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YOUR BENEFITS

2011-2012 GUIDE TO TRAINING AND HEALTH BENEFITS

2011-2012 BENEFITS BOOK

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WELCOME Welcome to the first “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 skills foundation 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 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

TRAINING DEADLINE Write your Training Deadline here for reference DAY

2

MONTH

MYSEIUBENEFITS.ORG

YEAR

HOURS NEEDED


TRAINING BASICS

Quick Start Guide

TRAINING STANDARDS

Your Benefits Book 4 If You Need Assistance 5 Multi-language Assistance 6 Quick Start: Training and Health 7 Access www.myseiubenefits.org 8 Home Care Aide Magazine Preview 10 Course Catalog Preview 11 Training Overview 13 How to Get the Most of Your Training 17 Interpretation 18 Online Continuing Education 19 How to Help Improve Future Classes 20

Training Standards Training Standards Overview 23 Training Standards Chart 24 Home Care Aide Categories 25 Support Contacts 26 Safety and Orientation 27

POLICIES

Training Policies Frequently Asked Questions 28 Classroom Policies 30 Reasonable Accommodation Policy 32

Health Benefits Health Benefits Overview 35 Participating Employers 36 Benefits Basics 37 2011-2012 Medical Plan Highlights 38 Urgent Care Centers 41 Dental and Vision Benefits 43

WELLNESS

Wellness Your Wellness 45 Health Benefits Quick Start 51

Health Benefits Policies

POLICIES

Frequently Asked Questions 52 Benefit Summaries 60 Group Health Options 61 Kaiser Permanente Health 68 Premera Dental 73 Willamette Dental 78 Questions and Appeals 80 Glossary 82 2011-2012 BENEFITS BOOK

HEALTH BENEFITS

ONTENTS

Training Basics

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QUICK REFER YOUR BENEFITS BOOK

One-Stop Resource for Training, Health Benefits To make it easier to understand your training and YOUR BENEFITS

health benefits, the Training Partnership and Health Benefits Trust put together the first “Your Benefits” book to guide you. These benefits are effective Aug. 1, 2011 through July 31, 2012.

GUIDE TO TRAIN ING AND

HEALT H BENEF ITS

Inside, you will find information about your benefits: Training Benefits • Training standards • Classroom policies • Glossary • Student resources

2012 BENEFITS BOOK

Health Benefits (For eligible Individual Providers or Home Care Aides covered through their employers) • • •

Eligibility Benefit summaries Wellness guide

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Where to find updates If there are changes to training standards or other information after the book is released, we will update “Your Benefits” book the following ways: Online - Updates will be available online at www.myseiubenefits.org/benefits YOUR Magazine - Updates will also be available three times a year in the new magazine for Home Care Aides, see Page 10 for more information.

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RENCE GUIDE IF YOU NEED ASSISTANCE

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 below. Agency Providers: Contact your employer for support.

General Training and Health Benefits Support For fastest response: Fill out a Contact Form at www.myseiubenefits.org/contact Member Resource Center 1-866-371-3200 Mon.-Fri., 7 a.m.-7 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

See chart on Page 26 for who to contact for specific training-related questions.

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

Dental Plan Support Premera Blue Cross (Dental) 1-800-722-1471 www.premera.com Willamette Dental 1-800-359-6019 www.willamettedental.com

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QUICK REFERENCE GUIDE

Specific Training Support


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。

QUICK REFERENCE GUIDE

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 Individual Providers 1. Find Your Training Standards • There are different Home Care Aide standards depending on what category 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.

Jane Doe

STUDENT

1234567890

To report suspected abuse

or neglect

of a vulnerable adult, call toll free 2. Schedule Training Early 1-866-END-HARM • Locate or create your Username and Password (see Page 8). • Go online to www.myseiubenefits.org to log in to register for training or call the Member Resource Center at 1-866-371-3200.

3. Get Student ID Card in the Mail • Your Student ID card will be mailed to the mailing address you provided to your primary DSHS contact. If you don’t receive your ID card within 7-14 days of your hire date, fill out a Contact form at www.myseiubenefits.org/contact or call the Member Resource Center at 1-866-371-3200.

Agency Providers 1. Review chart on Page 26 to see who can support you.

1. Check your eligibility for health insurance benefits and enroll 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. 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. 2011-2012 BENEFITS BOOK

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QUICK REFERENCE GUIDE

Health Benefits Quick Start


QUICK REFER ACCESS MYSEIUBENEFITS.ORG

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. We have now improved the Username and Password process to make it easier for you to access the site.

How to Log in to the Website 1. Sign up for a First Time Username and Password First Time User

QUICK REFERENCE GUIDE

Forgot Password or Username?

Note: We recommend you set up an email address to receive the quickest notifications, if you do not have one, you can get a free account at Gmail.com or Hotmail.com.

2. Verify Your Information

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RENCE GUIDE ACCESS MYSEIUBENEFITS.ORG

3. Create Your Username and Password

Note: You can choose any username or password you like

4. Confirm Your Username and Password

5. You’re Done!

Please write your Username and Password on Page 2 of this book to remember.

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QUICK REFERENCE GUIDE

Now You’re Ready to Log in to the Website!


QUICK REFER MAGAZINE

Coming in Fall 2011 - Home Care Aide 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 help share knowledge and skills with the Home Care Aide community, a new magazine will be published three times a year and will focus on you and your work. Look for the first issue in the Fall of 2011.

Magazine Highlights

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Training and Health •

Best practices for Home Care Aides

Knowledge and skills builders

Student participation policies and news

Health Benefits beneficiaries policies and news

Your safety at work

Important Updates to “Your Benefits” book • Updates to “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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RENCE GUIDE COURSE CATALOG

Course Catalog To help you find the Basic Training or Continuing Education courses you need, the Training Partnership will distribute a comprehensive course catalog. The course catalog, which will be released in August

SEIU Healthcare

NW Training Partnership

2011, will cover the Fall

-2011 CaTALOG

quarter of classes and will be an easy-to-use supplment to the online course catalog at www.myseiubenefits.org. Classes will be organized by region, date and title. The online course catalog will always have the most current information regarding courses. Please refer to the online catalog for updates.

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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 for their work to

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.

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 to meet and work with other students in small group exercises, activities, role plays and games.

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.

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

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

TRAINING BASICS

You can expect to be asked

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

what you think, to share what you know, to contribute to discussion, and to answer questions.

What can you expect from Continuing Education courses? •

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

You can expect choice in the style courses are taught, from expert lectures to group discussions.

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

You can expect instructors who are not only professional, but have knowledge or expertise in the area they are teaching.

What characterizes the work of the Training Partnership? There are several themes that infuse 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, 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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TRAINING BASICS

HOW TO GET THE MOST OF YOUR TRAINING 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 Wizard.

Register Early for Training If you need Basic Training, we encourage you to register for your classes within the first 30 days of hire to get the best choice of class options. If you need 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 – 24/7.

Go Online for Fastest 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 to 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 are you an Individual Provider, update your information with your primary DSHS contact. If you are

‘‘

an Agency Provider, update your information with your employer.

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

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INTERPRETATION Individual Providers: The Community Interpretation option is available to you.

Agency Providers: Indicate to the person who registers you for class that you will be bringing an interpreter.

Community Interpretation The Training Partnership values the diversity of Home Care Aides. Basic Training courses are offered in English, Cantonese, Spanish, Russian, Korean, and Vietnamese. 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 if you will be bringing someone with you to serve as your interpreter. 2. Reserve Space: 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 in the class. 3. Orientation: 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. Additional information about the Community Interpretation Orientation can be found at www.myseiubenefits.org/training/interpretation

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TRAINING BASICS

ONLINE CONTINUING EDUCATION As of August 2011, there are 10 Continuing Education (CE) classes you can take online by going to www.myseiubenefits.org. More classes will be added throughout the year. With online classes you pick the time and topics that work for you. You can see the available courses, register and access courses, receive credit, and navigate help information – all online and all 24 hours a day! Each online course takes about one hour to complete, which may vary depending on learning style, material covered and Internet

‘‘

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

connection speed.

