Training Partnership and Health Benefits Trust 2012-2013 Benefits Book

YOUR BENEFITS 2012-2013

2012-2013 GUIDE TO TRAINING AND HEALTH BENEFITS

SECOND EDITION

2012-2013 BENEFITS BOOK

1

WELCOME Welcome to the second “Your Benefits” book from the SEIU Healthcare NW Training Partnership and Health Benefits Trust. This book is designed to serve as a complete guide to your training and health benefits. It features resources and information to make it easier to get the support you need.

As a Home Care Aide, your training and health benefits are a critical part of the compensation you receive. Quality training and affordable health benefits provide the skills foundation and personal stability needed to help you deliver excellent care to your consumers and create future career pathways.

You are the key to quality care in Washington’s long-term care system. Thank you for all you do to promote excellence in home care.

Charissa Raynor Executive Director, Training Partnership and Health Benefits Trust

David Rolf Board Chair, Training Partnership and Health Benefits Trust President, SEIU Healthcare 775NW

MANAGE TRAINING / BENEFITS ONLINE www.myseiubenefits.org Enter your Username and Password below for easy reference USERNAME

PASSWORD

PRIMARY CARE PROVIDER (DOCTOR) / URGENT CARE CENTER Write your Doctor and nearest Urgent Care Center here for reference PRIMARY CARE DOCTOR NAME PHONE

URGENT CARE CENTER NAME AND ADDRESS

YOUR HEALTH PLAN Write your Health Benefits Plan name here PLAN NAME

2

MYSEIUBENEFITS.ORG

Health Benefits Health Benefits Overview

37

5

Participating Employers

38

Multi-language Assistance

6

Benefits Basics

39

Quick Start: Training and Health

7

2012-2013 Medical Plan Highlights

40

How to Access www.myseiubenefits.org 8

Prescription/RX Co-pay Grid

41

Update Online Preferences

10

Plan and Network Grid

42

2012-2013 Benefit Highlights

11

Medical Plan Highlights Grid

43

MySEIUBenefits.org Overview

12

Group Health Urgent Care Centers

45

Online Continuing Education Overview

13

Dental and Vision Benefits

47

Online Continuing Education Classes

14

Home Care Aide Magazine Preview

15

Training Basics

Wellness Your Wellness

49

Health Benefits Quick Start

55

17

Health Benefits Policies

Interpretation 22

Frequently Asked Questions

56

How to Help Improve Future Classes

Benefit Summaries

63

Willamette Dental

64

Delta Dental

66

Kaiser Permanente Health

71

Group Health

74 81

23

Training Standards Training Standards Overview

25

Training Standards Chart

26

Home Care Aide Categories

27

Questions and Appeals

Support Contacts

28

Notices 83

Safety and Orientation

29

Glossary 84

Training Policies

30

Classroom Policies

32

Reasonable Accommodation Policy

34

Home Care Aide Categories

86

Training Standards Chart

87

WELLNESS

Frequently Asked Questions

HEALTH BENEFITS

How to Get the Most from Your Training 21

POLICIES

ONTENTS

4

If You Need Assistance

TRAINING STANDARDS

Your Benefits Book

Training Overview

TRAINING BASICS

Quick Start Guide

POLICIES

2012-2013 BENEFITS BOOK

3

QUICK REFER YOUR BENEFITS BOOK

One-Stop Resource for Training, Health Benefits To make it easier to understand your training and health benefits, the Training Partnership and Health Benefits Trust put together this “Your Benefits” book to help guide you. These benefits are effective Aug. 1, 2012 through July 31, 2013.

This Benefits Book will be in effect until July 31, 2013.

YOUR BENEFITS 2012-2013

2012- 2013 GUIDE TO TRAIN

ING AND HEALT H BENEF

ITS

SECOND EDITION

Inside, you will find important benefits information, including: Training Benefits • Training standards • Classroom policies • Glossary • Student resources 2012-2013 BENEFITS

BOOK

Health Benefits (For eligible Individual Providers or Home Care Aides covered through their employers) • Eligibility • Benefit summaries • Wellness guide

Where to Find Updates If there are changes to training standards or other information after the book is released, we will update this “Your Benefits” book the following ways:

QUICK REFERENCE GUIDE

Online - Updates will be available online at www.myseiubenefits.org/benefits YOUR Magazine - Updates will also be in Home Care InSight, the magazine for Home Care Aides. See Page 15 for more information.

COLOR CODED - Throughout the book, you will see information for both Individual Providers (IPs) and Agency Providers (APs). To help keep them straight, look for these colors:

n Individual Providers

n Agency Providers

Did you know?

Did you know there is an online version of the Benefits Book? The online version of the Benefits Book is a useful tool if you misplace your book or want to view your benefits information from anywhere. You can view the online Benefits Book at www.myseiubenefits.org/benefits 4

MYSEIUBENEFITS.ORG

1

RENCE GUIDE IF YOU NEED ASSISTANCE

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

The MRC is closed the following holidays: New Year’s Day Martin Luther King, Jr. Day Presidents’ Day Memorial Day Independence Day Labor Day Thanksgiving

Day after Thanksgiving Christmas Eve Day Christmas Day Check www.myseiubenefits.org/MRC for office closures and the most updated hours

n Individual Providers: If you need information about your training or benefits eligibility, log in to www.myseiubenefits.org first.

If you cannot find the answer to your question, contact help.

n Agency Providers: Contact your employer for support.

Specific Training Support

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

Kaiser Permanente 1-800-813-2000 www.kp.org

Dental Plan Support Delta Dental (Dental) 1-800-554-1907 www.deltadentalwa.com Willamette Dental 1-800-359-6019 www.willamettedental.com

2012-2013 BENEFITS BOOK

5

QUICK REFERENCE GUIDE

See chart on Page 28 for who to contact for specific training-related questions.

QUICK REFER IF YOU NEED ASSISTANCE For Assistance Comuníquese con el Centro de Recursos para Miembros al 1-866-371-3200 si necesita asistencia para registrarse en su entrenameinto o para saber cuál es su elegibilidad para los beneficios de salud.

Hãy gọi Trung Tâm Nguồn Lực Thành Viên theo số 1-866-371-3200 nếu quý vị cần được trợ giúp trong việc lên lịch đào tạo hoặc tìm hiểu về điều kiện để nhận phúc lợi y tế. 훈련일정을 잡거나 건강혜택 자격 확인을 위해 도움이 필요하시면 회원지원센터 1-866-371-3200로 전화주세요. 如需在安排培训日程或了解您是否有资格获取保健福利方面获取协 助，请致电 1-866-371-3200 联系会员资源中心。

QUICK REFERENCE GUIDE

Если у Вас есть вопросы, связанные с определением расписания занятий, или относительно получения Вами пособия по нетрудоспособности, обращайтесь в Учебнометодический центр по телефону 1-866-371-3200.

6

MYSEIUBENEFITS.ORG

RENCE GUIDE QUICK START

Training Quick Start 1. Find Your Training Standards n Individual Providers: • •

There are different training standards depending on what type of care you provide.

Use the online Training Wizard – a tool to help you know which category applies to you – to find your individual training standards.

Go to: www.myseiubenefits.org/wizard to complete the Wizard.

n Agency Providers: •

Your employer can help you understand your training standards. Contact your employer to get your training standard information.

2. Watch the Safety and Orientation DVDs - If Required •

Look at the training grid on Page 26 to see your requirement.

3. Schedule Training Early Schedule within first two weeks of hire to ensure the best choices.

n Individual Providers: • •

Create your Username and Password to login to the training portal at www.myseiubenefits.org.

Go online to www.myseiubenefits.org to log in to register for training or call the Member Resource Center at 1-866-371-3200.

n Agency Providers: •

Check with your employer on the best way to register. Your employer has policies on scheduling for training.

1. Check your eligibility for health insurance benefits and enroll

n Individual Providers: Go online to www.myseiubenefits.org to log in to see your eligibility and enroll online, or call the Member Resource Center at 1-866371-3200. Your eligibility for health insurance depends on the number of hours you work.

n Agency Providers: Contact your employer to see if you are eligible for health benefits through your employer.

2. Make an appointment with your primary care doctor Go to your health insurance provider’s website or contact them by phone (see contact info on Page 5) to find available doctors and other providers. See the Health Benefits section for more details.

2012-2013 BENEFITS BOOK

7

QUICK REFERENCE GUIDE

Health Benefits Quick Start

QUICK REFER ACCESS MYSEIUBENEFITS.ORG

Manage Training and Benefits Easily Online The best way to manage your training and find your eligibility for benefits is through the www.myseiubenefits.org website. We have improved the Username and Password process to make it easier for you to access the site.

How to Log In to the Website

QUICK REFERENCE GUIDE

1. Sign up for a First Time Username and Password

You can enter EITHER your Student ID (the card sent to you by the Training Partnership) OR the last four of your Social Security Number and your birthdate. Note: If you work for DSHS, you should use the Student ID option.

2. Verify Your Information

8

MYSEIUBENEFITS.ORG

RENCE GUIDE ACCESS MYSEIUBENEFITS.ORG

3. Create Your Username and Password

Note: You can choose any username or password you like

4. Confirm Your Username and Password

5. You’re Done!

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

2012-2013 BENEFITS BOOK

9

QUICK REFERENCE GUIDE

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

QUICK REFER UPDATE PREFERENCES

Update Your Preferences for a Better Student Experience

Keeping your language and contact preferences updated is an important way to help the Training Partnership provide you with the best possible training experience. Make sure to update your preferences as soon as possible so we can reach you effectively.

1. Log in.

2. Click “Manage … Profile” link on the left side of the screen:

QUICK REFERENCE GUIDE

3. Modify the settings you wish to, and click the “Save Preferences” button.

10

MYSEIUBENEFITS.ORG

RENCE GUIDE 2012-2013 BENEFIT HIGHLIGHTS

What’s New and Improved?

TRAINING More Online Continuing Education Classes

The Training Partnership now has 26 English Online Continuing Education classes for students to take at their convenience. In addition, there are 10 Online CE courses available for students in Russian and Spanish. For more on Online CE, visit www.myseiubenefits.org/online-continuing-education

Home Care InSight Magazine The Training Partnership will be offering the second issue of Home Care InSight Magazine in Fall 2012. This magazine will be a resource for Training Partnership students and Health Benefits Trust members to learn about best practices in training and wellness as well as get important updates on their benefits.

Print Your Own Certificates Now, students who have completed their training can print their own certificates, quickly and easily through the online learning portal.

HEALTH BENEFITS Group Health Offers Free Mail Prescriptions for Value-Based Drugs In an exciting new benefit for Health Benefits Trust members, Group Health is now offering some mail-order Value-Based drugs at no cost to members. This is in addition to lower costs on other prescriptions as well.

The Health Benefits Trust will continue to offer incentives to members who use important parts of their health benefits: Initial Primary Care Appointment = $10 Members who make an initial primary care appointment within the first three months of coverage will receive a $10 check.

Complete a Health Profile = $25 Members who complete a Health Profile either online or on paper will receive a $25 check from the Health Benefits Trust.

Same Low Cost for Members Health Benefits Trust members still pay $25 a month for health, dental and vision benefits.

2012-2013 BENEFITS BOOK

11

QUICK REFERENCE GUIDE

Cash Incentives for Using Health Benefits

QUICK REFER GET ONLINE

MYSEIUBENEFITS.ORG

Your easy online source for online CE, training standards, class registration Once you get your online login and password, you’re ready to go online to manage and take training!

Over the past year, the Training Partnership has worked to increase the quantity and depth of the resources available on the website www.myseiubenefits.org.

In addition to the ability to register online, find training standards and other resources, students can now take a robust number of Online Continuing

www.myseiubenefits.o

Education courses – right from their computer.

Why go online?

Online Training Wizard

QUICK REFERENCE GUIDE

The online Training Wizard will give you a customized understanding of the training you need. The easy online Training Wizard is found at www.myseiubenefits.org/wizard.

Register for Training If you are an Individual Provider, you can register for training yourself online.

You can view available courses and pick times that work for you.

Online Continuing Education Students can now take their Continuing Education conveniently online – anytime, anywhere! See the following page for details on Online Continuing Education.

12

MYSEIUBENEFITS.ORG

rg

RENCE GUIDE ONLINE CONTINUING EDUCATION As of July 2012, there are 26 English Continuing Education (CE) classes you can take online by going to www.myseiubenefits. org. In addition, there are 10 online CE courses in Russian and Spanish available as well.

With online classes you pick the time and topics that work for you. You can see the available courses, register and access courses, receive credit, and navigate help information – all online and all 24 hours a day!

Each online course takes about one hour to complete, which may vary depending on

take the Multiple Sclerosis module online. I learned a lot and I could do it at home!

– Abdul, Training Partnership Student

connection speed.

