Your 2016 Benefits Book

Your Benefits

Guide to Training and Health Benefits

2015-20161

2015-2016 BENEFITS BOOK

Welcome to Your Benefits!

Welcome to the fifth “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 Worker, Care Begins With You. Your training and health benefits are a critical part of the compensation you receive and they provide the skills 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

David Rolf

Executive Director Training Partnership, Health Benefits Trust

Board Chair, Training Partnership President, SEIU 775

Keep track of your personal benefits information Student and Training Portal Information Student ID / Username:

Portal Password:

Health Benefits Information Primary Care Provider Name:

Phone Number:

24-Hour Consulting Nurse Line: Group Health:

Seattle Area: 206-901-2244

Closest Urgent Care Center:

Kaiser Permanente:

WA State: 1-800-297-6877

Phone Number:

1-800-813-2000

Hours:

Your Health Plan Name:

Your Health Plan Number:

Your Dental Plan Name:

Your Dental Plan Number:

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QUICK START GUIDE

Coverage Grant Application......................51

About This Guide.............................................4

Combined Hours Application...................53

Training Quick Start..........................................5

Switch to HMO Plan Application..............55

YOUR TRAINING

CONTENTS

Health Benefits Highlights................................6 Create Your Online Profile.................................8 Update Contact Information.............................10 Participate in Our Programs.............................11 Home Care InSight Magazine...........................13 Member Resource Center................................14

YOUR HEALTH........................................57 Find Your Primary Care Provider.......................59 Your Mental Health Benefits.............................60 Manage Your Prescriptions...............................62 Vision Benefits.................................................63 Your Dental Benefits.........................................64 Immediate Care Options...................................66

YOUR TRAINING.....................................16

Hurt at Work Support.......................................68

Basic Training..................................................20 Basic Training Refresher Course.......................21 Continuing Education.......................................22 Advanced Home Care Aide Apprenticeship......25 Interpretation...................................................26 Help Improve Future Classes............................27

HEALTH BENEFITS POLICIES + FAQ..........70 Who to Contact................................................70 Frequently Asked Questions: Eligibility and Enrollment..........................71 Group Health Options..............................75 Kaiser Permanente..................................76 Questions & Appeals...............................77

TRAINING STANDARDS...........................28

Group Health...........................................79

Training Standards Chart..................................30

Kaiser Permanente..................................90

State Exam Steps to Certification......................32

Willamette Dental....................................94

Frequently Asked Questions.............................35

Delta Dental............................................96 LANGUAGE ASSISTANCE..........................98

Student Code of Conduct and

Simplified Chinese.............................................98

Classroom Expectations....................................38

Korean.............................................................101

Reasonable Accommodation Policy..................40

Spanish...........................................................104

Notices............................................................41

Russian...........................................................107 Vietnamese......................................................110 Somali.............................................................113

YOUR HEALTH

TRAINING POLICIES................................37

HEALTH BASICS

Benefits Summaries.........................................78

HEALTH BASICS.....................................42

TRAINING POLICIES

How to Get the Most From Your Training...........18 Orientation & Safety.........................................19

TRAINING STANDARDS

Your SEIU Benefits Online................................7

3 Ways to Get Covered.....................................44 REFERENCE

Eligibility and Enrollment .................................48

Glossary...........................................................116

New Plan Opportunities & Applications.............49

Training Standards Chart..................................118

IP Enrollment Application........Tear Out Card

On the cover: Home Care Aides Kalkidan (left) and Flo (right).

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BENEFITS POLICIES

Get to Know Your HBT Benefits........................46

QUICK START GUIDE COLOR KEY Individual Providers

Training Information

Agency Providers

Health Information

In this book, you will see information for both Individual Providers (IPs) and Agency Providers (APs) and health and training benefits. Look for these colors to keep them straight.

One-Stop Guide for Training, Health Benefits This benefits book is here to guide you through all of your health and training benefits from the Training Partnership and Health Benefits Trust.

Where to Find Updates After the book is released, we will update your benefits in these places: ONLINE An online version of the book is always available if you misplace your copy or want to find updates. View it online at www.myseiu.be/2016benefits HOME CARE INSIGHT MAGAZINE Updates will also be in Home Care InSight, the magazine for Home Care Workers. The next issue will arrive in October 2015.

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Training Quick Start 1. Find Your Training Standards on Page 30 ■ I ndividual Providers There are different training standards depending on what type of care you provide. See the chart on page 30 to find your training needs.

■ Agency

Providers Your employer can help you understand your training standards.

Contact your employer to get your training standard information.

2. Watch the Orientation and Safety on DVD or Online See page 19 for the full course description and how to complete it. Coming Fall 2015, you can take the course online and receive instant feedback.

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

■ Individual Providers Create your Username and Password to log in to the training portal and register for classes at www.myseiubenefits.org (See page 8 for steps.)

For more support, call the Member Resource Center at 1-866-371-3200.

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

New Training Highlights 12 New Online Continuing Education Courses Added From supporting Consumers with their mental health to understanding Autism Spectrum Disorder. See page 22 for the full list of available CEs and pages 99–115 for translated courses.

New Basic Training Program Launched After hearing feedback from students and our partners, we looked at ways to improve our Basic Training classes. All new students will start to take the updated course that features more hands-on learning and skills practice. This approach will better prepare Home Care Aides to pass the state certification exam! (See page 32 for exam steps and FAQs.) 2015-2016 BENEFITS BOOK

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QUICK START GUIDE

Home Care Aide Jennifer and her daughter Jenny.

New Health Benefits Highlights Your Delta Dental annual benefit has increased to $2,000 We heard your feedback that a $1,000 annual benefit was not enough to cover members’ basic dental care. Members now have access to $2,000 of covered services per calendar year for preventive, diagnostic and restorative coverage. Willamettte Dental plans continue to have no annual maximum.

Monthly hours requirement dropped from 86 to 80 hours As of August 1, 2015, the Health Benefits Trust has reduced the monthly hours required for eligibility from 86 to 80 hours per month. This means that it will be a little easier for you to meet eligibility requirements and stay enrolled in your plan from month to month.

New Coverage Grant supports members with hours gap Our new Coverage Grant Pilot Fund can provide you with one additional month of insurance coverage once during your health plan year until the Pilot Fund is depleted. If your hours dip between 80 and 60 hours in a single month, you can apply for this Coverage Grant by contacting the Member Resource Center at 1-866-371-3200 or submitting the application on page 51.

See the Health Basics section on page 42 for a full description of changes and the Benefit Summaries section on page 78 for full insurance plan summaries.

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Now easy to read on all devices

MYSEIUBENEFITS.ORG Your easy online source for training, health benefits, and more!

Once you get your username and password, you’re ready to go online to manage and take training! (See following pages for instructions.)

Easy-to-use Portal login box.

The new “Coverage Finder” helps you find health coverage that works for you.

Take online courses, register for training.

Translated benefits information updated regularly.

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QUICK START GUIDE How to Create Your Online Profile for the Training Portal The best way to manage your training is through the www.myseiubenefits.org website.

Through the online Training Portal, you can easily update your information, register for classes, and stay on top of your Continuing Education courses.

1. Go to www.myseiubenefits.org In the top left corner you will find your login box. If you are brand new to the site, click on Sign Up! to create your profile.

If you would like a video walk-through, click on Need Help? for a full tutorial on how to log in.

2. Select your Provider Type Select your Provider Type, either Agency Provider or Individual Provider, then click Next. If you are both, you can select either.

3. Enter your name and Provider Number or Student ID You will need either your Provider Number (the 6-digit number you use to get paid) or your Student ID (the 12-digit number located in your welcome packet) to create your profile, then click Next.

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4. Fill out your contact and personal information Please provide your best contact information such as email, evening and mobile phone, and mailing address. On this screen you will also choose your password and language preferences. Then click Next.

5. Now you are ready to log in!

Enter your Username (Provider Number or Student ID) and the password you chose on the previous screen.

123456789102

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QUICK START GUIDE A Look Inside the Training Portal Once you are logged into the Training Portal, you can register for Basic Training courses around the state, take online Continuing Education Courses, and keep all of your contact information up to date.

Click on “Manage My Training” to register for courses On this page, you can see your current training, search and sign up for new courses, and view your training history.

Click on “View Your Profile” to update your contact information Found on the gray bar on the left side of the screen, click on “View Your Profile.”

On this page, you can update your email, mailing address, phone number, and language preferences.

Participate in Our Exciting New Programs This year the Training Partnership and Health Benefits Trust are launching a series of focus groups, pilots, and evaluation sessions with Home Care Workers. You will have the chance to share important feedback about your work and the benefits we provide.

Engage your passion for healthy living (statewide) Participate in programs focused on weight loss, workplace safety, and stress reduction. You will be introduced to healthy action steps, track your results, report back to us, and share your success with other Home Care Workers.

If you are interested in participating, complete and mail the form on the next page or email us at healthy@myseiubenefits.org to sign up.

Test out mobile technology on the job (King County only) Over 4–6 weeks, try using mobile technology to test the impact on your work, training, job satisfaction, and the care you provide for your Consumer.

If you are interested in participating, complete and mail the form on the next page or email us at development@myseiubenefits.org.

Share your expertise on a variety of topics (statewide) Throughout the year, we will have surveys, focus groups, and research areas pop up related to your life and work. We would like to call on you to share your expertise and experience.

If you are interested in joining our contact list for focus groups, complete and mail the form on the next page or email us at research@myseiubenefits.org to sign up.

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QUICK START GUIDE Tell Us About Your Interest in Our Programs We want to hear from you! Complete and mail in this form to share your interest in participating in the paid focus groups, pilots, and evaluation sessions. Once received, our staff will get in contact with you for more information on how to participate. Thank you for sharing your time, interest, and expertise with us! You can complete this form online at www.myseiu.be/pilotsurveys

Contact Information (Please print clearly and in English):

Last Name:

First Name: Apt #:

Street:

City:

Email:

ZIP Code:

Phone:

I am a/an: Individual Provider

Parent Provider

Agency Provider

I am interested in: (Check all that apply)

Healthy Living

Mobile Technology (King County only)

Submitting a story idea for InSight Magazine

Sharing my expertise (variety of topic areas)

Other (write in interests below)

Comments and/or interests:

MAIL TO : Attn: Communications Team SEIU Healthcare NW Training Partnership & Health Benefits Trust 215 Columbia St, Suite 300 Seattle, WA 98104 12

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Excerpts from the Spring 2015 InSight magazine.

Home Care InSight Magazine As a community of Home Care Workers, you do important work and you have an important story to tell. Home Care Workers across the region share their common challenges and experiences in each issue of the magazine. Share your ideas with us by emailing editor@myseiubenefits.org.

To receive your copy, make sure your mailing address is accurate in the Portal and you will receive one each time an issue is released.

Magazine highlights include: • Skills refreshers and useful resources • Powerful stories such as caregiving for Consumers with PTSD and how to find mental health support • Self care and health tips for Home Care Aides • Recipes from Home Care Workers • How to report workplace injuries • Updates to your training and health benefits

SEND US YOUR STORY IDEAS! As a Home Care Worker, you have amazing stories to tell. We want to hear from you! If you have a great story or tip to share, please send it to editor@myseiubenefits.org.

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QUICK START GUIDE

Member Resource Center (MRC) The Member Resource Center is available to support you with resolving issues and providing answers to common questions from certification to health information.

1-866-371-3200 Monday–Friday 8 a.m.–6 p.m.

The MRC is closed on 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/help/ for office closures and the most updated hours.

■ I ndividual 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 the Member Resource Center at 1-866-371-3200.

■ Agency Providers Contact your employer for support.

