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(1)

2016 Kaiser Permanente

Plan Highlights

Individual and Family Plans

Georgia

(2)

Important deadlines

There’s a deadline to apply for health care coverage, whether you apply during open enrollment

or during a special enrollment period.

Enrolling during the 2016 open enrollment period

You may change or apply for 2016 coverage during the open enrollment

period, which runs from November 1, 2015, through January 31, 2016.

You can do so either through the Health Insurance Marketplace or through

Kaiser Permanente.

To start coverage on:

Send your completed application

and premium by:

January 1, 2016

December 15, 2015

February 1, 2016

January 15, 2016

March 1, 2016

January 31, 2016

Enrolling during a special enrollment period

Outside of open enrollment, you may enroll or change your coverage if you

experience what’s known as a triggering event. Examples of triggering

events include getting married, having a baby, and losing coverage because

you lost your job.

From the date of your triggering event, the special enrollment period

generally lasts 60 days. That means you have 60 days to change or apply for

coverage for you and/or your dependents.

If you know you are going to have a triggering event, you may be able to

apply for new coverage ahead of time.

For more information, please refer to the Enrolling During a Special

Enrollment Period guide. If you didn’t receive this guide, you can find it at

buykp.org/apply, or you may call 1-800-494-5314 to request a copy.

Get started today

This booklet will show you

how to find a new plan

that best fits your needs.

Important deadlines

...

2

Health plan

benefit highlights

...

3

Working out your rate

...

8

Enrolling in a Kaiser

Permanente plan on

the Marketplace

...

10

To enroll during this open enrollment period,

you must make sure we receive your completed

Application for Health Coverage — along with

your first month’s premium — no later than

January 31, 2016.

(3)

Kaiser Permanente for Individuals and Families

Health plan benefit highlights

The charts on the next few pages show you a sample of each plan’s benefits. Review the

diagram below to help you understand how to read those charts.

KP GA Silver 2500/30

Plan type Deductible

Features

Annual medical deductible

(individual/family) $2,500/$5,000 Annual out-of-pocket maximum

(individual/family) $6,850/$13,700

Benefits

Preventive care

Routine physical exam, mammograms, etc. No charge

Outpatient services (per visit or procedure)

Primary care office visit $30

Specialty care office visit $60

Most X-rays Office visit: 30% after deductible Outpatient Hospital: 50% after deductible

Most lab tests

First $300 of office visit charges covered at 100%, then remaining at

30% after deductible. Outpatient Hospital covered at 50% after

deductible.

MRI, CT, PET Outpatient Hospital: $500Office visit: $300 Outpatient surgery 30% after deductible

Mental health visit $60

Inpatient hospital care

Room and board, surgery, anesthesia, X-rays,

lab tests, medications, mental health care 30% after deductible Maternity

Routine prenatal care visit,

first postpartum visit 30% after deductible Delivery and inpatient well-baby care 30% after deductible

Emergency and urgent care

Emergency Department visit 30% after deductible

Urgent care visit $100

Ambulance services 30% after deductible

Prescription drugs (up to a 30-day supply)

Generic Preventive generic: $5*Preferred generic: $15* Preferred brand $451 after $500/$1,000 deductible

Non-preferred brand 50% after $500/$1,000 deductible

Specialty 50% after $500/$1,000 deductible

Here’s a quick look at how to use the chart

Annual deductible

You need to pay this amount before your plan starts

helping you pay for most covered services. Under

this sample plan, you’d pay the full charges for covered

services until you reach $2,500 for yourself or

$5,000 for your family. Then you’d start paying copays

or coinsurance.

KP

Offered through Kaiser Permanente

M

Offered through the Health Insurance Marketplace

Preventive care at no charge

Most preventive care services — including routine

physical exams and mammograms — are covered at no

charge. Plus, they’re not subject to the deductible.

Coinsurance

After reaching your deductible, this is a percentage of

the charges that you may pay for covered services. Here,

you’d pay 30% of the cost per day for your inpatient

hospital care after you reach your deductible. Your plan

would pay the rest for the remainder of the calendar year.

