to Washington Dental Service. Claim payments will be based on actual charges or Washington Dental Service’s maximum allowable fees for nonparticipating dentists, whichever is less. You will be responsible for any balance remaining. Please be aware that Washington Dental Service has no control over nonparticipating dentists’ charges or billing procedures. NOTE: For information on out-of-state dentists, please refer to your benefits booklet. Predetermination (estimate) of benefits If your dental care will be extensive, you may ask your dentist to complete and submit a request for an estimate, sometimes called a “predetermination of benefits.” This will allow you to know in advance what procedures are covered, the amount Washington Dental Service will pay and your financial responsibility. A predetermination of benefits is not a guarantee of payment.

2013-2014 BENEFITS BOOK

WILLAMETTE DENTAL - Benefit Summaries Questions? 1-800-359-6019 www.willamettedental.com

NOTE: This is a benefit summary only and is not intended to replace the specifics of the Self-funded Dental Plan Document. If there is a contradiction, the Plan Document will govern.

MYSEIUBENEFITS.ORG

Willamette Dental Group SEIU Healthcare NW/Health Benefits Trust – IP/AP Plan COPAYS Annual Maximum

No Annual Maximum*

Deductible

No Deductible

General Office Visit

You pay $15 per Visit

DIAGNOSTIC AND PREVENTIVE SERVICES Routine and Emergency Exams

Covered with the Office Visit Copay

X-rays

Covered with the Office Visit Copay

Teeth Cleaning

Covered with the Office Visit Copay

Fluoride Treatment

Covered with the Office Visit Copay

Sealants (per Tooth)

Covered with the Office Visit Copay

Head and Neck Cancer Screening

Covered with the Office Visit Copay

Oral Hygiene Instruction

Covered with the Office Visit Copay

Periodontal Charting

Covered with the Office Visit Copay

Periodontal Evaluation

Covered with the Office Visit Copay

RESTORATIVE DENTISTRY Fillings (Amalgam)

Covered with the Office Visit Copay

Porcelain-Metal Crown

You pay a $250 Copay

PROSTHODONTICS Complete Upper or Lower Denture

You pay a $400 Copay

Bridge (per Tooth)

You pay a $250 Copay

ENDODONTICS AND PERIODONTICS Root Canal Therapy – Anterior

You pay a $85 Copay

Root Canal Therapy – Bicuspid

You pay a $105 Copay

Root Canal Therapy – Molar

You pay a $130 Copay

Osseous Surgery (per Quadrant)

You pay a $150 Copay

Root Planing (per Quadrant)

You pay a $75 Copay

ORAL SURGERY Routine Extraction (Single Tooth)

Covered with the Office Visit Copay

Surgical Extraction

You pay a $100 Copay

ORTHODONTIA TREATMENT Pre-Orthodontia Treatment

Not Covered

Comprehensive Orthodontia Treatment

Not Covered

2013-2014 BENEFITS BOOK

Willamette Dental Group MISCELLANEOUS Local Anesthesia

Covered with the Office Visit Copay

Dental Lab Fees

Covered with the Office Visit Copay

Nitrous Oxide

You pay a $40 Copay

Specialty Office Visit

You pay a $30 Copay per visit

Out of Area Emergency Care Reimbursement

You pay charges in excess of $250

*TMJ has a $1000 annual maximum/ $5000 lifetime maximum **Copayment credited towards the Comprehensive Orthodontic Service copayment if patient accepts treatment plan.

Underwritten by Willamette Dental of Washington, Inc. This plan provides extensive coverage of services and supplies to prevent, diagnose, and treat diseases or conditions of the teeth and supporting tissues. Presented are just some of the most common procedures covered in your plan. Please see the Certificate of Coverage for a complete plan description, limitations, and exclusions.

office for dental procedures, physician services, or facility fees. Maxillofacial prosthetic services.

Exclusions

Prescription and over-the-counter drugs and pre- medications.