ຕິດຕໍ່ຫາສູ ນຊ່ ວຍເຫື ຼ ອສະມາຊິກ (Member Resource Center) ທ່ີ ເບີ 1-866-371-3200 ຖ້ າທ່ າ ນຕ້ ອງການຄວາມຊ່ ວຍເຫື ຼ ອໃນການລົ ງທະບຽນ ສໍາລັ ບການຝຶກອົ ບຮົ ມຂອງທ່ ານ ຫື ຼ ເພ່ື ອຊອກ ຮູ້ ວ່ າທ່ ານມີສິດໄດ້ ຮັ ບເງິນຊ່ ວຍເຫື ຼ ອສໍາລັ ບການ ດູ ແລສຸ ຂະພາບຫື ຼ ບ່ໍ .

QUICK REFERENCE GUIDE | IF YOU NEED ASSISTANCE

For Assistance For Assistance

សូ មទាក់ទងមកមជ្ឈមណ្ឌលធនធានសមាជិក តាមលលខ 1-866-371 3200 ល�ើលោកអ្ន កត្រូវកា រជំនួយការចុះល្មះសតមា�់ការ�ណ្តះ�ណ្ តា លរ� ស់លោកអ្ន ក ឬល�ើម្បីឱ្យ�ឹងថា លោកអ្ន កមាន សិទ្ិតស�ចបា�់ចំលោះអ្​្ថ ត�លោជន៍ននការថែ ទា ំសុខភាពឬលទ។ 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 1-866371-3200 联系会员资源中心。 Contact the Member Resource Center at 1-866-371-3200 if you need assistance registering for your training or to find out if you are eligible for healthcare benefits. 훈련일정을 잡거나 건강혜택 자격 확인을 위해 도움이 필요하시면 회원지원센터 1-866-371-3200 로 전화주세요. ຕິດຕໍ່ຫາສູ ນຊ່ ວຍເຫື ຼ ອສະມາຊິກ (Member Resource Center) ທີ່ເບີ 1-866-371-3200 ຖ້ າທ່ າ ນຕ້ ອງການຄວາມຊ່ ວຍເຫື ຼ ອໃນການລົ ງທະບຽນ ສໍາລັ ບການຝຶກອົ ບຮົ ມຂອງທ່ ານ ຫື ຼ ເພ່ື ອຊອກ ຮູ້ ວ່ າທ່ ານມີສິດໄດ້ ຮັ ບເງິນຊ່ ວຍເຫື ຼ ອສໍາລັ ບການ ດູ ແລສຸ ຂະພາບຫື ຼ ບ່ໍ . Если у Вас есть вопросы, связанные с определением расписания занятий, или относительно получения Вами пособия по нетрудоспособности, обращайтесь в Учебно-методический центр по телефону 1-866-371-3200.

Если у Вас есть вопросы, связанные с Paragraph Style: Body Text определением расписания занятий, или относительно получения Вами пособия по нетрудоспособности, обращайтесь в Faafesootai le Member Resource Center Учебно-методический центр по телефону ile 188-371-3200 1-866-371-3200. pe afai ete manaomia

le fesoasoani mole resitaraina mo lau toleniga pe fia iloa pe ete agavaa mo faamanuiaga mo togafitiga tau soifua maloloina.

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.

Kala xiriir Xarunta Macluumaadka Xubinka 1-866-371-3200 haddii aad u baahan tahay caawimaadda diiwaangelinta tababarkaaga ama si aad u oggaatid haddii aad u qalantid dheefaha daryeelka caafimaad.

Makipag-ugnayan sa Member Resource Center sa 1-866-371-3200 kung kailangan ninyo ng tulong sa pagpaparehistro ng inyong pagsasanay o para malaman kung kayo ay karapat-dapat sa mga benepisyo sa pangangalaga ng kalusugan. Зверніться до Учбово-методичного центру за тел. 1-866-371-3200, якщо Вам буде потрібна допомога з реєстрацією для проходження навчання або якщо Вам буде необхідно з’ясувати, чи маєте Ви право на пільги з медичного забезпечення.

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.

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YOUR TRAINING

Welcome to Home Care Training Your work allows people to live their lives with dignity in their own homes.

Whether you’re just starting out as a Home Care Worker or you are interested in continuing your education, the Training Partnership is here to help.

As a source of support for your Consumer, you are the most trusted member of a Consumer’s care team. By successfully completing the training and certification process, you can be an even greater advocate for your Consumer, launch your career, and earn more money.

Types of Training •

Orientation & Safety - page 19

•

Basic Training - page 20

•

Refresher Courses - page 21

•

Continuing Education - page 22

•

Advanced Home Care Aide Apprenticeship - page 25

‘‘

I really like the support and background that (the Training Partnership) provides. This makes me really want to perfect my job. I can do this right and so much easier this way.”

– Annette, Training Partnership Student

On left: Training Partnership student Gladys works at a skill station with instructor Julie.

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Log in to your Portal to manage your training, contact information, and benefits at www.myseiubenefits.org

How to Get the Most From Your Training Understand State Certification Requirements If you are required to receive certification, do not delay–begin the process as soon as possible. Follow the instructions on the following pages to ensure you successfully complete certification.

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 to take 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 a convenient way to get the CE hours you need as a worker. You can view available courses, take classes, and view your credits all from your computer. Allow enough time before your deadline to take the credits you need.

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 Email, Address, and Phone Number 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 in the portal at www.myseiubenefits.org

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 Continuation Course courses. Sign up to receive news and alerts through email.

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YOUR TRAINING

Home Care Aide Liya and her Consumer Yvonne.

Orientation and Safety 5 hours

Online Course

Paid Hours

培 AB

Translation Available

You will receive an Orientation & Safety kit at the time of hiring or contracting. Taking Orientation and Safety prior to providing care helps prepare you for caring for your Consumer while you are in the process of receiving certification.

The Course Will Introduce the Following Skills: • Preparedness: What to expect in becoming a Home Care Aide • Emergency Readiness: How to handle emergencies • Preventive Care: How to stop the spread of infectious diseases • Accident Prevention: How to prevent accidents and injuries

Steps to Complete Orientation & Safety via DVD: 1. Watch the Safety and Orientation DVDs you receive when you are hired.

2. Call 1-866-483-1397 to confirm that you completed it.

3. You will need your confirmation number (from your welcome packet) and the last four digits of your Social Security number.

Coming Fall 2015: Take Orientation & Safety Online!

Log in to the Portal (see page 8) to complete this course on your computer.

New online features include: • Translated into 12 languages • Receive instant feedback on your answers • Easily pause and resume your progress 2015-2016 BENEFITS BOOK

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Basic Training 70 Hours

Paid Hours

Instructor Led

Classes Around State

培 AB

Translation Available

Basic Training prepares you with the information and skills you need to successfully pass the certification exam and become a Home Care Aide. Before certification, you’ll be equipped to deliver respectful, high-quality, and comprehensive care, learning how to properly perform a variety of tasks and skills to work with your Consumer and their care team.

Some of the Skills You Will Strengthen: • Active communication with your Consumer • How to best transfer a Consumer to avoid injuring yourself • How to provide medication assistance for your Consumer • Understanding Consumer rights and ways to encourage your Consumer to become independent • Respecting cultural background, lifestyle, and traditions while providing care

Register for classes at www.myseiubenefits.org See page 8 for how to register and log in to the Training Portal.

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On the path to certification See page 32 for the complete steps for Home Care Aide Certification.

YOUR TRAINING

Basic Training Skills Refresher 2 Hours

Free to Attend

Instructor Led

Classes Around State

培 AB Translation

Available

Want to sharpen a few skills before taking your Home Care Aide certification exam? The free two-hour Skills Refresher course is a chance for you to ask questions and practice skills with other students and an instructor in a small class environment.

Skills Refreshers Are a Chance to: • Practice skills that will be tested in the state certification exam.

• Work on skills that need the most practice.

• Attend as many courses as you would like.

Courses are held in the following counties: • Pierce

• Kitsap

• King

• Spokane

• Thurston

• Chelan

• Snohomish

• Benton

• Clark Register for a Skills Refresher course by calling the Member Resource Center at 1-866-371-3200.

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Continuing Education 12 Hours

Paid Hours

Instructor & Online

Classes Around State

培 AB Translation

Available

Our Continuing Education (CE) courses offer you the opportunity to expand your professional skills and further explore topics most relevant to your Consumer’s needs. We offer instructor-led classes across the state and Continuing Education courses online.

What Can You Expect From Continuing Education Courses?

• Instructor-led courses let you ask questions of the instructor, learn from and interact with other workers, and have hands-on practice with any skills covered.

• Online courses let you learn at your own pace whenever it is convenient for you.

• New online webinar courses allow you to interact with instructors and other students from your home computer.

• Subjects vary from broad overviews to in-depth explorations on specific topics.

• Online courses are provided in multiple languages available to take 24 hours a day, 7 days a week.

• New online and instructor-led courses are added every year. Check the Portal or InSight magazine for the latest on newly available courses.

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In addition to dozens of course in English, there are new online CE courses in Russian, Spanish, Vietnamese, Chinese, and Korean. (See pages 99-115 for listings.)

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

Each online course has one hour of content. Actual times may vary depending on learning style, reading speed, and Internet connection speed.

Newly released course Developmental Disabilities

Physical Disabilities

Dispelling Disability Myths

An Introduction to Physical Disabilities

The Faces of Down Syndrome

Multiple Sclerosis

Historical Perspectives on People With Developmental Disabilities

Hearing and Vision Conditions

Positive Behavior Support for Young Consumers With Developmental Disabilities Supporting Consumers With Positive Behavior Support Plans

Traumatic Brain Injury

Mental Illness An Introduction to Mental Illness

Autism Spectrum Disorder: Understanding How to Minimize Stress for Consumers

Supporting Consumers with Mental Illness, Part 1

ASD Part II: Understanding How to Support Consumers Throughout Their Lives

Supporting Behavior Changes in Consumers, Part 1

Dementia An Introduction to Dementia Person-Centered Care for People with Dementia

Supporting Consumers with Mental Illness, Part 2

Supporting Behavior Changes in Consumers, Part 2 Understanding Depression’s Effects Supporting Consumers with Anxiety Disorders

Dementia and Personal Care

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YOUR TRAINING

Available Online Continuing Education Courses

Health/Wellness Arthritis and Acute Mental Status Changes Hearing and Vision Conditions Cultural Competency: Pain Management and Health Literacy Skin Care Basics Heart Conditions Stroke and Seizure

Reducing the Spread of Infection Through Standard Precautions Using Household Cleaning Chemicals Safely Green Cleaning Body Mechanics Falls Prevention: Helping Consumers Stay Safe and Independent in Their Homes Ergonomics: Home Care Aide and Consumer Safety

Respiratory Conditions Oral Health Basics Denture Care and Cleaning Gaining Consumer Cooperation for Oral Care Providing Consumer-Directed Care for Common Medical Conditions: Dehydration Providing Consumer-Directed Care for Common Medical Conditions: Urinary Tract Infections Providing Consumer-Directed Care for Common Medical Conditions: Pneumonia Providing Consumer-Directed Care for Common Medical Conditions: Congestive Heart Failure

Nutrition Better Health Through Nutritious Cooking Cultural Competency: Nutrition Diabetes Nutrition: Managing Diabetes Through Diet Nutrition: Creating Healthy and Balanced Meals for Consumers

Other Arthritis & Acute Mental Status Changes

Providing Consumer-Directed Care for Common Medical Conditions: Seizure

Cultural Competency: Pain Management and Assumptions

Providing Consumer-Directed Care for Common Medical Conditions: Stroke

Providing End of Life Care, Part 1

Providing Consumer-Directed Care for Common Medical Conditions: Chronic Obstructive Pulmonary Disease

Recognizing and Reporting Consumer Abuse, Neglect, and Financial Exploitation

Providing Consumer-Directed Care for Common Medical Conditions: Peripheral Vascular Disease

Promoting Creativity

Providing End of Life Care, Part 2

Home Care Aides Make a Difference

Providing Consumer-Directed Care for Common Medical Conditions: Coronary Artery Disease

Relationships Between Consumers

Smoking Cessation: Supporting Consumers Who Want to Quit

The LGBTQ Community: Basics for a Better Working Relationship

Supporting Consumer Mobility and Health

The LGBTQ Community: Unique Needs of Older Adults

Supporting Consumer Independence

Safety Best Practices for the Professional HCA Infection Control and Workplace Safety Protecting Worker Safety Through Violence De-Escalation, Part 1 Protecting Worker Safety Through Violence De-Escalation, Part 2

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培 AB See pages 98–115 for translated Online Continuing Education courses.