Covered before you reach the deductible

With some services, you’ll only pay a copay or

coinsurance, regardless of whether you’ve reached

your deductible. Under this plan, primary care visits

are covered at a $30 copay — even before you meet

your deductible. With our Silver deductible plans,

primary care, specialty care, and urgent care visits all

are covered before you reach the deductible.

Copay

This is the set amount you pay for covered services,

usually after you reach your deductible. In this example,

you’d start paying a $100 copay for urgent care visits,

whether or not you have met your deductible.

Annual out-of-pocket maximum

This is the most you’ll pay for care during the calendar

year before your plan starts paying 100% for most

covered services. In this example, you’d never pay

more than $6,850 for yourself and no more than

$13,700 for your family for your copays, coinsurance,

and deductible in a calendar year.

KP M

*Mail order: 90-day supply of qualified prescriptions for the cost of a 60-day supply

(4)

1Mail order: 90-day supply of qualified prescriptions for the cost of a 60-day supply.

KP GA Bronze

6000/40%/HSA

KP GA Bronze

5000/50

KP GA Bronze

4000/20

2750/20%/HSA

KP GA Silver

Plan type

HSA-qualified

Deductible

Deductible

HSA-qualified

Features

Annual medical deductible

(individual/family) $6,000/$12,000 $5,000/$10,000 $4,000/$8,000 $2,750/$5,500 Annual out-of-pocket maximum

(individual/family) $6,450/$12,900 $6,850/$13,700 $6,850/$13,700 $5,000/$10,000

Benefits

Preventive care

Routine physical exam, mammograms, etc. No charge No charge No charge No charge

Outpatient services (per visit or procedure)

Primary care office visit 40% after deductible 4+ visits: 40% after deductibleFirst 3 office visits: $50 4+ visits: 30% after deductibleFirst 3 office visits: $20 20% after deductible

Specialty care office visit 40% after deductible 4+ visits: 40% after deductibleFirst 3 office visits: $70 4+ visits: 30% after deductibleFirst 3 office visits: $50 20% after deductible

Most X-rays Office visit: 40% after deductible Outpatient Hospital: 50% after deductible

Office visit: 40% after deductible Outpatient Hospital: 50% after

deductible

Office visit: 30% after deductible Outpatient Hospital: 50% after

deductible

Office visit: 20% after deductible Outpatient Hospital: 40% after

deductible

Most lab tests Office visit: 40% after deductible Outpatient Hospital: 50% after deductible

Office visit: 40% after deductible Outpatient Hospital: 50% after

deductible

Office visit: 30% after deductible Outpatient Hospital: 50% after

deductible

Office visit: 20% after deductible Outpatient Hospital: 40% after

deductible

MRI, CT, PET Office visit: 40% after deductible Outpatient Hospital: 50% after deductible

Office visit: 40% after deductible Outpatient Hospital: 50% after

deductible

Office visit: $500 after deductible Outpatient Hospital: $700 after

deductible

Office visit: 20% after deductible Outpatient Hospital: 40% after

deductible

Outpatient surgery 40% after deductible 40% after deductible 30% after deductible 20% after deductible

Mental health visit 40% after deductible 4+ visits: 40% after deductibleFirst 3 office visits: $70 4+ visits: 30% after deductibleFirst 3 office visits: $50 20% after deductible

Inpatient hospital care

Room and board, surgery, anesthesia, X-rays,

lab tests, medications, mental health care 40% after deductible 40% after deductible 30% after deductible 20% after deductible Maternity

Routine prenatal care visit,

first postpartum visit 40% after deductible 40% after deductible 30% after deductible 20% after deductible Delivery and inpatient well-baby care 40% after deductible 40% after deductible 30% after deductible 20% after deductible

Emergency and urgent care

Emergency Department visit 40% after deductible 40% after deductible 30% after deductible 20% after deductible

Urgent care visit 40% after deductible $100 $100 20% after deductible

Ambulance services 40% after deductible 40% after deductible 30% after deductible 20% after deductible