2012-2013 BENEFITS BOOK

13

QUICK REFERENCE GUIDE

learning style, material covered and Internet

‘‘

I loved being able to

QUICK REFER Online Continuing Education Classes as of July 2012 English Hearing and Vision Conditions Cultural Competency: Pain Management and Health Literacy

An Introduction to Physical Disabilities

Arthritis & Acute Mental Status Changes

An Introduction to Dementia

Cultural Competency: Pain Management and Assumptions

Best Practices for the Professional HCA

Gaining Consumer Cooperation for Oral Health Oral Health Basics Denture Care and Cleaning Using Household Cleaning Chemicals Safely Green Cleaning Cultural Competency - Nutrition Best Practices for the Professional HCA Multiple Sclerosis Traumatic Brain Injury Body Mechanics Infection Control and Workplace Safety

QUICK REFERENCE GUIDE

Better Health through Nutritious Cooking

Spanish & Russian

An Introduction to Mental Illness

Multiple Sclerosis Traumatic Brain Injury Body Mechanics Important Note: The following courses were available in early 2011 for a short time so if you took them at that time, you cannot take them again. If you did not take them then, they are available to take online.

Relationships Between Consumers Home Care Aides Make a Difference Supporting Consumer Independence The Faces of Down Syndrome Dispelling Disability Myths Promoting Creativity

Body Mechanics

Important Note: The following courses were available in early 2011 for a short time so if you took them at that time, you cannot take them again. If you did not take them then, they are available to take online.

Infection Control and Workplace Safety

Relationships Between Consumers

Better Health through Nutritious Cooking

Home Care Aides Make a Difference

An Introduction to Developmental Disabilities

Supporting Consumer Independence

An Intro to Physical Disabilities

Dispelling Disability Myths

An Introduction to Mental Illness

Promoting Creativity

Best Practices for the Professional HCA Multiple Sclerosis Traumatic Brain Injury

An Introduction to Dementia 14

An Introduction to Developmental Disabilities

MYSEIUBENEFITS.ORG

The Faces of Down Syndrome

RENCE GUIDE MAGAZINE

Fall 2012 - Next Issue of Home Care InSight Magazine As a community of Home Care Aides, you do important work and you have an important story to tell. You can help raise understanding of common challenges and experiences for Home Care Aides to help improve the profession.

To help share knowledge and skills with the Home Care Aide community, a new magazine will be published to focus on you and your work. Look for the next issue in the Fall of 2012.

Magazine Highlights Training and Health Training standards updates

•

Best practices for Home Care Aides

•

Knowledge and skills builders

•

Student participation policies and news

•

Health benefits policies and news

•

Your safety at work

Important Updates to the “Your Benefits” book • Updates to the “Your Benefits” book will be printed in the magazine as well as posted online; be sure to check your magazine for updates

Send us your story ideas!

Do you have an interesting story to share of your successes or challenges as a Home Care Aide? Do you have a story about personal health and wellness? Do you have suggestions for stories or profiles you would like to see in the magazine? Send them to us!

Go to www.myseiubenefits.org/stories to submit your story idea.

2012-2013 BENEFITS BOOK

15

QUICK REFERENCE GUIDE

•

TRAINING BASICS 16

MYSEIUBENEFITS.ORG

TRAINING BASICS

QUALITY TRAINING, QUALITY CARE The Training Partnership understands that adult learners bring a broad set of life experiences, education levels, and English language proficiency to the classroom. To meet that diversity, learning experiences are designed for you, adult students who bring previous knowledge and a passion for their work to

Vision Our vision is that every long-term care worker is a professional who has been trained rigorously, whose work is well respected and well compensated, who has meaningful opportunities for professional development and career growth, and who provides high quality care.

class. The focus is on practical skill development that will help you to do your job.

What Can You Expect from Basic Training Courses?

•

As a student, you can expect to meet an instructor with direct care experience who is passionate about supporting Home Care Aides in their professional growth.

•

You can expect opportunities to learn using different methods like watching video clips, completing written activities, and presenting to others.

•

You can expect to learn specific skills, see them demonstrated and then have a chance to demonstrate the skill yourself.

‘‘

•

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

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

– Jasmine, Training Partnership Student

2012-2013 BENEFITS BOOK

17

18

MYSEIUBENEFITS.ORG

You can expect to be asked what you think, to share what

Mission

you know, to contribute to

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

discussion, and to answer questions.

What Can You Expect from Continuing Education Courses?

•

TRAINING BASICS

•

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

•

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

•

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

•

You can expect to have online courses in multiple languages available to take 24-hours-a-day, seven days a week.

•

You can expect online learning courses that present information and ask you to apply what you have learned through interactive activities.

What Characterizes the Work of the Training Partnership?

There are several themes that infuse the courses, actions, and work of the Training Partnership. They are: •

Dignity of the work and the Home Care Aides who do the work;

•

Dignity of the consumer whose preferences, individuality, and needs must be respected;

•

Empowerment of the Home Care Aide to improve their lives and the lives of consumers;

•

Professionalism of the workforce; and

•

Cultural competency and inclusiveness to honor differences.

2012-2013 BENEFITS BOOK

19

20

MYSEIUBENEFITS.ORG

Use the Training Wizard Start with the easy online Training Wizard to find the training you need.

Go to: www.myseiubenefits.org/wizard to complete the Wizard.

Register Early for Training If you need Basic Training, we encourage you to register for your classes within the first two weeks of hire to get the best choice of class options. If you want Instructor Led Continuing Education (CE) classes, register as early as possible to get the best choice of class options before your deadline.

Take Online Learning for Continuing Education Credits Online Continuing Education courses are an easy and convenient way to get the CE hours you need as a Home Care Aide. You can view available courses, take classes and view your credits all from your computer – 24/7.

Go Online for Convenient Service and Support The www.myseiubenefits.org web portal is your comprehensive resource for available classes, your current training status, benefits eligibility and much more. Log in to the portal first to get the answers you need. Instructions for getting a username and password are on Page 8.

Update Your Contact Info Ensure you are receiving the most current information about your training by updating your contact information with your employer. If are you an Individual Provider, update your information with your primary DSHS contact. If you are an Agency Provider, update your information with your employer.

Sign Up for News and Alerts Help make sure you get all the latest news and information you need on training standards, deadlines and new online learning courses. Sign up to receive news and alerts through email.

2012-2013 BENEFITS BOOK

21

TRAINING BASICS

HOW TO GET THE MOST FROM YOUR TRAINING

INTERPRETATION n Individual Providers: The Community Interpretation option is available to you. You need to tell the Training Partnership you are using a community interpreter at time of registration.

n Agency Providers: Indicate to the person who registers you for class that you will be bringing a Community Interpreter.

Community Interpretation The Training Partnership values the diversity of Home Care Aides. Basic Training courses are offered in English, Cantonese, Spanish, Russian, Korean, and Vietnamese. For those students who speak another primary language and are unable to take courses in English, we offer a Community Interpretation option.

Steps to Register for Community Interpretation 1. Notify the Training Partnership: At the time of course registration, tell us either using the online portal or the Member Resource Center if you will be bringing someone with you to serve as your interpreter. If you are bringing someone to interpret, you are responsible for telling them when and where the class will be held and for reserving space for them in the class.

2. Orientation: Online Orientation Video: You and your Community Interpreter should watch a helpful online Orientation before their first community interpretation session. This Orientation will help prepare your Community Interpreter and you for the class. It is very important that your interpreter watches this orientation before your first class, especially if they do not have training in interpreting.

Tip Sheet: If you have a friend or family member interpret for you, we offer a tip sheet and other information that will help prepare your interpreter to assist you in class.

View orientation info and tip sheet here: www.myseiubenefits.org/training/interpretation 22

MYSEIUBENEFITS.ORG

TRAINING BASICS

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

Course Reviews All Home Care Aides are encouraged to complete a course review online at www.myseiubenefits.org after each course they take. Course reviews allow the Training Partnership to make adjustments in course content and instructors. Your feedback is taken seriously.

How do you submit a course review? Course

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

reviews are available on your student profile.

1. When a course has been completed, login to the online learning portal, look at the “Completed Training” box, and click the “Review Now” link for the course you wish to review.

2. Complete the form, and click the “Submit Answers” button below the form.

2012-2013 BENEFITS BOOK

23

TRAINING STANDARDS 24

MYSEIUBENEFITS.ORG

www.yes1163.com

TRAINING STANDARDS

TRAINING STANDARDS UPDATED JUNE 2012 The passage of Initiative 1163 in November 2011 reinstated the comprehensive training and certification standards for most new Home Care Aides (exempting those caring for a parent or child). These higher standards had been suspended in July 2011.

Home Care Aides who have already taken Basic Training will not need to take the more in-depth training.

Training standards vary for different types of workers. Be sure to check your own training standards through the online wizard and see the training standards chart on Page 26.

Training Wizard As training standards change, you may wonder: “How do I know what my training standards are?” The Training Partnership has a convenient and easy online Training Wizard to help. The Wizard – in addition to the Training Standards Chart on Page 26 - will help you understand the training you need.

Go to www.myseiubenefits.org/wizard to get started!

Basic Training Curriculum Different types of workers have different Basic Training standards. Basic Training is the introductory training you take to understand the fundamentals of Home Care Aide work.

Continuing Education Different types of workers have different Continuing Education standards.

The Training Partnership provides quality instructor-led and online Continuing Education (CE) classes across the state. Continuing Education is ongoing or refresher training covering a broad range of subjects. You choose the ones that are most suited to your interests and the consumers you serve.

2012-2013 BENEFITS BOOK

25

26

MYSEIUBENEFITS.ORG

Completed prior to providing care

Completed prior to providing care

Completed prior to providing care

Not required

Not required

Not required

Completed prior to providing care

Completed prior to providing care

Completed prior to providing care

Completed prior to providing care

Individual Providers or Agency Providers hired before 1/7/2012

Credentialed AP (per RCW 18.88B.041)

Credentialed IP (per RCW 18.88B.041)

Parent Individual Provider (HCS/AAA)

Parent DD IP (DDD)

Limited Service Provider

Adult Child Individual Provider (HCS/AAA/DDD)

Completed prior to providing care

Not required

Not required

Not required

Completed prior to providing care

Completed prior to providing care

Individual Provider (IP)

Completed prior to providing care

Completed prior to providing care

Safety Training 3 Hours

Agency Provider (AP)

Orientation 2 Hours

Within 120 days of employment

Within 120 days of employment

Not required

Within 120 days of employment

Not required

Not required

Not required

Not required

Not required

Accelerated Basic Training 30 Hours

UPDATED JUNE 2012

ORIENTATION AND SAFETY

TRAINING STANDARDS

Not required

Within 120 days of employment

Not required

Not required

Not required

Not required

Not required

Not required

No

As of 7/1/2012, 12 credits/year by your birthday. Use training wizard at www.myseiubenefits.org/wizard or call the MRC to see your requirement.

No

Not required, unless voluntarily certificed as a HCA. Not required

No

No

Not required, unless voluntarily certificed as a HCA.

Within 120 days of employment

12 hours/year by birthday

No

Not required, unless voluntarily certificed as a HCA. Not required

Not required

No

No

Yes

12 hours/year for the renewal of certification

12 hours/year by their birthday

Yes

HCA Certification Required?

12 hours/year for the renewal of certification

Continuing Education 12 Hours

CONTINUING EDUCATION

12 hours/year by their birthday Not required

Not required

Not required

Not required

Within 120 days of employment

Not required

Parent Provider (DDD Only) Class 7 Hours

Basic Training 70 Hours

BASIC TRAINING

Effective Jan. 7, 2012

HOME CARE AIDE CATEGORIES

The Training Partnership provides training to a variety of Home Care Aides (HCA).

The chart below describes the different categories of HCAs. Provides care to a consumer living in his or her home.

Employed by a private homecare agency or DSHS.

Agency Provider (AP)

Provides care to a consumer living in his or her home.

Employed by a private homecare agency.

Certified Home Care Aide

Individual Provider (IP)

Provides care to a consumer living in his or her home having successfully passed the DOH certification exam. Employed by a private homecare agency or DSHS. Provides care to a consumer living in his or her home.

Employer of record is DSHS.

Credentialed Agency Provider

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

Credentialed Individual Provider

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

Parent Individual Provider (HCS/AAA)

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

Parent DD Individual Provider (DDD)

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

Limited Service Provider (HCS/AAA/DDD)

This is any IP who provides care 20 hours a month or less for one consumer.

Adult Child Individual Provider

TRAINING STANDARDS

Home Care Aide (HCA)

An adult child providing care for his/her biological, step or adoptive parent.

2012-2013 BENEFITS BOOK

27

WHO TO CONTACT FOR TRAINING SUPPORT Agency Providers individual providers

Class registration and rescheduling

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

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

Agency Providers (Catholic Community Services Agency Provider, CDM)

Website or MRC

Website or MRC

Your Employer

Your Employer

How to complete your Website or MRC training

Website or MRC

Your Employer

Your Employer

Username and Website or MRC Password assistance

Website or MRC

Website, MRC or Employer

Your Employer

Confirmation Code

Website or MRC

Website or MRC

MRC

Your Employer

Requesting a student ID

Website or MRC

Website or MRC

MRC

Your Employer

Requesting a certificate

See Next Page

See Next Page

See Next Page

See Next Page

Confirming class schedule

Website or MRC

Website or MRC

Website, MRC or Employer

Your Employer

Training requirement Primary DSHS Contact Your Employer and deadlines

Your Employer

Your Employer

Questions about payment

Primary DSHS Contact Your Employer

Your Employer

Your Employer

Change of address

Primary DSHS Contact Your Employer

Your Employer

Your Employer

Change in training standards due to change in employment status

Primary DSHS Contact Your Employer

Your Employer

Your Employer

28

MYSEIUBENEFITS.ORG

SAFETY AND ORIENTATION If you are in aSEIcategory that requires U HEALTHCAR E NW TRAININ G

The Training PARTNERSH Partnership trains and deve IP care workers lops professi to deliver high onal long-term quality care and people and support with disabiliti to older adul es. ts

either the Training Partnership’s Safety or Orientation training (or both) you should or contracting.