Online Continuing Education Classes as of August 2011 Best Practices for the Professional Home Care Aide Traumatic Brain Injury

An Introduction to Mental Illness Multiple Sclerosis

Body Mechanics

An Introduction to Developmental Disabilities

Infection Control: Promoting Health and Well-Being

An Introduction to Physical Disabilities

Better Health through Nutritious Cooking

An Introduction to Dementia

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

Individual Providers: Use course reviews and the Wiki below.

Agency Providers: Use course reviews to provide feedback.

Course Reviews All Home Care Aides are encouraged to complete a course review online at

Course Reviews How do you submit a course review? Course reviews are available on your student profile. Log in with your username and password, select “manage my training,” and under the completed training box, click “review now.”

www.myseiubenefits.org after each course you take. Course reviews are allow the Training Partnership to make adjustments in course content and instructors. Your feedback is taken seriously. How do you submit a course review? Course reviews are available on your student profile. Log in with your username and password, select manage my training, and under the completed training box, click “review now.”

Wiki The Training Partnership welcomes the participation of home care aides, consumers, instructors and employers in the process of curriculum development. You’re invited to give your feedback on existing courses created by the Training Partnership as well as give suggestions for future courses by using the wiki. The wiki is a website which allows you to give your input. You can comment on current classes, suggest additional topics and subjects, and even provide comments on classes that in the development stages. How do you access the wiki? Visit http://trainingpartnership.pbworks.com •

If you have logged in previously, your username is your email address.

If you’ve never visited the wiki before, you can request access and in the next two business days, you’ll receive a response email with a link to activate your account.

Use the comment box at the bottom of any page to enter your suggestions on how to make training even better. 20

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TRAINING BASICS

Volunteer Auditor Program Have you ever wished you could register for a class that is not required for you to take? The Training Partnership is excited to announce a new program designed to help increase the feedback from our students about courses while giving you access to more classes. The Volunteer Auditor Program is designed for students who want to volunteer to sit in on classes around the state. In exchange for feedback on curriculum, instructors and classroom spaces, students can take additional classes which either are not required for them, or exceed their training needs. If you are interested in becoming a Volunteer Auditor, the Training Partnership will orient you to our expectations for observing courses and what to look for. Once you have been oriented, you can register for courses and participate like a typical student. After the class you go online to complete a survey and share your experience with the Training Partnership. Courses will appear in your training record as audited. Auditing can only happen once you have met your training standards for that year. If you are interested in becoming a student auditor, contact the Training Partnership at our Contact form www.myseiubenefits.org/contact. We anticipate this program will start in the fall of 2011.

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TRAINING STANDARDS 22

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www.yes1163.com

TRAINING STANDARDS

TRAINING STANDARDS The recent budget passed by the state legislature resulted in funding cuts that impact the Training Partnership. The legislation suspended the higher training standards of Initiative 1029, which set training levels for Home Care Aides. See a complete list of training standards on the following page.

Basic Training Curriculum As of July 1, 2011, Initiative 1029 – which increased basic training standards to a maximum of 75 hours – was suspended. The result was going back to previous standards which capped basic training hours at 28 and up to six hours of Safety and Orientation. In response, the Training Partnership has revised its basic training curriculum to address the new hours requirement. This revised curriculum, approved on

Initiative 1163 Initiative 1163 will appear on the ballot in November. If the initiative passes it will reinstate the higher-quality training and certification standards for most new Home Care Aides (exempting those caring for a parent or child) on Dec. 8, 2011. Home Care Aides who have already taken Basic Training will not need to take the higher quality training. For more on I-1163, visit www.yes1163.com.org

July 14, 2011 as an ADSA alternate basic training curriculum, is called Accelerated Basic Training.

Continuing Education The Continuing Education requirement remains 10 hours per year. The Training Partnership provides quality Continuing Education (CE) classes that help Home Care Aides (HCA) maintain skills in the profession and provide knowledge to reach the highest standards of practice. CE classes are widely available at 150 sites across the state and 10 classes are available online all day, every day. The classes cover a broad range of subjects. You choose the ones that are most suited to your interests and the consumers you serve. 2011-2012 BENEFITS BOOK

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Not Required

Not Required

Childcare IP (DDD)

Respite Worker (DDD)

Within 120 days of employment Not Required Not Required Required if performing a Nurse Delegated Task

Within 14 days of employment

Within 14 days of employment

Within 14 days of employment

Not Required

Not Required

Not Required

Within 180 days of employment

Not Required

Not Required

Not Required

Not Required

Within 180 days of employment Not Required

Not Required

10 hours/year beginning the year after completing ABT or MFOC

10 hours/year beginning the year after completing ABT or MFOC

10 hours/year beginning the year after completing ABT or MFOC

10 hours/year beginning the year after completing ABT or MFOC

Not Required

Not Required

Within 120 days of employment

Not Required

Not Required

Within 120 days of employment

Optional, consult with your employer

Not Required

Not Required

Within 120 days of employment

Within 120 days of employment

Within 120 days of employment

Within 120 days of employment

Continuing Education 10 hours by 12/31/11

Continuing Education

*If hired before 6/15/11, please refer to your training profile or to the Training Wizard on www.myseiubenefits.org/wizard for the most current requirement. **If you work for more than one consumer, you may have more than one basic training requirement. Please check with your employer.

Not Required

Parent DD IP (DDD)

Basic Training** Accelerated Basic Modified Fundamentals Parent Provider Training (ABT) OR of Caregiving (MFOC) OR Class 6 hours

Within 14 days of employment

Within 14 days of employment

Within 14 days of employment

Credentialed IP

Not Required

Not Required

Provided by Employer

Credentialed AP

Parent Individual Provider (HCS/AAA)

Within 14 days of employment

Within 14 days of employment

Individual Provider (IP)

Not Required

Safety Training 4 Hours

Provided by Employer

Orientation 2 Hours

Agency Provider (AP)

Hired after June 15, 2011*

Orientation and Safety

TRAINING STANDARDS


HOME CARE AIDE CATEGORIES The Training Partnership provides training to a variety of Home Care Aides. The chart below describes the different categories of HCAs Provide care to a consumer living in his or her home.

Agency Provider (AP)

Provide care to a consumer living in his or her home. Employed by a private homecare agency.

Individual Provider (IP)

Provide care to a consumer living in his or her home. Employer of record is DSHS.

Credentialed Agency Provider

This is an AP with a current healthcare credential as a Registered Nurse (RN), Licensed Practical Nurse (LPN), Nursing Assistant Certified (NAC), Physical Therapist, Occupational Therapist or Medicare-Certified Home Health Aide.

Credentialed Individual Provider

This is an IP with a current healthcare credential as a Registered Nurse (RN), Licensed Practical Nurse (LPN), Nursing Assistant Certified (NAC), Physical Therapist, Occupational Therapist or Medicare-Certified Home Health Aide.

Parent Individual Provider (HCS/AAA)

This is an IP who provides care to his/her own adult child and contracted through Home and Community Services (HCS) and/or an Area Agency on Aging (AAA).

Parent DD Individual Provider (DDD)

This is an IP who provides care to his/her own adult child with a developmental disability and is contracted through the Department of Developmental Disabilities (DDD).

Childcare Individual Provider (DDD)

This is an IP who provides care to a consumer under the age of 18 and is contracted through the Department of Developmental Disabilities (DDD).

Respite Workers (DDD)

This is an IP who provides short, intermittent relief for person normally providing care to waiver individuals.