YOUR TRAINING

Advanced Home Care Aide Apprenticeship Program 12 Hrs Peer Mentorship

70 Hours

Free, Unpaid Course

$0.25/Hour Raise

Instructor Led

The Advanced Home Care Aide Apprenticeship Program is a free, 70-hour training program that provides you with in-depth training for helping Consumers with physical disabilities. As a graduate, you receive a raise, Department of Labor Apprenticeship certificate, and new skills to boost your career.

All certified and grandfathered Home Care Aides who are currently employed are eligible to enroll and receive a 25-cent raise upon completing the Advanced Home Care Aide Apprenticeship Program.

ĺ&#x;š AB

Classes are taught in English, but there is room for two community interpreters per class.

A Graduation Celebration for Your Accomplishment!

We will honor students who complete this program with a special graduation ceremony each September in Seattle. Family and friends are encouraged to attend to celebrate your accomplishment.

For questions about this program, if you are eligible, and available locations, please contact the Member Resource Center at 1-866-371-3200.

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Learn in Your Language The Training Partnership values the diversity of Home Care Aides. We strive to offer training in a wide variety of languages to create the best classroom experience for your learning. We currently offer Basic Training and Continuing Education courses in the following languages: • English

• Laotian

• Cantonese

• Somali

• Spanish

• Arabic

• Russian

• Tagalog

• Korean

• Ukrainian

• Vietnamese

• Samoan

• Cambodian/Khmer See pages 98–115 for translated Continuing Education courses.

Don’t See a Class in Your Language?

If we do not offer classes in your primary language, you have a couple of options: For Basic Training courses, request a free personal interpreter: 1. Contact the Member Resource Center at 1-866-371-3200 to register for the course and have a translator assigned to you.

For all other courses, register and bring a Community Interpreter (friend or relative): 1. Notify the Training Partnership via the Training Portal when you register for a course or by calling the Member Resource Center at 1-866-371-3200.

2. Find and share our Tips for Community Interpreter with your interpreter. Go to www.myseiubenefits.org and search for “Community Interpreter” or call the MRC for support.

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YOUR TRAINING

Improve Future Classes by Sharing Your Feedback Through our online course surveys, you can share your experience honestly with us about how to improve our courses. These surveys are short and feedback is taken seriously.

The surveys will help us do the following: •

Make sure your that valuable opinions are heard.

•

Helps us better meet your needs in future training courses.

•

Improve training for all Home Care Aides.

How do you submit a course survey?

After you complete a course, you will see a “Take Survey” link on your student home page in the Training Portal. Simply follow that link to review the course.

In-Person Feedback and Focus Groups In addition to surveys, the Training Partnership collects input from students through in-person feedback and focus groups. These opportunities allow students to share their ideas and feedback to improve classes.

If you are interested in participating, email feedback@myseiubenefits.org and provide your full name and date of birth in the email.

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Home Care Aide Asia.

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TRAINING STANDARDS

Your Training Standards Training standards vary for different types of workers. Be sure to check your own training standards online and see the training standards chart on the next page.

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 covers a broad range of subjects. You choose the ones that are best suited to your interests and the Consumers you serve.

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Completed prior to providing care

Completed prior to providing care

Not applicable

Completed prior to providing care

Completed prior to providing care

Completed prior to providing care

Completed prior to providing care

Completed prior to providing care

Standard HCA IP or AP hired before 1/7/2012

Parent Individual Provider (HCS/AAA)*

Parent DD Individual Provider (DDD)*

Limited Service Provider*

Adult Child Individual Provider*

Respite

Within 120 days of starting to provide care

Within 120 days of starting to provide care

Within 120 days of starting to provide care

Not required

Within 120 days of starting to provide care

Not applicable

Not applicable

Not applicable

Not required

Not required

Not required

Not required

Not required

Not applicable

Not applicable

Within 120 days of starting to provide care

Basic Training 70 Hours

BASIC TRAINING

Not required

Not required

No

No

No

No

Within 120 days of starting to provide care Not required

No

No

Yes

Yes

HCA Credential Required?

Not required

Not applicable

Not applicable

Not required

Parent Provider (DDD Only) Class 7 Hours

CREDENTIAL

INITIAL CONTINUING EDUCATION (CE)

By your birthday

By your birthday in next calendar year after completing Accelerated Basic Training

Not required

Not required, unless you voluntarily obtain your HCA credential

Not required, unless you voluntarily obtain your HCA credential

Not required

Not required, unless you voluntarily obtain your HCA credential

Not required, unless you voluntarily obtain your HCA credential

Not required, unless you voluntarily obtain your HCA credential Not required, unless you voluntarily obtain your HCA credential

By your birthday

By your birthday

By your birthday

Continuing Education 12 Hours

ONGOING CE

By your birthday in next calendar year after completing Basic Training

By your birthday following your last HCA credential renewal date

If your first renewal period is less than a full year from the date of certification, no CE will be due for the first renewal period.**

Continuing Education 12 Hours

*NOTE: If you work for multiple employers, have multiple roles or multiple consumers, you may have different training standards than the chart indicates below. ** If you are credentialed on your birthday then your CE is due on your first birthday following your Current NAC Credential issuance date.

Completed prior to providing care

Completed prior to providing care

Completed prior to providing care

Not applicable

Not applicable

Not applicable

Standard HCA IP or AP hired on/after 1/7/2012 renewed certification

Completed prior to providing care

Completed prior to providing care

Safety Training 3 Hours

Standard HCA Individual Provider (IP) & Agency Provider (AP) hired on/after 1/7/2012 in process or Newly Issued HCA credential

Orientation 2 Hours

Accelerated Basic Training 30 Hours

UPDATED JULY 2015

ORIENTATION AND SAFETY

TRAINING STANDARDS

Not required

Providers with a new NAC or Special Education Endorsements

Not required

Not required

Not required

Not required

Not required

Not required

Not required

Not required

No

No

By your birthday

By your birthday

If CE is required in table above, then your CE is due by your first birthday after you start working as an HCA IP or AP. If CE is required in the table above, then your CE is due by your second birthday following your NAC Credential issuance date.**

Home Care Aide who does not work with their own parent or child. Works more than 20 hours a month or has more than one consumer.

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). This is often referred to as a non-DDD Parent Provider.

This is an IP who provides care to his/her own adult child with a developmental disability and is contracted through the Developmental Disability Administration.

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

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

This is an IP that provides DDA Respite services at 300 hours or less in a calendar year.

Parent Individual Provider (HCS/AAA)

Parent DD Individual Provider (DDA)

Limited Service Provider

Adult Child Individual Provider

Respite

Home Care Aide (HCA) employed by a private, Medicaid homecare agency.

Agency Provider (AP)

Standard HCA

This is an HCA with a current healthcare credential, such as a Registered Nurse (RN), Licensed Practical Nurse (LPN), or Nursing Assistant Certified (NAC).

Non-HCA Credentialed

Home Care Aide (HCA) whose employer of record is DSHS.

A worker who has successfully passed a test and been credentialed by the Department of Health as a Home Care Aide.

HCA Credentialed

Individual Provider (IP)

Provides care to a consumer living in his or her home. Employed by a private, Medicaid homecare agency or DSHS.

Home Care Aide (HCA)

HOME CARE DEFINITIONS

***If you are currently certified as an LPN or RN, CE is not required for your role as an Individual Provider (IP) or Agency Provider (AP). You must maintain your LPN or RN credential and be in good standing with the state of Washington. Note: A provider may fall into more than one of these definitions. They must meet the higher requirements for training and certification.

Not required

Providers with a renewed NAC or Special Education Endorsements

For Workers Who Have a Current NAC Credential, the Chart Below Applies (Not LPN or RN)***

TRAINING STANDARDS

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Department of Health Certification ONLY FOR WORKERS WHO REQUIRE CERTIFICATION The Department of Health (DOH) is the state agency responsible for issuing the Home Care Aide credential (HCA). DOH contracts with a testing company named Prometric to implement the HCA written and skills test.

If you are required to become certified, the Training Partnership is currently recommending the timeline on page 34 to allow ample time to work through the certification steps. The steps below outline the SUGGESTED timeline for the process.

Follow These Steps for Success Prior to Providing Care: Take Safety & Orientation • •

See page 19 for full information on this course.

All workers are required to complete a name and date of birth background check before beginning work. You will work with the contracting staff to complete this.

After the name and date of birth background check is complete, you are required to schedule a fingerprint appointment. Talk with your employer for directions on how to complete this.

Make sure to keep a copy of your OCA number found on the fingerprint receipt.

•

•

STEP 1: Submit DOH Certification Application DOH requires that you submit your application to become a Home Care Aide within 14 days of hire. The application and Prometric test fee is paid for as a training benefit.

NOTE: If you are limited English proficient (LEP) you must indicate this on your initial application. This means if your ability to read, write, or speak English is limited you may be issued a provisional certification allowing up to 60 additional days to become a certified HCA.

STEP 2: Register for Training ■ Individual Providers: • •

Create your username and password to log in to the portal at www.myseiubenefits.org Register for training in the Portal or call the Member Resource Center at 1-866-371-3200.

n Agency Providers: Check with your employer on the best way to register.

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STEP 3: Submit Candidate Exam Application

STEP 4: Target Completion of Basic Training Take your training as soon as possible to ensure best access to classes in your area and your preferred language.

STEP 5: Self Study and Prepare for Exam • •

To prepare for the exam, review “Exam Preparation Materials” found on the Prometric website for the HCA Exam at www.prometric.com/WADOH. You can also take a Skills Refresher course. See page 21 for details.

STEP 6: Take Exam Arrive at test location prepared to follow testing guidelines in the Candidate Information Booklet and General Instructions. Find those at www.prometric.com/WADOH

STEP 7: Get Certified Your exam results are reported to DOH and they will send you a letter confirming you are officially certified.

• You can check the DOH website listed in Step 2 to see if your certification is Active.

• If you are Pending, it means that DOH does not have all the information they need to complete certification.

• Make sure you have fully completed the application, completed the background check, fully explained any personal history that could affect your ability to get certified, and then you have successfully passed your written and skills examination through Prometric.

Next page: Suggested timeline for certification and FAQs.

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TRAINING STANDARDS

After registering for training, download and read the Candidate Information Booklet and the Sample Candidate Application Form.

• Submit the Candidate Application Form to Prometric to be scheduled for a Home Care Aide Exam.

• On the application form you will confirm that you are in training and the estimated date you will complete the required 75 hours. You should allow four weeks for your application to be processed.

Download the forms at www.prometric.com/WADOH

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1

14

30

60

120

DEADLINE FOR COMPLETION

90

200

DAY 200 STANDARD HOME CARE AIDES ARE REQUIRED TO RECEIVE CERTIFICATION

STEP 7. GET CERTIFIED

STEP 6. TAKE EXAM

STEP 5. SELF STUDY; PREPARE FOR EXAM

STEP 4. TARGET COMPLETION OF BASIC TRAINING

STEP 3. SUBMIT CANDIDATE EXAM APPLICATION

STEP 2. REGISTER FOR TRAINING

STEP 1. SUBMIT DOH CERTIFICATION APPLICATION

PRIOR TO PROVIDING CARE TAKE ORIENTATION & SAFETY

DAYS

SUGGESTED TIMELINE FOR TRAINING AND CERTIFICATION

English proficient (LEP) you must indicate this on your initial application. This means if your ability to read, write or speak English is limited you may be issued a provisional certification allowing up to 60 additional days to become a certified HCA.

