Kaiser Permanente Select Colorado Springs and surrounding areas

This information provided here is a summary only For a list of services available with your plan see your Summary of Benefits and Coverage The information provided here is not a contract and is not intended for use as a Summary Plan Description a Certificate of Coverage nor is it designed to serve as your Evidence of Coverage Upon enrollment your Evidence of Coverage or Certificate of Insurance will contain a description of your coverage including benefits exclusions and limitations Your Evidence of Coverage or Certificate of Insurance will prevail over this or any other plan summary

1 Please see the network provider directory for a list of providers included in your plan

In addition to our comprehensive network of local providers1 Kaiser Permanente has medical offi ces located in Southern Colorado

Briargate Medical Offi ces 4105 Briargate Pkwy Suite 125 Colorado Springs CO 80920 719-282-2533 bull Primary care bull Specialty care allergy dermatology bull Audiologyhearing aid center lab medical imaging

services optical dietitian services infusion services sleep apnea supportive care services and pharmacy

Pueblo North Medical Offi ces 3670 Parker Boulevard Suite 200 Pueblo CO 81008 719-595-5755 bull Family medicine bull Internal medicine bull Lab medical imaging services and pharmacy

Coming soon in 2015 Parkside Medical Offi ces 215 Parkside Drive Colorado Springs CO 80910 bull Primary care bull Specialty care bull Lab medical imaging services sleep apnea

supportive care services and pharmacy

kporg

An affordable high quality health care plan for the Colorado Springs area

Please recycle This material was produced from eco-responsible resources

60247208_KPSelectProductSheet_SOCO

Kaiser Permanente Select is all about keeping you healthy and keeping your health care costs down Members who choose the KP Select plan will benefi t from the same high quality care from Kaiser Permanente at an affordable price while following a few guidelines

This plan provides Colorado Springs and surrounding areas coverage at any Kaiser Permanente medical offi ces in Colorado includes care at more than 400 network providers hospital visits exclusively at Memorial Central and North Hospitals and refi lls for maintenance medication must be fi lled at a Kaiser Permanente medical offi ce pharmacy or through Kaiser Permanente mail order The KP Select health plan will be available for individuals families small groups and large groups in the Colorado Springs area

KP Select Plan

Members who choose the new KP Select plan will

bull Have access to a network of more than 400 providers and medical groups in the Colorado Springs area or with any Kaiser Permanente physician There is no coverage for unauthorized care out of the network except in case of

an emergencybull Fill maintenance medication prescriptions

(birth control high blood pressure diabetes cholesterol thyroid etc) at a Kaiser Permanente medical offi ce pharmacy or through

Kaiser Permanente mail order Non-maintenance medications for acute conditions such as infections (antibiotics) or pain can be fi lled immediately at a Kaiser Permanente medical offi ce pharmacy or a network pharmacy

bull Visit Memorial Central or North Hospitals exclusively for non- emergency hospital care

bull Use a preferred Ambulatory Surgery Centers (Audubon Colorado Springs Health Partners and Printers Park) for scheduled

outpatient surgeries bull In an emergency member should dial 911 or go

to the nearest hospital

Where to Get Care

The KP Select Network

When you sign up for KP Select you can receive care from any Kaiser Permanente physician and have access to a comprehensive group of more than 400 providers in the Colorado Springs area You also can choose any network KP Select provider If you seek care from a provider not on the KP Select provider list without a prior authorization you will be responsible for payment

Primary Care is available through any Kaiser Permanente provider as well as through Colorado Springs Health Partners Mountain View Medical Group and Colorado Health Medical GroupUniversity of Colorado Health Specialty Care will also be available through these groups and a select group of network providers in the area

Please be sure to choose only providers in the KP Select Kaiser Permanente ProviderDirectory The most current list of providers can be found on kporg Just click on ldquoLocate our servicesrdquo then ldquoFind doctors and locationsrdquo You can request a printed copy of the directory by calling Member Services at 1-800-681-7878TTY 1-800-521-4874