Bridges, crowns, dentures or any prosthetic devices requiring multiple treatment dates or fittings if the prosthetic item is installed or delivered more than 60 days after termination of coverage. The completion or delivery of treatments, services, or supplies initiated prior to the effective date of coverage Dental implants, including attachment devices and their maintenance. Endodontic services, prosthetic services, and implants that were provided prior to the effective date of coverage. Endodontic therapy completed more than 60 days after termination of coverage. Exams or consultations needed solely in connection with a service or supply not listed as covered. Experimental or investigational services or supplies and related exams or consultations. Full mouth reconstruction, including the extensive restoration of the mouth with crowns, bridges, or implants; and occlusal rehabilitation, including crowns, bridges, or implants used for the purpose of splinting, altering vertical dimension, restoring occlusions or correcting attrition, abrasion, or erosion. Hospital care or other care outside of a dental

MYSEIUBENEFITS.ORG

Nightguards. Personalized restorations. Plastic, reconstructive, or cosmetic surgery and other services or supplies, which are primarily intended to improve, alter, or enhance appearance.

Provider charges for a missed appointment or appointment cancelled without 24 hours prior notice. Replacement of lost, missing, or stolen dental appliances; replacement of dental appliances that are damaged due to abuse, misuse, or neglect. Replacement of sound restorations. Services or supplies and related exams or consultations that are not within the prescribed treatment plan and/or are not recommended and approved by a Willamette Dental Group dentist. Services or supplies and related exams or consultations to the extent they are not necessary for the diagnosis, care, or treatment of the condition involved. Services or supplies by any person other than a licensed dentist, denturist, hygienist, or dental assistant. Services or supplies for treatment of injuries sustained while practicing for or competing in a professional athletic contest. Services or supplies for the treatment of an occupational injury or disease, including an injury or disease arising out of self-employment

Willamette Dental Group or for which benefits are available under workersâ&#x20AC;&#x2122; compensation or similar law. Services or supplies for treatment of intentionally self- inflicted injuries. Services or supplies for which coverage is available under any federal, state, or other governmental program, unless required by law. Services or supplies not listed as covered in the contract. Services or supplies where there is no evidence of pathology, dysfunction, or disease other than covered preventive services. Limitations If alternative services can be used to treat a condition, the service recommended by the Willamette Dental Group dentist is covered. Services or supplies listed in the contract, which are provided to correct congenital or developmental malformations which impair functions of the teeth and supporting structures will be covered for dependent children if dental necessity has been established. Orthognathic surgery is covered as specified in the contract when the Willamette Dental Group dentist determines it is dentally necessary and authorizes the orthognathic surgery for treatment of an enrollee, under age 19, with congenital or developmental malformations. Crowns, casts, or other indirect fabricated restorations are covered only if dentally necessary and if recommended by the Willamette Dental Group dentist.

covered as part of the initial treatment for the first 24 months. When the initial root canal therapy was performed by a non-participating provider, the retreatment of such root canal therapy by a Willamette Dental Group dentist will be subject to the applicable copayments. General anesthesia is covered with the copayments specified in the contract if it is performed in a dental office; provided in conjunction with a covered service; and dentally necessary because the enrollee is under the age of 7, developmentally disabled or physically handicapped. The services provided by a dentist in a hospital setting are covered if medically necessary; pre-authorized in writing by a Willamette Dental Group dentist; the services provided are the same services that would be provided in a dental office; and applicable copayments are paid. The replacement of an existing denture, crown, inlay, onlay, or other prosthetic appliance or restoration denture is covered if the appliance is more than 5 years old and replacement is dentally necessary.

When initial root canal therapy was performed by a Willamette Dental Group dentist, the retreatment of such root canal therapy will be

2013-2014 BENEFITS BOOK

QUESTIONS & APPEALS What if I Have a Health Insurance or Dental Coverage Question or an Appeal?

When you have questions or a complaint about health or dental coverage: Call the Customer Service Department of your insurer, or for the Trustâ&#x20AC;&#x2122;s selffunded dental plan, Delta Dental: Group Health 1-800-542-6312 www.ghc.org Kaiser Permanente 1-800-813-2000 www.kp.org Self-funded Dental Plan Claims Administered by Delta Dental 1-800-547-9515 www.deltadentalwa.com

MYSEIUBENEFITS.ORG

QUESTIONS & APPEALS When you have an appeal: An appeal is a request to reconsider a decision to deny, modify, reduce, or end payment, coverage or authorization of coverage (known as an “adverse decision”). The appeal process for each of the Trust’s health and dental plans is different. You should review the Summary Plan Description of appeals procedures in your Benefits Summary provided by your insurer or, in the case of the Trust’s self-funded dental coverage, by Delta Dental. The Summary Plan Description contains a full explanation of the appeals process. You may also call the Customer Service Department of your insurer or, in the case of the Trust’s self-funded dental coverage, Delta Dental, for specific information about the appeals process. Those numbers are listed on the previous page. Your rights in an appeal: •

You must submit your appeals within 180 calendar days of the date you received notice of an “adverse decision.” Keep track of these deadlines as appeals that are filed late may not be considered.