NOTE: If you are limited

DOH/Prometric Exam Frequently Asked Questions Q: What happens if I don’t apply to the Department of Health (DOH) / What happens if I don’t send in my application to DOH? A: You must submit applications to Prometric within 14 days of the date approved. This is important because the Department of Health issues the candidate ID number or HM # needed to apply to Prometric.

In order for the Training Partnership to pay for your application and Prometric exam fee, you must submit your application to DOH.

If there is no application with Prometric, there is no data for the automated systems to match between DOH and Prometric.

Q: Does my information need to be the same on the DOH application and the Prometric application?

A: You must give the exact same first name, last name, birthdate, and Social Security number on both the DOH and Prometric application. Make sure you use the exact HM number given to you by the Department of Health to put on the Prometric application.

For example, you cannot use Robert on one application and Bob on another application.

Do not include hypens in your name. Also, your birthdate must match exactly in all applications. If any of your data doesn’t match, Prometric will not get confirmation of payment

Q: What happens if I don’t get an examination date within two weeks of completing basic training?

A: If you do not receive notification of an examination date within two weeks from the training completion date, you need to contact Prometric at 1-800-324-4689.

Verification of payment should not take longer than two weeks from the training completion date to reach Prometric. Prometric assigns an exam date and sends the notice out the day they receive verification of your payment. If you submit an email address on your application, you will receive that notice the same day Prometric receives verification of payment.

There are delayed cases where Prometric is working to obtain an interpreter or testing site date. However, if you don’t receive notice of a testing date within two weeks of training completion it may be because there is an error in your data and payment verification did not reach Prometric. If this is the case, call Prometric at 1-800-324-4689.

Q: What should I do if Prometric tells me they have not received payment for the exam?

A: If Prometric tells you that they did not receive your payment (and it’s two weeks after the training completion date), contact the Department of Health at 360-236-2700 immediately. DOH staff will then research the issue and get it corrected as soon as possible.

If you do not need an interpreter, you will receive a testing date the day your issue is resolved.

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TRAINING POLICIES

Q: When can I send my application to Prometric?

A: Send your application to Prometric as soon as you know your training completion date.

This is important because sending applications through the mail can take a couple of weeks to reach Prometric. (Applications submitted online are preferred.)

and you will not be able to schedule your examination (until the data is corrected).

FREQUENTLY ASKED QUESTIONS Student Policies and Procedures 1 What is www.myseiubenefits.org?

At www.myseiubenefits.org 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.

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

Logging in to your account is an easy process from the website. See page 8 for the full step-by-step to create your account.

The best way to manage your training and find your eligibility for benefits is through the www.mybenefits.org website. Through the portal, you can more easily update your information and stay on top of your training. There is also a library of videos online that will show you how to create your account, log in, and use a variety of the Portal’s features. Under the log in box, click “Help” to find these videos.

Remember, your username is your Student ID and your password is the word you chose when you signed in. Please save your username and password in a safe place.

3 How do I check in for classes?

You just need a state-issued picture ID to check in for your classes. That can be a driver’s license, an ID card, or a passport.

4 How do I update my contact information with the Training Partnership?

You can update your contact info and set your preferred contact and language preferences in your student record by logging in at www.myseiubenefits.org, or you can call the Member Resource Center (MRC) at 1-866-371-3200.

See page 10 for a step-by-step on how to change your information in the Portal.

5 How do I ensure the Training Partnership knows I need classes in another language?

Make sure you update your language preferences in the portal or call the Member Resource Center (MRC) for help in multiple languages at 1-866-371-3200. See page 26 for more information on taking courses in your language.

6 How do I use a Community Interpreter?

Learn about the Community Interpreter option, view an orientation, and download and print a tip sheet on our Community Interpreter page here: www.myseiu.be/courseinterpret 7 I arrived at class and I am not on the roster. What do I do?

If your name is not on the roster and you decide to stay in the class, you will need to fill out an attestation form. Please note that filling out an attestation form does not guarantee that credit will be granted.

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How do I find out how to take an Online Continuing Education class in English?

See page 23 for a full list of available Online Continuing Education classes offered in English. Log in to the Training Portal and see page 8 for steps on how to take courses online.

9

Where can I find Russian training support information?

Visit www.myseiubenefits.org and on the left side of the home page you will find a Russian menu with basic training and health information

10

Where can I find Spanish training support information?

Visit www.myseiubenefits.org and on the left side of the home page you will find a Spanish menu with basic training and health information.

11

What if I cannot meet my Continuing Education deadline because of a technical issue with the learning management portal, a class cancellation, or other unforeseen issue?

Students have 365 days a year to complete their Continuing Education requirements.

It is the student’s responsibility, even if there are unforeseen events, to ensure that they have enough time to complete their training before their deadline.

12

How do I get my training certificate?

Students (and Agency employers and DSHS staff) can print their own certificates at any time. Once you’ve completed all of your training requirements go to www.myseiubenefits.org, log in to your account, and go to Training History. From there, click the “Certificate” link and print from the browser.

13

I have a question about wages for training.

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

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8

CLASSROOM POLICIES Student Code of Conduct and Classroom Expectations At the Training Partnership we know you have taken your valuable time to come to class.

We created the following policies to ensure a successful learning environment in which everyone can support each other and get the most out of each class.

Any inappropriate behavior will not be tolerated and a student may be asked to leave resulting in non-completion of the module.

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, you will not be able to take the class.

• If your name is not on the roster you will need to fill out an attestation form if you decide to stay in the class. Please note that filling out an attestation form does not guarantee that credit will be granted.

Bring Picture ID • Students are expected to show a state-issued picture ID to sign in for class. It can be a state ID, a driver’s license, or a passport.

Safety • Students and staff must work within a safe and secure environment. Any behavior that comprises this is not acceptable.

• No firearms or other weapons may be brought into the classroom.

• No drugs or alcohol may be brought into the classroom. The Training Partnership reserves the right to remove any participant suspected of being under the influence of drugs or alcohol, or who otherwise behaves disruptively, from a training course.

Student Participation During Class Time • You should arrive to class 15 minutes before the start time to avoid being late.

• Students are expected to fully participate in the learning experience.

• Students will be doing skills over and over again; practicing skills is for the student’s benefit to help equip students to pass the state exam.

• Be respectful of others by listening when others are talking and waiting your turn.

• Class time is the opportunity to hear from other perspectives; please respect others’ opinions.

• Return promptly from breaks and lunches.

• Be prepared for all classes by bringing relevant books, files, pens, and supplies.

• Treat instructors, support staff, and fellow students with respect at all times.

Phones • Personal phone calls or other personal matters should be taken care of during breaks/lunch.

• Silence your cell phone during class.

• Refrain from texting during class.

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CLASSROOM POLICIES CLASSROOM EXPECTATIONS | TRAINING POLICIES

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

• Instructors will close class for attendance 10 minutes after the scheduled class start time, except for the first day of a Basic Training Course, when Instructors will provide an additional 10-minute grace period before closing class attendance.

• Students who arrive after this time will not be permitted to attend the class and will be directed to the Member Resource Center (or whoever registered them for class) to reschedule.

Facilities • Respect the property/classroom/restrooms; pick up after yourself (coffee cups, food, paper, etc.).

• If food is not allowed in the facility, please leave your food and drinks outside the classroom.

• Smoking, including vapor cigarettes and chewing tobacco, is not allowed in the facility or within 25 feet of its entrances. Use designated areas only.

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.

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.

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TRAINING POLICIES

Attendance • Only registered students and registered interpreters are allowed in the class.

• Students may not bring consumers, children, pets (excluding service animals), or any other visitors to the class.

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.

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, 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.

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.myseiu.be/adapolicy 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 functional limitations resulting from the disability, and recommendations for specific accommodations.

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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.myseiu.be/adapolicy

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 Health Benefits Trust Agreements and HBT Trustee Policy Manual, the SEIU Training Partnership Trust Agreement and Training Partnership Trustee Policy Manual, and the relevant employer participation agreements. Should the Trust documents, CBAs or other agreements 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.

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TRAINING POLICIES

About This Guide

Home Care Aide Fatima.

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HEALTH BENEFITS TRUST Supporting Home Care Workers’ Quality of Life You work hard to make sure that your Consumers’ needs are met with great care and dignity. It’s easy to ignore your own health when you are juggling the challenges of caring for others. Your health HEALTH BASICS

matters, too. We ensure that you have the helpful resources you need to succeed — professionally and personally.

The Health Benefits Trust is a nonprofit organization providing affordable health coverage focused on keeping you healthy. The healthcare benefits offered by the Health Benefits Trust are part of a community of care that starts with you.

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Home Care Aide Jernece

3 Ways to Get Covered

Care Begins With Your Health Insurance We want you and your family to get the coverage you need. Learn more about the health care options available to you in this plan breakdown and find out if you qualify for health care through the Health Benefits Trust, Medicaid (Apple Health), or the Washington Healthplanfinder.

Not sure how to get health care insurance?

Visit www.myseiubenefits.org and search for “Coverage Finder.�

This new questionnaire will help you find health coverage that works for you.

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Your Health Plan Options MEDICAID/ APPLE HEALTH

WASHINGTON HEALTH PLAN FINDER

$25/month.

Free, depending on your household income.

Varies depending on the plan you choose.

Silver level plans provide the best value for most people.

Dependents covered only for Agency providers who pay for the full premium of their dependents.

Spouses and children covered.

Spouses and children covered.

Work 80 hours for 3 months in a row.

Individual Providers may enroll at any time.

• Depends on household income.

• If you do not qualify for insurance through an employer, you may be eligible for a subsidy for health coverage purchased on the exchange.

• Enroll any time when eligible.

APPLY

Agency Providers, may enroll when initial eligibility is first met or at open enrollment if eligible then.

See page 48 to enroll, and for more information visit www.myseiubenefits.org

• Open from Nov. 1, 2015, to Jan. 31, 2016.

Or when you have a “qualifying event” such as marriage, a child, or losing coverage.

Visit Washington Healthplanfinder for more information at

Visit Washington Healthplanfinder for more information at

www.wahealthplanfinder.org

www.wahealthplanfinder.org

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HEALTH BASICS

ELIGIBILITY

COVERAGE

YOUR COST

HEALTH BENEFITS TRUST

Get to Know Your HBT Benefits If you are eligible for insurance through the Health Benefits Trust, you receive a variety of packaged benefits. We strive to provide you excellent access to medical care, while also guaranteeing you the lowest possible out-of-pocket costs.

Medical Benefits For $25 a month, you will receive medical, prescription drug, mental health and chemical dependencies, vision, and dental benefits. Depending on your ZIP code*, your medical, vision, and prescription drug health care coverage will be provided by Group Health or Kaiser Permanente.

Some of these services may be covered in full, or you may have a copay (small out-ofpocket cost) for the following services: • Acupuncture • Allergy shots and other injections • Chiropractor visits • Doctor’s office visits • Hearing exams • Hospitalization • Laboratory services

• Mammograms • Maternity services • Mental health • Rehabilitative therapies • Routine immunizations • X-rays and diagnostic imaging

Want more information on what’s covered?

See pages 78-97 for full Benefits Summaries. *If you are currently enrolled in the Health Benefits Trust, you are enrolled in one of the following plans depending on your ZIP code: Group Health Cooperative HMO You live within 30 miles of a Group Health Medical Center or contracted facility and enrolled in the Trust after 8/1/2012. This plan only has coverage in the Group Health network. There are no out-of-network benefits.

Group Health Options POS You live within 30 miles of a Group Health Medical Center or contracted facility and were enrolled in the Health Benefits Trust before August 1, 2012.