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TRAINING STANDARDS

Home Care Aide (HCA)

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WHO TO CONTACT FOR TRAINING SUPPORT Agency Providers individual providers

Class registration and rescheduling

(Visiting Nurse Homecare, Senior Life Resources, Oly CAP, CoastalCAP, Full Life)

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

Agency Providers (Catholic Community Services, CDM)

Website or MRC

Website or MRC

Your Employer

Your Employer

How to complete your Website or MRC training

Website or MRC

Your Employer

Your Employer

Username and Website or MRC Password assistance

Website or MRC

Website, MRC or Employer

Your Employer

Confirmation Code

Website or MRC

Website or MRC

MRC

Your Employer

Requesting a student ID

Website or MRC

Website or MRC

MRC

Your Employer

Requesting a certificate

Website or MRC

Website or MRC

MRC

Your Employer

Confirming class schedule

Website or MRC

Website or MRC

Website, MRC or Employer

Your Employer

Training requirement Primary DSHS Contact Your Employer and deadlines

Your Employer

Your Employer

Questions about payment

Primary DSHS Contact Your Employer

Your Employer

Your Employer

Change of address

Primary DSHS Contact Your Employer

Your Employer

Your Employer

Change in training standards due to change in employment status

Primary DSHS Contact Your Employer

Your Employer

Your Employer

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SAFETY AND ORIENTATION For Individual Providers If you are in a category that requires either Safety or Orientation training (or The kit contains the following: 1. Instructions on “How to Complete and Receive Credit for Safety and/or Orientation.” 2. Three DVDs: Orientation, Safety Training Part 1, Safety Training Part 2. 3. An activity sheet titled, “Safety and Orientation Self-Study Extension.” 4. Supplemental information titled, “Orientation & Safety – A Reference Tool for Individual Providers.” SEIU HEAL THCARE N Th

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e Training TRAINING Partners PARTNER hip trains care worke and deve SHIP rs to deliv lops profes er high qu and peop sional lon ality care le with dis g-term and supp abilities. ort to old er adults

Your deadline for completing Safety and/or Orientation is

14 days from your date of hire. If you did not receive the Safety and Orientation Kit, notify your DSHS contact immediately or contact the

SAFETY & ORIENTAT ION

Training Partnership at www.myseiubenefits.org/contact

WWW.MY

SEIUBEN

EFITS.OR

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635 ANDO

VER PARK

WEST SU

ITE 200, TU

KWILA, WA

98188

SEI U H E T R A IN INAGL T H C A R E N W PA R T N E R S H IP

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TRAINING STANDARDS

both) you should have received a kit at the time of hiring or contracting.


FREQUENTLY ASKED QUESTIONS 1. What is www.myseiubenefits.org?

I have a question about The website www.myseiubenefits.org is wages for training? where you can read important Contact your employer or announcements from the your DSHS case manager. Training Partnership, learn The Training Partnership about our different programs cannot answer questions and ask questions. On the regarding wages. website, you can register for classes, see your training history and track your progress. You can also take online Continuing Education classes by going to this website.

2. How do I get my training certificate? Your Basic Training certificate should be mailed to you within two weeks from the day you complete all hours of your required basic training. You should receive your Continuing Education certificate within one month following the day you complete all hours of your required continuing education credits. Refer to the Support chart on Page 26 if you need assistance. 3. How do I get a Student ID? Your Student ID card will be mailed to the mailing address you provided to your employer (DSHS or Agency) within 7-14 days of your hire date. If you do not receive your ID card, please check with your employer to make sure your address is correct. Replacement cards can take up to four weeks to receive. For fastest class check in, bring your Student ID. Bring a driver’s license, passport, or other legal identification to class. Refer to the Support chart on Page 26 if you need assistance. 4. How do I change my address with the Training Partnership? Ensure you are receiving the most current information about your training by updating your contact information with your employer. If are you an Individual Provider, update your information with your primary DSHS contact. If you are an Agency Provider, update your information with your employer.

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FREQUENTLY ASKED QUESTIONS 5. How do I log in to www.myseiubenefits.org? There is now a new and improved easier process for logging in to the website. Follow the instructions on Page 8 to log in. 6. I have a question about wages for training. Contact your employer or your DSHS contact. The Training Partnership cannot answer questions regarding wages 7. I arrived to class and I am not on the roster, what do I do? Only registered students and interpreters can attend Training Partnership classes. If you are not on the roster, you will need to reschedule your 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 review after attending a class by going to www.myseiubenefits.org. For more information on submitting feedback, see Page 20.

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POLICIES

8. How do I provide feedback about a class?


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

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 you are not on the class roster, you will not get credit for the class.

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, 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

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Students are expected to show valid picture ID to sign in for class.

You should bring your Training Partnership ID if you have one.

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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.

POLICIES

No Shows Cancelling late or not attending class results in a no show. After two no shows, you will have to pay a $25 no-show fee to access training.

Appeals Process •

If you wish to appeal the $25 “no show” fee because you believe you had a good reason for not attending the class you must file an appeal.

The appeal must be filed on an appeal form that is available at www.myseiubenefits.org.

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.

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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.

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.

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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 “ADA Request Form� found at www.myseiubenefits.org 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 will be asked to provide current documentation of his or her disability, the functional limita-

POLICIES

tions 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.

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HEALTH BENEFITS 34

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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 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.

2011-2012 Benefits Plan The Health Benefits Trust negotiated the 2011-2012 benefits – that took effect on Aug. 1, 2011 – to fulfill the following goals: • • •

Emphasis on preventive care to encourage wellness Increased participation in health risk assessments Higher use of urgent care facilities in urgent situations that don’t

HEALTH BENEFITS BASICS

Low out-of-pocket costs for Home Care Aides

require emergency-room care • •

Encouraging lower-cost prescriptions through mail order services Encouraging use of in-network providers

The 2011-2012 benefits plan accomplishes those goals and allows for the continuation of affordable, quality benefits for all eligible Home Care Aides.

How to Enroll Individual Providers: You can enroll by logging in to www.myseiubenefits.org and by filling out the enrollment form. Agency Providers: Contact your employer for enrollment information. Call the Member Resource Center toll-free at 1-866-371-3200 to get answers to your questions about eligibility for benefits.

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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 Healthcare Full Life Home Care Services of Montana KWA Lower Columbia Community Action Council

Oly CAP Coastal CAP Senior Life Resources Northwest State of Washington (employer of record) Visiting Nurse Home Care NOTE: ResCare is in the final stages of preparation to join the Health Benefits Trust.

Health Plan Partners We partner with the following health insurance providers to provide benefits for eligible Home Care Aides.

Group Health Options Offering you a health plan that gives you access to coordinated care and coverage that makes staying healthy easy.

Kaiser Permanente A large national health insurer, Kaiser provides coordinated care and innovative health care programs.

Premera Blue Cross (Dental) Premera offers dental insurance to Health Benefits Trust beneficiaries.

Willamette Dental Group Willamette is a managed dental program that provides general and specialized dental services to patients all over Washington and Oregon. 36

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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 Options or Kaiser Permanente. You pay very little out-of-pocket for the following services: • • • • • • •

Doctor office visits In-patient hospitalization X-rays and diagnostic imaging Laboratory services Mental health Hearing exams Chiropractor visits

• • • • • •

Acupuncture Mammograms Allergy shots and other injections Routine immunizations Rehabilitative therapies Maternity services

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 Premera Blue Cross 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). Major procedures: Covered procedures

HOW MUCH DOES IT COST? The Health Benefits Trust works hard to minimize the amount you pay out-of-pocket for your healthcare. 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.

include crowns, dentures and bridges. 2011-2012 BENEFITS BOOK

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2011-2012 Medical Plan Highlights Thanks to effective organizing by Home Care Aides and strong negotiating by the Health Benefits Trust, the health benefits Home Care Aides will receive through July 31, 2012, remain largely unchanged. Although insurance premiums are increasing overall, the Home Care Aide cost share will remain the same at $25 per month. The level of insurance coverage provided remains the same, with a few exceptions that encourage good use of Health Benefits Trust resources:

Premium Cost Share Unchanged The premium cost share for Home Care Aides will remain the same at $25 per month.

EMERGENCY ROOM Whenever you use the Emergency Room, you will pay a $200 copay regardless of facility. However, if you are admitted to the hospital as a result of your visit to the ER, the $200 will not be charged. As a better alternative to the Emergency Room in most situations, Urgent Care is available and your copay will be just $10 for Group Health and $30 for Kaiser.

IN-NETWORK PROVIDERS You do not have to pay as much when accessing an in-network group of providers and facilities, including purchasing your prescription drugs. •

In-network services continue to have a $0 annual deductible and $10 office visit copay. However, preventive care now is paid in full with no copay.

If you choose to access care out-of-network, your annual deductible will increase from $200 to $500.

Understanding Health Insurance Terms Copay 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.

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In-network You don’t have to pay as much when you use this network of providers. Out-of-network A broader network of providers where you may access care but your out of pocket expenses will be higher than with in-network providers.