Prescription drugs (up to a 30-day supply)

Generic Preventive generic: $5

1

Preferred generic: 40% after medical deductible

Preventive generic: $51

Preferred generic: $201 after

medical deductible

Preventive generic: $51

Preferred generic: $251

Preventive generic: $51

Preferred generic: $151 after

medical deductible

Preferred brand 50% after medical deductible 50% after medical deductible 50% after $1,000/$2,000 deductible $451 after medical deductible

Non-preferred brand 50% after medical deductible 50% after medical deductible 50% after $1,000/$2,000 deductible 50% after medical deductible

Specialty 50% after medical deductible 50% after medical deductible 50% after $1,000/$2,000 deductible 50% after medical deductible

This is a summary of the most frequently asked-about benefits and their copays, coinsurance, and deductibles. Detailed information about your plan is in the Evidence of Coverage,

which will be mailed to you upon enrollment or upon request. To request a copy of the Evidence of Coverage for a particular plan, please call us at 1-800-634-4579 or contact your

broker. For services subject to the deductible, you will have to pay health care expenses out of pocket until you meet your deductible. Most deductibles, copays, and coinsurance

contribute to the out-of-pocket maximum.

KP

Offered through Kaiser Permanente

M

Offered through the Health Insurance

Marketplace

Financial assistance options with lower copays, coinsurance, and

deductibles are available for certain plans, and for Native Alaskans

and American Indians on healthcare.gov.

(5)

1Mail order: 90-day supply of qualified prescriptions for the cost of a 60-day supply.

KP GA Silver

2500/30

KP GA Silver

1500/30

KP GA Gold

1500/20

KP GA Gold

1000/20

Plan type

Deductible

Deductible

Deductible

Deductible

Features

Annual medical deductible

(individual/family) $2,500/$5,000 $1,500/$3,000 $1,500/$3,000 $1,000/$2,000

Annual out-of-pocket maximum

(individual/family) $6,850/$13,700 $6,850/$13,700 $3,500/$7,000 $5,000/$10,000

Benefits

Preventive care

Routine physical exam, mammograms, etc. No charge No charge No charge No charge

Outpatient services (per visit or procedure)

Primary care office visit $30 $30 $20 $20

Specialty care office visit $60 $60 $40 $40

Most X-rays Office visit: 30% after deductible Outpatient Hospital: 50% after deductible

Office visit: 30% after deductible Outpatient Hospital: 50% after

deductible

First $100 of office visit charges covered at 100%, then remaining at 20% after deductible. Outpatient

Hospital covered at 40% after deductible.

First $100 of office visit charges covered at 100%, then remaining at 20% after deductible. Outpatient

Hospital covered at 40% after deductible.

Most lab tests

First $300 of office visit charges covered at 100%, then remaining at 30% after deductible. Outpatient

Hospital covered at 50% after deductible.

First $300 of office visit charges covered at 100%, then remaining at 30% after deductible. Outpatient

Hospital covered at 50% after deductible.

First $400 of office visit charges covered at 100%, then remaining at 20% after deductible. Outpatient

Hospital covered at 40% after deductible.

First $400 of office visit charges covered at 100%, then remaining at 20% after deductible. Outpatient

Hospital covered at 40% after deductible.

MRI, CT, PET Outpatient Hospital: $500 Office visit: $300 Outpatient Hospital: $500 Office visit: $250 Outpatient Hospital: $250 Office visit: $150 Outpatient Hospital: $250 Office visit: $150 Outpatient surgery 30% after deductible 30% after deductible 20% after deductible 20% after deductible

Mental health visit $60 $60 $40 $40

Inpatient hospital care

Room and board, surgery, anesthesia, X-rays,

lab tests, medications, mental health care 30% after deductible 30% after deductible 20% after deductible 20% after deductible Maternity

Routine prenatal care visit,

first postpartum visit 30% after deductible 30% after deductible 20% after deductible 20% after deductible Delivery and inpatient well-baby care 30% after deductible 30% after deductible 20% after deductible 20% after deductible

