2015 advantage plus brochure - kaiser...
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Kaiser Permanente Senior Advantage (HMO) Georgia
Get extra vision, dental, and hearing benefits
Enroll now for 2015
H1170_014_46 accepted
Advantage Plus
Now you have the option to add dental, hearing, and extra vision benefits to your Kaiser Permanente Senior Advantage (HMO) plan. And even better, it’s affordable.
Be healthy. Be vibrant.
1
Our Quick Start Guide below will give you a good overview of Advantage Plus. To learn more, turn to the table of contents on page 3.
Quick Start Guide
A Go to page 4 for a quick look at how Advantage Plus makes it easy to expand your health care coverage.
B Turn to “Benefits at a Glance” on page 5 for a summary of the dental, hearing, and extra vision benefits of Advantage Plus.
C Ready to sign up? Apply for coverage by filling out the Advantage Plus enrollment form.
For more information, visit us online at kp.org/vibrantyou.
Get started here
2
To learn more or enroll, call one of our licensed sales specialists toll-free at 1-877-451-3821 TTY 711 (for the deaf, hard of hearing, or speech impaired), 7 days a week, 8 a.m. to 8 p.m.
Or visit us online at kp.org/vibrantyou.
Take advantage of extra benefits today.
3
Table of contents
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2
3
4
5
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7
PageBenefits at a glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Dental coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Frequently asked questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Plan features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Hearing coverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Frequently asked questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Kaiser Permanente Contracted Hearing Aid Centers . . . . . . . . . 12
Vision coverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Frequently asked questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Kaiser Permanente Vision Partners . . . . . . . . . . . . . . . . . . . . . . . 14
Enroll in Advantage Plus . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Important information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Dental directory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
4 For more information, visit kp.org/vibrantyou
Advantage Plus
A BENEFITS PACKAGE FOR A HEALTHIER, MORE VIBRANT YOU
As a Kaiser Permanente Senior Advantage member, having your Medicare coverage combined with your Kaiser Permanente coverage in a single plan can make life easier. Now, with Advantage Plus, you can get valuable dental, hearing, and extra vision benefits added to your plan. So you get the total health care coverage you need. And all of your health benefits are in one convenient package.
Get more health coverage. More value.
• More benefits Only $20 a month premium** adds Advantage Plus coverage to your Kaiser Permanente Senior Advantage plan. You’ll get dental, hearing, and extra vision benefits.
• The convenience of one simple bill You’ll get one bill that includes both your Kaiser Permanente Senior Advantage and Advantage Plus coverage — so taking care of your health is easier than ever. If you like, you can pay your bill through monthly electronic bank payments.
Advantage Plus gives you the choice to add more benefits to your Kaiser Permanente Senior Advantage plan. The Advantage Plus package is optional, so if you want to add these benefits, be sure to fill out the Advantage Plus enrollment form.
Kaiser Permanente is a HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. **You must continue to pay your Medicare Part B premium and any other applicable Medicare premium(s), if not otherwise paid by Medicaid or another third party. You must also continue to pay applicable Kaiser Permanente Senior Advantage premiums. You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll. You must be a Kaiser Permanente Senior Advantage (HMO) Basic or Enhanced plan member to be eligible for Advantage Plus.
For more information, visit kp.org/vibrantyou 5
Benefits at a g
lance
Benefits at a glance1
*See your Evidence of Coverage for information about dental, hearing, and vision services provided under the Kaiser Permanente Senior Advantage plan. **You must continue to pay your Medicare Part B premium and any other applicable Medicare premium(s), if not otherwise paid by Medicaid or another third party. You must also continue to pay applicable Kaiser Permanente Senior Advantage premiums.
This chart shows the key dental, hearing, and extra vision benefits you receive when you add Advantage Plus to your Kaiser Permanente Senior Advantage Plan. For all three benefits, you pay a $20 monthly premium**, which is added to your monthly Kaiser Permanente Senior Advantage Plan premium. To learn more about how to enroll, please see “Enroll in Advantage Plus” on page 18.
Kaiser Permanente Senior Advantage coverage only
Advantage Plus coverage combined with Kaiser Permanente Senior Advantage
DENTAL
Dental services are generally not covered except for the dental services covered by Medicare.*
Key dental benefits:* $10 per office visit that includes the following: Oral examinations. Preventive X-rays and cleanings covered twice a year.• Nonroutine services: From $0 to $580
(in addition to office visit copay).• Restorative services: From $28 to $580
(in addition to office visit copay).• Endodontics, periodontics, extractions: From $0 to
$400 (in addition to office visit copay).• Prosthodontics, Oral/Maxillofacial Surgery: From $18
to $580 (in addition to office visit copay).
HEARING AIDS
Hearing aids are generally not covered except for certain implanted hearing devices covered by Medicare, which are provided at no additional charge.*
$250 credit per hearing aid, per ear, every three years. Certain implanted hearing devices covered by Medicare are provided at no additional charge.
VISION HARDWARE
Vision hardware is generally not covered except for post-cataract surgery eyewear covered by Medicare.*
$100 credit every two years.
6 For more information, visit kp.org/vibrantyou
Your dental health is key to your overall health. Healthy teeth and gums allow you to eat better and feel better—in body and mind. And nothing attracts the people around you like a bright smile.
Preventing and treating dental problems are important at any stage of life. You may feel more tooth sensitivity or have dental problems as a result of certain medications or health conditions. Regular oral exams not only keep your mouth healthy; they can also help spot medical problems.