Health Profile = $25 for you PRESCRIPTION DRUGS The prescription drug copays are increasing slightly. However, by using mail-order service to receive your prescriptions, you will now receive a discount on your prescription copay.

Fill out your Health Profile, offered by Group Health Options or the Total Health Assessment, offered by Kaiser Permanente and the Health Benefits Trust will send you a check for $25! Good for your health, good for your wallet.

HEALTHCARE REFORM CHANGES As a result of Healthcare Reform, your coverage will be improved in the following ways: •

There is no longer a lifetime maximum cap of benefits.

There are no longer lifetime benefit limits for essential benefits.

2011-2012 PLAN HIGHLIGHTS AT A GLANCE IN-NETWORK

OUT-OF-NETWORK

Preventive Care

Covered In Full

Covered in full up to $300

Covered In Full

$500 deduct, 80% Covered

Group Health Options

$10

$10 copay, deductible and coinsurance apply

Kaiser

$30

No out-of-network allowed

Generic

$15 copay

$20 copay

30 day supply; For Kaiser, no out-ofnetwork allowed

Brand

$30 copay

$35 copay

30 day supply: For Kaiser, no out-ofnetwork allowed

Group Health Options Mail-order

$30 Generic $75 Brand

Not applicable

90-day supply

Kaiser Mail-order

$30 Generic $60 Brand

Not applicable

90-day supply

$200 copay

$200 copay

Waived if admitted

Group Health Options

$0

$500

Kaiser

$0

Not allowed

Mammograms

NOTES

Routine mammograms

Urgent Care

Prescription Drugs

Emergency Room Out-of-Network Deductible

No out-of-network allowed

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HEALTH BENEFITS BASICS

BENEFIT


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Group Health Options: Urgent Care Centers Seven Group Health medical centers have Urgent Care Centers, most with evening, weekend, and holiday hours. Urgent Care Centers at the Bellevue Medical Center and Capitol Hill Campus in Seattle are open 24 hours a day, seven days a week. Use the Group Health Options Provider Directory www.ghc.org to find urgent care providers in other areas. (Select “All Specialists,” then select “Urgent Care” from the drop-down list.)

Silverdale Medical Center Monday-Friday 8 a.m.-5 p.m. 10452 Silverdale Way N.W. Silverdale, WA 98383 360-307-7300

Everett Medical Center Monday-Friday 8 a.m.-5 p.m. 2930 Maple St. Everett, WA 98201 425-261-1500

Riverfront Medical Center Monday-Friday 8 a.m.-5 p.m. 322 W. North River Drive Spokane, WA 99201 509-324-6464

Olympia Medical Center Monday-Friday 8 a.m.-5 p.m. 700 Lilly Road N.E. Olympia, WA 98506 360-923-7000

Tacoma Medical Center Monday-Friday 8 a.m.-5 p.m. 209 Martin Luther King Jr. Way Tacoma, WA 98405 253-596-3300

Capitol Hill Campus Monday-Friday 8 a.m.-5 p.m. 201 16th Ave. E. Seattle, WA 98112 206-326-3000

HEALTH BENEFITS BASICS

Bellevue Medical Center Monday-Friday 8 a.m.-5 p.m. 11511 N.E. 10th St. Bellevue, WA 98004 425-502-3000

URGENT CARE SAVES YOU MONEY The out-of-pocket cost for a trip to the emergency room is $200 (waived if you are admitted to the hospital) vs. just $10 for a trip to Urgent Care with Group Health Options, and $30 with Kaiser. 2011-2012 BENEFITS BOOK

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Dental Benefits Healthy teeth and gums are a critical part of

Did You Know?

your overall health. That’s why comprehensive

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

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

Depending on your plan, a portion 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 and gums, you should see your dentist every six months for a complete exam and cleaning.

Vision Benefits Keeping your eyes healthy and keeping optical prescriptions updated are also 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, whether or not you’re having any noticeable signs of problems.

• For a $10 copay per visit, you receive routine vision care. • Every two years you receive $200 worth of optical supplies, including contact lenses and frames.

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WELLNESS 44

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YOUR WELLNESS Working Together To Keep You Healthy As a Home Care Aide, you know how important it is to stay healthy. Through the benefits you receive through the Health Benefits Trust, you receive excellent health, dental and vision benefits at a low cost. To ensure that health care for Home Care Aides continues for years to come, there are three things we all need to do: • • •

Keep ourselves healthy Keep out-of-pocket costs low Help control health care costs so we do not have to pay more next year

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

Making your first primary care appointment

Using urgent care vs. the emergency room

Managing prescriptions

Completing a Health Profile or Assessment

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

WELLNESS

Healthy Home Care Aide

URGENT CARE

URGENT CARE

URGENT CARE See a Primary Care Doctor

Health Profile or Assessment

Find Urgent Care Centers

Manage Your URGENT CARE Prescriptions

Find a doctor, set up your first visit

Fill out an easy online quiz

Locate the centers near you

Transfer to Kaiser or Group Health Options

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1

See a Primary Care Doctor

One of the most important things to do is to select a primary care doctor and set up a first visit. A strong relationship with your primary care doctor (also known as your primary care provider) is at the heart of your care.

How to Select Your Primary Care Doctor 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 Options Customer Service at 1-888-901-4636 Kaiser Permanente Customer Service at 1-800-813-2000

Make an Initial Primary Care Appointment = Earn $10! Establishing a relationship with your primary care provider is important to your health. If you obtain a preventive care/wellness visit from your primary care doctor within the first three months of your coverage effective date, the Health Benefits Trust will pay you $10. You may only receive the benefit once.

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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 $40 vs. $500 or more with an out-of-network provider.


2

Complete a Health Profile or Assessment How Healthy are You? The Health Profile and Total Health Assessment will help you find out! •

What are your daily eating habits?

How often do you exercise?

How often do you drink alcohol?

URGENT to CARE Find out how the answers questions like these affect your health. Your Health Profile or Total Health Assessment are online quizzes to help you and your doctor take better control of your health. Filling out a Health Profile is a key step on the path to better health.

Fill out a Health Profile or Assessment, Receive $25! Beginning Aug. 1, 2011, Home Care Aides who complete a Group Health Options Health Profile or Kaiser Permanente Total Health Assessment will receive a $25 check from the Health Benefits Trust. You will receive a check within 6–8 weeks of submitting your profile.

WELLNESS

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

Register for Kaiser Online Access Using Kaiser online access, you can fill out your Total Health Assessment. Register at www.kp.org 2011-2012 BENEFITS BOOK

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3

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 as a complete list. URGENT CARE - $10 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 $10 for a trip to Urgent Care with Group Health Options and $30 with Kaiser. 48

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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 OPTIONS: Seven 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. See Page 41 for a list of centers. KAISER: Find an Urgent Care Center at www.kp.org


Manage Your Prescriptions

4

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 Options or Kaiser Permanente to receive best benefit from your coverage.

URGENT CARE

Mail Order Prescriptions Using mail order prescriptions saves money and saves time. Getting your prescriptions by mail is free and for Group Health Options members you get a discount of up to $5 per prescription.

How to Transfer Your Prescription Group Health Options: 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

WELLNESS

Service at 1-800-813-2000.

How to Set Up Mail Order Prescriptions Group Health Options: After setting up an online account you can order refills online and have them mailed – free of charge – directly to you. Kaiser Permanente: After setting up an online account you can order refills online and have them mailed – free of charge – directly to you. 2011-2012 BENEFITS BOOK

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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 for these benefits. You do not need to wait until you are eligible to enroll, you can complete the form after you’re hired.

Enroll Individual Providers: You can enroll by logging in to www.myseiubenefits.org and filling out the enrollment form. Agency Providers: Talk with your employer about enrollment.

URGENT CARE

Look for Your ID Card 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 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.

Fill Out Your Health Profile or Health Assessment The Health Profile or Assessment is an online quiz and report to help you manage your health. To help encourage participation, you will receive a check for $25 for filling it out.

Make a Primary Care Appointment

URGENT CARE

Use the online provider directory at www.ghc.org or www.kp.org to find a primary care doctor who’s a good match for you. You will receive $10 for attending a primary care appointment within the first three months of your coverage. 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 Options or Kaiser Permanente. Next, set up mail order prescription refills online to save money and save time. *The work requirement in each Home Care Aide’s governing Collective Bargaining Agreement (CBA) URGENT CARE determines their eligibility for the Trust’s benefits. Agency Providers should check the CBA for their agency to see if it has a different work requirement than 86 hours.