Group Health Options PPO You live more than 30 miles from a Group Health Medical Center or contracted facility.

Kaiser Permanente HMO You live within the Kaiser Permanente service area (southwest Washington/Portland, OR, only).

For more information, see page 78 for plan and network grid.

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We Have Exciting Changes in Your 2015-2016 Plan!

You now qualify for HBT insurance if you work 80 hours/month.

Your work requirement from 86 to 80 hours per month. In the past you had to work 86 hours per month for three months to be eligible for the Trust’s benefits, and continue to work 86 hours per month after that. Now you will only need to work 80 hours. We hope this change will make it a little easier to meet the requirements for coverage. See page 48 to see more information and to apply for our insurance.

Dip under 80 hours one month? We’ve got you covered!

Our new Coverage Grant Pilot Fund will provide one additional month of coverage to qualified members who dip between 80 and 60 hours once during the health plan year until the Pilot Fund is depleted. The Grant will assist members who dip between 80 and 60 hours in a single month. Members can apply for this coverage by contacting the Member Resource Center at 1-866-371-3200 or submitting the application form on page 51.

Delta Dental annual maximum has increased to $2,000!

We heard your feedback that a $1,000 annual maximum was not enough to cover your basic dental care. Members now have access to $2,000 of covered services per calendar year for preventive, diagnostic, and restorative coverage. See page 96 for your full plan summary.

Annual Plan Maximum Delta Dental

Delta Dental coverage maximum annual benefit increases from $1,000 to $2,000.

Transgender Services Group Health

The Transgender Services provision has been revised to reflect coverage of medically necessary medical and surgical services for Sex Reassignment Surgery to comply with the Washington Law Against Discrimination.

Kaiser Permanente

The exclusion for Sex Reassignment Surgery has been deleted to comply with the Washington Law Against Discrimination.

Mental Health Services Group Health

A clarification to the Mental Health provision has been made by removing inpatient residential treatment services and sexual and identity disorders from the list of exclusions.

Cardiac Rehabilitation Group Health

Coverage of cardiac rehabilitation is now included up to a total of 36 visits per cardiac event. The cardiac rehabilitation exclusion has also been removed.

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HEALTH BASICS

2015-2016 Plan Changes

Eligibility Do I Qualify for Health Benefits Trust Coverage?

1

2

3

Question 1:

Have you worked 3 months or more in a row as a Home Care Worker?

80 HOURS

Question 2:

In those months, have you worked at least 80 hours per month?*

If you answer “Yes” to both of these questions, you meet the first eligibility requirements!

Individual Providers can complete and mail in the form on the tear out card. Agency Providers, please see below for information on how to apply. *You can now combine all of your hours from multiple employers to qualify for insurance.

See page 50 for details.

If you answer “No” to either question, you can still receive health insurance through Washington Apple Health (Medicaid) or the Washington Healthplanfinder. See page 45 for more information.

n INDIVIDUAL PROVIDERS If you are contracted through the Department of Social and Health Services (DSHS), you are considered an Individual Provider (IP). You can apply at any time by using the enrollment form card (tear out and mail in) or by visiting www.myseiubenefits.org

n AGENCY PROVIDERS If you are a Home Care Worker working for the Washington agency employers below, you are considered an Agency Provider (AP). Talk with your employer about enrolling in our health insurance.

• Addus Healthcare • Amicable Healthcare • Catholic Community Services • CDM • Chesterfield • Concerned Citizens • Fidelis

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MYSEIUBENEFITS.ORG

• Home Care Services of Montana • Korean Women’s Association • Olympic Community Action Council • Coastal Community Action Council • ResCare • Senior Life Resources Northwest

Home Care Aides Jernece, Cerise, and Mark on a walk.

How to apply for three new HBT benefits

Do you have a Consumer who is temporarily entering a nursing home? Or maybe you are currently looking for a new Consumer?

We understand that unexpected changes happen that may affect your monthly work hours. Our new Coverage Grant Pilot Fund may provide one additional month of coverage to qualified members who dip between 80 and 60 hours once during the health plan year (August 1, 2015 - July 31, 2016) until the Pilot Fund is depleted.

If you would like to receive a Coverage Grant, please complete the application (on page 51) and send it in along with your $25 co-premium.

You can apply for this coverage by contacting the Member Resource Center at 1-866-371-3200 or submitting the application form on page 51.

HEALTH BASICS

A Dip under 80 hours one month? The new Coverage Grant may help keep you enrolled!

80 HOURS

60 HOURS

80 HOURS

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49

B

Combine your hours to qualify for health insurance

40 IP

HOURS

40 AP HOURS

The Health Benefits Trust now can combine all of your hours worked during a month for all of your participating employers. We will then use this information to determine your eligibility to receive healthcare coverage.

The Combined Hours Provider program applies to both Agency Providers and Individual Providers.

What does it mean to combine hours?

If you work at least 80 hours between two different employers, we will combine those hours and you will be eligible for HBT coverage.

Ex.: You work 40 hours as an IP and 40 hours as an AP, and separately you do not qualify for coverage.

However, by combining the hours, you qualify because you work 80 hours for the month.

How do I enroll?

If you qualify for the Combined Hours program, you will receive an enrollment form in the mail to complete and return.

How much is the premium? $25 per month.

How is the premium paid?

Self-payment. You will need to submit payment by the 10th of each month. No payment will be auto deducted from your paycheck.

For more information, call the Member Resource Center at 1-866-371-3200.

C Get $75 for switching to our HMO Plan If you are currently on a Health Benefits Trust Point of Service, or “POS,” insurance plan, you may prefer our HMO plan and you can receive $75 as an incentive for switching.

This switch may be appropriate for you IF: •

You are currently seeing a Group Health physician.

•

You live near a Group Health facility.

•

You don’t plan on moving in the next year.

$75

$75

What will change when I switch to the HMO plan?

•

You will have no deductibles. (The amount that you pay for covered services before the plan begins paying in a given year.)

•

If you currently see a doctor outside the Group Health network, you will have to switch to a Group Health doctor on the HMO plan.

•

The HMO plan does not cover any services outside of the Group Health network, except for emergency services.

This is a one-time change. Once you change your plan, you cannot switch back to your original plan. For more information, call the Member Resource Center at 1-866-371-3200.

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A

HEALTH COVERAGE GRANT APPLICATION DIP BETWEEN 80-60 HOURS? APPLY FOR ONE MONTH OF COVERAGE Eligibility Criteria The Health Benefits Trust is pleased to offer home care aides a one-time grant to actively enrolled health plan members whose hours drop below 80 compensable hours for one month but remain above 60 compensable hours for that same month. A member is eligible to apply for one month of coverage once within a plan year (August 1, 2015-July 31, 2016). The Health Coverage grant will be awarded on a firstcome, first-served basis for eligible Home Care Aides until the pilot fund is depleted. Members are able to combine their compensable hours from multiple employers to meet the 60-hour requirement.

If you would like to receive a Coverage Grant, please complete this application and send it in along with your payment for the $25 monthly co-premium to the address on the reverse. Applications will be accepted up to the 10th day of the month in which you request coverage. The Health Coverage grant does not cover family members or dependents.

Once your application and payment are received you will receive confirmation that your coverage grant is approved. You will be able to continue to use your regular health insurance card and will have access to the same health benefits as when you are regularly enrolled in the plan.

See page 49 for full information.

HEALTH BASICS

PERSONAL INFORMATION (Please print clearly and in English):

Middle Initial:

First Name:

Apt #:

Street:

Social Security Number: Phone Number: Gender:

Female Male

Last Name: City:

ZIP Code:

Date of Birth: Email Address: IP Number or Agency Name(s): Preferred Language:

Complete and sign form on reverse.

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COVERAGE GRANT PILOT FUND FORM (CONTINUED) Please provide the following information - We would appreciate your responses to the following questions to help us understand why HCAs lose health coverage. We will use this information to inform our future planning in reaching our goal of helping to provide continuous health coverage.

The information you provide will not affect whether or not you receive the grant.

The reduction of my hours was voluntary.

Yes

No

The reduction of my hours resulted from (check all that apply):

I was caring for a family member or friend.

Yes

No

Consumer needed different type/ level of care

I anticipate my hours will increase to 80 next month.

If No, why not:

Yes

No

Consumer passed away or moved Personal Health/Work related injury Wasn’t able to obtain additional hours Dispute with consumer/employer Personal Reasons

I hereby apply for the Health Coverage grant as indicated on this application. I understand that the SEIU Healthcare NW Health Benefits Trust and the Insurers may collect, use, and disclose protected health information about each individual enrolled under this application in order to carry out their routine business functions, including but not limited to: determining eligibility for benefits, paying claims, coordinating benefits with other insurance carriers or payer, underwriting and conducting case management care management, and quality reviews. The SEIU Healthcare NW Health Benefits Trust and the Insurers may also disclose protected health information to state and federal agencies, or other third parties, as required by law. The undersigned understands that it is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purposes of defrauding the company. Penalties may include imprisonment, fines, and denial of insurance benefits.

Signature:

Date:

TO APPLY: Please send signed application with your $25 co-premium payment to the Health Benefits Trust. Please keep a copy for your records.

Mail to: SEIU Healthcare NW Health Benefits Trust PO Box 6 Mukilteo, WA 98275

Fax to: (206) 859-2637

Email to seiu@bsitpa.com QUESTIONS? If you have questions about this form or benefits, call the Member Resource Center toll free at (866) 371-3200 CoverageGrant-FY15/16

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B

COMBINED ENROLLMENT APPLICATION COMBINE YOUR IP/IP, IP/AP, AP/AP SERVICE HOURS Participation Rules To be eligible for this Plan, Home Care Workers must work at least 80 hours per month for 3 consecutive months. Your coverage will begin once your enrollment application is processed; it typically takes 2 months after your application is received and after you have met your initial requirements of 80 hours for 3 consecutive months before your coverage will start. This insurance does not cover family members or dependents.

If you currently have other health insurance, you must cancel that insurance when your new coverage starts.

If you sign up for a different health insurance plan while you are covered on this Plan, you must notify the Health Benefits Trust immediately at 1-866-771-7359.

Once your enrollment application is received we will mail you a letter confirming your application has been processed. If you do not receive a confirmation letter within 45 days of submitting this application, please contact the Health Benefits Trust at 1-866-771-7359.

See page 50 for more information.

PERSONAL INFORMATION (Please print clearly and in English):

Middle Initial:

First Name:

Last Name: City:

Social Security Number:

Female Male

ZIP Code:

Date of Birth:

Phone Number: Gender:

HEALTH BASICS

Apt #:

Street:

Email Address: IP Number or Agency Name:

DENTAL PLAN CHOICE (CHECK ONE) Delta Dental (Washington Dental Service) 1-800-554-1907 www.deltadentalwa.com Willamette Dental 1-800-359-6019 www.willamettedental.com

Preferred Language:

MEDICAL: Based on your ZIP code, your medical, vision and prescription drug coverage will be provided by Group Health or Kaiser Permanente.

Complete and sign form on reverse.

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COMBINED ENROLLMENT APPLICATION COMBINE IP AND/OR AP SERVICE HOURS (CONTINUED) I hereby apply for enrollment as indicated on this application. I understand that the SEIU Healthcare NW Health Benefits Trust and the Insurers may collect, use and disclose protected health information about each individual enrolled under this application in order to carry out their routine business functions, including but not limited to, determining eligibility for benefits, paying claims, coordinating benefits with other insurance carriers or payer, underwriting and conducting case management care management and quality reviews. The SEIU Healthcare NW Health Benefits Trust and the Insurers may also disclose protected health information to state and federal agencies, or other third parties, as required by law. The undersigned understands that it is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purposes of defrauding the company. Penalties may include imprisonment, fines and denial of insurance benefits. By signing below, I agree to send in the required monthly self-payment for my health insurance. In the event of an involuntary loss of HBT coverage, if minimum hour eligibility requirements are met again within 12 months from the date of coverage loss, coverage will be automatically reinstated.