Advantage Plus makes it easy to smile because you know you’re getting the dental care you need.
Enjoy the power of a healthy smile2
Brushing and flossing are important for healthy teeth. They also help reduce the risk of infection. Bacteria can travel from the mouth to other parts of the body, causing infection. This is a major cause of joint replacements failing. With proper oral health, including brushing, flossing, and regular check-ups and cleaning, you can help keep your whole body healthy.
Reduce your risk of infection
Health tip:
For more information, visit kp.org/vibrantyou 7
Dental co
verage
Q: What is the DeltaCare USA Program?
A: The DeltaCare USA Program, offered by Delta Dental, provides dental care through the DeltaCare USA network of dentists. When you enroll, Delta Dental will assign you to a contract dentist. The DeltaCare USA network consists of private practice dental facilities that have been carefully screened for quality. You can contact Delta Dental to change your contract dentist.
Q: When can I begin to use my dental benefits?
A: Once you receive confirmation of your enrollment in Advantage Plus, you can begin using your dental benefits on your effective date at your assigned facility. You will also receive a dental identification card from Delta Dental.
Q: How do I choose my dentist?
A: When you enroll in Advantage Plus, Delta Dental will assign you to a contract dentist based on your home ZIP code. If you would like to change your assigned dentist, you can do so at any time. Call Delta Dental’s Customer Service Department toll free at 1-800-422-4234 (TTY 711), Monday through Friday, 8 a.m. to 9 p.m. Delta Dental is always expanding its network and adding new dentists and areas. For the most up-to-date list of dentists, visit deltadentalins.com/directory.
Note: It can take a few weeks for the dentist you selected to be activated in Delta Dental’s system. If you would like to see your dentist within the first few weeks of your enrollment in Advantage Plus, you should call Delta Dental to confirm that the dentist you chose is in their system
and accepting patients. For questions about your dentist, or if you would like to change your dentist, call Delta Dental’s Customer Service Department toll free at 1-800-422-4234 (TTY 711), Monday through Friday, 8 a.m. to 9 p.m.
Q: How do I make an appointment?
A: To make an appointment, simply call your assigned dentist’s facility and identify yourself as a DeltaCare USA Program enrollee. To get covered services, you must go to your assigned Delta dentist. Services provided by a specialist pre-approved by Delta Dental or emergency services are exceptions. Any other treatment is not covered under this dental program.
Q: What happens if I have an emergency?
A: If emergency services are needed, you should get in touch with your contract dentist whenever possible. If you are a new member and do not have an assigned contract dentist yet, and you need emergency services, you should contact Delta Dental’s Customer Service department toll free at 1-800-422-4234 (TTY: 711 for the hearing/speech impaired), Monday through Friday, 8 a.m. to 9 p.m., Eastern time. For more information about emergency benefits, see your Kaiser Permanente Senior Advantage Evidence of Coverage.
Frequently asked questions
Advantage Plus dental benefits are provided through DeltaCare® USA Program offered by Delta Dental Insurance Company (Delta Dental).
8 For more information, visit kp.org/vibrantyou
Q: Can I get a second opinion?
A: You may ask for a second opinion if you disagree with or question your contract dentist’s diagnosis and/or treatment plan. Delta Dental may also ask you to get a second opinion to confirm that your contract dentist’s treatment or your use of benefits is necessary and appropriate. For more information, see your Kaiser Permanente Senior Advantage Evidence of Coverage.
Q: What if I need to change my Delta dentist?
A: You may change your dentist at any time by calling Delta Dental’s Customer Service Department toll free at 1-800-422-4234 (TTY 711), Monday through Friday, 8 a.m. to 9 p.m. You must make your request for a contract dentist change before the 21st of the month for the change to be effective the first day of the next month.
Before you can change your contract dentist, you must also complete any treatment in progress, such as (a) partial or full dentures for which final impressions have been taken, (b) completion of root canals, or (c) delivery of crowns when teeth have been prepared.
DeltaCare USA Plan
With enrollment in Advantage Plus, you will receive dental coverage for comprehensive services through the DeltaCare USA Program. You must visit a dentist in the DeltaCare USA network to receive benefits. Services provided by out-of-network dentists will not be covered.
Please refer to your Evidence of Coverage for more information on benefits, limitations and exclusions. For more information regarding your medical plan benefits, please refer to your Summary of Benefits. For full information on Kaiser Permanente Senior Advantage benefits, call our Member Services department toll free at 1-800-232-4404 or at 404-233-3700, seven days a week, 8 a.m. to 8 p.m. TTY users should call 711.
For more information, visit kp.org/vibrantyou 9
Dental co
verage
How your plan works
Features DeltaCare USA Program
Cost to patient Coverage is included in your $20 Advantage Plus monthly premium.
Covered services Comprehensive dental services provided by your assigned contract dentist.
Copays Out-of-pocket costs are clearly defined.
Dentist network advantages
When you enroll, Delta Dental will assign you to a contract dentist. You can contact Delta Dental to change your contract dentist. The DeltaCare USA network consists of private practice dental facilities that have been carefully screened for quality.• Services provided by out-of-network dentists will not be
covered.
Out-of-area coverage Services provided by out-of-network dentists will not be covered. You must receive services from your assigned DeltaCare USA provider.
Deductibles/maximums No deductible or maximums on covered procedures.
Additional advantages Claims convenience — DeltaCare USA providers file all claims for you and process all referrals to specialty care.