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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 Premera Blue Cross 1-800-722-1471 Willamette (contact the clinic where the services were provided) 2. Can I add dependents to my plan? Individual Provider: Dependents are not covered. The Individual Provider benefits do not allow coverage for dependents under this plan. 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 before the 15th of the month will stop further payroll deductions. 4. If I haven’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 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. 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 – Group Health or Kaiser. You have the choice of dental coverage either through Premera Blue Cross or Willamette. 6. Is there a pre-existing condition waiting period? Yes. It is a 3-month waiting period unless you have had prior documented creditable group coverage which can be used as a credit toward the waiting period.

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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? Individual Provider: Log on to www.myseiubenefits.org to complete enrollment or call the Member Resource Center at 1-866-3713200.

How do I enroll for coverage? Individual Provider: Log on to www.myseiubenefits.org to complete enrollment or call the Member Resource Center at 1-866-371-3200. Agency Provider: Contact your employer to coordinate your enrollment.

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. The work requirement in each Home Care Aide’s governing Collective Bargaining Agreement (CBA) determines their eligibility for the Trust’s benefits. Agency Providers should check the CBA for their agency to see if it has a different work requirement than 86 hours. 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 you need to re-qualify. 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.

POLICIES

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FREQUENTLY ASKED QUESTIONS 12. What happens if I work less than 86 hours in a month after I am enrolled in the plan? You will NOT have coverage the second month following the month you worked less than 86 hours. Example: If you work only 50 hours in September, no deduction will be taken from your October paycheck and you will not have coverage for the month of November. However, if you do not work enough hours in a month, you may choose to pay the full monthly (COBRA) premium yourself. The Health Benefits Trust will send you a COBRA notice and election form and if you sign-up for COBRA benefits, you will receive a bill for payment. 13. When can I submit my enrollment form for coverage? Individual Provider: You should enroll as soon as you have authorization to work as an Individual Provider. 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 don’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 (aka 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 I’m enrolled in the Health Benefits Trust Plan and use it as secondary coverage? As in Individual Provider or Agency Provider, participants may not have other coverage. This includes Basic Health Plan, another employer’s coverage or another family member’s coverage. The only exception is that you may retain Medicare or Medicaid coverage while enrolled in the Health Benefits Trust Plan. 16. How do I notify you that my address has changed? A request for an address change must be made to either your DSHS case worker or to Social Service Payment System (SSPS) directly if you are an Individual Provider. If you are an Agency Provider, contact your employer to make this change. 54

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Is dental or coverage in with this pl


r vision ncluded lan?

FREQUENTLY ASKED QUESTIONS 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 with this plan? Yes. Vision coverage is part of your medical plan administered by your medical insurance provider – Group Health or Kaiser. You have the choice of dental coverage either through Premera Blue Cross 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 Options, Kaiser Permanente, Premera Blue Cross 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). 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?

2011-2012 BENEFITS BOOK

POLICIES

Yes. There is a place on the enrollment application to indicate the current plan termination date.

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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? Individual Providers: Log on to www.myseiubenefits.org and use the eligibility calculator to estimate when your coverage will begin or call the Member Resource Center at 1-866-371-3200. Agency Providers: please contact your Human Resources department to coordinate your enrollment. 25. Why do you need prior coverage information? HIPAA Law allows prior group coverage to be used as a credit toward the required pre-existing condition waiting period.

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 Options 1-888-901-4636 www.ghc.org Kaiser Permanente 1-800-813-2000 www.kp.org Premera Blue Cross (Dental) 1-800-722-1471 www.premera.com Willamette Dental 1-800-359-6019 www.willamettedental.com

Who do I call to enroll or ask eligibility questions? Contact the Member Resource Center toll-free at 1-866-371-3200.

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FREQUENTLY ASKED QUESTIONS Group Health Options Specific Questions 26. What if I don’t want to see any doctors who practice with Group Health Medical Centers? 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 / Beech Street 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 Options POS vs. PPO mean? If you live within 30 miles of a Group Health facility or contracted provider, you will automatically be enrolled in the POS plan. If you live beyond 30 miles, you will automatically be enrolled in the PPO plan. In both 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 Options? For POS Plan (within 30 miles of Group Health facilities): On left hand column of www.ghc.org, click on “Doctors & Healthcare Services”; then click on “Provider Directory”; then click on “Select a health plan provider network” and choose “Options.” For PPO Plan (all others): On left hand column of GHC website, click on “Doctors & Healthcare Services”; then click on “Provider Directory”; then click on “Select a health plan provider network” and 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

POLICIES

29. How do I look up my Group Health Medical Centers providers? On the left hand side of the www.ghc.org website, click “Pharmacy Services.” 2011-2012 BENEFITS BOOK

57


FREQUENTLY ASKED QUESTIONS Group Health Options PLANS Group Health Options Point of Service POS Plan (POS)

Group Health Options, PPO Plan You will be automatically enrolled in this plan

You will be automatically enrolled in this

if you live farther than 30 miles from a Group

plan if you live within 30 miles of a Group

Health Medical Center facility or contracted

Health Medical Center facility or con-

provider.

tracted provider. You can choose to access coverage in- or

The First Choice Health Network has an

out-of-network each time you seek service.

extensive panel of preferred providers in WA,

You do not have to see the physicians who

OR, ID, AK and MT. Beech Street providers

practice at Group Health Medical Centers

are located in all other states.

locations, although use of these providers will give you the most cost savings.

“Options”

“Options PPO” Network

Options is the POS plans giving you in-

In-network care is provided by First Choice

network access to Group Health Medical

Health Network and Beech Street providers.

Centers care, and care from contracted

Out-of-network care is provided by any other

providers. Out-of-network care is provided

licensed provider.

by First Choice Health Network Providers.

Link to look up both Options and Options PPO Providers. http://myseiu.be/imSCSp

Pharmacy www.ghc.org/pharmacy/index.jhtml POS Plan

PPO Plan

In-network: Any Group Health Medi-

In-network: Group Health Medical Centers and

cal Centers or contracted community

MedImpact pharmacies.

pharmacy.;

Out-of-network: All other pharmacies

Out-of-network: Med Impact Pharmacies

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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. Kaiser Permanente Membership Services Or 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. Register for Kaiser Online Access

2011-2012 BENEFITS BOOK

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 our monthly e-newsletter Register at https://members.kaiserpermanente.org/redirects/register/

59


BENEFIT SUMMARIES The following pages are benefit summaries, only, and are not intended to replace the specifics of the individual plan’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 plan’s coverage, contact your health insurance provider. Group Health Options www.ghc.org 1-888-901-4636 Mon.-Fri., 8 a.m.-5 p.m. Kaiser Permanente 1-800-813-2000 www.kp.org Premera Blue Cross (Dental) 1-800-722-1471 www.premera.com Willamette Dental 1-800-359-6019 www.willamettedental.com

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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 plan’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.

2011-2012 BENEFITS BOOK

61


Options PPO Preferred Provider Network (PPN)

BENEFIT

Non-Preferred Provider Network

Plan deductible

No annual deductible

Individual deductible: $500 per calendar year

Individual deductible carryover

Not applicable

4th quarter carryover applies

No plan coinsurance

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

Individual out-of-pocket limit: $1,000

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

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 Preferred Provider Network (PPN) facility and ambulance services.

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

Pre-existing condition (PEC) waiting period

No PEC

Same as preferred provider network

Lifetime maximum

Unlimited

Shared with preferred provider maximum

Outpatient services (Office visits)

$10 copay

$10 copay, deductible and coinsurance apply

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

Inpatient services: $100 copay, per 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 $15/$30 copay per 30 day supply

Formulary generic/formulary brand $20/$35 copay per 30 day supply

Prescription mail order

$5 discount per 30 day supply

Not covered

12 visits per calendar year

Shared with preferred provider visit limit $10 copay, deductible and coinsurance apply

Plan coinsurance

Out-of-pocket limit

Hospital services

Acupuncture Ambulance services

$10 copay

Plan coinsurance and emergency services at a Preferred Provider Network (PPN) facility.