The kit contains the following:

TRAINING STANDARDS

SAFETY & ORIENTATIO N

have received a kit at the time of hiring

1. Instructions on “How to Complete and Receive Credit for

D HELP? CON

TACT THE MEM

Safety and/or Orientation.”

BER RESOUR

1-866-371-32

00

CE CENTER

WWW.MYSEIUBE NEFIT

S.ORG

635 ANDOVER

2. Three DVDs: Orientation, PARK WEST

SUITE 200, TUKW

ILA, WA 98188

SEI U H E A L TR AI NI NG TPAH C A R E N W RT NE RS HI P

Safety Training Part 1, and Safety Training Part 2.

3. Supplemental information titled, “Orientation & Safety – A Reference Tool for Individual Providers.”

Agencies may supplement this training with an agency specific orientation program.

If you did not receive the Safety and Orientation Kit, please contact your employer.

Safety and Orientation Verification Line: 1-866-483-1397

CERTIFICATES Students (and Agency employers and DSHS staff) can now print their own certificates. Once you have completed your training, log in to your account and go to:

1.

2.

That’s it, you’re done! It’s fast and easy and you can do it from home.

2012-2013 BENEFITS BOOK

29

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

The website www.myseiubenefits.org is where you can read important announcements from the Training Partnership, learn about our different programs and ask questions.

On the website, you can register for classes, see your training history and track your progress.

I have a question about wages for training?

Contact your employer or your DSHS case manager.

The Training Partnership cannot answer questions regarding wages.

You can also take online Continuing Education classes by going to this website.

2. How do I log in to www.myseiubenefits.org?

Logging into your account is an easy process from the website.

Follow the instructions on Page 8 to log in.

3. How do I get a Student ID? As a new student you will receive an ID card in the Welcome Packet that is sent to you.

If you do not receive your ID card, please check with your employer to make sure your address is correct. Replacement cards can take up to six weeks to receive. For fastest class check in, bring your student ID card. If you don’t have a student ID card, bring driver’s license, passport, or other legal identification to class.

Refer to the Support chart on Page 28 if you need assistance.

4. How do I change my address with the Training Partnership?

Ensure you are receiving the most current information about your training by updating your contact information with your employer. If you are an Individual Provider, update your information with your primary DSHS contact. If you are an Agency Provider, update your information with your employer.

30

MYSEIUBENEFITS.ORG

FREQUENTLY ASKED QUESTIONS 5. I arrived to class and I am not on the roster, what do I do?

Only registered students and interpreters can attend Training Partnership classes. If you are not on the roster, you will need to reschedule your class.

6. How do I provide feedback about a class?

Your feedback is very important to us and we want to know about your class experience with the Training Partnership. You can complete a course review after attending a class by going to www.myseiubenefits.org.

For more information on submitting feedback, see Page 23.

7. How do I get my training certificate?

POLICIES

You now have access to printing your own certificate at any time. Once you’ve completed all your training requirements, you can log on your record on the Website www.myseiubenefits.org and get your certificate of completion at your convenience.

Refer to the Certificate section on Page 29 if you need assistance.

8. I have a question about wages for training.

Contact your employer or your DSHS contact. The Training Partnership cannot answer questions regarding wages.

‘‘

The class on mental health really helped me understand the issue better and gave me tools. I feel more prepared to help my client with mental health issues now.

– Marcos, Training Partnership Student

2012-2013 BENEFITS BOOK

31

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

Class Registration •

Students need to be registered for class and on the class roster in order to take a class.

•

If you have not previously registered for a class, you will not be able to take the class.

•

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

Only Registered Students and Interpreters are Allowed in Class •

The only people allowed in class are registered students and registered interpreters.

•

Students may not bring consumers, children, or any other visitors to class.

Classes Start On Time •

If you arrive to class after the start time, you will be considered late, you will need to reschedule your class.

•

You should arrive to class 15 minutes before the start time to avoid being late.

Bring Picture ID

32

•

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

•

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

MYSEIUBENEFITS.ORG

CLASSROOM POLICIES Student Participation •

Students are expected to fully participate in the learning experience.

•

Personal phone calls or other personal matters should be taken care of during breaks.

Class Cancellation •

A student will need to cancel class registration at least 72 hours in advance of the class time.

•

If the Training Partnership has to cancel a class, a notification of the class cancellation will be sent to you based on the communication preference in your online profile. The Training Partnership will work with you to reschedule the class.

•

POLICIES

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

Appeals Process •

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

•

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

Inclement Weather •

If the Training Partnership has to cancel a class due to inclement weather, a notification of the class cancellation will be sent based on the communication preference in your profile. The Training Partnership will work with you to reschedule the class.

2012-2013 BENEFITS BOOK

33

REASONABLE ACCOMMODATION POLICY Policy on Reasonable Accommodation of Students with Disabilities The SEIU Healthcare NW Training Partnership (“Training Partnership”) admits students regardless of race, color, national origin, ethnic origin, gender, age, disability and sexual orientation to all the rights, privileges, programs, and activities generally accorded or made available to students by the Training Partnership.

It does not discriminate on the basis of race, color, national origin, ethnic origin, gender, age, disability and sexual orientation in administration of its training and educational policies, admissions policies, scholarship and loan programs, and other Training Partnership administered programs.

What is Reasonable Accommodation?

Reasonable accommodation means modifying or adjusting practices, procedures, policies, educational services and delivery, or the training environment so that a student with a disability can enjoy equal educational opportunity, so long as (1) there is sufficient medical evidence establishing a relationship between the disability and the need addressed by the specific accommodation; and (2) it does not impose an undue hardship on the Training Partnership.

Students with disabilities have the right to request and receive reasonable accommodation so that students may have the opportunity to take full advantage of the Training Partnership’s programs and activities.

When is a person regarded as having a disability?

For purposes of accommodation, a person is regarded as having a disability if he or she has a sensory, mental, or physical impairment that is medically cognizable or diagnosable or exists as a record or history or is perceived to exist.

What is Reasonable Accommodation?

Reasonable accommodation means modifying or adjusting practices, procedures, policies, educational services and delivery, or the training environment so that a student with a disability can enjoy equal educational opportunity, so long as (1) there is sufficient medical evidence establishing a relationship between the disability and the need addressed by the specific accommodation; and (2) it does not impose an undue hardship on the Training Partnership.

34

MYSEIUBENEFITS.ORG

REASONABLE ACCOMMODATION POLICY What is Undue Hardship?

Undue hardship means, among other things, an excessively costly, extensive, substantial or disruptive modification or one that would fundamentally alter the nature or operations of the Training Partnership or its programs.

Overview of Accommodation Process To request reasonable accommodation, a student with a disability should request accommodation from the Training Partnership by completing the “ADA Request Form� found at www.myseiubenefits.org/ADA_policy or by calling the Member Resource Center. Once the request is received by the Training Partnership, the Accommodation process will start, during which the student will be asked to provide current documentation of his or her disability, the

POLICIES

functional limitations resulting from the disability and recommendations for specific accommodations.

As part of the Accommodation process, the Training Partnership will confer with the student to identify appropriate and reasonable accommodations that may be warranted under the particular circumstances.

The Training Partnership has the right to establish qualifications and other essential standards and requirements for its courses, programs, activities and services. All students are expected to meet these essential qualifications, standards, and requirements with or without reasonable accommodations.

More detailed information on the Accommodation process can be found at www.myseiubenefits.org/ADA_policy.

2012-2013 BENEFITS BOOK

35

HEALTH BENEFITS 36

MYSEIUBENEFITS.ORG

AFFORDABLE HEALTH BENEFITS FOR YOU For eligible Individual Providers and Agency Providers, the Health Benefits Trust is a nonprofit organization providing affordable health coverage focused on keeping you healthy. The health care benefits offered by the Health Benefits Trust are part of a community of care that starts with the wellness of you, the Home Care Aide.

2012-2013 Benefits Plan The Health Benefits Trust designed the 2012-2013 benefits, which took effect on Aug. 1, 2012, to fulfill the following goals: • • • •

Lower out-of-pocket costs for Home Care Aides Emphasis on preventive care to encourage wellness Increased participation in health risk assessments Higher use of urgent care facilities in urgent situations that don’t require emergency-room care

• •

Encouraging convenient, lower-cost prescriptions through mail order

HEALTH BENEFITS BASICS

•

Making mail prescriptions for some chronic conditions free Encouraging use of in-network providers

The 2012-2013 benefits plan accomplishes those goals and allows for the continuation of affordable, quality benefits for all eligible Home Care Aides.

You may be eligible if you worked 86 hours in each of the previous three months. Your coverage will begin the first of the second month after you become eligible and enroll. For example, if you begin work in January and work more than 86 hours in January, February and March, you will be come eligible to enroll in April and your coverage will start on May 1. Once enrolled in health coverage, your coverage will continue as long as you work at least 86 hours every month and pay your monthly co-premium.

How to Enroll n Individual Providers: You can enroll by logging in to www.myseiubenefits.org and by filling out the enrollment form.

Call the Member Resource Center toll-free at 1-866-371-3200 to get answers to your questions about eligibility for benefits.

n Agency Providers: Contact your employer for assistance and enrollment information.

2012-2013 BENEFITS BOOK

37

Participating Employers Washington employers whose employees are eligible for benefits through the Health Benefits Trust. NOTE: This list may change, check with your employer to verify participation.

AAA Residential Services Addus Healthcare Amicable Healthcare Catholic Community Services (Agency Provider) CDM Chesterfield Healthcare Concerned Citizens Full Life Home Care Services of Montana

KWA Lower Columbia CAC Olympic CAP Coastal CAP ResCare Senior Life Resources Northwest State of Washington (employer of record) Visiting Nurse Home Care

Eligibility and Enrollment How many hours do I have to work for continuing coverage?

After your coverage begins, you must work at least 86 hours each month to have continuous coverage.

How do I enroll?

Individual Provider: Log on to www.myseiubenefits.org to complete enrollment or call the Member Resource Center at 1-866-371-3200.

Agency Provider: Contact your employer to coordinate your enrollment.

38

MYSEIUBENEFITS.ORG

BENEFITS BASICS Home Care Aides get the following comprehensive benefits through the Health Benefits Trust:

Medical Nobody ever plans to get sick, but the Health Benefits Trust has you covered.

Depending on where you live, your medical, vision and prescription drug coverage will be provided by Group Health or Kaiser Permanente. You pay very little out-of-pocket for the following services: • • • • • • •

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

• • • • • •

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

Vision •

Hardware, such as glasses and contacts

HEALTH BENEFITS BASICS

•

Routine exams

Prescription Drugs • •

Generic drugs Brand-name drugs

Dental The Health Benefits Trust helps with routine dental care as well as dental emergencies. Dental benefits are provided by Delta Dental and Willamette Dental.

Preventive care: There is no annual deductible for preventive procedures. Covered procedures include check-ups, cleanings and X-rays.

Basic procedures: Covered procedures include fillings, oral surgery, periodontics (gum disease) and endodontics (root canals).

HOW MUCH DOES IT COST? The Health Benefits Trust works hard to keep your out-of-pocket costs low. You pay $25 per month toward the premium for medical/prescription/vision and dental coverage. You cannot enroll for only medical or only dental coverage.

Major procedures: Covered procedures include crowns, dentures and bridges.

2012-2013 BENEFITS BOOK

39

2012-2013 Medical Plan Highlights • • • • • •

Prescriptions for some value-based drugs will be free using mail order services Office visit co-pay will change from $10 to $15 Prescription/Rx co-pays will be cheaper (except for nonformulary brand name drugs) Self-Insured Dental network will change to Delta Dental (Washington Dental Service) All changes are effective 8/1/2012 Your $25 monthly payroll deduction will stay at $25

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

Your Current Insurance Plan If you are currently enrolled in the Trust, you are enrolled in one of the following plans depending on your ZIP code: Group Health POS – you live within 30 miles of a Group Health Medical Center or contracted facility Group Health PPO – you live more than 30 miles from Group Health Medical Center or contracted facility Kaiser Permanente HMO – you live within the Kaiser Permanente service area (southwest Washington/ Portland, OR only)

If You Enroll for Coverage Effective 8/1/12 or Later If you enroll for coverage effective 8/1/12 or later and you live within 30 miles of a Group Health Medical Center of contracted facility, you will be covered under Group Health Options Select - HMO Plan. This plan only has coverage in-network. There are no out-of-network benefits.

Understanding Health Insurance Terms Co-pay The amount you will pay at the time of your visit.

Deductible The amount that you pay for covered services before the plan begins paying in a given year. You need only to satisfy your deductible once in a calendar year.

40

MYSEIUBENEFITS.ORG

In-network You don’t have to pay as much when you use this group of providers. HMO: You only have coverage in-network.

Out-of-network A bigger group of providers where you may access care but your out of pocket expenses will be higher than with in-network providers.