Contact us
DeltaCare USA
Customer Service (includes automated voice attendant)Call toll free: 1-800-422-4234 TDD: 711 TTY: 711 8 a.m. – 9 p.m. Monday – Friday
Dentist Search, Online Eligibility, Benefits and Claims Status
deltadentalins.com
Claims Submission Delta Dental Insurance Company P.O. Box 1809 Alpharetta, GA 30023-1809
10 For more information, visit kp.org/vibrantyou
Good hearing allows you to participate in life more fully. You’re more confident, more secure, and more connected to your world.
Millions of Americans experience some degree of hearing loss. Among people over 50, it’s the third most common ailment, behind heart disease and arthritis. But now, more than ever, hearing loss doesn’t mean that your quality of life has to change. Today’s hearing products are smaller, more effective, and more comfortable.
Hearing benefits from Advantage Plus can help make sure you’re not missing the sounds and conversations that make life more fulfilling.
You can use these questions for a simple self-check of your hearing health:
• Do you often ask people to speak up or repeat themselves?
• Do you have trouble following conversations in a noisy room or understanding speech on the phone?
• Do you have trouble hearing the sound of your telephone, alarm clock, or doorbell?
• Do others complain that your TV or stereo is too loud?
Quick hearing self-check
Hear well. Live well.3
Health tip:
For more information, visit kp.org/vibrantyou 11
Hearing
coverag
e
Q: If I have a hearing loss, are hearing aids covered?
A: As a Kaiser Permanente member with the Advantage Plus package, you will receive a $250 credit toward the purchase of a hearing aid in each ear (maximum $500 for both ears). This credit is available once every three years. You will be responsible for the difference between the $250 credit and the price of the hearing aid.
Q: Where can I obtain my hearing aids?
A: You may use your hearing aid benefit at our core Kaiser Permanente audiology facilities and by referral at designated contracted providers.
Q: How does my hearing aid benefit work?
A: If a hearing aid is prescribed, you may use your hearing aid benefit at our core Kaiser Permanente audiology facilities and by referral at designated contracted providers.
Q: Are there any limitations to the type or style of hearing aid that is covered?
A: You may purchase your hearing aid at our core Kaiser Permanente audiology facilities and by referral at designated contracted providers. The audiologist will assist you in selecting the hearing aids that best meet your needs. A complete range of technologies and styles is available, and you will receive a thorough explanation of your test results and recommended treatment options.
Frequently asked questions
Q: What if I have a medical problem with my hearing?
A: If a medical problem is identified during the hearing examination, the audiologist will notify your primary care physician of the results and assist you in obtaining the appropriate medical follow-up.
Q: What if I need service or repairs on my hearing aid?
A: The hearing aid you purchase at our core Kaiser Permanente audiology facilities and by referral at designated contracted providers may be covered by the manufacturer’s warranty. The warranty details will be explained at the time of purchase. Batteries and accessories are not covered under this hearing aid benefit.
The hearing aids that Advantage Plus covers are provided at select Kaiser Permanente facilities and by referral at designated contracted providers.
12 For more information, visit kp.org/vibrantyou
Kaiser Permanente Core Facilities
CLAYTON COUNTYJonesboro
Gwinnett Comprehensive Medical Center3650 Steve Reynolds Boulevard Duluth, GA 30096(770) 931-6012
FULTON COUNTYAtlanta
Glenlake Comprehensive Medical Center20 Glenlake Parkway Atlanta, GA 30328(770) 677-6075
GWINNETT COUNTYDuluth
Southwood Comprehensive Medical Center2400 Mount Zion Parkway Jonesboro, GA 30326 (770) 603-3649
Designated Contracted Providers— Kaiser Permanente Referral Required
CHEROKEE COUNTYWoodstock
Progressive Audiology Center, Inc
2230 Towne Lake Parkway Building 800, Suite 100 Woodstock, GA 30189 (770) 592-4744
DEKALB COUNTYDecatur
Atlanta Hearing Aid Services of Decatur2655-D North Decatur Road Decatur, GA 30033 (404) 373-2411
For more information, visit kp.org/vibrantyou 13
Visio
n coverag
e
Health tip:
Here’s an immediate way to enhance your life: improve your vision. It’s possible that your vision has changed—but you haven’t noticed. When you see clearly, your daily activities, such as driving and reading, become noticeably easier.
It’s important to have your eyes checked regularly to identify minor as well as more serious eye problems. Advantage Plus adds a material eyewear allowance to your Senior Advantage plan. So you’ll have more choices to help you see a brighter, more vibrant world.
Better night visionIf your night vision isn’t what it used to be, keep these helpful nighttime-driving guidelines in mind:
• Drive more slowly, so that you have more time to react.
• Keep your windshield, as well as all the lights on your car, clean.
• Ask your eye care professional about getting anti-reflective coating on your eye-glass lenses to cut down on glare.
• Check with your doctor to find out if any medications you are taking can affect your night vision.
Focus on a healthier you4
14 For more information, visit kp.org/vibrantyou
Q: What is my coverage for eyeglasses and contact lenses?
A: As a Kaiser Permanente member with the Advantage Plus package, you will receive a credit of $100 to use toward the purchase of eyeglasses or contact lenses. This means that you will have a total credit of $100 to use toward an eyewear purchase (one purchase every two years). If you do not use the entire $100 credit at the initial point of sale, you cannot use it later. If the eyewear you purchase costs more than $100, you will be responsible for paying the difference.
Q: After I first use my Advantage Plus vision benefit, when can I use it again?
A: You are eligible to use your Advantage Plus vision benefit two years from the date that you last obtained your eyeglasses or contact lenses using this benefit.