Plan pays 80%, you pay 20%

Same as preferred provider benefit

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

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

Outpatient: $10 copay

Outpatient: $10 copay, deductible and coinsurance apply

Chemical dependency

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. Effective date 8/1/11.

Form No. 015-WA (4/08) Contract No. 001-WA (4/06)

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

Preferred Provider Network (PPN)

Non-Preferred Provider Network

Covered at 50%

Covered at 50%, deductible applies

Covered at 50%

Covered at 50%, deductible applies

Diabetic supplies

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.

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.

Diagnostic lab and X-ray services

Inpatient: Covered under Hospital services Outpatient: Covered in full

Inpatient: Covered under Hospital services Outpatient: Deductible and coinsurance apply

Emergency services (copay waived if admitted)

$200 copay

$200 copay

Hearing exams (routine)

$10 copay

$10 copay, deductible and coinsurance apply

Hearing hardware

Not covered

Not covered

Home health services

Covered in full up to 130 visits total per calendar year

Shared with preferred provider visit limit Deductible and coinsurance apply

Hospice services

Covered in full

Deductible and coinsurance apply

Infertility services

Not covered

Not covered

Manipulative therapy

12 visits per calendar year $10 copay

Shared with preferred provider visit limit $10 copay, deductible and coinsurance apply

12 visits per calendar year

Shared with preferred provider visit limit $10 copay, deductible and coinsurance apply

• Ostomy supplies • Prosthetic devices

Massage services

Maternity services

$10 copay Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $10 copay

Mental Health

Inpatient: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: $10 copay, deductible and coinsurance apply

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

Inpatient: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: $10 copay Outpatient: $10 copay, deductible and coinsurance apply Form No. 015-WA (4/08) Contract No. 001-WA (4/06)

2011-2012 BENEFITS BOOK

63


Options PPO BENEFIT

Naturopathy

Preferred Provider Network (PPN) 12 visits per calendar year $10 copay

Non-Preferred Provider Network Shared with preferred provider visit limit $10 copay, deductible and coinsurance apply

Newborn Services

Any applicable coinsurance applies to the newborn while both mother and baby are confined. Otherwise, all applicable inpatient cost shares apply. Office visits: See Outpatient Services; Routine well care: See Preventive care.

Any applicable coinsurance applies to the newborn while both mother and baby are confined. Otherwise, all applicable inpatient cost shares apply. Office visits: See Outpatient Services; Routine well care: See Preventive care.

Obesity-related surgery (bariatric)

Not covered

Not covered

Unlimited, no waiting period

Not covered

Organ transplants Donor search & harvest applies to lifetime max

Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $10 copay

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

Covered in full

Rehabilitation services (Occupational, speech, physical including services for neurodevelopmentally disabled children age six and under) Rehabilitation visits are a total of combined therapy visits per calendar year

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

Skilled nursing facility

Sterilization (vasectomy, tubal ligation)*

Temporomandibular Joint (TMJ) services

Not covered Routine mammograms: Deductible and coinsurance apply

Outpatient: 60 visits per calendar year $10 copay

Inpatient: Day limits shared with preferred provider benefit limit $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: Visit limits shared with preferred provider benefit limit $10 copay, deductible and coinsurance apply

Covered in full up to 60 days per calendar year

Day limits shared with preferred provider benefit, deductible and coinsurance apply

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

Inpatient: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: $10 copay, deductible and coinsurance apply

Outpatient: $10 copay $1,000 per calendar year; $5,000 lifetime max

Shared with preferred provider benefit

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

Inpatient: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: $10 copay, deductible and coinsurance apply

Outpatient: $10 copay Tobacco cessation counseling

Free & Clear Program - covered Applicable cost shares apply in full

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

$10 copay

$10 copay, deductible and coinsurance apply

$200 per 24 months

Shared with preferred provider benefit

Coverage provided by Group Health Options * Not available for Catholic Community Services Home Care Aides

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RQ-45343


Options BENEFIT Plan deductible Individual deductible carryover

Inside Network No annual deductible

Outside Network Individual deductible: $500 per calendar year

Not applicable

4th quarter carryover applies

No plan coinsurance

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

Individual out-of-pocket limit: $1,000

Individual out-of-pocket limit: $2,000

Plan coinsurance

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

Inpatient services, outpatient services, emergency services at a Managed Health Care Network (MHCN) facility and ambulance services.

Plan coinsurance, emergency services at a non-Managed Health Care Network (MHCN) facility.

Pre-existing condition (PEC) waiting period

No PEC

Same as in-network

Lifetime maximum

Unlimited

Shared with in-network maximum

Outpatient services (Office visits)

$10 copay

$10 copay, deductible and coinsurance apply

Hospital services

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 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 $15/$30 copay per 30 day supply brand $20/$35 copay per 30 day supply

Prescription mail order

$5 discount per 30 day supply

Acupuncture

Self-referred up to 8 visits per medical diagnosis per calendar year; additional visits when approved by the plan $10 copay

Ambulance services

Plan pays 80%, you pay 20%

Chemical dependency

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: $10 copay Outpatient: $10 copay, deductible and coinsurance apply

Not covered $10 copay, deductible and coinsurance apply

Same as in-network

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. Effective date 8/1/11.

2011-2012 BENEFITS BOOK

65


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

Inside Network

Outside Network

Covered at 50%

Covered at 50%, deductible applies

Covered at 50%

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.

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 services Outpatient: MRI/PET/CT - $50 copay

Inpatient: Covered under Hospital services Outpatient: MRI/PET/CT - $50 copay

Diagnostic lab and X-ray services

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

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

Emergency services (copay waived if admitted)

$200 copay

$200 copay

$10 copay

$10 copay, deductible and coinsurance apply

Not covered

Not covered

Covered in full. No visit limit.

No visit limit. Deductible and coinsurance apply

Hospice services

Covered in full

Deductible and coinsurance apply

Infertility services

Not covered

Not covered

Manipulative therapy

Self-referred up to 10 visits per calendar year $10 copay

Visit limits shared with in-network $10 copay, deductible and coinsurance apply

Massage services

See Rehabilitation services

See Rehabilitation services

Maternity services

Inpatient: $100 copay, per day for Inpatient: $100 copay, per day up to 5 days per admit for up to 5 days per admit Deductible and coinsurance apply Outpatient: $10 copay Outpatient: $10 copay, deductible and coinsurance apply

Mental Health

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: $10 copay Outpatient: $10 copay, deductible and coinsurance apply

• Ostomy supplies • Prosthetic devices

Diabetic supplies

Hearing exams (routine) Hearing hardware Home health services

66

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Options BENEFIT

Naturopathy

Newborn Services

Obesity-related surgery (bariatric) Organ transplants Donor search & harvest applies to lifetime max

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

Rehabilitation services (Occupational, speech, physical)) Rehabilitation visits are a total of combined therapy visits per calendar year

Skilled nursing facility

Inside Network Self-referred up to 3 visits per medical diagnosis per calendar year; additional visits when approved by plan $10 copay

Outside Network $10 copay, deductible and coinsurance apply

Any applicable coinsurance applies to the newborn while both mother and baby are confined. Otherwise, all applicable inpatient cost shares apply. Office visits: See Outpatient Services; Routine well care: See Preventive care.

Any applicable coinsurance applies to the newborn while both mother and baby are confined. Otherwise, all applicable inpatient cost shares apply. Office visits: See Outpatient Services; Routine well care: See Preventive care.