Health Profile = $25 for you Fill out your Health Profile, offered by Group Health Options or the Total Health Assessment, offered

by Kaiser Permanente and the Health Benefits Trust will send you a check for $25! Good for your health, good for your wallet.

A Little More About These Changes The Office Visit Co-pay will increase from $10 to $15. However, preventive care visits will continue with a $0 co-pay.

Insurance Carrier for Dental

The Trust’s self-insured dental plan will be administered by Delta Dental (Washington Dental Service) instead of Premera Blue Cross. To receive the highest level of benefits, you should choose a Delta Dental PPO Provider. You also have a choice of dental insurance plans: Delta Dental (Washington Dental Service) or Willamette Dental. There are no changes to the dental benefits for either dental programs.

Group Health: No Cost for Value Based Prescriptions by Mail The Rx co-pay will be lowered for value based drugs that treat diabetes, high blood pressure, high cholesterol and heart failure. The co-pay will also be lowered for other generic drugs, and formulary brand name drugs. However, if you choose to use brand name drugs that are not a part of Group Health or Kaiser’s formulary, your co-pay will increase to $50.

HEALTH BENEFITS BASICS

Use Mail Order for your Prescriptions: You will have the lowest co-pay, or no co-pay, by using mail order prescription drugs.

Prescription/Rx Co-Pay Grid Rx Co-pay

Current

Effective 8/1/12

(In-network) for 30 day supply

Effective 8/1/12 Mail order

Value Based Drugs* Group Health

$15

$4

$0

Kaiser

$15

$5

$10 for 90 day supply

Generic drugs Group Health

$15

$8

$3

Kaiser

$15

$5

$10 for 90 day supply

Formulary brand name drugs Group Health

$30

$25

$20

Kaiser

$30

$25

$50 for 90 day supply

Non-formulary brand name drugs Group Health

$30

$50

$45

Kaiser (requires approval)

$30

$50

$100 for 90 day supply

Value Based Drugs are for Diabetes: metformin, glipizide, glyburide, insulin NPH High Cholesterol: simvastatin, lovastatin, pravastatin Heart Failure: carvedilol, metoprolol XL, spironolactone High Blood Pressure: hydrochlorothiazide, chlorthalidone, lisinopril, enalapril, captopril, ramipril, lisinopril/HCTZ, amlodipine, verapamil, diltiazem, metoprololIR, atenolol

2012-2013 BENEFITS BOOK

41

Plan and Network Grid

WHICH PLAN AND NETWORK APPLIES TO ME? New Plan Group Health Options Select – HMO Plan for members who enroll 8/1/2012 or later Your network is called: “Group Health Options Select” If you are enrolling effective 8/1/2012 or later, you will be automatically enrolled in this plan if you live within 30 miles of a Group Health Facility or Contracted Provider.

Group Health “Options Select” – POS Plan

Group Health “Options” – PPO Plan

if you have been previously enrolled prior to 8/1/2012 and are re-enrolling: Your network is called: “Group Health Options Select” If you are enrolling effective 8/1/2012 or later, you will be automatically enrolled in this plan if you live within 30 miles of a Group Health Facility or Contracted Provider.

Your in-network is called: “Options” You will be automatically enrolled in this plan if you live farther than 30 miles from a Group Health Facility or Contracted Provider or live in Montana.

Your in-network is called: “Options Select”

All care is provided at Group Health Medical Centers and from other Group Health contracted providers

In-Network care is provided at Group Health Medical Centers and from other Group Health contracted providers

No out-of-network coverage is available.

Out-of-Network care is provided

by First Choice Health Network Providers The First Choice Health Network has an extensive panel of preferred providers in WA, OR, ID, AK and MT.

In-Network care is provided by Group Health Medical Centers; other Group Health contracted providers; First Choice Health Network Providers and Beech Street Providers The First Choice Health Network has an extensive panel of preferred providers in WA, OR, ID, AK and MT. Out-of-Network care is any other licensed provider

Link to look up Group Health Providers http://myseiu.be/imSCSp

Group Health PHARMACY HMO Plan

POS Plan

PPO Plan

Any Group Health Medical Center or contracted community pharmacy.

In-Network: Any Group Health Medical Center or contracted Community Pharmacy

In-Network: Group Health Medical Centers and Med Impact Pharmacies Out-of-Network: All other pharmacies

Out-of-Network: Med Impact Pharmacies

KAISER PERMANENTE If you live in the Kaiser Permanente Service Area (please see FAQ #30) you will be automatically enrolled in this plan. You must access a Kaiser Permanente provider/facility for your care. There is no out-of-network coverage under this plan.

Link to look up Kaiser Permanente Providers http://myseiu.be/mTdBBa

DENTAL PLANS You have a choice of dental plans, however you would only choose Willamette Dental if you lived near a Willamette Dental Clinic.

Delta Dental (Washington Dental Service) PPO Plan

Willamette Dental

In-network: You will have the highest level of coverage by using a Delta Dental PPO dentist. You can find a Delta Dental PPO network dentist by visiting their Web site at www.

DeltaDentalWA.com. Click on the Patients tab and then on the Find a Dentist tab at the top of the screen to begin your search. Choose the “Delta Dental PPO” option for participating dentists under the In a Certain Plan or Network.

Be sure to check the Delta Dental PPO network.

Coverage for this plan is only offered at Willamette Dental Clinics. You can find the locations of Willamette Dental clinics by visiting www. willamettedental.com. Click on the Locations tab for your state.

For dentists outside of Washington state, click on the green “search the national Delta Dental directory” link. This will take you to the national directory.

42

MYSEIUBENEFITS.ORG

Medical Plan Highlights 2012-2013 BENEFIT

IN-NETWORK

OUT-OF-NETWORK POS PLAN ONLY

Preventive Care

Covered In Full

Covered in full up to $300; 80% covered

Covered In Full

$500 deduct, 80% Covered

Group Health

$15

$15 co-pay, deductible and coinsurance apply

Kaiser

$30

No out-of-network allowed

$200 co-pay

$200 co-pay

Group Health

$0

$500 and services may not be covered depending on your plan

Kaiser

$0

Not allowed

Mammograms

NOTES

Routine mammograms

Urgent Care

Emergency Room

Waived if admitted

Out-of-Network Deductible

No out-of-network allowed

2012-2013 BENEFITS BOOK

43

44

MYSEIUBENEFITS.ORG

Group Health Urgent Care Centers Seven Group Health medical centers have Urgent Care Centers, most with evening, weekend, and holiday hours. Use the Group Health Provider Directory at www.ghc.org to find urgent care providers in other areas. You can also find urgent care locations, hours and wait times from the Group Health iPhone and Android App. Call the Consulting Nurse Line at 1-800-297-6877 for the nearest location.

Olympia Medical Center 700 Lilly Road N.E. Olympia, WA 98506 360-923-7740 Mon.-Fri. 8 am-11 pm Weekends 9 am-7 pm

Everett Medical Center 2930 Maple St. Everett, WA 98201 425-261-1660 Mon.-Fri. 4:30 pm-8 pm Sat. 9 am - 3:30 pm Sun. 9 am - 12:30 pm

Seattle Capitol Hill 201 16th Ave. E. Seattle, WA 98112 206-326-3175 Open 24 hours a day, 7 days a week Silverdale Medical Center 10452 Silverdale Way NW Silverdale, WA 98383 360-307-7300

Saturday Clinics - 9 a.m.-12:30 p.m.

In addition to the Centers above, these clinics are for minor injuries or issues that require immedidate attention.

Mon.-Fri. 3-11 pm Weekends 11 am-7 pm Spokane Riverfront 322 North River Drive Spokane, WA 99201 509-324-6464 Mon.-Fri. 1-9 p.m.

Weekends 9 a.m.-9 p.m.

Tacoma (coming in Fall 2012) 209 MLK Jr. Way Tacoma, WA 98405 253-596-3300 Open 24 hours a day, 7 days a week

URGENT CARE SAVES MONEY $200 vs. $15

Bothell-Northshore 11913 N.E. 195th St. Bothell, WA 98011 425-489-3100

Lynnwood 20200 54th Ave. W. Lynnwood, WA 98036 425-672-6400

Burien 140 S.W. 146th St. Burien, WA 98166 206-901-2400

Renton 275 Bronson Way N.E. Renton, WA 98056 425-235-2800

Federal Way 301 S. 320th St. Federal Way, WA 98003 253-874-7000

Seattle-Northgate 9800 4th Ave. N.E. Seattle, WA 98115 206-302-1200

The out-of-pocket cost for a trip to the emergency room is $200 (waived if you are admitted to the hospital) vs. just $15 for a trip to Urgent Care with Group Health and $30 with Kaiser.

2012-2013 BENEFITS BOOK

45

HEALTH BENEFITS BASICS

Bellevue Medical Center 11511 N.E. 10th St. Bellevue, WA 98004 425-502-4120 Open 24 hours a day, 7 days a week

46

MYSEIUBENEFITS.ORG

Dental Benefits Healthy teeth and gums are a critical part of your overall health. That’s why comprehensive dental benefits are included in the coverage you receive through the Health Benefits Trust.

To keep your teeth healthy, your dental benefits include at no additional cost to you for in-network services: •

Routine exams

•

Regular cleanings

•

X-rays

•

Gum care

•

Fillings

Did You Know?

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

Depending on your plan, some of the cost of the following procedures may also be covered: Crowns, inlays

•

Dentures

•

Implants

HEALTH BENEFITS BASICS

•

To take the best care of your teeth, gums and overall health, you should see your dentist every six months for a complete exam and cleaning.

Vision Benefits Keeping your eyes healthy and regularly updating optical prescriptions are important to your overall health and well being. Vision benefits through the Health Benefits Trust are an affordable way to ensure your sight is protected.

Did You Know?

As part of a complete wellness plan, everyone should have regular eye exams, even if you’re not having problems with your vision.

• For a $15 co-pay per visit, you receive routine vision care.

• Every two years you receive $200 worth of optical supplies, including contact lenses and frames.

2012-2013 BENEFITS BOOK

47

WELLNESS 48

MYSEIUBENEFITS.ORG

YOUR WELLNESS Working Together To Keep You Healthy As a Home Care Aide, you know how important it is to stay healthy. With the benefits you receive from the Health Benefits Trust, you have excellent health care, dental and vision benefits at a low cost.

There are three things we can all do to ensure that health care for Home Care Aides continues for years to come: •

Keep ourselves healthy

•

Keep out-of-pocket costs low

•

Help control health care costs (for example through limiting use of the emergency room, using mail order, generic prescriptions) so we do not have to pay more next year

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

Making your first appointment with a Primary Care Provider (and earning $10!)

•

Using urgent care vs. the emergency room when appropriate

•

Managing prescriptions

•

Completing a Health Profile or Assessment (and earning $25!)

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

WELLNESS

Healthy Home Care Aide

URGENT CARE

URGENT CARE

URGENT CARE See a Primary Care Provider

Health Profile or Assessment

Find Urgent Care Centers

Manage Your URGENT CARE Prescriptions

Find a doctor, set up your first visit

Fill out an easy online quiz

Locate the centers near you

Earn $10! See P. 50

Earn $25! See P. 51

Transfer prescriptions to your provider, use mail order

2012-2013 BENEFITS BOOK

49

1

See a Primary Care Provider

One of the most important things for you to do is to select a Primary Care Provider and set up your first visit. A strong relationship with your Primary Care Provider is at the heart of your care, and helping you stay healthy.

How to Select Your Primary Care Provider Go Online: Use the provider directory at www.ghc.org URGENT CAREor www.kp.org to find a personal physician who’s a good match for you. or Call: Group Health Customer Service at 1-888-901-4636 Kaiser Permanente Customer Service at 1-800-813-2000

Make an Initial Primary Care Appointment = Earn $10!

Establishing a relationship with your Primary Care Provider is important to your health. If you complete a preventive care/wellness visit with your Primary Care Provider within the first three months of your coverage effective date, the Health Benefits Trust will pay you $10. You can only receive this benefit once.

What’s a Primary Care Provider?

A Primary Care Provider is a family practice, general practice, internal medicine, or pediatrics physician who provides most of a member’s primary care. A PCP helps coordinate a member’s specialty care.

50

MYSEIUBENEFITS.ORG

DID YOU KNOW? Your out-of-pocket expenses are much less when you use in-network providers. Assuming you have four office visits this year, your out-of-pocket expenses using a Group Health provider would be $60 vs. $500 or more with an out-of-network provider.

2

Complete a Health Profile How Healthy are You? Filling out an easy health quiz called a Health Profile or Health Risk Assessment will help you find out!

•

What are your daily eating habits?

•

How often do you exercise?

•

How often do you drink alcohol?

URGENT to CARE Find out how the answers questions like these affect your health.

Your Health Profile (Group Health) or Total Health Assessment (Kaiser) are online quizzes to help you and your doctor take better control of your health.

Filling out a Health Profile is a key step on the path to better health.

Fill out a Health Profile, Earn $25!

Home Care Aides who complete a Group Health Profile or Kaiser Permanente Total Health Assessment will receive a $25 check from the Health Benefits Trust. You will receive a check within 6–8 weeks of submitting your health profile. You can also fill out a paper version of the profile by contacting your provider.

WELLNESS

Register for MyGroupHealth for Members at ghc.org To access the Health Profile, you need to upgrade your MyGroupHealth account so you have access to online services.