Q: Where can I obtain my eye- glasses and contact lenses?
A: You may use your vision benefit for soft contacts at kp2020.org or for contacts and eyeglasses at our vision partner locations. You can also find out more information about your vision benefit by calling our Member Services department at 1-800-232-4404 (TTY: 711).
Frequently asked questions
The vision hardware benefits covered by Advantage Plus are provided at our core Kaiser Permanente and vision partners in the Atlanta metro area. For information about vision services (including limitations and exclusions) covered by Senior Advantage and Advantage Plus, see your Kaiser Permanente Senior Advantage Evidence of Coverage.
CHEROKEE COUNTYCanton
The Eye Gallery Canton3760 Sixes Rd. Ste. 106Canton, GA 30114(770) 345-3120
Suresight Eyecare217 Riverston Dr. Ste. B217 Canton, GA 30114(770) 345-5220
Woodstock
Suresight Eyecare12924 Hwy. 92 Ste. 100Woodstock, GA 30188(678) 717-9121
Kaiser Permanente vision partners
Order contact lenses through Kaiser Permanente at kp2020.org.N
EW
!
For more information, visit kp.org/vibrantyou 15
Visio
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CLAYTON COUNTYCollege Park
The Eye Doctor Unlimited1704 Virginia Ave. College Park, GA 30337 (404) 768-3500
Morrow
Clayton Eye Center1000 Corporate Center Dr.Ste. 100Morrow, GA 30260(770) 968-8888
Family Eye Care & Southlake Eye Clinic7175 Jonesboro Rd.Ste. AMorrow, GA 30260(770) 961-2020
For Eyes Optical Co.1297 Mount Zion Rd.Morrow, GA 30260(770) 960-9077
T. Joel Byars OD5916 Jonesboro Rd.Morrow, GA 30260(770) 961-4967
COBB COUNTYAcworth
Eye Contact Inc.3450 Cobb Pkwy. Ste. 250Acworth, GA 30101 (770) 529-1925
Austell
Mobley Eye Care3999 AustelI Rd.Austell, GA 30106(770) 941-2323
Marietta
20/20 Eye Care4101 Roswell Rd. NE Ste. 905Marietta, GA 30062(770) 565-3970
For Eyes Optical Co.4101 Roswell Rd. NE Ste. 905Marietta, GA 30062(770) 565-6763
The Eye Gallery— East Cobb1311 Johnson Ferry Rd. Ste. 120Marietta, GA 30068(770) 977-4139
Smyrna
Eye Associates of Smyrna2430 Herodian Way Ste. 200Smyrna, GA 30080(770) 953-9000
COWETA COUNTYSharpsburg
Mobley Eye Care of Sharpsburg, LLC3339 Hwy. 34 EastSharpsburg, GA 30277(770) 304-2025
DEKALB COUNTYAtlanta
The Eye Gallery Perimeter Place4520 Olde Perimeter Way Ste. 110Atlanta, GA 30346(770) 500-3937
Decatur
Belvedere Eye Center 3479 Memorial Dr. (Inside Kroger) Decatur, GA 30032(404) 534-1222
Tucker
For Eyes Optical Co. 4104 Lavista Rd. Tucker, GA 30084(770) 493-3995
LAC Optometric Services 4104 Lavista Rd. Tucker, GA 30084(770) 493-6490
Robert Elwell, OD2256 Northlake Pkwy. Ste. 205Tucker, GA 30084(770) 934-0337
16 For more information, visit kp.org/vibrantyou
FAYETTE COUNTYFayetteville
Mobley Eye Care539-A N. Glynn St.Fayetteville, GA 30214(678) 817-7722
FORSYTH COUNTYCumming
Complete Family Eyecare & Optique2320 Atlanta Hwy. Ste. 103Cumming, GA 30040(678) 965-5558
FULTON COUNTYAlpharetta
20/20 Eyecare Inc.10945 State Bridge Rd.Ste. 306Alpharetta, GA 30022(678) 339-0423
For Eyes Optical5230 Windward Pkwy. Ste. 100Alpharetta, GA 30004(678) 537-0002
Suresight Eyecare LLC3975 Old Milton Pkwy. Ste. 2Alpharetta, GA 30005(678) 624-7766
The Eye Gallery Northpoint1000 Northpoint Cir. Ste. 2006Alpharetta, GA 30022(770) 475-6500
Atlanta
The Eye Gallery Atlantic Station1380 Atlantic Dr.Ste. 14150Atlanta, GA 30363(404) 593-2926
Atlanta Eye Care Associates 6015-B Roswell Rd. NE Atlanta, GA 30328(404) 705-4283
Atlanta Vision Clinic 5445 Meridian Mark Rd. Ste. 370Atlanta, GA 30342(404) 765-2020
Atlanta Vision Group 2391 Peachtree Rd. NE Ste. B3ABAtlanta, GA 30305(404) 237-4922
Eye 1st Vision Center4920 Roswell Rd. Ste. 11Atlanta, GA 30342(404) 252-1702
Family First Vision Center 2184 Henderson Mill Rd. NE Ste. 12BAtlanta, GA 30345(770) 938-2923
For Eyes Optical2391 Peachtree Rd. Ste. BAtlanta, GA 30305(404) 262-2017
Ronald B. Gurin, OD 49 Forsyth St. NW Atlanta, GA 30303(404) 688-7398
The Eye Gallery Sandy Springs5975 Roswell Rd. Ste. F-75Atlanta, GA 30328(404) 252-4111
The Eye Gallery Buckhead3330 Piedmont Rd. Ste. 1Atlanta, GA 30305(404) 231-3772
West End Eye Center807 Ralph David Abernathy Blvd.Atlanta, GA 30310(404) 755-4300
Hapeville
Atlanta Vision Cataract & Laser Center3619 S Fulton Ave.Ste. 101Hapeville, GA 30354(404) 765-2020
Roswell
Visual Eyes2300 Holcomb Bridge Rd. Ste. 306Roswell, GA 30076(678) 722-3937
Sandy Springs
For Eyes Optical6015-B Roswell Rd.Sandy Springs, GA 30328(404) 843-8277
For more information, visit kp.org/vibrantyou 17
Visio
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GWINNETT COUNTYDuluth
For Eyes Optical2130 Pleasant Hill Rd. Ste. B Duluth, GA 30096(770) 622-4135