Not covered

Not covered

Unlimited, no waiting period Shared with 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 apply Outpatient: $10 copay Outpatient: $10 copay, deductible and coinsurance apply Covered in full

$300 per person, coinsurance applies Routine mammograms: Deductible and coinsurance apply

Inpatient: 60 days per calendar year $100 copay, per day for up to 5 days per admit Outpatient:60 visits per calendar year $10 copay Covered in full up to 60 days per calendar year

Inpatient: Day limits shared with in-network $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: Visit limits shared with in-network $10 copay, deductible and coinsurance apply Day limits shared with in-network benefit, deductible and coinsurance apply

Sterilization (vasectomy, tubal ligation)*

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: $10 copay Outpatient: $10 copay, deductible and coinsurance apply

Temporomandibular Joint (TMJ) services

$1,000 per calendar year; $5,000 Shared with in-network lifetime max 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: $10 copay Outpatient: $10 copay, deductible and coinsurance apply

Tobacco cessation Free & Clear Program - covered in full counseling $10 copay Routine vision care (1 visit every 12 months) Optical hardware $200 per 24 months Lenses, including contact lenses and frames Coverage provided by Group Health Options

* Not available for Catholic Community Services Home Care Aides

Applicable cost shares apply $10 copay, deductible and coinsurance apply Shared with in-network

RQ-45343

2011-2012 BENEFITS BOOK

67


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 plan’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.

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Individual Providers Medical Plan B

General Information www.kp.org

Website Member Services Number

1-800-813-2000 or (503) 813-2000

Member Services Weekday Hours

8am-6pm

Member Services Weekend Hours

Closed

Annual Deductible: Individual

None

Annual Out-of-Pocket Max: Individual

$750 Individual Office Visits (Outpatient)

Primary Care

$10 copay

Specialty Care

$10 copay / $0 preventative

Preventive Care

100% covered

Scheduled Prenatal Visits and 1st Postpartum Visit

100% covered

Well-Baby Care (23 months or younger)

100% covered

Vision Exam - Optometrist

$10 copay

Vision Exam - Ophthalmologist

$10 copay

Physical, Occupational, Speech Therapy Outpatient/Ambulatory Surgery

$10 copay $50 copay / $0 preventative

Continued on next page

This is a summary of the most frequently asked-about benefits. This chart does not explain benefits, cost sharing, out-of-pocket maximums, exclusions, or limitations, nor does it list all benefits and cost sharing. For a complete explanation, please refer to the applicable EOC, or to the Disclosure Form for California, or to the Member Handbook for Hawaii.

2011-2012 BENEFITS BOOK

69


Individual Providers Medical Plan B Cont’d.

Lab and X-Ray Laboratory

100% covered

X-Ray

100% covered

MRI/CT/PET/Nuclear Medicine

$50 copay Emergency Care

Ambulance (Ground or Air)

$75 copay

Emergency Room

$200 copay

Urgent Care

$30 copay Hospital Care (Inpatient)

Inpatient

$100 copay

Delivery and Inpatient Baby Care

$100 copay

Mental Health and Chemical Dependency Mental Health Outpatient (Individual)

$10 copay

Mental Health Outpatient (Group)

$10 copay

Mental Health Inpatient

$100 copay

Chemical Dependency Outpatient (Individual)

$10 copay

Chemical Dependency Outpatient (Group)

$10 copay

Chemical Dependency Inpatient

$100 copay Prescription Drugs

Pharmacy/Retail: Generic

$15 copay

Pharmacy/Retail: Brand

$30 copay

Pharmacy/Retail: Day Supply

30

Mail Order - Generic

$30 copay

Mail Order - Brand

$60 copay

Mail Order - Day Supply

90 Other

Skilled Nursing Facility (SNF) Infertility Services Hospice Care Home Health Care Durable Medical Equipment (DME)

100% covered; limited to 100 days per calendar year Diagnosis and treatment 50% covered 100% covered for patient diagnosed with life expectancy of 6 months or less 100% covered, limited to 130 days per year 20% coinsurance

Vision Hardware

$200 allowance, every 24 months

Vision Hardware

$10 copay for chiro, naturopathic, & acupuncture

This is a summary of the most frequently asked-about benefits. This chart does not explain benefits, cost sharing, outof-pocket maximums, exclusions, or limitations, nor does it list all benefits and cost sharing. For a complete explanation, please refer to the applicable EOC, or to the Disclosure Form for California, or to the Member Handbook for Hawaii.

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Agency Providers Medical Plan B

General Information Website

www.kp.org

Member Services Number

1-800-813-2000 or (503) 813-2000

Member Services Weekday Hours

8am-6pm

Member Services Weekend Hours

Closed

Annual Deductible: Individual/Family

None

Annual Out-of-Pocket Max: Individual/Family

$750 Individual/$2250 Family Office Visits (Outpatient)

Primary Care

$10 copay

Specialty Care

$10 copay / $0 preventative

Preventive Care

100% covered

Scheduled Prenatal Visits and 1st Postpartum Visit

100% covered

Well-Baby Care (23 months or younger)

100% covered

Vision Exam - Optometrist

$10 copay

Vision Exam - Ophthalmologist

$10 copay

Physical, Occupational, Speech Therapy

$10 copay

Outpatient/Ambulatory Surgery

$50 copay / $0 preventative

Continued on next page

This is a summary of the most frequently asked-about benefits. This chart does not explain benefits, cost sharing, outof-pocket maximums, exclusions, or limitations, nor does it list all benefits and cost sharing. For a complete explanation, please refer to the applicable EOC, or to the Disclosure Form for California, or to the Member Handbook for Hawaii.

2011-2012 BENEFITS BOOK

71


Agency Providers Medical Plan B Cont’d.

Lab and X-Ray Laboratory

100% covered

X-Ray

100% covered

MRI/CT/PET/Nuclear Medicine

$50 copay Emergency Care

Ambulance (Ground or Air)

$75 copay

Emergency Room

$200 copay

Urgent Care

$30 copay Hospital Care (Inpatient)

Inpatient

$100 copay

Delivery and Inpatient Baby Care

$100 copay

Mental Health and Chemical Dependency Mental Health Outpatient (Individual)

$10 copay

Mental Health Outpatient (Group)

$10 copay

Mental Health Inpatient

$100 copay

Chemical Dependency Outpatient (Individual)

$10 copay

Chemical Dependency Outpatient (Group)

$10 copay

Chemical Dependency Inpatient

$100 copay Prescription Drugs

Pharmacy/Retail: Generic

$15 copay

Pharmacy/Retail: Brand

$30 copay

Pharmacy/Retail: Day Supply

30

Mail Order - Generic

$30 copay

Mail Order - Brand

$60 copay

Mail Order - Day Supply

90 Other

Skilled Nursing Facility (SNF) Infertility Services Hospice Care Home Health Care Durable Medical Equipment (DME)

100% covered; limited to 100 days per calendar year Diagnosis and treatment 50% covered 100% covered for patient diagnosed with life expectancy of 6 months or less 100% covered, limited to 130 days per year 20% coinsurance

Vision Hardware

$200 allowance, every 24 months

Vision Hardware

$10 copay for chiro, naturopathic, & acupuncture

This is a summary of the most frequently asked-about benefits. This chart does not explain benefits, cost sharing, outof-pocket maximums, exclusions, or limitations, nor does it list all benefits and cost sharing. For a complete explanation, please refer to the applicable EOC, or to the Disclosure Form for California, or to the Member Handbook for Hawaii.

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PREMERA DENTAL - Benefit Summaries

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.

This is a summary of the most frequently asked-about benefits. This chart does not explain benefits, cost sharing, outof-pocket maximums, exclusions, or limitations, nor does it list all benefits and cost sharing. For a complete explanation, please refer to the applicable EOC, or to the Disclosure Form for California, or to the Member Handbook for Hawaii.