Emergency and urgent care

Emergency Department visit 30% after deductible 30% after deductible 20% after deductible 20% after deductible

Urgent care visit $100 $100 $75 $75

Ambulance services 30% after deductible 30% after deductible 20% after deductible 20% after deductible

Prescription drugs (up to a 30-day supply)

Generic Preventive generic: $5Preferred generic: $1511 Preventive generic: $5 1

Preferred generic: $151 Preventive generic: $5 1

Preferred generic: $101 Preventive generic: $5 1

Preferred generic: $101

Preferred brand $451 after $500/$1,000 deductible $451 after $500/$1,000 deductible $301 after $500/$1,000 deductible $301 after $500/$1,000 deductible

Non-preferred brand 50% after $500/$1,000 deductible 50% after $500/$1,000 deductible 45% after $500/$1,000 deductible 45% after $500/$1,000 deductible

Specialty 50% after $500/$1,000 deductible 50% after $500/$1,000 deductible 45% after $500/$1,000 deductible 45% after $500/$1,000 deductible

This is a summary of the most frequently asked-about benefits and their copays, coinsurance, and deductibles. Detailed information about your plan is in the Evidence of Coverage,

which will be mailed to you upon enrollment or upon request. To request a copy of the Evidence of Coverage for a particular plan, please call us at 1-800-634-4579 or contact your

broker. For services subject to the deductible, you will have to pay health care expenses out of pocket until you meet your deductible. Most deductibles, copays, and coinsurance

contribute to the out-of-pocket maximum.

KP

Offered through Kaiser Permanente

M

Offered through the Health Insurance

Marketplace

Financial assistance options with lower copays, coinsurance, and

deductibles are available for certain plans, and for Native Alaskans

and American Indians on healthcare.gov.

(6)

1Mail order: 90-day supply of qualified prescriptions for the cost of a 60-day supply.

2 Only applicants under age 30, or applicants age 30 and older who provide a certificate from Health Insurance Marketplace in Georgia demonstrating hardship

or lack of affordable coverage, may purchase a KP GA Catastrophic 6850/0 plan.

KP GA Gold

500/20

KP GA Catastrophic

6850/0

2

KP GA Silver

1500/30/73% CSR

2500/30/73% CSR

KP GA Silver

1500/30/87% CSR

2500/30/87% CSR

Plan type

Deductible

Deductible

Deductible

Copay

Features

Annual medical deductible

(individual/family) $500/$1,000 $6,850/$13,700 $1,500/$3,000 None/None

Annual out-of-pocket maximum

(individual/family) $6,350/$12,700 $6,850/$13,700 $5,200/$10,400 $2,250/$4,500

Benefits

Preventive care

Routine physical exam, mammograms, etc. No charge No charge No charge No charge

Outpatient services (per visit or procedure)

Primary care office visit $20 4+ visits: no charge after deductibleFirst 3 office visits: no charge $30 $15

Specialty care office visit $40 No charge after deductible $50 $25

Most X-rays

First $100 of office visit charges covered at 100%, then remaining at 30% (ded waived). Outpatient Hospital

covered at 50% (ded waived).

No charge after deductible Office visit: 20% after deductible Outpatient Hospital: 40% after deductible

Office visit: 20% Outpatient Hospital: 40%

Most lab tests

First $400 of office visit charges covered at 100%, then remaining at 30% (ded waived). Outpatient Hospital

covered at 50% (ded waived).

No charge after deductible

First $300 of office visit charges covered at 100%, then remaining at 20% after deductible. Outpatient Hospital covered

at 40% after deductible.

First $300 of office visit charges covered at 100%, then remaining at 20%. Outpatient Hospital

covered at 40%.