Signature:

Date:

TO APPLY: Please send this completed, signed application to the Health Benefits Trust.

Please keep a copy for your records.

Mail to: SEIU Healthcare NW Health Benefits Trust PO Box 6 Mukilteo, WA 98275

Fax to: (206) 859-2637

Email to: seiu@bsitpa.com QUESTIONS? If you have questions about this form or benefits, call the Member Resource Center toll free at (866) 371-3200 Group Health Cooperative • 320 Westlake Ave. N., Ste. 100 • Seattle, WA 98109 Group Health Options • 320 Westlake Ave. N., Ste. 100 • Seattle, WA 98109 Kaiser Foundation Health Plan of NW • 500 NE Multnomah St., Ste. 100 • Portland, OR 97232 Washington Dental Service • PO Box 75688 NG Station • Seattle, WA 98175 Willamette Dental of Washington Inc • 6950 NE Campus Way • Hillsboro, OR 97124 IP-FY14/15

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C

CHANGE IN PLAN ENROLLMENT FORM MAKE THE SWITCH TO OUR HMO PLAN If you are currently on a Health Benefits Trust Point of Service, or “POS,” insurance plan, you can receive $75 by switching to an HMO plan.

See page 50 for details to see if this switch is right for you.

PERSONAL INFORMATION (Please print clearly and in English):

Middle Initial:

First Name:

Apt #:

Street:

Last Name: City:

Social Security Number: Phone Number:

ZIP Code:

Date of Birth: Email Address:

HEALTH BASICS

Individual Providers IP Provider Number: Agency Providers Agency Name (if applicable):

Branch:

Dependent Enrollment Information (APs only) Dependent 1

Dependent 2

Dependent 3

Relationship First Name Last Name Gender DOB SSN

Complete and sign form on reverse.

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55

MAKE THE SWITCH TO OUR HMO PLAN CHANGE IN PLAN ENROLLMENT FORM (CONTINUED) I understand voluntary completion of this enrollment form will result in change of coverage from my current coverage to the Group Health HMO plan. As has been previously communicated to me, pursuant to the terms of the plan, I understand that once this change of coverage is effective, I will no longer be eligible to re-enroll in the Group Health POS plan in the future. I also understand that the HMO plan does not cover providers outside of the Group Health network.

Signature:

Date:

To change your enrollment and receive your incentive, please send this completed, signed enrollment change form to the Health Benefits Trust.

Mail to:

Fax to:

SEIU Healthcare NW Health Benefits Trust PO Box 6 Mukilteo, WA 98275

(206) 859-2637

Email to: seiu@bsitpa.com

QUESTIONS? If you have questions about this form or benefits, call the Member Resource Center toll free at (866) 371-3200

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Home Care Aide Cerise

As Home Care Workers, you help others but may not have the time to focus on your own health and personal care. You deserve the same attention that you give others. Care Begins With You means caring for yourself as compassionately and deeply as you care for others.

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YOUR HEALTH

Tips to Save Time, Money and Support Your Health

Home Care Aide Linda

Get to Know Your Primary Care Provider A strong relationship with your Primary Care Provider (PCP) is at the heart of your care, and helping you stay healthy. Through regular checkups, screening tests, and immunizations, you can work with your PCP to take charge of your health. And when injuries or illnesses pop up, you will have a provider who is familiar with your personal health.

Find a provider today: Kaiser Permanente www.KP.org 1-800-813-2000

Group Health www.MyGroupHealth.org 1-888-901-4636

DID YOU KNOW? It costs much less when you use in-network providers.

One office visit with a Group Health or Kaiser Permanente provider is just $15.

In-network office visits are the best value for your money!

$15

$15

Group Health or Kaiser Permanente provider

$$$

$$$

Out-of-network providers. Costs could include co-insurance, deductibles, or the full cost of the visit depending on your plan.

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Find More Health Information Online

Registering at www.MyGroupHealth.org or www.KP.org will help get you connected to the most convenient care. At www.MyGroupHealth.org you can make appointments online, order prescriptions, and email your Primary Care Provider (PCP).

Group Health www.MyGroupHealth.org

Kaiser Permanente www.KP.org

On the Go Both Group Health and Kaiser Permanente have mobile apps • • • • •

YOUR HEALTH

where you can: Make appointments Refill prescriptions Email your medical team See lab and test results Find locations and more!

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59

Home Care Aide Ben

Know Your Mental Health Benefits As a Home Care Worker, you know the importance of staying healthy. But when you think about staying healthy, is your mental health part of the equation? Mental health is just as important to your overall health as physical health.

What can mental health support look like?

For our members, mental health care and treatment can look like a number of things: • • • • •

One-on-one therapy with a mental health counselor Medication Psychiatric care Group therapy Support from your Primary Care Provider

Often, the first step to getting care is talking to your Primary Care Provider. Let them know you would like to access your mental health benefits and that you are aware of the different options available to you. With your input and preferences, they can help guide you to the care that is best for you.

Make the Call Today: Group Health members: • First time appointments: call 1-888-287-2680 or 206-901-6300 • Urgent or crisis care, call the Consulting Nurse Service: 1-800-297-6877

Kaiser Permanente members: • Call, e-mail, or schedule online with your doctor • Call for therapy and counseling services: • Vancouver: 360-571-3133 • Longview: 360-575-4821

Call 911 if you or a friend show any signs of self harm.

You can also call the 24-hour Washington Recovery Help Line at 1-866-789-1511.

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10 Common Signs of Depression and/or Anxiety If you can check off two or more of these, you may have symptoms of depression, anxiety, or both. They may show up slowly or arrive suddenly.

More irritability. Example: The behavior of children, partners, or friends may be more annoying than usual.

More frustration than usual and that lasts longer, like when you are stuck in traffic.

More anger.

Difficulty sleeping, interrupted sleep, sleeping more than usual, or not being able to return to sleep after waking.

Decreased hunger, maybe even missing meals.

Thoughts that you would be better off dead.

Trouble focusing on simple things.

People in your life noticing you are very distracted.

Feeling nervous, on edge, and/or unable to calm yourself down.

Not being able to stop worrying.

Visit www.myseiu.be/checkmymentalhealth to take an online depression self-assessment.

Steps to Finding Help: Your Health Benefits Trust insurance includes mental health and chemical dependency services. Your copay for one-on-one mental health visits is $15.

STEP 1:

Make an appointment with your Primary Care Provider (PCP) to talk about your concerns and hear options available to you.

STEP 2:

With a referral from your PCP to Behavioral Health Services, make an appointment for a mental health visit. In this visit, you will discuss specific options from one-on-one therapy, group therapy, medication, or a combination.

STEP 3:

Start meeting with your new mental health professional or support group. It is OK to feel nervous at your first session. A counselor, for example, is on your side, there to listen to your concerns and suggest tools, ideas, and resources for your work and personal life.

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YOUR HEALTH

Or call Group Health at 206-901-6300 or Kaiser at 360-571-3133 to get a personalized screening and determine the best next steps for you. Making this call can be the hardest step. But know that it is the first step on your road to a happier, healthy life.

Find Your Affordable Prescriptions Your prescriptions are a big part of your health benefits. Make the most of them by managing them wisely. The co-pay is lower for drugs that treat diabetes, high blood pressure, high cholesterol, and heart failure. The co-pay is also lower for other generic drugs and formulary brand-name drugs.

Get the Best Deal Through Group Health and Kaiser Pharmacies You will have a lower co-pay, or no co-pay, by using mail order prescription drugs through the Group Health and Kaiser Permanente pharmacies.

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

Mail-Order Prescriptions Getting your prescriptions by mail helps make your prescriptions more affordable. Group Health members get a co-pay discount of up to $5 vs. filling your prescription at the pharmacy.

1-month supply: up to a $5 discount on your Group Health copay 3-month supply: up to a $15 discount on your Group Health copay Kaiser members can obtain a three-month supply for only two co-pays vs. three copays at the pharmacy.

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

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Manage Your Chronic Conditions

**Value-Based Drugs

Rx Co-pay (In-network) for 30-day supply

Diabetes:

Drugs

Group Health

Kaiser Permanente

Metformin

Formulary contraceptives*

$0

$0

Glipizide

Value based drugs**

$4

$5

Insulin NPH

Generic drugs

$8

$5

High Cholesterol:

Formulary brand name drugs

$25

$25

Simvastatin

Non-formulary brand name drugs

$50

$50

Glyburide

* Catholic Community Services does not pay for contraceptive and sterilization services

Lovastatin Pravastatin Heart Failure: Carvedilol Metoprolol XL Spironolactone

How to Transfer Your Prescription

High Blood Pressure: Hydrochlorothiazide Chlorthalidone Lisinopril Enalapril Captopril Ramipril Lisinopril/ HCTZ Amlodipine Verapamil Diltiazem MetoprololIR Atenolol

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 1-800-813-2000.

How to Set Up a Mail-Order Prescription 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.

Your Vision Benefits YOUR HEALTH

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

DID YOU KNOW? 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.

Want more information on what’s covered?

See pages 78-92 for Benefits Summaries 2015-2016 BENEFITS BOOK

63

Give Your Teeth Some Love It is easy with full dental coverage with Willamette or Delta Dental Each Home Care Worker chooses either a Willamette or Delta Dental plan during enrollment. If you have chosen Delta Dental, dental cleanings are covered in full – two times every calendar year. Under Willamette Dental, you also have full coverage for cleanings two times a year after a $15 copay.

You might be surprised what is covered in your dental benefits These in-network services are covered at no or minimal additional cost: • Routine exams • Regular cleanings • X-rays • Gum care • Fillings

Depending on your plan, some of the cost of the following procedures may also be covered: • Crowns, Inlays • Bridges, Dentures • Implants • Oral surgery • Periodontics (treatment for gum disease) • Endodontics (root canals)

Your Delta Dental annual maximum has increased to $2,000!

BRAND NEW THIS YEAR!

We heard your feedback that a $1,000 annual benefit was not enough to cover members’ basic dental care. Members now have access to $2,000 of covered services per calendar year for preventive, diagnostic, and restorative coverage.

See pages 94-97 for your full dental plan summary. Willamette Dental plans continue to have no annual maximum.

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Find your dentist and more information online

Visit the Delta Dental and Willamette Dental websites to find a dentist in your area, schedule an appointment, and learn more about your oral health.

Delta Dental www.deltadental.com

Willamette Dental www.willamettedental.com

Eva, Parent Provider and Home Care Aide

YOUR HEALTH

“

I always make sure that I go every six months to get my teeth cleaned. I think that’s really important. Also it feels really good.”

Your mouth plays a critical role in your health!

According to the Center for Disease Control and Prevention, half of adults over age 30 have some form of gum disease.

It is never too late to take action on your oral health by finding your dentist and taking advantage of your benefits such as regular cleanings.

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65

REE) F ( E E LIN S R U N

ffice doctor’s o

emergency room

URGENT CARE

$200 copay

$15/30 copay*

(waived if you are admitted)

*Above copays are $15 for Group Health and $30 for Kaiser Permanente.

Need immediate care? Look for these options.

A trip to the Emergency Room can rack up quickly, costing you a $200 copay. Sometimes, the ER is the best place to go for serious illness or injury. But a 24-hour nurse consulting line, same-day doctor visits, or urgent care may give you the care you need for a fraction of the price!

urgent care

24-hour Consulting Nurse can provide advice and direct you to the best place for care.

Group Health:

Seattle area: 206-901-2244 WA State: 1-800-297-6877

Your Primary Care Provider (PCP) may offer same-day appointments.

Urgent Care centers (UC) are located around the state.