•

You may request an expedited 72-hour review of your appeal when the adverse determination could jeopardize your life or health.

•

You may request all of the documents relevant to your request and the decision by the insurer or administrator.

•

You may submit additional comments, documents or other information to support your appeal.

More information about how to file an appeal can be found at “How to Appeal a Health Care Insurance Decision, A Guide for Consumers in Washington State” on the Office of the Insurance Commissioner’s website, www.insurance.wa.gov/consumers/health/Appeal/Table-of-Contents.shtml

2013-2014 BENEFITS BOOK

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NOTICES About This Guide This handbook is intended to be an overview of your benefits and a general resource. For more detailed information about your health and dental benefits, you should consult the Summary Plan Description (SPD) and Certificate of Coverage for those benefits. This handbook is not a “Plan document” or the official SPD. In case of any conflict between this document and any “Plan document,” the terms of the Plan Document shall govern. The handbook is not a promise of benefits. All benefits described in the handbook are provided pursuant to existing collective bargaining agreements (CBA) and employer participation agreements with the SEIU Healthcare NW Health Benefits Trust and Training Partnership. Should the CBA or other agreements with the Health Benefits Trust and/or Training Partnership terminate, change or otherwise become ineffective, the benefits described in this book may also terminate or change.

Equal Opportunity The SEIU Healthcare NW Training Partnership (“Partnership”) admits students regardless of race, color, national origin, ethnic origin, gender, age, disability and sexual orientation to all the rights, privileges, programs, and activities generally accorded or made available to students by the Training Partnership. It does not discriminate on the basis of race, color, national origin, ethnic origin, gender, age, disability and sexual orientation in administration of its training and educational policies, admissions policies, scholarship and loan programs, and other Training Partnership administered programs.

2013-2014 BENEFITS BOOK

GLOSSARY AAA – Area Agency on Aging ABT – Accelerated Basic Training AP – Agency Provider A Home Care Aide who works for an agency – agency provider ARC – Advocates for the Rights of Citizens with Developmental Disabilities ARNP – Advanced Registered Nurse Practitioner. Can be a Primary Care Provider. BHP – Basic Health Plan of Washington CNA – Certified Nursing Assistant CE – Continuing Education Supplemental training required for skills development COBRA – A private-pay insurance that covers you if you have a lapse in coverage or you are between jobs cultural competency – An awareness of the customs, beliefs and religious practices of others diagnostic imaging – MRI (Magnetic Resonance Imaging), X-rays, mammograms DME – Durable Medical Equipment Walkers, crutches, etc. DSHS – Department of Social and Health Services health insurance provider – The company that manages your health insurance, for example Group Health, Kaiser Permanente. Health Risk Assessment or Health Profile – An online health assessment or questionnaire that assesses your general health and wellness through a series of questions IP – Individual Provider A Home Care Aide that provides care to a consumer living in his or her home and whose employer of record is the Department of Social and Health Services. LPN – Licensed Practical Nurse

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GLOSSARY MRC – Member Resource Center NDC – Nurse Delegated Core NDD – Nurse Delegation Diabetes orthopedic appliances – braces, splints, etc. PCP – Primary Care Provider The doctor or ARNP you choose to oversee your care Portal 2.0 – Portal 2.0 is the second and improved version of the Training and Health Benefits website students use to manage their training. POS – Point of Service Insurance pays percentage of doctor visit that is out-of-network PPO – Preferred Provider Organization A provider who is in-network RN – Registered Nurse RNA – Registered Nurse’s Assistant S&O – Safety and Orientation TBI – Traumatic Brain Injury Training Wizard – A computer program that assists you in getting started at the Training Partnership www.myseiubenefits.org/wizard

2013-2014 BENEFITS BOOK

Not required

For Workers Who Have a Current Non-HCA Credential, the Chart Below Applies (Not LPN or RN)*** Provider with a Renewed Non-HCA Credential

Provider with a Newly Issued Non-HCA Credential

If CE is required in the table above, then your CE is due by your second birthday following you non-HCA Credential issuance date.**

If CE is required in table above, then your CE is due by your first birthday after you start working as an HCA IP or AP.