MRI, CT, PET Outpatient Hospital: $500 Office visit: $250 No charge after deductible Outpatient Hospital: $500 Office visit: $250 Outpatient Hospital: $300 Office visit: $150

Outpatient surgery 30% after deductible No charge after deductible 20% after deductible 20%

Mental health visit $40 4+ visits: no charge after deductibleFirst 3 office visits: no charge $50 $25

Inpatient hospital care

Room and board, surgery, anesthesia, X-rays,

lab tests, medications, mental health care deductible, then covered at 100%$500 per day up to 3 days after No charge after deductible 20% after deductible 20%

Maternity

Routine prenatal care visit,

first postpartum visit No charge No charge after deductible 20% after deductible 20% Delivery and inpatient well-baby care $2,000 per admission No charge after deductible 20% after deductible 20%

Emergency and urgent care

Emergency Department visit $250 No charge after deductible 20% after deductible 20%

Urgent care visit $75 No charge after deductible $100 $50

Ambulance services $300 No charge after deductible 20% after deductible 20%

Prescription drugs (up to a 30-day supply)

Generic Preventive generic: $5Preferred generic: $1011 No charge after deductible Preventive generic: $5 1

Preferred generic: $151 Preventive generic: $5 1

Preferred generic: $151

Preferred brand $301 after $500/$1,000 deductible No charge after deductible $451 after $250/$500 deductible $451

Non-preferred brand 45% after $500/$1,000 deductible No charge after deductible 50% after $250/$500 deductible 50%

Specialty 45% after $500/$1,000 deductible No charge after deductible 50% after $250/$500 deductible 50%

This is a summary of the most frequently asked-about benefits and their copays, coinsurance, and deductibles. Detailed information about your plan is in the Evidence of Coverage,

which will be mailed to you upon enrollment or upon request. To request a copy of the Evidence of Coverage for a particular plan, please call us at 1-800-634-4579 or contact your

broker. For services subject to the deductible, you will have to pay health care expenses out of pocket until you meet your deductible. Most deductibles, copays, and coinsurance

contribute to the out-of-pocket maximum.

KP

Offered through Kaiser Permanente

M

Offered through the Health Insurance

Marketplace

Financial assistance options with lower copays, coinsurance, and

deductibles are available for certain plans, and for Native Alaskans

and American Indians on healthcare.gov.

(7)

1Mail order: 90-day supply of qualified prescriptions for the cost of a 60-day supply.

KP GA Silver

1500/30/94% CSR

2500/30/94% CSR

KP GA Silver

2750/20%/73% CSR

3

KP GA Silver

2750/20%/87% CSR

3

KP GA Silver

2750/20%/94% CSR

3

Plan type

Copay

Deductible

Deductible

Deductible

Features

Annual medical deductible

(individual/family) None/None $1,400/$2,800 $500/$1,000 $100/$200

Annual out-of-pocket maximum

(individual/family) $1,900/$3,800 $5,000/$10,000 $2,250/$4,500 $1,400/$2,800

Benefits

Preventive care

Routine physical exam, mammograms, etc. No charge No charge No charge No charge

Outpatient services (per visit or procedure)

Primary care office visit $5 20% after deductible 10% after deductible 5% after deductible

Specialty care office visit $10 20% after deductible 10% after deductible 5% after deductible

Most X-rays Outpatient Hospital: 40%Office visit: 5% Office visit: 20% after deductible Outpatient Hospital: 40% after deductible

Office visit: 10% after deductible Outpatient Hospital: 40% after

deductible

Office visit: 5% after deductible Outpatient Hospital: 40% after

deductible

Most lab tests

First $300 of office visit charges covered at 100%, then remaining at 5%. Outpatient Hospital covered

at 40%.

Office visit: 20% after deductible Outpatient Hospital: 40% after

deductible

Office visit: 10% after deductible Outpatient Hospital: 40% after

deductible

Office visit: 5% after deductible Outpatient Hospital: 40% after

deductible

MRI, CT, PET Outpatient Hospital: $150 Office visit: $50 Office visit: 20% after deductible Outpatient Hospital: 40% after deductible

Office visit: 10% after deductible Outpatient Hospital: 40% after

deductible

Office visit: 5% after deductible Outpatient Hospital: 40% after

deductible

Outpatient surgery 5% 20% after deductible 10% after deductible 5% after deductible