Group Health: $15 copay (PCP and UC) Kaiser Permanente: $15 copay (PCP), $30 copay (UC) Health examples to treat at Urgent Care or Primary Care Provider:

• Headache/Migraine

• Constipation/Diarrhea

Kaiser Permanente:

• Urinary Tract Infection

• Viral Infection

1-800-813-2000

• Bronchitis

• Asthma

• Back/Neck Pain • Sprains

• Cold, Flu, Fever, Sore Throat

• Painful Respiration

• Minor Injury/Illness

For life-threatening emergencies, always call 911.

Group Health: www.myseiu.be/GHLocations Kaiser Permanente: www.myseiu.be/KPLocations

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Group Health Urgent Care Centers Six Group Health medical centers have Urgent Care Centers, most with evening, weekend, and holiday hours. Group Health also contracts with many community Urgent Care Centers throughout the state of Washington. Use the Group Health Provider Directory at www.myseiu.be/GHLocations to find urgent care providers in other areas.

BELLEVUE MEDICAL CENTER URGENT CARE | 425-502-4120 425-502-3000 11511 N.E. 10th St. Bellevue, WA 98004

SILVERDALE MEDICAL CENTER URGENT CARE | 360-307-7300 360-307-7300 10452 Silverdale Way N.W. Silverdale, WA 98383

CAPITOL HILL CAMPUS, SEATTLE URGENT CARE | 206-326-3175 206-326-3000 201 16th Ave. E. Seattle, WA 98112

TACOMA MEDICAL CENTER URGENT CARE | 253-596-3300 253-596-3300 209 Martin Luther King Jr. Way Tacoma, WA 98405

EVERETT MEDICAL CENTER URGENT CARE | 425-261-1660 425-261-1500 2930 Maple St. Everett, WA 98201

RIVERFRONT MEDICAL CENTER URGENT CARE | 509-324-6464 509-324-6464 322 W. North River Dr. Spokane, WA 99201

OLYMPIA MEDICAL CENTER URGENT CARE | 360-923-7740 360-923-7000 700 Lilly Rd. N.E. Olympia, WA 98506

Use the Kaiser Permanente Directory at www.myseiu.be/KPLocations to find urgent care providers in other areas.

LONGVIEW-KELSO MEDICAL OFFICE URGENT CARE | 360-636-2400 1230 Seventh Avenue Longview, WA 98632 M-F: 6 p.m. - 9 p.m.

Sat: 9 a.m. - 6 p.m.

Holidays: 9 a.m. - 6 p.m.

Closed: Sundays, Thanksgiving, Christmas Day

CASCADE PARK MEDICAL OFFICE URGENT CARE | 1-800-813-2000 360-307-7300 12607 SE Mill Plain Blvd.

Vancouver, WA 98684 M-F: 6 p.m. - 10 p.m.

Weekends/Holidays: 9 a.m. - 6 p.m.

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Kaiser Permanente Urgent Care Centers

0

Hurt at work?

Follow these steps to file a claim.

When you provide care to a family member, friend, or Consumers, it can be difficult to know when an injury happens “at work.”

A good rule to go by: If you are injured performing any tasks on your Consumer’s Care Plan, you can file for worker’s compensation through the Washington State Department of Labor & Industries (L&I).

Top injuries for Home Care Aides on the job include: • SPRING 2015

Overexertion from lifting, straining, or repetitive INSIGHT MAGAZINE SPRING 2015 INSIGHT MAGAZINE 20 movement

•

Trips and falls

•

Assaults and violent actions

•

Car or transit injuries while performing Care Plan tasks (although uncommon, covered by L&I)

INSIGHT MAGAZINE

SPRING 2015 21

Steps to Reporting Your Injury Step 1: Get first aid. Many falls, cuts, and sprains can become serious injuries if they aren’t treated right away. If you are injured at work, go to your doctor, nearest Urgent Care center, or for severe injuries, the Emergency Room.

Step 2: File a claim. You can file an accident report for your injury at your doctor’s office, over the phone to the L&I office at 1-877-561-FILE (business hours only), or online at www.LNI.WA.gov Individual Providers: Ask your doctor for the “Report of Injury or Occupational Disease” form. List your employer as:

HCQA Negotiated Contract

601 Union St., Suite 3500, Seattle, WA 98101.

A company called Sedwick CMS will manage your claim.

Contact them toll free at 1-866-897-0386.

Agency Providers: Let your employer know right away about your injury.

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Step 3a: Your claim is approved. L&I will approve your claim if your doctor certifies that you were injured at a specific time and place at work, or if you have a disease or disorder caused by your work. Benefits cover medical bills.

They also may include wage replacement, return-to-work help, and disability for the severely injured.

Step 3b: Your claim is rejected. Claims can be rejected if the doctor cannot certify your medical condition is related to something specific that happened at work or an occupational disease. You and/or your doctor have the right to protest any decision made about your claim online at www.lni.wa.gov. Appeals can be made directly to the Board of Industrial Insurance Appeals.

Step 4: Get back to work. Some injured workers miss days of work while they recover. However, many can return to work gradually, while still receiving medical benefits. Returning to work as quickly as possible is a team effort between you, your doctor, and your employer. Stay in touch with them. L&I will provide assistance when you need it.

Step 5: Close your claim. Claims are closed when: •

Your doctor certifies that further treatment won’t improve your condition.

•

L&I has no new information showing you need further assistance.

•

Your treatment was successful! (In these cases, L&I accepts and closes your claim at the same time in a “Notice of Decision.”)

HBT Members: Your insurance coverage through the Health Benefits Trust will NOT be affected by reporting your injury to L&I. You can continue to use your current benefits while collecting additional benefits from L&I.

Learn more and file your claim at www.LNI.WA.gov

Participate in programs focused on weight loss, workplace safety, and stress reduction. You will be introduced to healthy action steps, track your results, report back to us, and share your success with other Home Care Workers.

If you are interested in participating, complete and mail the form on page 12 or email us at healthy@myseiubenefits.org to sign up.

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Engage your passion for healthy living (statewide)

Home Care Aide Jernece

Who to Contact About Your Benefits TYPE OF QUESTION

WHO TO CONTACT Individual Providers: Visit www.myseiubenefits.org or call MRC at 1-866-371-3200

How do I enroll in Health Benefits Trust insurance coverage?

How do I apply for the Coverage Grant when I dip under 80 hours?

Group Health plans

Agency Providers: Talk with your employer first, then call the MRC for further questions at 1-866-371-3200 Complete and mail in the form on page 51 or call the Member Resource Center at 1-866-371-3200

Call 1-888-901-4636 or visit www.ghc.org Mental Health Services: 206-901-6300 Call 1-800-813-2000 or visit www.kp.org

Kaiser Permante plans

Mental Health Services: 360-571-3133 (Vancouver) 360-575-4821 (Longview)

Delta Dental plans

Call 1-800-554-1907 or visit www.deltadentalwa.com

Willamette Dental plans

Call 1-855-433-6825 or visit www.willamettedental.com

Questions about your monthly co-premium or payroll deductions

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Individual Providers: Contact your DSHS contact Agency Providers: Contact your employer

FREQUENTLY ASKED QUESTIONS Eligibility and Enrollment 1. How many hours do I have to work for continuing coverage?

After your coverage begins, you must work at least 80 hours each month to have continuous coverage. Training hours and accrued vacation hours can be used to satisfy the 80-hour requirement.

2. 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.

However, if you had training during the month you can count those hours. You can also use accrued vacation hours.

3. How do I enroll for coverage?

■ Individual Providers Complete the enrollment card in this book, log on to www.myseiubenefits.org to complete enrollment, or call the Member Resource Center at 1-866-371-3200.

■A gency Providers Contact your employer to coordinate your enrollment.

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

■ Individual Providers You can enroll as soon as you have authorization to work as an Individual Provider. See page 48 for details and to enroll.

■ Agency Providers Contact your employer to coordinate your enrollment.

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

No, you only need to meet the initial eligibility requirements if you are not covered by the plan for 12 months in a row. If you’ve been out of the plan for 12 months or more you will need to re-qualify by working three months of 80 hours and waiting the administrative period.

6. I work for a Home Care Agency that does not participate in the Health Benefits Trust 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?

NOTE You cannot be covered under both the Health Benefits Trust as an Individual Provider and another employer’s plan.

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Yes, but please keep in mind the initial eligibility requirements when determining your cancellation date with your agency employer’s plan. You should keep your current plan until your coverage as an Individual Provider begins.

FREQUENTLY ASKED QUESTIONS Individual & Agency Providers Your coverage will terminate on the first day of the second month.

Example Worked less than 80 hrs in May

Coverage ends last day of June

7. What happens if I work less than 80 hours in a month after I am enrolled in the plan?

Your coverage will end. However, using the form on page 51, you can apply for one month of coverage per plan year if you dip below 80 hours, but remain above 60 hours.

8. 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 (also known as your Remittance Advice) and invoice showing you claimed at least 80 hours for that month.

It is 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.

9. 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?

No, participants may not have health care benefits or insurance through other individual, family, employment-based, military, or veterans coverage or insurance. The only exception is Medicare and Medicaid. If enrolled in Medicare or Medicaid, you may enroll in the Trust and your Medicare or Medicaid coverage becomes secondary to your Trust coverage.

10. Can I add dependents to my plan?

■ I ndividual Providers Dependents are not covered. The Individual Provider benefits do not allow coverage for dependents under this plan.

■ Agency Providers If you are covered by the Health Benefits Trust through your employer, you can cover dependent children only by paying the full premium for them through payroll deduction. Dependent children can only be added when they are initially eligible or during the annual open enrollment period. Check with your employer for more information.

11. When will my coverage be effective?

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BENEFITS POLICIES

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

■ Individual Providers

You must work at least 80 hours per month for 3 consecutive months. After you’ve met this requirement, it takes 2 months before your coverage starts. See the example below: February

March

April

May

You worked at least 80 hours

You worked at least 80 hours

You worked at least 80 hours

Administrative period You worked at least 80 hours

Submit an enrollment application any time before May 20th

June

You worked at least 80 hours

July Coverage begins on July 1st

First $25 payroll deduction for July coverage

■ Agency Providers

Contact your employer to coordinate your enrollment. See the example below for what to expect: February

March

April

You worked at least 80 hours

You worked at least 80 hours

Administrative period You worked at least 80 hours

May

You worked at least 80 hours

June

July

Coverage begins on June 1st

First $25 payroll deduction for June coverage Submit an enrollment application any time before May 20th

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

No.

13. What if I have coverage, other than Washington Apple Health (Medicaid), through Washington Health Plan Finder (the Washington Health Benefit Exchange or Affordable Care Act)? Can I enroll in this plan?

Only if you cancel your coverage. You cannot have both. If you are an Agency Provider, you can only enroll during open enrollment, if you have a qualifying event, or if you have an involuntary loss of coverage.

14. 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.

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

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

The request must be made in writing and can be faxed or mailed. Requests received

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Yes. When you become eligible for Health Benefits Trust coverage, you can cancel your COBRA coverage and enroll.

FREQUENTLY ASKED QUESTIONS before the 15th of the month will stop further payroll deductions. (See next page.)

Fax: (206) 859-2637 Mail: SEIU Healthcare NW Health Benefits Trust PO Box 6 Mukilteo, WA 98275

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

Yes, but if you have voluntarily canceled your coverage, you will have to meet the initial eligibility requirements again in order to regain coverage. If you are an Agency Provider, you must wait until the next annual open enrollment.

Plan Specifics 1. If I haven’t received my medical ID card, who do I call?

If you do not receive your card by the 15th of the month that your coverage starts: Group Health 1-888-901-4636 Kaiser 1-800-813-2000

2. I want to change my dental insurance provider. How can I do this?

■ Individual Providers, please call the Member Resource Center at 1-866-371-3200 about options for changing dental insurance providers.

■ Agency Providers, please contact your employer about open enrollment or qualifying events. 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.