Eye 1st Vision & Laser 10080 Medlock Bridge Rd.Duluth, GA 30097(770) 623-3931
For Eyes Optical Co. 2130 Pleasant Hill Rd. Duluth, GA 30096(770) 622-8883
Gwinnett Eye Clinic3455 Peachtree Industrial Blvd. Ste. 845Duluth, GA 30096(770) 448-5688
Sugarloaf Eyecare6555 Sugarloaf Pkwy. Ste. 303 Duluth, GA 30097(770) 495-0937
Grayson
Richard S Reagin, OD1707 Bristol Farms Ct. Grayson, GA 30017(770) 668-6693
Lilburn
Lilburn Eyecare & Optical Center4319 Lawrenceville Hwy. Ste. ALilburn, GA 30047(770) 921-4707
Norcross
Pure Vue Vision Care6050 Peachtree Pkwy.Ste. 210Norcross, GA 30092(770) 903-4555
The Eye Gallery The Forum5165 Peachtree Pkwy. Ste. 225Norcross, GA 30092(770) 447-4790
Snellville
Choice Eye Care & For Eyes Optical2055 Scenic Hwy. Ste. B Snellville, GA 30078(770) 736-8311
HENRY COUNTYLocust Grove
Eye Associates of Locust Grove4946 Bill Gardner Pkwy.Locust Grove, GA 30248(770) 957-9814
Stockbridge
Henry Vision Center3564 Hwy. 138 SEStockbridge, GA 30281(770) 474-5618
18 For more information, visit kp.org/vibrantyou
1. Go online today! To learn more and to download an enrollment form, visit kp.org/vibrantyou
2. We’re here to help If you’re ready to enroll or have questions, call a licensed sales specialist at 1-877-451-3821 (TTY 711), seven days a week, 8 a.m. to 8 p.m.
• You must be a Kaiser Permanente Senior Advantage individual plan member to enroll in the Advantage Plus package.
• If you’re already a Kaiser Permanente Senior Advantage member, you can enroll in the Advantage Plus package any time from October 15, 2014 through March 31, 2015.
• If you’re a new Kaiser Permanente Senior Advantage member, or enrolling because you have moved and need to fill out a new
enrollment form, you can add Advantage Plus within 30 days of enrolling in Kaiser Permanente Senior Advantage.
• The premium for your Advantage Plus dental, hearing, and extra vision benefits is $20 per month. The $20 monthly premium is in addition to your monthly Kaiser Permanente Senior Advantage premium, if any, and you must also continue to pay your Medicare Part B premium.
Other important information about applying for Advantage Plus:
Applying for Advantage Plus is easy!
Thank you for taking this step toward better dental, hearing, and vision health. We’ll let you know when your enrollment form has been approved and give you more details about your coverage and start date. For more information, visit us online at kp.org/vibrantyou. Or call one of our licensed sales specialists at 1-877-451-3821 (TTY 711), seven days a week, 8 a.m. to 8 p.m. We’ll be happy to help.
Enroll in Advantage Plus5
For more information, visit kp.org/vibrantyou 19
Inform
ation yo
u need to
know
The Advantage Plus benefit package gives you additional dental*, hearing, and extra vision coverage for an additional monthly premium of $20. This is in addition to any premiums required for Kaiser Permanente Senior Advantage described in your Kaiser Permanente Senior Advantage Evidence of Coverage, and you must also continue to pay your monthly Medicare premiums.
For more information about dental, hearing, and extra vision coverage through Advantage Plus, see your Kaiser Permanente Senior Advantage Evidence of Coverage.
Enrollment and disenrollment
Enrollment To enroll in Advantage Plus, you must complete the Advantage Plus enrollment form.
If you are already a Kaiser Permanente Senior Advantage member, you may add Advantage Plus benefits to your Kaiser Permanente Senior Advantage individual plan coverage by sending us the enrollment form before March 31, 2015 for coverage to become effective on April 1, 2015. Coverage is effective the 1st of the month following the date we receive your completed enrollment form.
If you are enrolling in Kaiser Permanente Senior Advantage either as a new member or because you have moved and you must complete a new Kaiser Permanente Senior Advantage enrollment form, you can add Advantage Plus within 30 days of enrolling in Kaiser Permanente Senior Advantage. Coverage is effective the 1st of the month following the date we receive your completed enrollment form.
DisenrollmentYou can stop your Advantage Plus coverage anytime. Your disenrollment will be effective the first of the month following the date we receive your completed disenrollment form. To request a disenrollment form, please call our Member Service Contact Center toll free at 1-800-232-4404 (TTY 711 for the hearing/speech impaired), seven days a week, 8 a.m. to 8 p.m. For more details about disenrollment, see your Kaiser Permanente Senior Advantage Evidence of Coverage.