To register, visit www.ghc.org or call Website Customer Service at 1-888-874-1620.

Register for Kaiser Online Access Using Kaiser online access, you can fill out your Total Health Assessment. Register at www.kp.org 2012-2013 BENEFITS BOOK

51

3

Locate Closest Urgent Care Center

It is important to locate your Urgent Care Center in

URGENT CARE

advance because in the event you need urgent care, it is often a difficult time to look for an Urgent Care Center.

When to Use Urgent Care vs. Emergency Room Here are some examples of when to use urgent care or the emergency room. This is not intended to be a complete list.

URGENT CARE - $15 per visit Allergies Asthma Attack (Minor) Cold, Flu, Fever Cough Dizziness Fractures Nausea Minor Burns Minor Cuts/Lacerations Sore Throat Sprains Stitches

DID YOU KNOW? Urgent Care is a much more affordable option for Home Care Aides through the Health Benefits Trust. The out-of-pocket cost for a trip to the emergency room is $200 (waived if you are admitted to the hospital) vs. just $15 for a trip to Urgent Care with Group Health Options and $30 with Kaiser.

52

MYSEIUBENEFITS.ORG

EMERGENCY ROOM - $200 per visit (waived if admitted) Chest Pain Compound Fractures (Bone Visible) High Fever Ingestion of Poison Major Head Injury Seizures Severe Asthma Attack Severe Burns Shock Uncontrollable Bleeding

Where to Find Urgent Care GROUP HEALTH: Many Group Health medical clinics have Urgent Care Centers, most with evening, weekend, and holiday hours. Use the Provider Directory online to find urgent care providers in other areas.

Find an Urgent Care Center at www.ghc.org or call 1-888-901-4636.

KAISER: Find an Urgent Care Center at www.kp.org or call 1-800-813-2000.

Manage Your Prescriptions

4

Your prescriptions are a big part of your health benefits.

Make the most of them by managing them wisely.

Transfer Prescriptions If you have existing prescriptions, have them transferred to Group Health or Kaiser Permanente to receive the best benefit from your coverage.

URGENT CARE

Mail Order Prescriptions

Getting your prescriptions by mail does not cost any more than the co-pays.

Group Health members get a co-pay discount of up to $5 vs. filling your prescription at the pharmacy. Kaiser members can obtain 3 months supply for only 2 co-pays vs. 3 co-pays at the pharmacy.

New Prescription Benefit: Value-Based Prescriptions Free for You For some Value-Based prescriptions through Group Health, there is no co-pay when you have drugs mailed to you through convenient mail order services. See Page 41 for a list of the prescriptions available for this benefit.

WELLNESS

How to Transfer Your Prescription Group Health: Go online to www.ghc.org to transfer your prescription or call Customer Service at 1-888-901-4636.

Kaiser Permanente: Go online to www.kp.org or call Customer Service at 1-800-813-2000.

How to Set Up Mail Order Prescriptions Group Health: After setting up an online account you can order refills online or by phone and have them mailed to you – free of charge.

Kaiser Permanente: After setting up an online account you can order refills online and have them mailed to you – free of charge.

2012-2013 BENEFITS BOOK

53

54

MYSEIUBENEFITS.ORG

HEALTH BENEFITS QUICK START Check Your Eligibility for Health Benefits •

You must work at least 86 hours per month for three consecutive months to be eligible for these benefits. You do not need to wait until you are eligible to enroll, you can complete the form after you’re hired.

Enroll n Individual Providers: You can enroll by logging in to

URGENT CARE

www.myseiubenefits.org and filling out the enrollment form.

n Agency Providers: Talk with your employer about enrollment.

Look for Your ID Card After you are eligible and enroll you should receive an ID card in the mail. You will need the ID card number to access your benefits. If you do not receive the card by the 10th of the month that your coverage starts, call the MRC at 1-866-371-3200 if you are an Individual Provider or, if you are an Agency Provider, talk with your employer. Look for and write down your nearest Urgent Care Center and keep it with your card for reference.

Fill Out Your Health Profile The Health Profile is an online quiz and report to help you manage your health. To help encourage participation, you will receive a check for $25 for filling it out. If you do not have computer access, you can fill out the profile in paper format as well.

URGENT CARE

Make a Primary Care Appointment Use the online provider directory at www.ghc.org or www.kp.org to find a primary care doctor who’s a good match for you. You will receive $10 for attending a primary care appointment within the first three months of your coverage.

Locate Your Nearest Urgent Care Center URGENT CARE

As soon as possible, you should identify the closest urgent care center to you in case of an emergency. You can find urgent care centers online at www.ghc.org or www.kp.org.

Manage Your Prescriptions If you have existing prescriptions, have them transferred to Group Health or Kaiser Permanente. Next, set up mail order prescription refills online to save money and save time.

URGENT CARE

2012-2013 BENEFITS BOOK

55

WELLNESS

URGENT CARE

FREQUENTLY ASKED QUESTIONS COVERAGE BASICS 1. When I am outside Washington state or the United States am I covered by the plan?

Yes, but you must contact the health insurance provider for specific benefits and claim submission procedures at: Group Health 1-888-901-4636 Kaiser 1-800-813-2000 Delta Dental 1-800-554-1907 Willamette (contact the clinic where the services were provided) 2. Can I add dependents to my plan?

n Individual Provider: Dependents are not covered. The Individual Provider benefits do not allow coverage for dependents under this plan.

n Agency Provider: If you are covered by the Health Benefits Trust, you can cover dependents by paying the full premium for them through payroll deduction. Dependents can only be added when they are initially eligible or during the annual open enrollment period. Check with your employer for information.

3. How do I cancel my coverage and the corresponding paycheck deductions?

The request must be made in writing and sent to the Health Benefits Trust via fax or U.S. Mail. Fax to 206-859-2637 or mail to SEIU Healthcare NW Health Benefits Trust PO Box 6, Mukilteo, WA 98275. Requests in writing received before the 15th of the month will stop further payroll deductions.

4. If I haven’t received an ID card, who do I call?

Allow up to 10 days after your coverage begins for processing and mailing your ID cards. After you enroll and are eligible you should receive an ID card in the mail. You will need the ID card number to access your benefits. If you do not receive the card by the 10th of the month that your coverage starts, call the MRC at 1-866-371-3200 if you are an Individual Provider or if you are an Agency Provider, talk with your employer. Look for and write down your nearest Urgent Care Center and keep it with your card for reference.

5. Is dental or vision coverage included with this plan?

Yes. Vision coverage is part of your medical plan administered by your medical health insurance provider – Group Health or Kaiser. You have the choice of dental coverage either through Delta Dental or Willamette.

6. Is there a pre-existing condition waiting period?

No.

56

MYSEIUBENEFITS.ORG

FREQUENTLY ASKED QUESTIONS ELIGIBILITY 7. Can I use authorized, unclaimed hours from a previous month to satisfy my hour requirement in a subsequent month?

No. For the purpose of health care insurance eligibility, hours are only applicable to the month in which they are authorized, not when they are claimed or paid.

8. How do I enroll for coverage?

n Individual Provider: Log on to www.myseiubenefits.org to complete enrollment or call the Member Resource Center at 1-866-371-3200.

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

n Agency Provider: Contact your employer to coordinate your enrollment.

n Agency Provider: Contact your employer to coordinate your enrollment.

9. How many hours do I have to work for continuing coverage?

After your coverage begins, you must work at least 86 hours each month to have continuous coverage.

10. I don’t have enough hours some months resulting in a lapse in coverage, do I have to meet the initial eligibility requirements again?

If you are not covered by the plan for 12 months in a row, you will need to requalify for the initial eligibility requirements.

11. I work for a Home Care Agency and I’m also an Individual Provider. If I’m currently enrolled in my agency employer’s plan, can I terminate that coverage and enroll in the Health Benefits Trust as an Individual Provider instead of keeping my agency plan?

Yes, but please keep in mind the initial eligibility requirements when determining your cancellation date. You’ll need to keep your current plan until your coverage as an Individual Provider begins. NOTE: You cannot be covered under both the Health Benefits Trust as an Individual Provider and another employer’s plan.

12. What happens if I work less than 86 hours in a month after I am enrolled in the plan?

For all Grandfathered Agency Providers - (this means you were an Agency Provider and must have had health care coverage by the Trust in the month of September 2011).

POLICIES

Your coverage will terminate the first day of the following month.

2012-2013 BENEFITS BOOK

57

FREQUENTLY ASKED QUESTIONS Example: If you work less than 86 hours in May, your health care coverage will end that month and you will NOT have coverage starting June 1st.

For all Individual Providers and all Non-Grandfathered Agency Providers Your coverage will continue for one month and end the first of day of the second month.

Example: If you work less than 86 hours in May, you WILL have health care coverage in June, but you will NOT have coverage starting July 1st.

If you lose coverage, you may choose to pay the full monthly (COBRA) premium out of pocket. In this case, the Health Benefits Trust will send you a COBRA notice and election form explaining your coverage option and the cost.

13. When can I submit my enrollment form for coverage?

n Individual Provider: You should enroll as soon as you have authorization to work as an Individual Provider.

n Agency Provider: Contact your employer to coordinate your enrollment.

MISCELLANEOUS 14. I am an Individual Provider. What if I report my hours to Social Service Payment System (SSPS) so late that they don’t make the $25 deduction from my check?

You will need to notify the Health Benefits Trust and mail in a check or money order for $25 payable to SEIU Healthcare NW Benefits Trust, PO Box 6, Mukilteo, WA 98275. You will also need to send a copy of your paycheck stub (aka Remittance Advice) and invoice showing you claimed at least 86 hours for that month.

It is very important to report your hours to SSPS in a timely manner to avoid having to make a payment by mail. Your health insurance provider may not be able to verify your eligibility and your coverage will be considered lapsed until we receive your check and supporting documentation.

15. Can I be covered by another plan at the same time that I’m enrolled in the Health Benefits Trust Plan and use it as secondary coverage?

Participants may not have comprehensive health care benefits or insurance through other individual, family, employment-based, military or veterans coverage or insurance.

16. How do I notify you that my address has changed?

A request for an address change must be made to either your DSHS case worker or to Social Service Payment System (SSPS) directly if you are an Individual Pro58

MYSEIUBENEFITS.ORG

Is dental or coverage in with this pl

r vision ncluded lan?

FREQUENTLY ASKED QUESTIONS vider. If you are an Agency Provider, contact your employer to make this change.

17. I currently have coverage, but not through the Health Benefits Trust plan. Can I enroll in the Health Benefits Trust plan if my other current coverage terminates?

Yes. 18. I want to change my dental insurance provider, how can I do this?

Is dental or vision coverage included with this plan?

Yes. Vision coverage is part of your medical plan administered by your medical insurance provider – Group Health or Kaiser.

You have the choice of dental coverage either through Delta Dental or Willamette.

Typically, this is only allowed during the annual open enrollment period that takes place in July of each year and has an August 1 effective date. If you are an Agency Provider, please contact your employer about open enrollment or other location change options available.

If you are an Individual Provider, please call the Member Resource Center tollfree at 1-866-371-3200 about options for changing dental insurance providers.

19. If I cancel my insurance, can I enroll again later?

Yes, but if you have voluntarily cancelled your coverage, you will have to meet the initial eligibility requirements again in order to regain coverage. If you are an Agency provider, you cannot enroll again until the next annual open enrollment.

20. If I have coverage through my spouse, can I cancel that coverage and sign up for the Health Benefits Trust plan?

Yes, but please keep in mind the initial eligibility requirements when determining your cancellation date.

21. What benefit plans are offered by the Health Benefits Trust?

Currently, three insurance providers provide fully insured medical and/or dental coverage and one insurance provider provides self-insured dental coverage.

Providers currently include: Group Health, Kaiser Permanente, Delta Dental Self-insured Dental, and Willamette Dental Group. Trust enrollees are automatically enrolled in the Group Health coverage unless they reside in the Kaiser Permanente service area (southwest Washington and Portland, OR areas). Trust enrollees have a choice of dental insurance providers.

22. What if I am currently on COBRA through another plan? Can I cancel COBRA and enroll?

POLICIES

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

2012-2013 BENEFITS BOOK

59

FREQUENTLY ASKED QUESTIONS 23. What if I have Washington’s Basic Health Plan (BHP) coverage? Can I enroll in this plan?

Only if you cancel your BHP coverage. You cannot have both. There is a place on the Health Benefit Trust’s enrollment application to indicate the termination date of the current coverage.

24. When will my coverage be effective?

n Individual Providers: Call the Member Resource Center at 1-866-371-3200 to determine.

n Agency Providers: Please contact your Human Resources department to coordinate your enrollment.

Group Health Specific Questions

26. What if I don’t want to see any doctors who practice with Group Health Medical Centers?

If you are a new enrollee in the Health Benefits Trust effective 8/1/2012 or later, and you live within 30 miles of a Group Health Medical Center or contracted provider, your health care coverage is only for using Group Health Medical Centers or contracted providers. There is no out-of-network coverage.

For all other enrollees, each time you seek health care services, you can choose to use your in-network providers, or not. Your highest level of benefits ($0 deductible) will be found using in-network providers: Group Health Physicians for the POS (Options) plan and First Choice Health Network / Beech Street Network of Providers for the PPO (Options PPO) plan.