Mental health visit $10 20% after deductible 10% after deductible 5% after deductible

Inpatient hospital care

Room and board, surgery, anesthesia, X-rays,

lab tests, medications, mental health care 5% 20% after deductible 10% after deductible 5% after deductible Maternity

Routine prenatal care visit,

first postpartum visit 5% 20% after deductible 10% after deductible 5% after deductible Delivery and inpatient well-baby care 5% 20% after deductible 10% after deductible 5% after deductible

Emergency and urgent care

Emergency Department visit 5% 20% after deductible 10% after deductible 5% after deductible

Urgent care visit $20 20% after deductible 10% after deductible 5% after deductible

Ambulance services 5% 20% after deductible 10% after deductible 5% after deductible

Prescription drugs (up to a 30-day supply)

Generic Preventive generic: $5Preferred generic: $511

Preventive generic: $51

Preferred generic: $151 after

medical deductible

Preventive generic: $51

Preferred generic: $51 after

medical deductible

Preventive generic: $51

Preferred generic: $51 after

medical deductible

Preferred brand $101 $451 after medical deductible $101 after medical deductible $101 after medical deductible

Non-preferred brand 50% 50% after medical deductible 50% after medical deductible 50% after medical deductible

Specialty 50% 50% after medical deductible 50% after medical deductible 50% after medical deductible

This is a summary of the most frequently asked-about benefits and their copays, coinsurance, and deductibles. Detailed information about your plan is in the Evidence of Coverage,

which will be mailed to you upon enrollment or upon request. To request a copy of the Evidence of Coverage for a particular plan, please call us at 1-800-634-4579 or contact your

broker. For services subject to the deductible, you will have to pay health care expenses out of pocket until you meet your deductible. Most deductibles, copays, and coinsurance

contribute to the out-of-pocket maximum.

KP

Offered through Kaiser Permanente

M

Offered through the Health Insurance

Marketplace

Financial assistance options with lower copays, coinsurance, and

deductibles are available for certain plans, and for Native Alaskans

and American Indians on healthcare.gov.

(8)

Working out your rate

Use the monthly rates chart on the following page to help you evaluate your plan options, or

apply on kp.org/apply to have your rate calculated automatically. Along with your monthly rate,

consider what you will need to pay when you get care.

What determines your rate?

Your rate is based on the following:

The plan you select

Your age on your start date (effective date)

Whether you use tobacco

Rates are determined based on each person’s age on

the plan’s start date, whether they apply individually or

as a family. For example, if your 29th birthday is on

February 14 and you submit your completed application

on January 15, you’ll have a start date of February 1 and

the rate for a 28-year-old.

However, if you submit your application on January 16,

your start date will be March 1. Since this is after your

birthday, you’ll have the rate for a 29-year-old.

Although family members can enroll in different

plans, there are some advantages to enrolling family

members in the same plan:

Children can be covered under your plan until they

reach age 26, whether or not they’re in school or

living at home.

If you have more than 3 children under 21 on the same

plan, you will only be charged for the 3 oldest. Other

children under 21 are covered at no additional cost. If

you have a child-only account and everyone on the

account is under 21, you will only be charged for the

subscriber and the 3 oldest children under 21.

The rates on page 9 apply to the counties below.

Please check that your county is listed below. If it

isn’t, call us at 1-800-494-5314 for information on

other rate areas.

Service Area—Counties

Barrow

Coweta

Gwinnett

Newton

Bartow

Dawson

Hall

Paulding

Butts

DeKalb

Haralson

Pickens

Carroll

Douglas

Heard

Pike

Cherokee

Fayette

Henry

Rockdale

Clayton

Forsyth

Lamar

Spalding

Cobb

Fulton

Meriwether

Walton

(9)

Rates are effective January 1, 2016, through December 31, 2016.