For additional information about the Kaiser Permanente Senior Advantage individual plan, see your Kaiser Permanente Senior Advantage Evidence of Coverage.
Important information6
* Kaiser Permanente has an agreement with Delta Dental to provide you comprehensive dental care through a network of dentists that contract with Delta Dental’s DeltaCare® USA Dental program. For information about dental coverage, please refer to your Kaiser Permanente Senior Advantage Evidence of Coverage.
20 For more information, visit kp.org/vibrantyou
Hearing and vision coverage
For more information about hearing and vision coverage, including exclusions and limitations, please see the Kaiser Permanente Senior Advantage Evidence of Coverage (EOC).
Dental coverage
For more information about dental coverage including exclusions and limitations, please see your Kaiser Permanente Senior Advantage Evidence of Coverage for detailed information about dental services provided under your Senior Advantage individual plan.
For more information, visit kp.org/vibrantyou 21
Dental d
irectory
Contract dentist facilities — as of September 2014
Please choose a dentist from the following list of dental contract facilities.
Delta Dental is always expanding its network and adding new dentists and areas. For the most up-to-date list of dentists, call Delta Dental’s Customer Service department toll free at 1-800-422-4234 (TTY 711 for the hearing/speech impaired), Monday through Friday, 8 a.m. to 9 p.m.
Dental directoryParticipating dental offices — Georgia7
CHEROKEE COUNTYCanton
Aspen Dental2030 Cumming Hwy. Ste. 110Canton, GA 30115(404) 974-9000
Woodstock
Coast Dental of Woodstock12195 Hwy. 92 Ste. 148Woodstock, GA 30188
(770) 517-2772
Metropolitan Dental Assoc.
8294 Hwy. 92 Ste. 200 Woodstock, GA 30189 (770) 928-2376
Timothy Byrd, DMD2035 Towne Lake Pkwy. Ste. 130Woodstock, GA 30189(770) 926-8200
CLAYTON COUNTYJonesboro
Great Expressions Dental Center GA1002 Pointe South Pkwy.Jonesboro, GA 30238(770) 472-9399
Great Expressions Dental Center GA
2292 Mount Zion Rd. Jonesboro, GA 30236 (770) 961-8300
Tara Blvd. Family Dentistry772 North Ave.Jonesboro, GA 30236(770) 892-5328
Lake City
Coast Dental – Morrow5656 Jonesboro Rd. Ste. 103Lake City, GA 30260(678) 422-6967
Morrow
Southlake Dental Associates PC6630 Exchange Pl.Morrow, GA 30260(770) 968-1710
Riverdale
Alliance Ortho & Family Dentistry7218 Hwy. 85Riverdale, GA 30274(678) 545-1560
COBB COUNTYAcworth
Coast Dental of Acworth3509 Baker Rd. NW Ste. 401Acworth, GA 30101(770) 917-8943
Dental Essentials Family Dentistry4450 Calibre Xing NW Ste. 1206Acworth, GA 30101(770) 529-9060
22 For more information, visit kp.org/vibrantyou
Ga Dentistry LLC2460 Cumberland Pkwy. SE Ste. 210Atlanta, GA 30339(770) 433-2414
Lake Point Dental3950 Cobb Pkwy. NW Ste. 402Acworth, GA 30101(770) 966-9396
Austell
Anisa Hailey, DDS4760 Austell Rd.Austell, GA 30106(770) 941-9995
Great Expressions Dental Center GA3845 Medical Park Dr.Austell, GA 30106(770) 739-2100
Kennesaw
Dentistry At Kennesaw Point1350 Wooten Lake Rd. NW Ste. 203 Kennesaw, GA 30144(678) 275-2066
Great Expressions Dental Center GA
400 E W Barr Pkwy. NW Ste. 607 Kennesaw, GA 30144 (770) 425-1324
Great Expressions Dental Center GA3525 Busbee Dr. NW Ste. 200Kennesaw, GA 30144-5677(678) 836-2103
Great Expressions Dental Center GA1301 Shiloh Rd. Blvd. Ste. 660Kennesaw, GA 30144(770) 423-9699
Mableton
Coast Dental of Mableton4875 Floyd Rd. SW Ste. 113Mableton, GA 30126(770) 732-0900
Marietta
Coast Dental of Sprayberry2550 Sandy Plains Rd. Ste. 145Marietta, GA 30066(770) 321-2755
Coast Dental of Marietta Trade270 Cobb Pkwy. S Ste. 180Marietta, GA 30060 (770) 425-6333
Dr John Family Dentistry
550 Franklin Rd. SE Ste. B Marietta, GA 30067 (770) 514-5055
Great Expressions Dental Center GA
2209 Roswell Rd. Ste. 300 Marietta, GA 30062 (678) 560-2970
Great Expressions Dental Center GA
3823 Roswell Rd. Ste. 205 Marietta, GA 30062 (770) 973-9275
Great Expressions Dental Center GA
1545 Powers Ferry Rd. SE Ste. 220 Marietta, GA 30067 (770) 980-9404
Sprayberry Dental Assoc.2663 Sandy Plains Rd.Marietta, GA 30066(770) 977-0827