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PREMERA DENTAL - Benefit Summaries Standard PPO Group Number: 1034825 Effective date: 8/1/2011 DENTAL PLAN

COVERED SERVICES

DENTAL PREFERENCES FLEX PLUS— STANDARD PPO – INDIVIDUAL PROVIDER IN-NETWORK

OUT-OF-NETWORK

Individual/Family Deductible PCY

$0

$50 (waived for diagnostic/ preventive)

DIAGNOSTIC/PREVENTIVE

$0

20%

$0

40%

- cleanings (limited to 2 PCY) - fluoride treatments (limited to 2 applications PCY for members age 19 and under) - routine oral exams (limited to 2 PCY) - routine x-rays (complete series or panoramic x-ray once every 5 calendar years, but not both) - sealants (limited to permanent teeth for members age 18 and under) - space maintainers BASIC - emergency exams (unlimited) - non-routine exams (limited to 1 PCY) - emergency palliative treatment - endodontic (root canal) treatment (limited to once per tooth every 2 calendar years) - fillings - full mouth debridement (limited to once every 3 calendar years) - periodontal maintenance (limited to 2 visits per calendar year) - periodontal scaling (limited to once per quadrant every 2 calendar years) - periodontal surgery once in the same quadrant every 3 calendar years

An Independent Licensee of the Blue Cross Blue Shield Association

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BASIC Continued

$0

40%

20%

60%

$1,000 PCY

Shared with In-Network Cost Share

- limited occlusal adjustments (limited to 1 PCY) - re-cementing of crowns, inlays, bridgework and dentures - re-line, re-base, and adjustments when performed six or more months after denture installation - simple and surgical extractions - general anesthesia (limited to covered dental procedures at a dental care providers office when dentally necessary) MAJOR - repair of crowns, inlays, bridgework and dentures - inlays, onlays and crowns (replacements limited to once per tooth every 7 calendar years) - dentures, partials and fixed bridges (replacements limited to once every 7 calendar years) - implant and implant related services once every 7-consecutive years - Stainless steel crowns on non-permanent molars are limited to once per tooth every 5 calendar years Annual Maximum

Any deductibles, copays, and coinsurance percentages shown are amounts for which you’re responsible.

In-network services aren’t subject to a calendar year deductible. The out-of-network calendar year deductible is waived for Diagnostic/Preventive Care services. PCY = Per calendar year. Balance billing may apply if a provider is not contracted with Premera Blue Cross. Members are responsible for amounts in excess of the allowable charge. This is not a complete explanation of covered services, exclusions, limitations, reductions or the terms under which the program may be continued in force. This benefit highlight is not a contract. For full coverage provisions, including a description of waiting periods, limitations and exclusions please contact Customer Service.

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Out-of-Area Plan Group Number: 1034826 Any deductibles, copays, and coinsurance percentages shown are amounts for which you’re responsible. Effective date: 8/1/2011 DENTAL PLAN COVERED SERVICES

DENTAL PREFERENCES FLEX PLUS— OUT OF AREA PLAN IN-NETWORK

OUT-OF-NETWORK

Individual/Family Deductible PCY

$0

$50 (waived for diagnostic/ preventive)

DIAGNOSTIC/PREVENTIVE

$0

$0

$0

20%

- cleanings (limited to 2 PCY) - fluoride treatments (limited to 2 applications PCY for members age 19 and under) - routine oral exams (limited to 2 PCY) - routine x-rays (complete series or panoramic x-ray once every 5 calendar years, but not both) - sealants (limited to permanent teeth for members age 18 and under) - space maintainers BASIC - emergency exams (unlimited) - non-routine exams (limited to 1 PCY) - emergency palliative treatment - endodontic (root canal) treatment (limited to once per tooth every 2 calendar years) - fillings - full mouth debridement (limited to once every 3 calendar years) - periodontal maintenance (limited to 2 visits per calendar year) - periodontal scaling (limited to once per quadrant every 2 calendar years) - periodontal surgery once in the same quadrant every 3 calendar years

An Independent Licensee of the Blue Cross Blue Shield Association

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Continued on next page


BASIC Continued

$0

20%

20%

50%

$1,000 PCY

Shared with In-Network Cost Share

- limited occlusal adjustments (limited to 1 PCY) - re-cementing of crowns, inlays, bridgework and dentures - re-line, re-base, and adjustments when performed six or more months after denture installation - simple and surgical extractions - general anesthesia (limited to covered dental procedures at a dental care providers office when dentally necessary) MAJOR - repair of crowns, inlays, bridgework and dentures - inlays, onlays and crowns (replacements limited to once per tooth every 7 calendar years) - dentures, partials and fixed bridges (replacements limited to once every 7 calendar years) - implant and implant related services once every 7-consecutive years - Stainless steel crowns on non-permanent molars are limited to once per tooth every 2 calendar years - Stainless steel crowns on permanent molars are limited to once per tooth every 5 calendar years Annual Maximum

In-network services aren’t subject to a calendar year deductible. The out-of-network calendar year deductible is waived for Diagnostic/Preventive Care services. PCY = Per calendar year. Balance billing may apply if a provider is not contracted with Premera Blue Cross. Members are responsible for amounts in excess of the allowable charge. This is not a complete explanation of covered services, exclusions, limitations, reductions or the terms under which the program may be continued in force. This benefit highlight is not a contract. For full coverage provisions, including a description of waiting periods, limitations and exclusions please contact Customer Service.

An Independent Licensee of the Blue Cross Blue Shield Association

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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.

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IP Plan & Agency Plan

BENEFIT

CO-PAYMENT

Annual Maximum

No Annual Maximum*

Deductible

No Deductible

General Office Visit

$15 per Visit DIAGNOSTIC AND PREVENTIVE SERVICES

Routine and Emergency Exams

Covered at 100%

All X-rays

Covered at 100%

Teeth Cleaning

Covered at 100%

Fluoride Treatment

Covered at 100%

Sealants

Covered at 100%

Head and Neck Cancer Screening

Covered at 100%

Oral Hygiene Instruction

Covered at 100%

Periodontal Charting

Covered at 100%

Periodontal Evaluation

Covered at 100% RESTORATIVE DENTISTRY

Fillings (Amalgam)

Covered at 100%

Stainless Steel Crown

Covered at 100%

Porcelain-Metal Crown

$250 PROSTHETICS

Complete Upper or Lower Denture

$400

Bridge (per Tooth)

$250 ENDODONTICS AND PERIODONTICS

Root Canal Therapy – Anterior

$85

Root Canal Therapy – Bicuspid

$105

Root Canal Therapy – Molar

$130

Osseous Surgery (per Quadrant)

$150

Root Planing (per Quadrant)

$75 ORAL SURGERY

Routine Extraction (Single Tooth)

Covered at 100%

Surgical Extraction

$100 ORTHODONTIA

Pre-Orthodontic Service Comprehensive Orthodontia

$150** Value Added Services Available MISCELLANEOUS

**Fee credited towards comprehensive orthodontic co-payment if patient accepts treatment plan.

Local Anesthesia (Novocain)

Covered at 100%

Dental Lab Fees

Covered at 100%

Nitrous Oxide

$40 per Visit

Specialty Office Visit

$30 per Visit

Emergency Office Visit

$50 per Visit

Out of Area Emergency Care Reimbursement up to $250 *TMJ has a $1000 annual maximum / $5000 lifetime maximum Form No. 015-WA (4/08) Contract No. 001-WA (4/06)

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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 Trust’s self-funded dental plan, Premera Blue Cross: Group Health Options 1-800-542-6312 www.ghc.org Kaiser Permanente 1-800-813-2000 www.kp.org Willamette Dental Oregon: 1-800-461-8994 Washington: 1-800-359-6019 www.willamettedental.com Self-funded Dental Plan Claims Administered by Premera Blue Cross 1-800-547-9515 www.premera.com

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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 Premera Blue Cross. 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, Premera Blue Cross, 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

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GLOSSARY AAA – Area Agency on Aging ABT – Accelerated Basic Training ADSA – Aging and Disability Services Administration Department of Department of Social and Health Services serving adults with chronic illnesses or conditions and people with developmental disabilities. AP – Agency Provider A Home Care Aide who works for an agency – agency provider ARC – Advocates for the Rights of Citizens with Developmental Disabilities 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 DDD – Division of Developmental Disabilities diagnostic imaging – MRI (Magnetic Resonance Imaging), X-rays, mammograms DME – Durable Medical Equipment Walkers, crutches, etc. DSHS – Department of Social and Health Services HCS – Home Community Services The Home Community Services (HCS) Division of DSHS promotes, plans, develops and provides long-term care services for persons with disabilities and older adults who may need state funds (Medicaid) to help pay for them. 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

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GLOSSARY 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 MFOC – Modified Fundamentals of Caregiving MRC – Member Resource Center NDC – Nurse Delegated Core NDD – Nurse Delegation Diabetes orthopedic appliances – braces, splints, etc. PCP – Primary Care Provider The doctor you choose to oversee your care 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

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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.

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2011-2012 GUIDE TO TRAINING AND HEALTH BENEFITS Inside: • • •

Changes to Training Standards and Benefits Ways to stay healthy, save money and save time How to access training and health benefits online … and much more!

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