Age on 2016

effective

date

KP GA Bronze 6000/40%/ HSA KP GA Bronze 5000/50 KP GA Bronze 4000/20 KP GA Silver 2750/20%/ HSA KP GA Silver

2500/30 KP GA Silver 1500/30 KP GA Gold 1500/20 KP GA Gold 1000/20 KP GA Gold 500/20

KP GA Catastrophic 6850/0

0–18

$123.61

$130.80

$134.28

$159.33

$159.79

$167.68

$189.71

$191.33

$196.67

$105.45

19–20

123.61

130.80

134.28

159.33

159.79

167.68

189.71

191.33

196.67

105.45

21

194.63

205.95

211.43

250.87

251.60

264.01

298.70

301.25

309.65

166.04

22

194.63

205.95

211.43

250.87

251.60

264.01

298.70

301.25

309.65

166.04

23

194.63

205.95

211.43

250.87

251.60

264.01

298.70

301.25

309.65

166.04

24

194.63

205.95

211.43

250.87

251.60

264.01

298.70

301.25

309.65

166.04

25

195.36

206.72

212.22

251.80

252.54

265.00

299.82

302.38

310.81

166.66

26

199.24

210.83

216.43

256.80

257.55

270.26

305.77

308.38

316.98

169.96

27

203.84

215.70

221.44

262.74

263.50

276.50

312.84

315.51

324.31

173.89

28

211.36

223.65

229.60

272.42

273.22

286.70

324.37

327.14

336.26

180.30

29

217.66

230.32

236.44

280.54

281.36

295.24

334.04

336.89

346.29

185.68

30

220.81

233.65

239.87

284.61

285.43

299.52

338.87

341.77

351.30

188.37

31

225.41

238.53

244.87

290.54

291.39

305.77

345.94

348.90

358.63

192.30

32

230.02

243.40

249.87

296.48

297.34

312.01

353.01

356.03

365.95

196.22

33

232.93

246.48

253.03

300.23

301.10

315.96

357.47

360.53

370.58

198.71

34

236.08

249.81

256.45

304.29

305.17

320.23

362.31

365.41

375.59

201.39

35

237.77

251.61

258.30

306.47

307.37

322.53

364.91

368.03

378.29

202.84

36

239.23

253.15

259.88

308.35

309.25

324.51

367.14

370.28

380.61

204.08

37

240.93

254.94

261.72

310.54

311.44

326.81

369.75

372.91

383.31

205.53

38

242.38

256.48

263.30

312.41

313.32

328.78

371.98

375.16

385.62

206.77

39

245.53

259.81

266.72

316.47

317.39

333.05

376.82

380.04

390.63

209.46

40

248.68

263.15

270.15

320.53

321.47

337.33

381.65

384.91

395.65

212.15

41

253.29

268.02

275.15

326.47

327.42

343.58

388.72

392.04

402.97

216.07

42

257.65

272.64

279.89

332.09

333.06

349.49

395.41

398.80

409.91

219.80

43

263.95

279.31

286.73

340.21

341.21

358.04

405.09

408.55

419.94

225.17

44

271.71

287.51

295.16

350.21

351.23

368.56

416.99

420.55

432.28

231.79

45

280.92

297.26

305.16

362.08

363.14

381.06

431.12

434.81

446.93

239.65

46

291.83

308.80

317.01

376.14

377.24

395.85

447.86

451.69

464.29

248.95

47

303.94

321.63

330.18

391.76

392.90

412.29

466.46

470.45

483.57

259.29

48

318.00

336.50

345.45

409.88

411.08

431.36

488.04

492.21

505.93

271.28

49

331.82

351.12

360.46

427.69

428.94

450.10

509.24

513.59

527.91

283.07

50

347.33

367.54

377.31

447.68

448.99

471.14

533.05

537.60

552.59

296.30

51

362.84

383.95

394.16

467.68

469.04

492.18

556.85

561.61

577.27

309.53

52

379.81

401.90

412.59

489.55

490.97

515.20

582.89

587.88

604.27

324.01

53

396.78

419.86

431.02

511.42

512.90

538.21

608.93

614.14

631.26

338.48

54

415.20

439.35

451.03

535.16

536.72

563.20

637.20

642.65

660.57

354.20

55

433.86

459.10

471.31

559.21

560.84

588.52

665.84

671.54

690.26

370.12

56

453.74

480.13

492.90

584.83

586.54

615.48

696.35

702.30

721.88

387.07

57

474.10

501.67

515.01

611.07

612.85

643.09

727.59

733.81

754.27

404.44

58

495.67

524.50

538.45

638.88

640.74

672.36

760.70

767.20

788.59

422.84

59

506.33

535.79

550.03

652.62

654.53

686.82

777.07

783.71

805.56

431.94

60

527.90

558.61

573.47

680.43

682.41

716.08

810.17

817.10

839.88

450.35

61

546.57

578.36

593.74

704.48

706.54

741.40