You will pay more out of pocket costs by using an out-of-network provider. For example, you will have a $500 deductible.

27. What does Group Health HMO vs. POS vs. PPO mean?

If you live within 30 miles of a Group Health facility or contracted provider, and your coverage begins 8/1/2012 or later, you will automatically be enrolled in the HMO plan. If you are already enrolled, then your coverage is through the POS Plan.

If you live beyond 30 miles, you will automatically be enrolled in the PPO plan.

In the POS and PPO Plans, you have the choice of in-network or out-of-network providers each time you seek service.

60

MYSEIUBENEFITS.ORG

FREQUENTLY ASKED QUESTIONS 28. How do I look for a provider available to me through Group Health?

For POS Plan (within 30 miles of Group Health facilities): On right hand side of www.ghc.org, under “Find a Doctor or Medical Facility” click on “Provider & Facility Directory”; then click on “Doctors and Other Providers”; then under “*Health plan provider network:” choose “Options PPO” or “Options POS” or “Options Select” (for the HMO plan) For PPO Plan (all others): On right hand side of www.ghc.org, under “Find a Doctor or Medical Facility” click on “Provider & Facility Directory,” click on “Doctors and Other Providers”; then under “*Health plan provider network:” choose Options PPO. Or call Group Health Customer Service toll free: 1-888-901-4636 • Finding a provider • Specific benefit questions • Complex medical care case management • Inpatient care case management

Who do I contact if I have questions about my benefits?

Contact your insurance provider directly for an explanation of benefits and/or questions you have about claims.

Group Health (POS, POS, HMO) 1-888-901-4636 www.ghc.org Kaiser Permanente 1-800-813-2000 www.kp.org Delta Dental (Dental) 1-800-554-1907 www.deltadentalwa.com Willamette Dental 1-800-359-6019 www.willamettedental.com

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

POLICIES

n Agency Providers: Contact your employer

2012-2013 BENEFITS BOOK

61

FREQUENTLY ASKED QUESTIONS Kaiser Permanente Specific Questions 30. What is Kaiser Permanente’s service area?

If you live in any of the following counties/zip codes, your medical coverage will be provided by Kaiser Permanente’s HMO plan.

Washington counties: Clark, Cowlitz, Lewis 98591 98593 98596, Skamania 98639 98648, Wahkiakum 98612 98647 Oregon counties: Multnomah, Polk, Washington, Yamhill 31. Do I have out-of-network coverage under Kaiser Permanente?

No (with the exception of emergency services). To access your comprehensive coverage, you must use a Kaiser Permanente provider/facility. www.kp.org Link to find Kaiser Permanente Providers http://myseiu.be/mTdBBa 32. Kaiser Permanente Membership Services Or call Kaiser Permanente Membership Services toll free: 1-800-813-2000 • • • • • •

Choose a primary care provider Specific benefit questions Complex medical care case management Inpatient care case management Speak to an advice nurse Ask about Kaiser Permanente facilities across the country

33. Register for Kaiser Online Access Where you Can:

62

MYSEIUBENEFITS.ORG

POLICIES

• E-mail your doctor’s office • View select test results • Order prescription refills (and have them mailed to you, with free shipping) • Request or cancel routine appointments • Review recent past office visits • See a list of your recent immunizations and allergies • Act for a family member (e-mail your child’s doctor, and more) • Receive a monthly e-newsletter Register at https://members.kaiserpermanente.org/redirects/register

BENEFIT SUMMARIES The following pages are benefit summaries, only, and are not intended to replace the specifics of the individual plan’s Certificate of Coverage, Contract, or Evidence of Insurance. If there is a contradiction, the Certificate of Coverage, Contract, or Evidence of Insurance will take precedence.

IF YOU HAVE QUESTIONS If you have questions about your plan’s coverage, contact your health insurance provider.

Group Health www.ghc.org 1-888-901-4636 Mon.-Fri., 8 a.m.-5 p.m.

Kaiser Permanente 1-800-813-2000 www.kp.org Delta Dental 1-800-554-1907 www.deltadentalwa.com Willamette Dental 1-800-359-6019 www.willamettedental.com

2012-2013 BENEFITS BOOK

63

WILLAMETTE DENTAL - Benefit Summaries Questions?

1-800-359-6019 www.willamettedental.com

NOTE: This is a benefit summary only and is not intended to replace the specifics of the Self-funded Dental Plan Document. If there is a contradiction, the Plan Document will govern.

64

MYSEIUBENEFITS.ORG

IP Plan & Agency Plan

BENEFIT

CO-PAYMENT

Annual Maximum

No Annual Maximum*

Deductible

No Deductible

General Office Visit

$15 per Visit DIAGNOSTIC AND PREVENTIVE SERVICES

Routine and Emergency Exams

Covered at 100%

All X-rays

Covered at 100%

Teeth Cleaning

Covered at 100%

Fluoride Treatment

Covered at 100%

Sealants

Covered at 100%

Head and Neck Cancer Screening

Covered at 100%

Oral Hygiene Instruction

Covered at 100%

Periodontal Charting

Covered at 100%

Periodontal Evaluation

Covered at 100% RESTORATIVE DENTISTRY

Fillings (Amalgam)

Covered at 100%

Stainless Steel Crown

Covered at 100%

Porcelain-Metal Crown

$250 PROSTHETICS

Complete Upper or Lower Denture

$400

Bridge (per Tooth)

$250 ENDODONTICS AND PERIODONTICS

Root Canal Therapy – Anterior

$85

Root Canal Therapy – Bicuspid

$105

Root Canal Therapy – Molar

$130

Osseous Surgery (per Quadrant)

$150

Root Planing (per Quadrant)

$75 ORAL SURGERY

Routine Extraction (Single Tooth)

Covered at 100%

Surgical Extraction

$100 ORTHODONTIA

Pre-Orthodontic Service Comprehensive Orthodontia

$150** Value Added Services Available MISCELLANEOUS

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

Local Anesthesia (Novocain)

Covered at 100%

Dental Lab Fees

Covered at 100%

Nitrous Oxide

$40 per Visit

Specialty Office Visit

$30 per Visit

Emergency Office Visit

$50 per Visit

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

2012-2013 BENEFITS BOOK

65

Delta Dental – In Service Area Group Name

Delta Dental PPO - Program # 00018 Effective August 1, 2012

Washington Dental Service - Delta Dental PO Box 75983 Seattle, WA 98175-0983 Customer Service (206) 522-1300 Toll-free (800) 554-1907 Monday – Friday 8 a.m. to 5 p.m PST NOTE: This is a brief summary of benefits only and does not constitute a contract. You will receive a benefits booklet that completely details your Delta Dental PPO dental benefits.

Please feel free to call our Customer Service Department if you have any questions.

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

66

MYSEIUBENEFITS.ORG

Benefit Summary

PAYMENT LEVELS Members utilizing “Delta Dental PPO” Dentists

Members utilizing “Non-PPO Dentists”

100%

80%

100%

60%

80%

40%

$1,000

$1,000

$0

$50

Class I - Diagnostic & Preventive Exams, cleanings, x-rays, sealants, fluoride treatment

Class II - Basic Fillings, periodontal maintenance, periodontics, endodontics, oral surgery

Class III – Major Crowns, onlays, dentures, partials, bridges, implants

Maximum per Benefit Period Benefit period: January 1 – December 31

Deductible – Waived on Class I Per person per benefit period

Highlights of Covered Benefits Class I – Diagnostic & Preventive

• Exams (covered twice in a benefit period) • Regular Cleanings (covered twice in a benefit period or up to four times for patients with advanced periodontal disease) • Bitewing X-rays (covered once in a benefit period) Class II - Basic

• Fillings (covered on the same surface per tooth once every two years) • Oral Surgery & Simple Extractions • Periodontics • Periodontal Cleanings (covered twice in a benefit period or up to four times for patients with advanced periodontal disease) • Endodontics (root canals covered once per tooth in a two year period) Class III - Major

• Crowns (covered once in a seven year period per tooth) • Dentures (covered once in a seven year period per tooth) • Bridges (covered once in a seven year period per tooth) • Onlays (covered once in a seven year period per tooth)

2012-2013 BENEFITS BOOK

67

Delta Dental - Out of Service Area Group Name

Delta Dental PPO - Program # 00018 Effective August 1, 2012

Washington Dental Service/Delta Dental PO Box 75983 Seattle, WA 98175-0983 Customer Service (206) 522-1300 Toll-free (800) 554-1907 Monday – Friday 8 a.m. to 5 p.m PST NOTE: This is a brief summary of benefits only and does not constitute a contract. You will receive a benefits booklet that completely details your Delta Dental PPO dental benefits.

Please feel free to call our Customer Service Department if you have any questions.

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

68

MYSEIUBENEFITS.ORG

Benefit Summary

PAYMENT LEVELS Members utilizing “Delta Dental PPO” Dentists

Members utilizing “Non-PPO Dentists”

100%

100%

100%

80%

80%

50%

$1,000

$1,000

$0

$50

Class I - Diagnostic & Preventive Exams, cleanings, x-rays, sealants, fluoride treatment

Class II - Basic Fillings, periodontal maintenance, periodontics, endodontics, oral surgery

Class III – Major Crowns, onlays, dentures, partials, bridges, implants

Maximum per Benefit Period Benefit period: January 1 – December 31

Deductible – Waived on Class I Per person per benefit period

Highlights of Covered Benefits Class I – Diagnostic & Preventive

• Exams (covered twice in a benefit period) • Regular Cleanings (covered twice in a benefit period or up to four times for patients with advanced periodontal disease) • Bitewing X-rays (covered once in a benefit period) Class II - Basic

• Fillings (covered on the same surface per tooth once every two years) • Oral Surgery & Simple Extractions • Periodontics • Periodontal Cleanings (covered twice in a benefit period or up to four times for patients with advanced periodontal disease) • Endodontics (root canals covered once per tooth in a two year period) Class III - Major

• Crowns (covered once in a seven year period per tooth) • Dentures (covered once in a seven year period per tooth) • Bridges (covered once in a seven year period per tooth) • Onlays (covered once in a seven year period per tooth)

2012-2013 BENEFITS BOOK

69

How to use your Delta Dental PPO program The dental plan offered to your group is Delta Dental PPO, a preferred provider plan.

You can choose any dentist – in or out of the PPO network – at the time of treatment.

However, if you select a dentist who is part of the Delta Dental PPO network, you will receive a higher level of benefits and your out-of-pocket expenses may be lower.

Washington Dental Service/Delta Dental in Seattle, Washington, will handle all customer service and claims for your plan. Until you receive your identification card(s), tell your dentist you are covered by Washington Dental Service/Delta Dental and give him or her your employer name and the program number.

Delta Dental PPO dentists You will receive a higher level of benefits by choosing a Delta Dental PPO dentist. Delta Dental PPO dentists complete claim forms and submit them directly to Washington Dental Service/Delta Dental. PPO dentists receive payment based on their lower, pre-approved PPO fees and they cannot charge you more than these fees. You are responsible only for your stated deductible, coinsurance and/or amounts in excess of the program maximums. You can find a Delta Dental PPO dentist in your area by visiting their web site at www.DeltaDentalWA.com. Go to “Looking for a Dentist” and click on “Find a Dentist.” This will bring you to our online dentist directory. For dentists outside of Washington state, click on the green “search the national Delta Dental directory” link under the Mileage section. Be sure to select the Delta Dental PPO plan and follow the prompts.

Non-PPO dentists You are not limited to visiting a Delta Dental PPO dentist. By choosing a non-PPO dentist, your benefits will be paid at a lower benefit level. You may also be responsible for having the dentist complete and sign claim forms. Claim payments to Delta Dental Premier dentists will be based off their maximum allowable fee with Delta Dental. They cannot charge you above these allowable fees. Claim payment for nonparticipating dentists will be based on Delta Dental’s maximum allowable fees for nonparticipating dentists in the state in which services are performed. You will be responsible for any balance remaining.

Please be aware that Delta Dental has no control over nonparticipating dentists’ charges or billing procedures.

Please Note: This is a brief summary of benefits only and does not constitute a contract. You will receive a benefits booklet that completely details your Delta Dental PPO dental benefits. Please feel free to call our Customer Service Department if you have any questions.

70

MYSEIUBENEFITS.ORG

Kaiser Medical Plan B Individual and Agency Providers Summary of Medical Benefits Washington Traditional Plan B Individual and Agency Providers August 1, 2012 through July 31, 2013

All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest.

500 NE Multnomah St., Suite 100, Portland, OR 97232

Questions?

Call Membership Services (M-F, 8 am-6 pm) or visit kp.org Portland area: 503-813-2000 All other areas: 1-800-813-2000 TTY: 1-800-735-2900 Language Interpretation Services, all areas: 1-800-324-8010 NOTE: This is not a contract. This benefit summary does not fully describe your benefit coverage with Kaiser Foundation Health Plan of the Northwest. For more details on your benefit coverage, claims review, and adjudication procedures, please see your Evidence of Coverage (EOC) or call Membership Services. In the case of conflict between this summary and the EOC, the EOC will prevail.

2012-2013 BENEFITS BOOK

71

(Not all services apply to the maximum; refer to your Evidence of Coverage for clarification.)