Powder Springs
Coast Dental of Powder Springs3721 New Macland Rd. Ste. 210Powder Springs, GA 30127(770) 222-3300
COWETA COUNTYNewnan
Aspen Dental201 Newnan Crossing BypassNewnan, GA 30263(678) 621-6410
Great Expressions Dental Center GA38 Jefferson Pkwy.Newnan, GA 30263(678) 836-2139
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Dental d
irectory
Great Expressions Dental Center GA148 Bullsboro Dr.Newnan, GA 30263(770) 251-4370
DEKALB COUNTYAtlanta
Coast Dental of Northlake4805 Briarcliff Rd. NE Ste. 10430345-2737(770) 414-9282
Coast Dental North Druid Hills2484 Briarcliff Rd. NE Ste. 29Atlanta, GA 30329(404) 315-7375
Great Expressions Dental Center GA13 Corporate Blvd. Bldg. 13, Suite 120Atlanta, GA 30329(678) 836-2120
Great Expressions Dental Center GA2138 Henderson Mill Rd. NEAtlanta, GA 30345(770) 493-1242
Great Expressions Dental Center GA1720 Old Spring House Ln. Ste. 315Atlanta, GA 30338(770) 451-7041
Lyndon Naipaul Inc1776 Old Spring House Ln. Ste. 302Atlanta, GA 30338(770) 936-0113
Decatur
Great Expressions Dental Center GA200 Ponce De Leon Ave. Ste. 300Decatur, GA 30030(678) 836-2113
Great Expressions Dental Center GA2853 Candler Rd. Ste. 101Decatur, GA 30034(404) 244-1166
Great Expressions Dental Center GA2785 Lawrenceville Hwy. Ste. 103Decatur, GA 30033(770) 491-1132
Metro Decatur Dental Group4570 Memorial Dr.Decatur, GA 30032(404) 292-3133
Dunwoody
Michelle Jacques, DDS1853 Peeler Rd. Ste. ADunwoody, GA 30338(770) 391-9212
Stone Mountain
Burlin Dental Associates4687 Rockbridge Rd. Ste. 7Stone Mountain, GA 30083(404) 296-9070
Dentures And Family Dentistry1825 Rockbridge Rd. Ste. 14CStone Mountain, GA 30087(770) 482-7800
Metro DeKalb Dental Group4849 Memorial Dr.Stone Mountain, GA 30083(404) 296-4119
Smiles For Less1525 E Park Place Blvd. Ste. 1500Stone Mountain, GA 30087(770) 879-0845
DOUGLAS COUNTYDouglasville
Aspen Dental6351 Douglas Blvd.Douglasville, GA 30135(404) 267-0400
Coast Dental of Douglasville3308 Georgia Hwy. 5 Ste. EDouglasville, GA 30135(770) 947-0006
24 For more information, visit kp.org/vibrantyou
Great Expressions Dental Center GA3387 Hwy. 5 Ste. EDouglasville, GA 30135(770) 489-6200
Great Expressions Dental Center GA3271 Hwy. 5Douglasville, GA 30135(678) 836-2111
Great Expressions Dental Center GA8505 Hospital Dr. Ste. 7 & 8Douglasville, GA 30134(770) 489-6735
Jerry Nutt Assoc.8505 Hospital Dr. Ste. 7Douglasville, GA 30134(770) 489-6735
Timothy Byrd, DMD6740 Douglasville Blvd. Ste. ADouglasville, GA 30135(770) 949-5600
FAYETTE COUNTYFayetteville
Alliance Ortho & Family Dentistry1307 Hwy. 85 N Ste. BFayetteville, GA 30214(770) 719-3300
Coast Dental of Fayetteville805 Glynn St. S Ste. 131Fayetteville, GA 30214(770) 460-6651
Peachtree City
Great Expressions Dental Center GA320 Stevens EntryPeachtree City, GA 30269(770) 486-0110
FULTON COUNTYAlpharetta
Alpharetta Dental Assoc. PC2795 Old Milton Pkwy. Ste. 900Alpharetta, GA 30009(770) 754-1155
Byrd Dental Group— North Point4000 North Point Pkwy. Ste. 500Alpharetta, GA 30022(770) 777-0911
Great Expressions Dental Center GA5230 McGinnis Ferry Rd.Alpharetta, GA 30005(678) 527-1130
Great Expressions Dental Center GA401 South Main St. Ste. B5Alpharetta, GA 30009(770) 663-8717
Kimball Bridge Dental4380 Kimball Bridge Rd.Alpharetta, GA 30022(678) 256-6304
Utah Med Holding Facility1130 Sanctuary Pkwy.Alpharetta, GA 30009
Atlanta
Alliance Ortho & Family Dentistry275 14th St. NW Ste. 100Atlanta, GA 30318(404) 254-0149
Art of The Smile3280 Howell Mill Rd. NW Ste. 112Atlanta, GA 30327(404) 355-5332
Coast Dental of Buckhead3330 Piedmont Rd. NE Ste. 16Atlanta, GA 30305(404) 237-5330
Coast Dental of Perimeter1100 Hammond Dr. Ste. 210Atlanta, GA 30328(770) 399-9300
Coast Dental of Sandy Springs7539 Roswell Rd.Atlanta, GA 30350(678) 443-9300
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irectory
Collins Family Dentistry759 MLK Dr. NW Ste. 200Atlanta, GA 30314(404) 588-0464
Dental One Associates1901 Phoenix Blvd. Ste. 100Atlanta, GA 30349(770) 991-0913
Dental One Associates600 W. Peachtree St. NWSte. 750Atlanta, GA 30308(404) 876-7200