Hospital Emergency Inpatient and Urgent Care

Members on the KP Select plan who need to be cared for in the hospital will visit either Memorial Central Hospital or Memorial North Hospital In an emergency member should dial 911 or go to the nearest hospital

Scheduled outpatient surgeries can be arranged at a preferred Ambulatory Surgery Center including Audubon Colorado Springs Health Partners and Printers Park

Urgent care is available at any contracted Kaiser Permanente facility The most current list of urgent care locations may be found on the facility search at kporglocations

Selecting a Personal Physician

When you enroll in KP Select you will need to choose a Primary Care Physician (PCP) for you and your enrolled dependents Each enrolled family member can choose a different PCP To fi nd a PCP please visit Find a Provider or call our Physician Selection Services at 1-855-208-7221TTY 711 weekdays 7 am ndash 530 pm

VisionDental Coverage

Individual and family plans will include routine eye exams and dental coverage only for children up to 19 years old The Catastrophic plan does not include dental coverage for children

Prescriptions and Pharmacy Benefi t

Members who choose the new KP Select plan will enjoy these benefi ts

bull You can have your fi rst fi ll of a prescription done at a Kaiser Permanente or a network pharmacy

bull Refi lls for maintenance medication (birth control high blood pressure diabetes cholesterol thyroid etc) at a Kaiser Permanente medical offi ce pharmacy or through Kaiser Permanente mail order Most prescriptions will be mailed directly to you via fi rst-class mail at no additional charge to you within just a few days

Kaiser Permanente also has pharmacies conveniently located in our medical offi ce buildings at 4105 Briargate Parkway Suite 125 Colorado Springs CO 80920 And coming soon in 2015

215 Parkside Drive Colorado Springs CO 80910bull Fill non-maintenance medications for acute

conditions such as infections (antibiotics) or pain immediately at a Kaiser Permanente medical

offi ce pharmacy or an affi liated network pharmacy bull Refi ll 24 hours a day seven days a week at kporgrxrefl ill or by calling 1-866-938-0077TTY 1-800-521-4874 Please call in your refi ll(s) at least

10 days before you run out of your current supply bull To fi nd out more about the prescription benefi t

members can call Member Services at 1-800-681-7878TTY 1-800-521-4874 or call the Clinical Pharmacy Call Center toll free at 1-866-244-4119TTY 1-866-513-9964 8 am to 6 pm weekdays

Behavioral Health Benefi ts

A list of behavior health providers is available at the ValueOptions website at valueoptionscom or by calling 1-866-702-9026TTY 1-866-835-2755 and include inpatient and outpatient mental health and substance about care for issues such as

bull Depressionbull AlcoholDrug abusebull Mental illnessbull Marriage and family counselingbull Special needs therapy

The Kaiser Permanente Difference

You can be assured that getting healthy and staying healthy is easy when you are a Kaiser Permanente member Whether you have a chronic illness have health goals or want alternative methods of treatment you can fi nd it with us Personalized online wellness programs webinars and classes give you the tools to lose or maintain a healthy weight manage stress stop smoking and more with your Healthy Lifestyle programs And if you have a chronic condition such as asthma heart disease or diabetes we provide extra coordinated support through our care coordination programs including assistance with complex care needs

In addition you have 247 online access to My Health Manager at kporg or through the app You will be able to view most lab results order prescription refi lls and more

Maximize Your Health and Your Health Dollars

For more information Visit us at kporg or call Member ServicesMon-Fri 8 am to 5 pm

1-888-681-7878 TTY 1-800-521-4874

Maximize Your Health and Your Health Dollars

Kaiser Permanente Select is all about keeping you healthy and keeping your health care costs down Members who choose the KP Select plan will benefit from the same high quality care from Kaiser Permanente at an affordable price while following a few guidelines

This plan provides Colorado Springs and surrounding areas coverage at any Kaiser Permanente medical offices in Colorado includes care at more than 400 network providers hospital visits exclusively at Memorial Central and North Hospitals and refills for maintenance medication must be filled at a Kaiser Permanente medical office pharmacy or through Kaiser Permanente mail order The KP Select health plan will be available for individuals families small groups and large groups in the Colorado Springs area

