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2018 Tabard Inn - Open Enrollment

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Katie Trinh

on 4 September 2018

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Transcript of 2018 Tabard Inn - Open Enrollment

2018 Open Enrollment
presented by:
Meeting Agenda

Healthcare 101
Insurance Definitions
Preventive Services
DHMO DC Signature
HMO DC Signature
Kaiser Resources
Rx Management
MetLife Dental
Insurance Definitions
Amount you pay before insurance starts to pay
May be different for certain benefits (i.e. Rx drugs)

Amount of charges for a service that you are required to pay

Out-of-Pocket Limit
Maximum amount you pay for covered services in a year
Often (but not always) includes deductible, co-insurance and co-payments
Understanding Your Rx Program
Simple ways to save on Prescriptions:
Know Your Prescription Plan Tiers – understanding the tier system can help you choose high value, low cost medications
Generics – Usually the least expensive option
Mail-order – 90-day supply of maintenance medications for only 2 copays
Kaiser Resources
MetLife Dental
Potomac Contacts
Dedicated Team:

Stephanie Williams- Director of Account Management
Jon Lee – Account Manager

Joseph Appelbaum - President

Pill splitting:

Physician writes you a prescription for 2 times the strength and then you split the tablet - you get your usual dosage for half the cost! (not suitable for all medications)

Over-the-Counter (OTC) Substitutions: Some prescriptions have OTC alternatives - check with your doctor or pharmacy

Synthroid (100 mcg - $39.16) $15 $25
Zoloft (50mg - $298.77): $30 $40
Xanax (.5mg - $157.04): $15 $25
Crestor (10mg - $88.21): $30 $40

Generic Equivalent
Levothyroxine Sodium –($4.00) $4.00 $4.00
Sertraline HCL – ($6.56) $6.56 $6.56
Alprazolam – ($4.07) $4.07 $4.07
Simvastatin – ($4.00) $4.00 $4.00
Generic prescriptions fall under Tier 1 of Tabard Inn's Rx plan, resulting in the lowest cost. Depending upon your plan, members will pay a $7 or $15 copay for generic prescriptions
Brand/Non-Preferred Brand Name vs. Generic Prescriptions
DHMO DC Signature
Below is only a brief overview
See detailed Summary of Benefits or Evidence of Coverage for more specifics

Next Steps

Note that MetLife does not issue ID cards, therefore it is important for all members to verify a dental provider’s network participation prior to a dental appointment – the easiest way to do this is online at MetLife’s MyBenefits

Access the Dental Center and MyBenefits from

Once registered with your own ID and password you will have direct access to:
Find a dentist
View your plan coverage
Check a claim
Common questions and answers
Everything under one roof
Because we know across the hall is easier than across town you have hassle-free access to the following at multiple Kaiser Permanente locations:
Primary care, OBGYN, Pediatrician
Specialty care
Laboratory services

HMO DC Signature
Below is only a brief overview
See detailed Summary of Benefits or Evidence of Coverage for more specifics

The right care, at the right time
Easy to schedule or change routine appointments online, by phone, or mobile app

Save a trip to the doctor and copay when you email your questions

30 convenient locations throughout MD, DC, and VA

24/7 access to medical advice

Emergency care coverage anywhere in the world
Digital Tools
KP Mobile App – access to your health from anywhere in the world
Email your doctors office with questions
Schedule or change routine appointments
Find a medical center

Video Chat with an emergency trained physician from any mobile device with video capabilities and save a trip to the Urgent Care/Emergency Room and a copay
Stay Connected 24/7
My Health Manager on kp.org
Email your questions to your Doctors office
View most lab results
Refill prescriptions
Schedule or change routine appointments
View or change doctors
Print your children’s immunization forms
Help manage the care of a family member or child*
And more
*Requires separate authorization for children or family member over age 13
Video Chart - How it works
You call nurse hotline, available 24/7 – 365 days a year
Nurse will ask questions to determine the best course of action
If your condition & symptoms are a fit for a video chat (i.e. flu symptoms/aches & pains, rash/skin condition, visible eye condition, extremity injuries), you will do the following:
schedule an appointment with the support staff to speak to an emergency trained physician, either immediately or for a later time

your video chat link is sent via email, you will log into the video chat on an electronic device that has video capability at your scheduled time

Once logged in, you will have a real time video chat with an emergency physician who will either help you resolve your health care issue or make you an appointment for a follow-up
Voluntary Life / AD&D Insurance
Provided by MetLife
If you are enrolling for the first time or making a change, you will need to complete an enrollment form

Everyone who is currently enrolled will automatically default to the current level of enrollment

Forms are due:
September 24
Signature Network Overview
Health care services are delivered by approximately 900 Mid-Atlantic Permanente Medical Group, P.C. (MAPMG) providers who practice exclusively in 30 Kaiser Permanente Medical Centers.

Free language services are available to members
Interpreters are available 24/7 via phone
Certified bilingual physicians and staff in some medical centers
In a fee-for-service world, care is fragmented which forces patients to:
Coordinate their own care

Visit or call various locations for services

Pay multiple copays

More time away from office
How health care works outside an Integrated Health Care Model
Preventive care services are provided during a wellness exam. You and your doctor will determine what tests and health screenings are right for you. The screenings are based on your:

Personal health history
Current health

Examples of Preventive Care:

Wellness visits and standard immunizations
Screenings for blood pressure, cancer, cholesterol, depression, obesity and diabetes
Pediatric screenings for hearing, vision, autism and developmental disorders, depression and obesity

Your provider may invoice for the non-preventive part of your annual preventive exam for treatment of a diagnosis (high blood pressure, diabetes, skin rash, headache, etc.)

Example of non-preventive care during a preventive care visit:
During the preventive visit, member complains of pain/swelling in the knee. The provider codes for both examinations and a cost share will apply to the non-preventive examination of the knee.
Voluntary Life & AD&D
Full transcript