By your birthday

Parent DD Individual Provider (DDA)

Parent Individual Provider (HCS/AAA)

Standard HCA

Individual Provider (IP)

Agency Provider (AP)

HCA Credentialed

Home Care Aide (HCA)

This is any IP who provides care 20 hours a month or less for one consumer.

This is an IP who provides care to his/her own adult child with a developmental disability and is contracted through the Developmental Disability Administration.

Home Care Aide who does not work with their own parent or child. Works more than 20 hours a month or has more than one consumer.

Home Care Aide (HCA) whose employer of record is DSHS.

Home Care Aide (HCA) employed by a private, Medicaid homecare agency.

A worker who has successfully passed a test and been credentialed by Department of Health as a Home Care Aide.

Provides care to a consumer living in his or her home. Employed by a private, Medicaid homecare agency or DSHS.

A provider may fall into more than one of these definitions.

Limited Service Provider

An adult child providing care for his/her biological, step or adoptive parent.

HOME CARE AIDE DEFINITIONS

Adult Child Individual Provider

This is an HCA with a current healthcare credential, such as a Registered Nurse (RN), Licensed Practical Nurse (LPN) or Nursing Assistant Certified (NAC).

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Non-HCA Credentialed

TRAINING STANDARDS UPDATED JULY 2013

INITIAL CONTINUING EDUCATION (CE)

ONGOING CE

Continuing Education 12 Hours

CREDENTIAL

Continuing Education 12 Hours

BASIC TRAINING

HCA Credential Required?

ORIENTATION AND SAFETY

Parent Provider (DDD Only) Class 7 Hours

By your birthday

Basic Training 70 Hours

By your birthday following your last HCA credential renewal date

By your birthday

Accelerated Basic Training 30 Hours

Yes

By your birthday in next calendar year after completing Basic Training

Not required, unless you voluntarily obtain your HCA credential

Safety Training 3 Hours

Not applicable

Not required, unless you voluntarily obtain your HCA credential

Orientation 2 Hours

Not applicable

Not required, unless you voluntarily obtain your HCA credential

By your birthday

Not applicable

Not required

Not required, unless you voluntarily obtain your HCA credential

By your birthday

By your second birthday following your HCA credential issuance date**

Not applicable

Not required

Within 120 days of starting to provide care

By your birthday in next calendar year after completing Accelerated Basic Training

Yes

Not applicable

Within 120 days of starting to provide care

Not required

Standard HCA IP or AP hired after 1/7/2012 renewed certification Not applicable

Completed prior to providing care

Not required

Within 120 days of starting to provide care

Standard HCA IP or AP hired before 1/7/2012 Completed prior to providing care

Completed prior to providing care

Within 120 days of starting to provide care

Not required

Parent Individual Provider (HCS/AAA)* Completed prior to providing care

Completed prior to providing care

Within 120 days of starting to provide care

Completed prior to providing care

Parent DD Individual Provider (DDD)*

Completed prior to providing care

Limited Service Provider*

Completed prior to providing care

Standard HCA Individual Provider (IP) & Agency Provider (AP) hired after 1/7/2012 in process or Newly Issued HCA credential

Adult Child Individual Provider*

2013-2014 BENEFITS BOOK

PRSRT STD US POSTAGE UNTIL 9/30/2013 - 635 Andover Park W. Suite 200, Tukwila, WA 98188 BEGINNING 10/1/2013 - 215 Columbia, Seattle, WA 98104

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2013-2014 YOUR BENEFITS BOOK A GUIDE TO TRAINING & HEALTH BENEFITS Featured Inside: • Updated Training Standards and Benefits • Ways to stay healthy, save money and save time • How to earn $100 by taking care of your health

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