KP Select Plan

Members who choose the new KP Select plan will

bull Have access to a network of more than 400 providers and medical groups in the Colorado Springs area or with any Kaiser Permanente physician There is no coverage for unauthorized care out of the network except in case of an emergency

bull Fill maintenance medication prescriptions (birth control high blood pressure diabetes cholesterol thyroid etc) at a Kaiser Permanente medical office pharmacy or through Kaiser Permanente mail order Non-maintenance medications for acute conditions such as infections (antibiotics) or pain can be filled immediately at a Kaiser Permanente medical office pharmacy or a network pharmacy

bull Visit Memorial Central or North Hospitals exclusively for non- emergency hospital care

bull Use a preferred Ambulatory Surgery Centers (Audubon Colorado Springs Health Partners and Printers Park) for scheduled outpatient surgeries

bull In an emergency member should dial 911 or go to the nearest hospital

Where to Get Care

The KP Select Network

When you sign up for KP Select you can receive care from any Kaiser Permanente physician and have access to a comprehensive group of more than 400 providers in the Colorado Springs area You also can choose any network KP Select provider If you seek care from a provider not on the KP Select provider list without a prior authorization you will be responsible for payment

Primary Care is available through any Kaiser Permanente provider as well as through Colorado Springs Health Partners Mountain View Medical Group and Colorado Health Medical Group University of Colorado Health Specialty Care will also be available through these groups and a select group of network providers in the area

Please be sure to choose only providers in the KP Select Kaiser Permanente Provider Directory The most current list of providers can be found on kporg Just click on ldquoLocate our servicesrdquo then ldquoFind doctors and locationsrdquo You can request a printed copy of the directory by calling Member Services at 1-800-681-7878TTY 1-800-521-4874

Hospital Emergency Inpatient and Urgent Care

Members on the KP Select plan who need to be cared for in the hospital will visit either Memorial Central Hospital or Memorial North Hospital In an emergency member should dial 911 or go to the nearest hospital

Scheduled outpatient surgeries can be arranged at a preferred Ambulatory Surgery Center including Audubon Colorado Springs Health Partners and Printers Park

Urgent care is available at any contracted Kaiser Permanente facility The most current list of urgent care locations may be found on the facility search at kporglocations

Selecting a Personal Physician

When you enroll in KP Select you will need to choose a Primary Care Physician (PCP) for you and your enrolled dependents Each enrolled family member can choose a different PCP To find a PCP please visit Find a Provider or call our Physician Selection Services at 1-855-208-7221TTY 711 weekdays 7 am ndash 530 pm

VisionDental Coverage

Individual and family plans will include routine eye exams and dental coverage only for children up to 19 years old The Catastrophic plan does not include dental coverage for children

Prescriptions and Pharmacy Benefi t

Members who choose the new KP Select plan will enjoy these benefi ts

bull You can have your fi rst fi ll of a prescription done at a Kaiser Permanente or a network pharmacy

bull Refi lls for maintenance medication (birth control high blood pressure diabetes cholesterol thyroid etc) at a Kaiser Permanente medical offi ce pharmacy or through Kaiser Permanente mail order Most prescriptions will be mailed directly to you via fi rst-class mail at no additional charge to you within just a few days Kaiser Permanente also has pharmacies conveniently located in our medical offi ce buildings at 4105 Briargate Parkway Suite 125 Colorado Springs CO 80920 And coming soon in 2015 215 Parkside Drive Colorado Springs CO 80910

bull Fill non-maintenance medications for acute conditions such as infections (antibiotics) or pain immediately at a Kaiser Permanente medical offi ce pharmacy or an affi liated network pharmacy

bull Refi ll 24 hours a day seven days a week at kporgrxreflill or by calling 1-866-938-0077TTY 1-800-521-4874 Please call in your refi ll(s) at least 10 days before you run out of your current supply

bull To fi nd out more about the prescription benefi t members can call Member Services at 1-800-681-7878TTY 1-800-521-4874 or call the Clinical Pharmacy Call Center toll free at 1-866-244-4119TTY 1-866-513-9964 8 am to 6 pm weekdays