Kaiser Plan B - Individual and Agency Providers Out-of-pocket Maximum (Not all services apply to the maximum; refer to your Evidence of Coverage for clarification.)

You pay

For one Member

$750 per calendar year

For an entire Family (AP Workers Only)

$2,250 per calendar year

Preventive Care Services

You pay

Prenatal care and first postpartum visit

$0

Immunizations

$0

Preventive tests

$0

Outpatient Services Primary care visit

$15

Specialty care visit

$15

Routine eye exam

$10

Allergy shots and other injections

$5

Urgent Care visit

$30

Emergency department visit

$200 (Waived if admitted)

Outpatient surgery visit

$50

Physician-referred acupuncture and naturopathy visit

$15

Spinal and Extremity Manipulation therapy (after 12 visits, prior authorization needed)

$15

Inpatient Hospital Services $100 per admission

Ambulance Services $75 per transport

Chemical Dependency Services Outpatient Services

$15

Inpatient hospital & residential Services

$100 per admission

Mental Health Services Outpatient Services

$15

Inpatient hospital & residential Services

$100 per admission

Outpatient Durable Medical Equipment (DME), External Prosthetic Devices, and Orthotic Devices 20% Coinsurance

Outpatient Laboratory, X-ray, Imaging, and Special Diagnostic Procedures $0 per department visit; $50 for specialized scans, i.e., MRI, CT, PET

Outpatient Rehabilitative Therapy Services (up to 20 visits per therapy per Calendar Year)

72

Physical, Speech, and Occupational therapies

$15

All other therapies

$15

MYSEIUBENEFITS.ORG

Skilled Nursing Facility Services (up to 100 days per Calendar Year)

$0

Optional Benefits Alternative Care (self-referred)

Not covered

Hearing Aids

Not covered

Outpatient Prescription Drugs, Supplies, and Supplements

$5 generic/$25 brand/$50 approved nonformulary brand & generic up to 30-day supply; up to 90-day supply of maintenance drugs for two Copayments when you use mail delivery.

Vision Hardware Optical Services

Balance after $200 allowance every 24 months

Travel Services

Not covered

Exclusions and Limitations The Services listed below are either completely excluded from coverage or partially limited. This applies to all Services that would otherwise be covered and is in addition to the exclusions and limitations that apply only to a particular Service as listed in the description of that Service in your Evidence of Coverage, to be provided after you enroll for coverage.

Certain exams and Services; Cosmetic Services; Custodial Services; Dental Services. Except when Medically Necessary for Members who have a medical condition that would place undue risk if performed in a dental office. The procedure must be approved.; Designated blood donations; Detained or confined members; Employer responsibility; Experimental or investigational Services; Eye surgery; Family Services. Services provided by a member of your immediate family.; Genetic testing; Government agency responsibility; Hearing aids. Unless the Hearing Aid rider has been purchased.; Hypnotherapy; Non-Medically Necessary Services; Nonreusable medical supplies; Outpatient Prescription Drugs. Unless the Outpatient Prescription Drug rider has been purchased.

Kaiser Permanente formulary applies. We cover non-formulary drugs only when you meet exception criteria unless specifically covered by your prescription drug plan.; Services related to a non-covered Service; Sexual reassignment surgery; Supportive care and other Services; Travel and lodging. Limited to: (a) Medically Necessary “Ambulance Services� in this Summary, and (b) certain expenses that we preauthorize.; Travel Services. All travel-related Services including travel-only immunizations (such as yellow fever, typhoid, and Japanese encephalitis), unless the Travel Services rider has been purchased.; Vision hardware optical Services. Unless the Vision Hardware Optical Services rider has been purchased.; Vision therapy and orthoptics or eye exercises; Professional Services for fitting and follow-up care for contact lenses; Low-vision aids.

This is not a contract. This benefit summary does not fully describe your benefit coverage with Kaiser Foundation Health Plan of the Northwest. For more details on your benefit coverage, claims review, and adjudication procedures, please see your Evidence of Coverage (EOC) or call Membership Services. In the case of conflict between this summary and the EOC, the EOC will prevail.

2012-2013 BENEFITS BOOK

73

Group Health Options - Plan B HMO Individual and Agency Providers Summary of Medical Benefits Group Number: 1363700 - IP HMO

Group Number: 1363800 - AP HMO Effective Date: 8/1/2012 Health Plan: Options Select Ref: RQ-58241 This is a brief summary of benefits. THIS IS NOT A CONTRACT OR CERTIFICATE OF COVERAGE. All benefit descriptions, including alternative care, are for medically necessary services. The Member will be charged the lesser of the cost share for the covered service or the actual charge for that service. For full coverage provisions, including limitations, please refer to your certificate of coverage.

In accordance with the Patient Protection and Affordable Care Act of 2010, • The lifetime maximum on the dollar value of covered essential health benefits no longer applies. Members whose coverage ended by reason of reaching a lifetime limit under this plan are eligible to enroll in this plan, and • Dependent children who are under the age of twenty-six (26) are eligible to enroll in this plan.

74

MYSEIUBENEFITS.ORG

Group Health Plan B HMO - Individual and Agency Providers Benefits

Inside Network

Plan deductible

No annual deductible

Individual deductible carryover

Not applicable

Plan coinsurance

No plan coinsurance Individual out-of-pocket limit: $1,000 per calendar year Family out-of-pocket limit (AP Workers Only): $2,000 per calendar year

Out-of-pocket limit

Out-of-pocket expenses for the following covered services are included in the out-of-pocket limit: Inpatient services, outpatient services, emergency services at a Managed Health Care Network (MHCN) or non-MHCN facility and ambulance services.

Pre-existing condition (PEC) waiting period

No PEC

Lifetime maximum

Unlimited

Outpatient services (Office visits)

$15 co-pay

Hospital services

Inpatient services: $100 co-pay, per day for up to 5 days per admit Outpatient surgery: $50 co-pay

Prescription drugs (some injectable drugs may be covered under Outpatient services)

Value based/formulary generic/formulary brand $4/$8/$25 co-pay per 30 day supply

Prescription mail order

$5 discount per 30 day supply

Acupuncture

Covered up to 8 visits per medical diagnosis per calendar year without prior authorization; additional visits when approved by the plan $15 co-pay

Ambulance services Chemical dependency

Plan pays 80%, you pay 20% Inpatient: $100 co-pay, per day for up to 5 days per admit Outpatient: $15 co-pay

Devices, equipment and supplies Durable medical equipment Orthopedic appliances Post- mastectomy bras limited to two (2) every six (6) months Ostomy supplies Prosthetic devices

Diabetic supplies

Covered at 50%

Insulin, needles, syringes and lancets-see Prescription drugs. External insulin pumps, blood glucose monitors, testing reagents and suppliessee Devices, equipment and supplies. When Devices, equipment and supplies or Prescription drugs are covered and have benefit limits, diabetic supplies are not subject to these limits.

Inpatient: Covered under Hospital services

Diagnostic lab and X-ray services

Outpatient: Covered in full. MRI/PET/CT - $50 co-pay High end radiology imaging services such as CT, MR and PET must be determined Medically Necessary and require prior authorization except when associated with Emergency care or inpatient services.

Emergency services

$200 co-pay at a designated facility

(co-pay waived if admitted)

$200 co-pay at a non designated facility

Hearing exams (routine)

$15 co-pay

2012-2013 BENEFITS BOOK

75

Hearing hardware

Not covered

Home health services

Covered in full. No visit limit.

Hospice services

Covered in full

Infertility services

Not covered

Manipulative therapy Massage services

Covered up to 10 visits per calendar year without prior authorization $15 co-pay See Rehabilitation services Inpatient: $100 co-pay, per day for up to 5 days per admit

Maternity services Mental Health Naturopathy

Outpatient: $15 co-pay. Routine care not subject to outpatient services co-pay.

Inpatient: $100 co-pay, per day for up to 5 days per admit Outpatient: $15 co-pay Covered up to 3 visits per medical diagnosis per calendar year without prior authorization; additional visits when approved by plan $15 co-pay

Newborn Services

Initial hospital stay: See Hospital Services; Office visits: See Outpatient Services; Routine well care: See Preventive care. Any applicable cost share for newborn services is separate from that of the mother.

Obesity-related surgery (bariatric)

Not covered

Organ transplants Donor search & harvest applies to lifetime max

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

Unlimited, no waiting period Inpatient: $100 co-pay, per day for up to 5 days per admit Outpatient: $15 co-pay Covered in full Women's preventive care services (including contraceptive drugs and devices and sterilization) are covered in full.

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

Skilled nursing facility Sterilization (vasectomy, tubal ligation)

Temporomandibular Joint (TMJ) services Tobacco cessation counseling Routine vision care (1 visit every 12 months)

Inpatient: 60 days per calendar year $100 co-pay, per day for up to 5 days per admit Outpatient: 60 visits per calendar year $15 co-pay

Covered in full up to 60 days per calendar year Inpatient: $100 co-pay, per day for up to 5 days per admit Outpatient: $15 co-pay Women's sterilization procedures are covered in full. $1,000 per calendar year; $5,000 lifetime max Inpatient: $100 co-pay, per day for up to 5 days per admit Outpatient: $15 co-pay Quit for Life Program - covered in full $15 co-pay

Optical hardware Lenses, including contact lenses and frames

76

MYSEIUBENEFITS.ORG

$200 per 24 months

Group Health Options Plan B POS Group Health Options Plan B PPO Individual and Agency Providers Summary of Medical Benefits Group Number: 6356700 - IP POS

Group Number: 6356800 - IP PPO Group Number: 6356200 - AGENCY POS Group Number: 6356300 - AGENCY PPO Effective Date: 8/1/2012 Health Plan Options Ref: RQ-58241 This is a brief summary of benefits. THIS IS NOT A CONTRACT OR CERTIFICATE OF COVERAGE. All benefit descriptions, including alternative care, are for medically necessary services. The Member will be charged the lesser of the cost share for the covered service or the actual charge for that service. For full coverage provisions, including limitations, please refer to your certificate of coverage.

In accordance with the Patient Protection and Affordable Care Act of 2010, • The lifetime maximum on the dollar value of covered essential health benefits no longer applies. Members whose coverage ended by reason of reaching a lifetime limit under this plan are eligible to enroll in this plan, and • Dependent children who are under the age of twenty-six (26) are eligible to enroll in this plan.

2012-2013 BENEFITS BOOK

77

Group Health Options Plan B POS, PPO - Individual and Agency Providers Benefits

Inside Network

Outside Network Individual deductible: $500 per calendar year

Plan deductible

No annual deductible

Individual deductible carryover

Not applicable

4th quarter carryover applies

Plan coinsurance

No plan coinsurance

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

Individual out-of-pocket limit: $1,000 per calendar year Family out-of-pocket limit (AP workers only): $2,000 per calendar year

Out-of-pocket limit

Out-of-pocket expenses for the following covered services are included in the out-of-pocket limit: Inpatient services, outpatient services, emergency services at a Managed Health Care Network (MHCN) facility and ambulance services.

Family deductible (AP workers only): $1,000 per calendar year

Individual out-of-pocket limit: $2,000 per calendar year Family out-of-pocket limit (AP workers only): $4,000 per calendar year Out-of-pocket expenses for the following covered services are included in the out-of-pocket limit: Plan coinsurance, emergency services at a non-Managed Health Care Network (MHCN) facility.

Pre-existing condition (PEC) waiting period

No PEC

Same as in-network

Lifetime maximum

Unlimited

Same as in-network maximum

Outpatient services (Office visits)

$15 co-pay

$15 co-pay, deductible and coinsurance apply

Hospital services

Inpatient services: $100 co-pay, per day for up to 5 days per admit Outpatient surgery: $50 co-pay

Prescription drugs (some injectable drugs may be covered under Outpatient services)

Prescription mail order

Acupuncture

Inpatient services: $100 co-pay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient surgery: $50 co-pay, deductible and coinsurance apply

Value based/formulary generic/ formulary brand/non-formulary $4/$8/$25/$50 co-pay per 30 day supply

Formulary generic/formulary brand/ non-formulary $13/$30/$55 co-pay per 30 day supply

$5 discount per 30 day supply

Not covered

Covered up to 8 visits per medical diagnosis per calendar year without prior authorization; additional visits when approved by the plan

$15 co-pay, deductible and coinsurance apply

$15 co-pay

Ambulance services

Plan pays 80%, you pay 20%

Chemical dependency

Inpatient: $100 co-pay, per day for up to 5 days per admit Outpatient: $15 co-pay

Same as in-network Inpatient: $100 co-pay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: $15 co-pay, deductible and coinsurance apply

Devices, equipment and supplies Durable medical equipment Orthopedic appliances Post-mastectomy bras limited to two (2) every six (6) months Ostomy supplies Prosthetic devices

78

MYSEIUBENEFITS.ORG

Covered at 50%

Covered at 50%, deductible applies

Diabetic supplies

Insulin, needles, syringes and lancets-see Prescription drugs.

External insulin pumps, blood glucose monitors, testing reagents and supplies-see Devices, equipment and supplies. When Devices, equipment and supplies or Prescription drugs are covered and have benefit limits, diabetic supplies are not subject to these limits.