Great Expressions Dental Center GA675 W Peachtree St. NW Ste. 120Atlanta, GA 30308(404) 874-2038
Great Expressions Dental Center GA10 10th St. NW Ste. 100Atlanta, GA 30309(404) 892-2337
Great Expressions Dental Center GA3752 Cascade Rd. SW Ste. 190Atlanta, GA 30331(678) 836-2118
Great Expressions Dental Center GA3365 Piedmont Rd. NE Ste. 1110Atlanta, GA 30305(404) 237-3070
Great Expressions Dental Center GA4920 Roswell Rd. Ste. 13AAtlanta, GA 30342(404) 236-7222
Great Expressions Dental Center GA785 Virginia Ave. Ste. AAtlanta, GA 30354(404) 768-8700
Great Expressions Dental Center GA1571 Phoenix Blvd. Ste. 8Atlanta, GA 30349(770) 996-7700
Perfect Touch Dental80 Peyton Rd. SWAtlanta, GA 30311(404) 696-6675
Southside Medical Center Inc.1046 Ridge Ave SWAtlanta, GA 30315(404) 688-1350
Roswell
Great Expressions Dental Center GA770 Holcomb Bridge Rd.Roswell, GA 30076(678) 836-2102
Wei-Yen Chang, DDS415 E Crossville Rd. Ste. ARoswell, GA 30075(678) 461-4875
FORSYTH COUNTYCumming
Aspen Dental1530 Market Place Blvd.Cumming, GA 30041(678) 208-3470
Castleberry Dental LLC5905 Iron Gate Trce.Cumming, GA 30040(770) 888-8834
North Cumming Denistry LLC1715 Friendship Cir. Ste. 100Cumming, GA 30028(470) 253-7349
GWINNETT COUNTYDuluth
Alliance Ortho & Family Dentistry3796 Satellite Blvd. Ste. 101Duluth, GA 30096(770) 687-2353
Coast Dental of Duluth3870 Peachtree Industrial Blvd.Duluth, GA 30096(770) 476-9004
Coast Dental of Pleasant Hill1630 Pleasant Hill Rd. Ste. 200Duluth, GA 30096(770) 381-7878
26 For more information, visit kp.org/vibrantyou
Grayson
Comfort Dental Studio PC 2219 Loganville Hwy.Grayson, GA 30017(678) 377-1800
Johns Creek
Dentistry of John Creek10305 Medlock Brg Rd. Ste. B3Johns Creek, GA 30097(770) 418-4939
Lawrenceville
Coast Dental of Lawrenceville650 Gwinnett Dr. Ste. 210Lawrenceville, GA 30046(770) 963-5999
Great Expressions Dental Center GA555 Old Norcross Rd. Ste. 120Lawrenceville, GA 30046(770) 277-9700
Great Expressions Dental Center GA1960 Riverside Pkwy. Ste. 105Lawrenceville, GA 30043(678) 836-2109
Great Expressions Dental Center GA2000 Riverside Pkwy. Ste. 200Lawrenceville, GA 30043(678) 836-2109
Great Expressions Dental Center GA4850 Sugarloaf Pkwy. Ste. 204Lawrenceville, GA 30044(770) 995-6109
Great Expressions Dental Center GA1699 Duluth Hwy. Ste. 5Lawrenceville, GA 30043(770) 338-1963
Lilburn
Coast Dental of Lilburn3050 5 Forks Rd. SW Ste. HLilburn, GA 30047(770) 982-7533
Great Expressions Dental Center GA4145 Lawrenceville Hwy. 15Lilburn, GA 30047(770) 923-1814
Great Expressions Dental Center GA4145 Lawrenceville Hwy. Ste. 5Lilburn, GA 30047(770) 638-8090
Norcross
Gibbons Dental Studios5635 Peachtree Pkwy. Ste. 100Norcross, GA 30092(770) 642-4711
Great Expressions Dental Center7760 Spalding Dr.Norcross, GA 30092(770) 270-5700
Spalding Dental Center6460 Spalding Dr. Ste. CNorcross, GA 30092(770) 263-8408
Snellville
Captivating Smiles2118 Scenic Hwy.Snellville, GA 30078(770) 609-2901
Great Expressions Dental Center GA2220 Wisteria Dr. Ste. 300Snellville, GA 30078(678) 836-2107
Great Expressions Dental Center GA2341 Henry Clower Blvd. Ste. ASnellville, GA 30078(770) 736-0099
S. Alaba Fawole, DDS MD PC2488 Scenic Hwy.Snellville, GA 30078(678) 377-6830
Sugar Hill
The Teeth Doctor LLC6025 Cumming Hwy. Ste. 610Sugar Hill, GA 30518(678) 482-5170
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irectory
Suwanee
Coast Dental2855 Lawrenceville- Suwanee Rd.Suwanee, GA 30024(678) 482-2197
Tucker
Great Expressions Dental Center GA4500 Hugh Howell Rd. Ste. 140Tucker, GA 30084(770) 938-9090
Tucker Town Dental4865 Lavista Rd. Ste. CTucker, GA 30084(404) 761-1542
HENRY COUNTYMcDonough
Aspen Dental1430 Hwy. 20 WMcDonough, GA 30253(678) 537-6000
Stockbridge
Alliance Ortho & Family Dentistry31 Hwy. 138 W Ste. 160Stockbridge, GA 30281(770) 507-6580
Great Expressions Dental Center GA1040 Eagles Ldg Pkwy. Ste. 200Stockbridge, GA 30281(678) 836-2136
Great Expressions Dental Center GA330 Corporate Center Court AStockbridge, GA 30281(678) 289-6707
Sacred Dental & Assoc.4362 N Henry Blvd.Stockbridge, GA 30281(770) 474-9202
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