Behavioral Health Benefi ts

A list of behavior health providers is available at the ValueOptions website at valueoptionscom or by calling 1-866-702-9026TTY 1-866-835-2755 and include inpatient and outpatient mental health and substance about care for issues such as

bull Depression bull AlcoholDrug abuse bull Mental illness bull Marriage and family counseling bull Special needs therapy

The Kaiser Permanente Difference

You can be assured that getting healthy and staying healthy is easy when you are a Kaiser Permanente member Whether you have a chronic illness have health goals or want alternative methods of treatment you can find it with us Personalized online wellness programs webinars and classes give you the tools to lose or maintain a healthy weight manage stress stop smoking and more with your Healthy Lifestyle programs And if you have a chronic condition such as asthma heart disease or diabetes we provide extra coordinated support through our care coordination programs including assistance with complex care needs

In addition you have 247 online access to My Health Manager at kporg or through the app You will be able to view most lab results order prescription refills and more

For more information Visit us at kporg or call Member Services Mon-Fri 8 am to 5 pm

1-888-681-7878 TTY 1-800-521-4874

Kaiser Permanente Select is all about keeping you healthy and keeping your health care costs down Members who choose the KP Select plan will benefi t from the same high quality care from Kaiser Permanente at an affordable price while following a few guidelines

This plan provides Colorado Springs and surrounding areas coverage at any Kaiser Permanente medical offi ces in Colorado includes care at more than 400 network providers hospital visits exclusively at Memorial Central and North Hospitals and refi lls for maintenance medication must be fi lled at a Kaiser Permanente medical offi ce pharmacy or through Kaiser Permanente mail order The KP Select health plan will be available for individuals families small groups and large groups in the Colorado Springs area

KP Select Plan

Members who choose the new KP Select plan will

bull Have access to a network of more than 400 providers and medical groups in the Colorado Springs area or with any Kaiser Permanente physician There is no coverage for unauthorized care out of the network except in case of

an emergencybull Fill maintenance medication prescriptions

(birth control high blood pressure diabetes cholesterol thyroid etc) at a Kaiser Permanente medical offi ce pharmacy or through

Kaiser Permanente mail order Non-maintenance medications for acute conditions such as infections (antibiotics) or pain can be fi lled immediately at a Kaiser Permanente medical offi ce pharmacy or a network pharmacy

bull Visit Memorial Central or North Hospitals exclusively for non- emergency hospital care

bull Use a preferred Ambulatory Surgery Centers (Audubon Colorado Springs Health Partners and Printers Park) for scheduled

outpatient surgeries bull In an emergency member should dial 911 or go

to the nearest hospital

Where to Get Care

The KP Select Network

When you sign up for KP Select you can receive care from any Kaiser Permanente physician and have access to a comprehensive group of more than 400 providers in the Colorado Springs area You also can choose any network KP Select provider If you seek care from a provider not on the KP Select provider list without a prior authorization you will be responsible for payment

Primary Care is available through any Kaiser Permanente provider as well as through Colorado Springs Health Partners Mountain View Medical Group and Colorado Health Medical GroupUniversity of Colorado Health Specialty Care will also be available through these groups and a select group of network providers in the area

Please be sure to choose only providers in the KP Select Kaiser Permanente ProviderDirectory The most current list of providers can be found on kporg Just click on ldquoLocate our servicesrdquo then ldquoFind doctors and locationsrdquo You can request a printed copy of the directory by calling Member Services at 1-800-681-7878TTY 1-800-521-4874

Hospital Emergency Inpatient and Urgent Care

Members on the KP Select plan who need to be cared for in the hospital will visit either Memorial Central Hospital or Memorial North Hospital In an emergency member should dial 911 or go to the nearest hospital

Scheduled outpatient surgeries can be arranged at a preferred Ambulatory Surgery Center including Audubon Colorado Springs Health Partners and Printers Park

Urgent care is available at any contracted Kaiser Permanente facility The most current list of urgent care locations may be found on the facility search at kporglocations