838.81

845.99

869.57

466.27

62

558.93

591.44

607.17

720.42

722.52

758.17

857.79

865.12

889.24

476.81

63

574.20

607.60

623.76

740.10

742.26

778.88

881.22

888.75

913.53

489.84

64+

583.65

617.60

634.03

752.28

754.47

791.70

895.73

903.39

928.57

497.90

2016 Monthly rates

Do you qualify for federal financial assistance? If so, you may

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1. Get ready

Here are some examples of documents and information you may need

to complete your application:

Most recent pay stub and tax return

Birthdates of everyone in your family (even if they DON’T want coverage)

Social Security numbers for all family members who DO want coverage

Proof of citizenship or immigration status

Policy numbers of any current health insurance plan

Paperwork for health insurance available through your employer

2. Get your plan

Visit www.healthcare.gov. Select “Get Coverage,” then select Georgia

and then click “Get Coverage.” Enter your ZIP code and select “Start a

marketplace application,” followed by “Create an Account.” Fill in the

account setup page. Sign in to your email and click on the link that says

verify your email address.

Accept the Terms and Conditions and complete all 4 sections.

Review and sign.

On the next page, click “Find a Plan.” In the Getting Started section, hit

“Continue.” Choose “Health” as your Coverage Type, and click “Continue.”

Under Decision Support for Medical, click “Skip & View Plans.” Use the

green filter on the left to check “Kaiser Permanente” and hit “Apply Filter.”

Select a plan and click “Add to Cart.” Finally, scroll up and hit “Save and

Continue to Checkout.”

Click “Continue” to confirm your selections on the next several screens.

When you reach the Proceed to the Initial Payment Details page, click

“Make a Payment” and then click “Continue.”

Read and accept the User Agreement, add your digital signature,

and hit “Finish.”

Thank you for choosing Kaiser Permanente, the right choice for a healthier you.

Enrolling in a Kaiser Permanente plan on the Marketplace

Need help choosing a plan? Visit buykp.org, call us at 1-800-494-5314, or contact your agent

or broker. We can also help you apply for federal financial help through healthcare.gov.

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The right choice for a healthier you

Learn more about all that Kaiser Permanente has to offer. Visit kp.org/thrive

or call us at 1-800-494-5314 (711 TTY for the deaf, hard of hearing, or

speech impaired).

Kaiser Foundation Health Plan of Georgia, Inc.

References

Related documents

[r]

For Kaiser Permanente HMO members, you must use network providers for care to be covered by our Plan except in emergency or urgent care situations.. The “network providers”

With these plans, you pay full charge for most covered services until your expenses meet an annual medical deductible.. Then, for covered services, you pay a copayment

Material and methods: Existing examples of cognitive mapping tools, web portals, workflow systems, best practices, and expert systems as well as intelligent agents are screened

require covered Services not available from Plan Providers, he or she will recommend to the Medical Group that you be referred to a Non–Plan Provider inside or outside your

Primary care office visit 20% of AC* (after deductible) No charge (after deductible) Specialty care office visit 20% of AC (after deductible) No charge (after deductible)

The Affordable Care Act requires most people to have health care coverage that qualifies as “minimum essential coverage.” This plan or policy does provide minimum essential

Network deductible does not apply to primary care visits, specialist visits, preventive care services, emergency room services, urgent care, outpatient mental health,