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

Insulin, needles, syringes and lancetssee Prescription drugs. External insulin pumps, blood glucose monitors, testing reagents and supplies-see Devices, equipment and supplies. When Devices, equipment and supplies or Prescription drugs are covered and have benefit limits, diabetic supplies are not subject to these limits.

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

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

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

$200 co-pay

$200 co-pay

Hearing exams (routine)

$15 co-pay

$15 co-pay, deductible and coinsurance apply

Hearing hardware

Not covered

Not covered

Home health services

Covered in full. No visit limit.

No visit limit Deductible and coinsurance apply

Hospice services

Covered in full

Deductible and coinsurance apply

Infertility services

Not covered

Not covered Visit limits shared with in-network

Manipulative therapy

Covered up to 10 visits per calendar year without prior authorization

Diagnostic lab and X-ray services

Emergency services (co-pay waived if admitted)

Massage services

$15 co-pay

$15 co-pay, deductible and coinsurance apply

See Rehabilitation services

See Rehabilitation services

Inpatient: $100 co-pay, per day for up to 5 days per admit

Maternity services

Mental Health

Outpatient: $15 co-pay. Routine care not subject to outpatient services co-pay.

Inpatient: $100 co-pay, per day for up to 5 days per admit Outpatient: $15 co-pay

Naturopathy

Covered up to 3 visits per medical diagnosis per calendar year without prior authorization; additional visits when approved by plan

Inpatient: $100 co-pay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: $15 co-pay, deductible and coinsurance apply. Routine care not subject to outpatient services co-pay.

Inpatient: $100 co-pay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: $15 co-pay, deductible and coinsurance apply

$15 co-pay, deductible and coinsurance apply

$15 co-pay

Newborn Services

Initial hospital stay: See Hospital Services; Office visits: See Outpatient Services; Routine well care: See Preventive care. Any applicable cost share for newborn services is separate from that of the mother.

Initial hospital stay: See Hospital Services; Office visits: See Outpatient Services; Routine well care: See Preventive care. Any applicable cost share for newborn services is separate from that of the mother.

2012-2013 BENEFITS BOOK

79

Obesity-related surgery (bariatric)

Not covered

Not covered Shared with in-network

Organ transplants Donor search & harvest applies to lifetime max

Unlimited, no waiting period Inpatient: $100 co-pay, per day for up to 5 days per admit Outpatient: $15 co-pay

Inpatient: $100 co-pay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: $15 co-pay, deductible and coinsurance apply $300 per person; $600 per family per calendar year

Covered in full

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

Women’s preventive care services (including contraceptive drugs and devices and sterilization) are covered in full.

Coinsurance applies Women’s preventive care services (including contraceptive drugs and devices and sterilization) are subject to the applicable Preventive Care cost share and benefit maximums.

Routine mammograms: Deductible and coinsurance apply

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

Skilled nursing facility

Inpatient: 60 days per calendar year $100 co-pay, per day for up to 5 days per admit Outpatient: 60 visits per calendar year $15 co-pay

Covered in full up to 60 days per calendar year

Inpatient: Day limits shared with innetwork $100 co-pay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: Visit limits shared with in-network $15 co-pay, deductible and coinsurance apply Day limits shared with in-network benefit, deductible and coinsurance apply Inpatient: $100 co-pay, per day for up to 5 days per admit

Sterilization (vasectomy, tubal ligation)

Temporomandibular Joint (TMJ) services

Inpatient: $100 co-pay, per day for up to 5 days per admit Outpatient: $15 co-pay Women’s sterilization procedures are covered in full.

$1,000 per calendar year; $5,000 lifetime max Inpatient: $100 co-pay, per day for up to 5 days per admit

Deductible and coinsurance apply Outpatient: $15 co-pay, deductible and coinsurance apply Women’s sterilization procedures are covered subject to the applicable Preventive Care cost share and benefit maximums.

Shared with in-network Inpatient: $100 co-pay, per day for up to 5 days per admit Deductible and coinsurance apply

Outpatient: $15 co-pay

Outpatient: $15 co-pay, deductible and coinsurance apply

Tobacco cessation counseling

Quit for Life Program covered in full

Applicable cost shares apply

Routine vision care (1 visit every 12 months)

$15 co-pay

$15 co-pay, deductible and coinsurance apply

$200 per 24 months

Shared with in-network

Optical hardware Lenses, including contact lenses and frames

80

MYSEIUBENEFITS.ORG

QUESTIONS & APPEALS What if I Have a Health Insurance or Dental Coverage Question or an Appeal?

When you have questions or a complaint about health or dental coverage: Call the Customer Service Department of your insurer, or for the Trust’s selffunded dental plan, Delta Dental: Group Health 1-800-542-6312 www.ghc.org Kaiser Permanente 1-800-813-2000 www.kp.org Willamette Dental Oregon: 1-800-461-8994 Washington: 1-800-359-6019 www.willamettedental.com Self-funded Dental Plan Claims Administered by Delta Dental 1-800-547-9515

2012-2013 BENEFITS BOOK

81

QUESTIONS & APPEALS www.deltadentalwa.com

When you have an appeal: An appeal is a request to reconsider a decision to deny, modify, reduce, or end payment, coverage or authorization of coverage (known as an “adverse decision”).

The appeal process for each of the Trust’s health and dental plans is different.

You should review the Summary Plan Description of appeals procedures in your Benefits Summary provided by your insurer or, in the case of the Trust’s self-funded dental coverage, by Delta Dental. The Summary Plan Description contains a full explanation of the appeals process.

You may also call the Customer Service Department of your insurer or, in the case of the Trust’s self-funded dental coverage, Delta Dental, for specific information about the appeals process. Those numbers are listed on the previous page.

Your rights in an appeal: •

You must submit your appeals within 180 calendar days of the date you received notice of an “adverse decision.” Keep track of these deadlines as appeals that are filed late may not be considered.

•

You may request an expedited 72-hour review of your appeal when the adverse determination could jeopardize your life or health.

•

You may request all of the documents relevant to your request and the decision by the insurer or administrator.

•

You may submit additional comments, documents or other information to support your appeal.

More information about how to file an appeal can be found at “How to Appeal a Health Care Insurance Decision, A Guide for Consumers in Washington State” on the Office of the Insurance Commissioner’s website, www.insurance.wa.gov/consumers/health/Appeal/Table-of-Contents.shtml

82

MYSEIUBENEFITS.ORG

NOTICES About This Guide This handbook is intended to be an overview of your benefits and a general resource. For more detailed information about your health and dental benefits, you should consult the Summary Plan Description (SPD) and Certificate of Coverage for those benefits. This handbook is not a “Plan document” or the official SPD. In case of any conflict between this document and any “Plan document,” the terms of the Plan Document shall govern.

The handbook is not a promise of benefits. All benefits described in the handbook are provided pursuant to existing collective bargaining agreements (CBA) and employer participation agreements with the SEIU Healthcare NW Health Benefits Trust and Training Partnership. Should the CBA or other agreements with the Health Benefits Trust and/or Training Partnership terminate, change or otherwise become ineffective, the benefits described in this book may also terminate or change.

Equal Opportunity The SEIU Healthcare NW Training Partnership (“Partnership”) admits students regardless of race, color, national origin, ethnic origin, gender, age, disability and sexual orientation to all the rights, privileges, programs, and activities generally accorded or made available to students by the Training Partnership. It does not discriminate on the basis of race, color, national origin, ethnic origin, gender, age, disability and sexual orientation in administration of its training and educational policies, admissions policies, scholarship and loan programs, and other Training Partnership administered programs.

2012-2013 BENEFITS BOOK

83

GLOSSARY AAA – Area Agency on Aging ABT – Accelerated Basic Training ADSA – Aging and Disability Services Administration Department of Department of Social and Health Services serving adults with chronic illnesses or conditions and people with developmental disabilities.

AP – Agency Provider A Home Care Aide who works for an agency – agency provider ARC – Advocates for the Rights of Citizens with Developmental Disabilities ARNP – Advanced Registered Nurse Practitioner. Can be a Primary Care Provider.

BHP – Basic Health Plan of Washington CNA – Certified Nursing Assistant CE – Continuing Education Supplemental training required for skills development COBRA – A private-pay insurance that covers you if you have a lapse in coverage or you are between jobs cultural competency – An awareness of the customs, beliefs and religious practices of others DDD – Division of Developmental Disabilities diagnostic imaging – MRI (Magnetic Resonance Imaging), X-rays, mammograms DME – Durable Medical Equipment Walkers, crutches, etc.

DSHS – Department of Social and Health Services HCS – Home Community Services The Home Community Services (HCS) Division of DSHS promotes, plans, develops and provides long-term care services for persons with disabilities and older adults who may need state funds (Medicaid) to help pay for them. health insurance provider – The company that manages your health insurance, for example Group Health, Kaiser Permanente.

84

MYSEIUBENEFITS.ORG

GLOSSARY Health Risk Assessment or Health Profile – An online health assessment or questionnaire that assesses your general health and wellness through a series of questions IP – Individual Provider A Home Care Aide that provides care to a consumer living in his or her home and whose employer of record is the Department of Social and Health Services.

LPN – Licensed Practical Nurse MFOC – Modified Fundamentals of Caregiving MRC – Member Resource Center NDC – Nurse Delegated Core NDD – Nurse Delegation Diabetes orthopedic appliances – braces, splints, etc.

PCP – Primary Care Provider The doctor or ARNP you choose to oversee your care POS – Point of Service Insurance pays percentage of doctor visit that is out-of-network PPO – Preferred Provider Organization A provider who is in-network RN – Registered Nurse RNA – Registered Nurse’s Assistant S&O – Safety and Orientation TBI – Traumatic Brain Injury Training Wizard – A computer program that assists you in getting started at the Training Partnership www.myseiubenefits.org/wizard

2012-2013 BENEFITS BOOK

85

HOME CARE AIDE CATEGORIES Effective Jan. 7, 2012 The Training Partnership provides training to a variety of Home Care Aides.

The chart below describes the different categories of HCAs Home Care Aide (HCA)

Provide care to a consumer living in his or her home.

Employed by a private homecare agency or DSHS.

Agency Provider (AP)

Provide care to a consumer living in his or her home.

Employed by a private homecare agency.

Certified Home Care Aide

Individual Provider (IP)

Provide care to a consumer living in his or her home having succesfully passed the DOH certification exam. Employed by a private homecare agency or DSHS. Provide care to a consumer living in his or her home.

Employer of record is DSHS.

Credentialed Agency Provider

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

Credentialed Individual Provider

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

Parent Individual Provider (HCS/AAA)

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

Parent DD Individual Provider (DDD)

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

Limited Service Provider (HCS/AAA/DDD)

This is any IP who provides care 20 hours a month or less for one consumer.

Adult Child Individual Provider

An adult child providing care for his/her biological, step or adoptive parent.

TRAINING STANDARDS UPDATED JUNE 2012

CONTINUING EDUCATION

Basic Training 70 Hours

Not required

Parent Provider (DDD Only) Class 7 Hours

12 hours/year for the renewal of certification

Yes

Yes

BASIC TRAINING Accelerated Basic Training 30 Hours

Within 120 days of employment

12 hours/year for the renewal of certification

ORIENTATION AND SAFETY Safety Training 3 Hours Not required

Not required

HCA Certification Required?

Orientation 2 Hours Completed prior to providing care

Within 120 days of employment

Continuing Education 12 Hours

Completed prior to providing care Not required

Not required

Not required

Not required

Within 120 days of employment

Not required

Not required

Not required

Not required

Not required

Not required

Not required

Within 120 days of employment

Not required

Not required

Not required

Not required

12 hours/year by birthday

Not required, unless voluntarily certificed as a HCA.

Not required, unless voluntarily certificed as a HCA.

Not required, unless voluntarily certificed as a HCA.

12 hours/year by their birthday

12 hours/year by their birthday

As of 7/1/2012, 12 credits/year by your birthday. Use training wizard at www.myseiubenefits.org/wizard or call the MRC to see your requirement.

No

No

No

No

No

No

No

Agency Provider (AP) Completed prior to providing care

Credentialed AP (per RCW 18.88B.041) Not required

Completed prior to providing care

Not required

Not required

Not required

Completed prior to providing care

Not required

Credentialed IP (per RCW 18.88B.041) Completed prior to providing care

Completed prior to providing care

Within 120 days of employment

Not required

Individual Provider (IP) Not required

Parent Individual Provider (HCS/AAA) Completed prior to providing care

Completed prior to providing care

Within 120 days of employment

Not required

Parent DD IP (DDD)

Completed prior to providing care

Completed prior to providing care

Not required

Limited Service Provider

Completed prior to providing care

Individual Providers or Agency Providers hired before 1/7/2012

Adult Child Individual Provider (HCS/AAA/DDD)

87

2012-2013 BENEFITS BOOK

635 Andover Park W. Suite 200, Tukwila, WA 98188

PRSRT STD US POSTAGE

PAID PERMIT NO. 1632 SEATTLE WA

SECOND EDITION STP000GK0BB02ENG

2013-2013 YOUR BENEFITS BOOK A GUIDE TO TRAINING & HEALTH BENEFITS Featured Inside: • Updated Training Standards and Benefits • Ways to stay healthy, save money and save time • How to take Online Continuing Education

www.myseiubenefits.org 88

MYSEIUBENEFITS.ORG

TP-HBT-BB-102