Selecting a Personal Physician

When you enroll in KP Select you will need to choose a Primary Care Physician (PCP) for you and your enrolled dependents Each enrolled family member can choose a different PCP To fi nd a PCP please visit Find a Provider or call our Physician Selection Services at 1-855-208-7221TTY 711 weekdays 7 am ndash 530 pm

VisionDental Coverage

Individual and family plans will include routine eye exams and dental coverage only for children up to 19 years old The Catastrophic plan does not include dental coverage for children

Prescriptions and Pharmacy Benefi t

Members who choose the new KP Select plan will enjoy these benefi ts

bull You can have your fi rst fi ll of a prescription done at a Kaiser Permanente or a network pharmacy

bull Refi lls for maintenance medication (birth control high blood pressure diabetes cholesterol thyroid etc) at a Kaiser Permanente medical offi ce pharmacy or through Kaiser Permanente mail order Most prescriptions will be mailed directly to you via fi rst-class mail at no additional charge to you within just a few days

Kaiser Permanente also has pharmacies conveniently located in our medical offi ce buildings at 4105 Briargate Parkway Suite 125 Colorado Springs CO 80920 And coming soon in 2015

215 Parkside Drive Colorado Springs CO 80910bull Fill non-maintenance medications for acute

conditions such as infections (antibiotics) or pain immediately at a Kaiser Permanente medical

offi ce pharmacy or an affi liated network pharmacy bull Refi ll 24 hours a day seven days a week at kporgrxrefl ill or by calling 1-866-938-0077TTY 1-800-521-4874 Please call in your refi ll(s) at least

10 days before you run out of your current supply bull To fi nd out more about the prescription benefi t

members can call Member Services at 1-800-681-7878TTY 1-800-521-4874 or call the Clinical Pharmacy Call Center toll free at 1-866-244-4119TTY 1-866-513-9964 8 am to 6 pm weekdays

Behavioral Health Benefi ts

A list of behavior health providers is available at the ValueOptions website at valueoptionscom or by calling 1-866-702-9026TTY 1-866-835-2755 and include inpatient and outpatient mental health and substance about care for issues such as

bull Depressionbull AlcoholDrug abusebull Mental illnessbull Marriage and family counselingbull Special needs therapy

The Kaiser Permanente Difference

You can be assured that getting healthy and staying healthy is easy when you are a Kaiser Permanente member Whether you have a chronic illness have health goals or want alternative methods of treatment you can fi nd it with us Personalized online wellness programs webinars and classes give you the tools to lose or maintain a healthy weight manage stress stop smoking and more with your Healthy Lifestyle programs And if you have a chronic condition such as asthma heart disease or diabetes we provide extra coordinated support through our care coordination programs including assistance with complex care needs

In addition you have 247 online access to My Health Manager at kporg or through the app You will be able to view most lab results order prescription refi lls and more

Maximize Your Health and Your Health Dollars

For more information Visit us at kporg or call Member ServicesMon-Fri 8 am to 5 pm

1-888-681-7878 TTY 1-800-521-4874

Maximize Your Health and Your Health Dollars

Kaiser Permanente Select is all about keeping you healthy and keeping your health care costs down Members who choose the KP Select plan will benefit from the same high quality care from Kaiser Permanente at an affordable price while following a few guidelines

This plan provides Colorado Springs and surrounding areas coverage at any Kaiser Permanente medical offices in Colorado includes care at more than 400 network providers hospital visits exclusively at Memorial Central and North Hospitals and refills for maintenance medication must be filled at a Kaiser Permanente medical office pharmacy or through Kaiser Permanente mail order The KP Select health plan will be available for individuals families small groups and large groups in the Colorado Springs area

KP Select Plan

Members who choose the new KP Select plan will

bull Have access to a network of more than 400 providers and medical groups in the Colorado Springs area or with any Kaiser Permanente physician There is no coverage for unauthorized care out of the network except in case of an emergency

bull Fill maintenance medication prescriptions (birth control high blood pressure diabetes cholesterol thyroid etc) at a Kaiser Permanente medical office pharmacy or through Kaiser Permanente mail order Non-maintenance medications for acute conditions such as infections (antibiotics) or pain can be filled immediately at a Kaiser Permanente medical office pharmacy or a network pharmacy

bull Visit Memorial Central or North Hospitals exclusively for non- emergency hospital care

bull Use a preferred Ambulatory Surgery Centers (Audubon Colorado Springs Health Partners and Printers Park) for scheduled outpatient surgeries

bull In an emergency member should dial 911 or go to the nearest hospital

Where to Get Care

The KP Select Network

When you sign up for KP Select you can receive care from any Kaiser Permanente physician and have access to a comprehensive group of more than 400 providers in the Colorado Springs area You also can choose any network KP Select provider If you seek care from a provider not on the KP Select provider list without a prior authorization you will be responsible for payment

Primary Care is available through any Kaiser Permanente provider as well as through Colorado Springs Health Partners Mountain View Medical Group and Colorado Health Medical Group University of Colorado Health Specialty Care will also be available through these groups and a select group of network providers in the area

Please be sure to choose only providers in the KP Select Kaiser Permanente Provider Directory The most current list of providers can be found on kporg Just click on ldquoLocate our servicesrdquo then ldquoFind doctors and locationsrdquo You can request a printed copy of the directory by calling Member Services at 1-800-681-7878TTY 1-800-521-4874

Hospital Emergency Inpatient and Urgent Care

Members on the KP Select plan who need to be cared for in the hospital will visit either Memorial Central Hospital or Memorial North Hospital In an emergency member should dial 911 or go to the nearest hospital

Scheduled outpatient surgeries can be arranged at a preferred Ambulatory Surgery Center including Audubon Colorado Springs Health Partners and Printers Park

Urgent care is available at any contracted Kaiser Permanente facility The most current list of urgent care locations may be found on the facility search at kporglocations

Selecting a Personal Physician

When you enroll in KP Select you will need to choose a Primary Care Physician (PCP) for you and your enrolled dependents Each enrolled family member can choose a different PCP To find a PCP please visit Find a Provider or call our Physician Selection Services at 1-855-208-7221TTY 711 weekdays 7 am ndash 530 pm

VisionDental Coverage

Individual and family plans will include routine eye exams and dental coverage only for children up to 19 years old The Catastrophic plan does not include dental coverage for children

Prescriptions and Pharmacy Benefi t

Members who choose the new KP Select plan will enjoy these benefi ts

bull You can have your fi rst fi ll of a prescription done at a Kaiser Permanente or a network pharmacy

bull Refi lls for maintenance medication (birth control high blood pressure diabetes cholesterol thyroid etc) at a Kaiser Permanente medical offi ce pharmacy or through Kaiser Permanente mail order Most prescriptions will be mailed directly to you via fi rst-class mail at no additional charge to you within just a few days Kaiser Permanente also has pharmacies conveniently located in our medical offi ce buildings at 4105 Briargate Parkway Suite 125 Colorado Springs CO 80920 And coming soon in 2015 215 Parkside Drive Colorado Springs CO 80910

bull Fill non-maintenance medications for acute conditions such as infections (antibiotics) or pain immediately at a Kaiser Permanente medical offi ce pharmacy or an affi liated network pharmacy

bull Refi ll 24 hours a day seven days a week at kporgrxreflill or by calling 1-866-938-0077TTY 1-800-521-4874 Please call in your refi ll(s) at least 10 days before you run out of your current supply

bull To fi nd out more about the prescription benefi t members can call Member Services at 1-800-681-7878TTY 1-800-521-4874 or call the Clinical Pharmacy Call Center toll free at 1-866-244-4119TTY 1-866-513-9964 8 am to 6 pm weekdays

Behavioral Health Benefi ts

A list of behavior health providers is available at the ValueOptions website at valueoptionscom or by calling 1-866-702-9026TTY 1-866-835-2755 and include inpatient and outpatient mental health and substance about care for issues such as

bull Depression bull AlcoholDrug abuse bull Mental illness bull Marriage and family counseling bull Special needs therapy

The Kaiser Permanente Difference

You can be assured that getting healthy and staying healthy is easy when you are a Kaiser Permanente member Whether you have a chronic illness have health goals or want alternative methods of treatment you can find it with us Personalized online wellness programs webinars and classes give you the tools to lose or maintain a healthy weight manage stress stop smoking and more with your Healthy Lifestyle programs And if you have a chronic condition such as asthma heart disease or diabetes we provide extra coordinated support through our care coordination programs including assistance with complex care needs

In addition you have 247 online access to My Health Manager at kporg or through the app You will be able to view most lab results order prescription refills and more

For more information Visit us at kporg or call Member Services Mon-Fri 8 am to 5 pm

1-888-681-7878 TTY 1-800-521-4874

Maximize Your Health and Your Health Dollars

Kaiser Permanente Select is all about keeping you healthy and keeping your health care costs down Members who choose the KP Select plan will benefit from the same high quality care from Kaiser Permanente at an affordable price while following a few guidelines

This plan provides Colorado Springs and surrounding areas coverage at any Kaiser Permanente medical offices in Colorado includes care at more than 400 network providers hospital visits exclusively at Memorial Central and North Hospitals and refills for maintenance medication must be filled at a Kaiser Permanente medical office pharmacy or through Kaiser Permanente mail order The KP Select health plan will be available for individuals families small groups and large groups in the Colorado Springs area

KP Select Plan

Members who choose the new KP Select plan will

bull Have access to a network of more than 400 providers and medical groups in the Colorado Springs area or with any Kaiser Permanente physician There is no coverage for unauthorized care out of the network except in case of an emergency

bull Fill maintenance medication prescriptions (birth control high blood pressure diabetes cholesterol thyroid etc) at a Kaiser Permanente medical office pharmacy or through Kaiser Permanente mail order Non-maintenance medications for acute conditions such as infections (antibiotics) or pain can be filled immediately at a Kaiser Permanente medical office pharmacy or a network pharmacy

bull Visit Memorial Central or North Hospitals exclusively for non- emergency hospital care

bull Use a preferred Ambulatory Surgery Centers (Audubon Colorado Springs Health Partners and Printers Park) for scheduled outpatient surgeries

bull In an emergency member should dial 911 or go to the nearest hospital

Where to Get Care

The KP Select Network

When you sign up for KP Select you can receive care from any Kaiser Permanente physician and have access to a comprehensive group of more than 400 providers in the Colorado Springs area You also can choose any network KP Select provider If you seek care from a provider not on the KP Select provider list without a prior authorization you will be responsible for payment

Primary Care is available through any Kaiser Permanente provider as well as through Colorado Springs Health Partners Mountain View Medical Group and Colorado Health Medical Group University of Colorado Health Specialty Care will also be available through these groups and a select group of network providers in the area

Please be sure to choose only providers in the KP Select Kaiser Permanente Provider Directory The most current list of providers can be found on kporg Just click on ldquoLocate our servicesrdquo then ldquoFind doctors and locationsrdquo You can request a printed copy of the directory by calling Member Services at 1-800-681-7878TTY 1-800-521-4874

Hospital Emergency Inpatient and Urgent Care

Members on the KP Select plan who need to be cared for in the hospital will visit either Memorial Central Hospital or Memorial North Hospital In an emergency member should dial 911 or go to the nearest hospital

Scheduled outpatient surgeries can be arranged at a preferred Ambulatory Surgery Center including Audubon Colorado Springs Health Partners and Printers Park

Urgent care is available at any contracted Kaiser Permanente facility The most current list of urgent care locations may be found on the facility search at kporglocations

Selecting a Personal Physician

When you enroll in KP Select you will need to choose a Primary Care Physician (PCP) for you and your enrolled dependents Each enrolled family member can choose a different PCP To find a PCP please visit Find a Provider or call our Physician Selection Services at 1-855-208-7221TTY 711 weekdays 7 am ndash 530 pm

VisionDental Coverage

Individual and family plans will include routine eye exams and dental coverage only for children up to 19 years old The Catastrophic plan does not include dental coverage for children

Prescriptions and Pharmacy Benefi t

Members who choose the new KP Select plan will enjoy these benefi ts

bull You can have your fi rst fi ll of a prescription done at a Kaiser Permanente or a network pharmacy

bull Refi lls for maintenance medication (birth control high blood pressure diabetes cholesterol thyroid etc) at a Kaiser Permanente medical offi ce pharmacy or through Kaiser Permanente mail order Most prescriptions will be mailed directly to you via fi rst-class mail at no additional charge to you within just a few days Kaiser Permanente also has pharmacies conveniently located in our medical offi ce buildings at 4105 Briargate Parkway Suite 125 Colorado Springs CO 80920 And coming soon in 2015 215 Parkside Drive Colorado Springs CO 80910

bull Fill non-maintenance medications for acute conditions such as infections (antibiotics) or pain immediately at a Kaiser Permanente medical offi ce pharmacy or an affi liated network pharmacy

bull Refi ll 24 hours a day seven days a week at kporgrxreflill or by calling 1-866-938-0077TTY 1-800-521-4874 Please call in your refi ll(s) at least 10 days before you run out of your current supply

bull To fi nd out more about the prescription benefi t members can call Member Services at 1-800-681-7878TTY 1-800-521-4874 or call the Clinical Pharmacy Call Center toll free at 1-866-244-4119TTY 1-866-513-9964 8 am to 6 pm weekdays

Behavioral Health Benefi ts

A list of behavior health providers is available at the ValueOptions website at valueoptionscom or by calling 1-866-702-9026TTY 1-866-835-2755 and include inpatient and outpatient mental health and substance about care for issues such as

bull Depression bull AlcoholDrug abuse bull Mental illness bull Marriage and family counseling bull Special needs therapy

The Kaiser Permanente Difference

You can be assured that getting healthy and staying healthy is easy when you are a Kaiser Permanente member Whether you have a chronic illness have health goals or want alternative methods of treatment you can find it with us Personalized online wellness programs webinars and classes give you the tools to lose or maintain a healthy weight manage stress stop smoking and more with your Healthy Lifestyle programs And if you have a chronic condition such as asthma heart disease or diabetes we provide extra coordinated support through our care coordination programs including assistance with complex care needs

In addition you have 247 online access to My Health Manager at kporg or through the app You will be able to view most lab results order prescription refills and more

For more information Visit us at kporg or call Member Services Mon-Fri 8 am to 5 pm

1-888-681-7878 TTY 1-800-521-4874

Kaiser Permanente Select Colorado Springs and surrounding areas

An affordable high quality health care plan for the Colorado Springs area

This information provided here is a summary only For a list of services available with your plan see your Summary of Benefi ts and Coverage The information provided here is not a contract and is not intended for use as a Summary Plan Description a Certifi cate of Coverage nor is it designed to serve as your Evidence of Coverage Upon enrollment your Evidence of Coverage or Certifi cate of Insurance will contain a description of your coverage including benefi ts exclusions and limitations Your Evidence of Coverage or Certifi cate of Insurance will prevail over this or any other plan summary

1 Please see the network provider directory for a list of providers included in your plan

In addition to our comprehensive network of local providers1 Kaiser Permanente has medical offi ces located in Southern Colorado

Briargate Medical Offi ces4105 Briargate Pkwy Suite 125 Colorado Springs CO 80920719-282-2533bull Primary carebull Specialty care allergy dermatologybull Audiologyhearing aid center lab medical imaging

services optical dietitian services infusion services sleep apnea supportive care services and pharmacy

Pueblo North Medical Offi ces3670 Parker Boulevard Suite 200Pueblo CO 81008719-595-5755bull Family medicinebull Internal medicinebull Lab medical imaging services and pharmacy

Coming soon in 2015 Parkside Medical Offi ces215 Parkside DriveColorado Springs CO 80910bull Primary carebull Specialty carebull Lab medical imaging services sleep apnea supportive care services and pharmacy

kporg

Please recycle This material was produced from eco-responsible resources

60247208_KPSelectProductSheet_SOCO