3. 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 1-855-433-6825

4. Who do I contact if I have specific questions about my coverage or a claim?

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

Group Health (POS, PPO, 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 1-855-433-6825 www.willamettedental.com

5. My address has changed. Who do I notify?

If you are an Individual Provider, request for an address change must be made to 74

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either your DSHS case worker or to Social Service Payment System (SSPS) directly. If you are an Agency Provider, contact your employer to make this change.

Group Health Specific Questions 1. 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 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.

2. 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 enrolled in the HBT plan prior to 8/1/2012 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.

3. How do I look for a provider available to me through Group Health?

The easiest way to find a provider is through the Group Health website, www.ghc.org.

On the 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:” either choose “Group Health” for the HMO plan or “Options PPO” for the PPO plan or “Options” for the POS plan.

Or call Group Health Customer Service toll free: 1-888-901-4636.

4. How do I pay my co-pay?

Group Health no longer accepts cash payments at Group Health Medical Centers.

Group Health expects payment at time of service. For more info, go to www.ghc.org/payment or call Customer Service toll-free at 1-888-901-4636.

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• Finding a provider • Specific benefit questions • Complex medical care case management • Inpatient care case management

FREQUENTLY ASKED QUESTIONS Group Health accepts: Credit cards, debit cards, and personal checks. Visa, MasterCard®, American Express, and Discover® credit and debit cards are welcome.

Personal checks will be scanned, converted to electronic transactions, and immediately deducted from your checking account.

Prepaid debit cards you can purchase at large stores, including Safeway, QFC, and Target. Look for them where gift cards are sold. Prepaid debit cards from banks or credit unions. You can reload these cards at any time.

Kaiser Permanente Specific Questions 1. 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

2. 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.

Find a provider today at www.kp.org

3. How do I contact Kaiser Permanente Membership Services?

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

4. What can I do when I register for Kaiser Online Access?

• 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 www.kp.org

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QUESTIONS & APPEALS When you have questions or complaints about health or dental coverage: Call the Customer Service Department of your insurer, or for the Trust’s self-funded dental plan, Delta Dental: Group Health 1-800-542-6312 www.ghc.org

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

Delta Dental 1-800-547-9515 www.deltadentalwa. com

Willamette Dental 1-855-433-6825 www.willamettedental. 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 the Insurance Commissioner’s website, www.insurance.wa.gov

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Care Insurance Decision: A Guide for Consumers in Washington State” on the Office of

Parent Provider & Home Care Aide Eva

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.

WHICH PLAN AND NETWORK APPLIES TO ME? Group Health Cooperative – HMO Plan For members who enroll 8/1/2012 or later:

Group Health “Options Select” – POS Plan If you have been previously enrolled prior to 8/1/2012:

Group Health “Options” – PPO Plan

Your network is called: “Group Health Cooperative.”

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 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 Select.”

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.

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

No out-of-network coverage is available.

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

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 First Health Network 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.

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GROUP HEALTH COOPERATIVE HMO Questions? 1-888-901-4636 www.ghc.org NOTE: This is a benefit summary, only, and is not intended to replace the specifics of the 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.

Effective Date: 8/1/2015

Health Plan: Group Health Cooperative HMO

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

•

Agency Providers only: Dependent children who are under the age of twenty-six (26) are eligible to enroll in this plan. You will be responsible for paying the full cost of the premium for your dependents. Contact your employer for premium rates.

Benefits

Inside Network

Plan Deductible

No annual deductible

Individual deductible carryover

Not applicable

Plan coinsurance

No plan coinsurance Individual out-of-pocket limit: $1,200

Out-of-pocket limit

Out-of-pocket expenses for the following covered services are included in the out-of-pocket limit: All cost shares for covered services

Pre-existing condition (PEC) waiting period

No PEC

Lifetime maximum

Unlimited

Outpatient services (Office visits)

$15 copay

Hospital services

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

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

Value based/preferred generic/preferred brand $4/$8/$25 copay 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 copay

Chemical dependency

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

* Catholic Community Services does not pay for contraceptive and sterilization services

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Ambulance services

Group Health HMO 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 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

Diagnostic lab and X-ray services

Emergency services (copay waived if admitted)

Outpatient: Covered in full, MRI/PET/CT $50 copay 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 copay at a designated facility $200 copay at a non designated facility

Hearing exams (routine)

$15 copay

Hearing hardware

Not covered

Home health services

Covered in full. No visit limit.

Hospice services

Covered in full

Infertility services

Not covered

Manipulative therapy

Covered up to 10 visits per calendar year without prior authorization

Massage services

See Rehabilitation services

$15 copay Inpatient: $100 copay, per day for up to 5 days per admit

Maternity services

Mental Health

Naturopathy

Outpatient: $15 copay. Routine care not subject to outpatient services copay.

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

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

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Group Health HMO Unlimited, no waiting period

Organ transplants

Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $15 copay

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

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 members) Rehabilitation visits are a total of combined therapy visits per calendar year Skilled nursing facility Sterilization (vasectomy, tubal ligation)* Temporomandibular Joint (TMJ) services

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

Covered in full up to 60 days per calendar year Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $15 copay Women’s sterilization procedures are covered in full.

Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $15 copay

Tobacco cessation counseling

Quit for Life Program - covered in full

Routine vision care (1 visit every 12 months)

$15 copay

Optical hardware Lenses, including contact lenses and frames

Members under 19: 1 pair of frames and lenses per year or contact lenses covered at 50% coinsurance Members age 19 and over: $200 per 24 months

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* Catholic Community Services does not pay for contraceptive and sterilization services

Group Health Options POS Effective Date: 8/1/2015

Health Plan: Group Health Options POS

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 Agency Providers only: Dependent children who are under the age of twenty-six (26) are eligible to enroll in this plan. You will be responsible for paying the full cost of the premium for your dependents. Contact your employer for premium rates.

Benefits

Inside Network

Outside Network

Plan deductible

No annual deductible

Individual deductible: $500 per calendar year

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: $1,200

Out-of-pocket limit is shared with in-network

Out-of-pocket expenses for the following covered services are included in the out-of-pocket limit:

Out-of-pocket expenses for the following covered services are included in the out-of-pocket limit:

All cost shares for covered services

All cost shares for covered services

Pre-existing condition (PEC) waiting period

No PEC

Same as in-network

Lifetime maximum

Unlimited

Same as in-network maximum

$15 copay

$15 copay, deductible and coinsurance apply

Out-of-pocket limit

Outpatient services (office visits)

Hospital services

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

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

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

Value based/preferred generic/ preferred brand/non-preferred $4/$8/$25/$50 copay per 30 day supply

Preferred generic/preferred brand/non-preferred $13/$30/$55 copay per 30 day supply

Prescription mail order

$5 discount per 30 day supply

Not covered

* Catholic Community Services does not pay for contraceptive and sterilization services

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Group Health Options POS Acupuncture

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

$15 copay, deductible and coinsurance apply

Ambulance services

Plan pays 80%, you pay 20%

Same as in-network

Inpatient: $100 copay, per day for up to 5 days per admit

Inpatient: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply

Chemical dependency

Outpatient: $15 copay

Outpatient: $15 copay, 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

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.

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: Covered in full Diagnostic lab and X-ray services

Emergency 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.

Inpatient: Covered under Hospital services Outpatient: Deductible and coinsurance apply 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 copay

Hearing exams (routine)

$15 copay

$15 copay, 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

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$200 copay

(copay waived if admitted)

Group Health Options POS Hospice services

Covered in full

Deductible and coinsurance apply

Infertility services

Not covered

Not covered

Manipulative therapy

Covered up to 10 visits per year without prior authorization $15 copay

Visit limits shared with innetwork $15 copay, deductible and coinsurance apply

Massage services

See Rehabilitation services

See Rehabilitation services

Inpatient: $100 copay, per day for up to 5 days per admit Maternity services

Mental health

Outpatient: $15 copay.

Routine care not subject to outpatient services copay.

Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $15 copay

Naturopathy

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

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

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

$15 copay, deductible and coinsurance apply

$15 copay

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.

Obesity-related surgery (bariatric)

Not covered

Not covered Shared with in-network

Unlimited, no waiting period Organ transplants

Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $15 copay

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

* Catholic Community Services does not pay for contraceptive and sterilization services

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Group Health Options POS Deductible and coinsurance apply Women’s preventive care services (including contraceptive drugs and devices and sterilization) are subject to the applicable Preventive Care cost share and benefit maximums.

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.

Routine mammograms: Deductible and coinsurance apply

Rehabilitation services (Occupational, speech, physical including services for neurodevelopmentally disabled members) Rehabilitation visits are a total of combined therapy visits per calendar year

Skilled nursing facility

Inpatient: Day limits shared with in-network $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply

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

Outpatient: Visit limits shared with in-network $15 copay, deductible and coinsurance apply Day limits shared with innetwork benefit, deductible and coinsurance apply

Covered in full up to 60 days per calendar year

Inpatient: $100 copay, per day for up to 5 days per admit Sterilization (vasectomy, tubular ligation)*

Outpatient: $15 copay Women’s sterilization procedures are covered in full.

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

Optical hardware

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

Inpatient: $100 copay, per day for up to 5 days per admit

Applicable cost shares apply

Outpatient: $15 copay Quit for Life Program - covered in full $15 copay, deductible and coinsurance apply

$15 copay Members under 19: 1 pair of frames and lenses per year or contact lenses covered at 50% coinsurance

Shared with in-network

Members age 19 and over: $200 per 24 months

* Catholic Community Services does not pay for contraceptive and sterilization services

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Lenses, including contact lenses and frames

Inpatient: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply

Group Health Options PPO Effective Date: 8/1/2015

Health Plan: Group Health Options PPO

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 •

Agency Providers only: Dependent children who are under the age of twenty-six (26) are eligible to enroll in this plan. You will be responsible for paying the full cost of the premium for your dependents. Contact your employer for premium rates.

Benefits

Preferred Provider Network (PPN)

Non-Preferred Provider Network

Plan deductible

No annual deductible

Individual deductible: $500 per calendar year

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: $1,200

Out-of-pocket limit

Out-of-pocket expenses for the following covered services are included in the out-of-pocket limit:

Shared with in-network

All cost shares for covered services Pre-existing condition (PEC) waiting period

No PEC

Same as preferred provider network

Lifetime maximum

Unlimited

Same as preferred provider maximum

$15 copay

$15 copay, deductible and coinsurance apply

Outpatient services (office visits)

Hospital services

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

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

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

Preferred generic/preferred brand/non-preferred $4/$8/$25/$50 copay

Preferred generic/preferred brand/non-preferred $13/$30/$55 copay

Acupuncture

12 visits per calendar year $15 copay

Shared with preferred provider visit limit $15 copay, deductible and coinsurance apply

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Group Health Options PPO Ambulance services

Chemical dependency

Same as preferred provider benefit

Plan pays 80%, you pay 20%

Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $15 copay

Inpatient: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: $15 copay, 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

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.

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.

Diagnostic lab and X-ray services

Inpatient: Covered under Hospital services

Inpatient: Covered under Hospital services

Outpatient: Covered in full

Outpatient: Deductible and coinsurance apply

$200 copay

$200 copay

Hearing exams (routine)

$15 copay

$15 copay, deductible and coinsurance apply

Hearing hardware

Not covered

Not covered

Home health services

Covered in full up to 130 visits total per calendar year

Shared with preferred provider visit limit Deductible and coinsurance apply

Hospice services

Covered in full

Deductible and coinsurance apply

Infertility services

Not covered

Not covered

Manipulative therapy

Covered up to 12 visits per calendar year without prior authorization

Emergency Services (copay waived if admitted)

$15 copay

Shared with preferred provider visit limit $15 copay, deductible and coinsurance apply

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Massage services

12 visits per calendar year $15 copay

Shared with preferred provider visit limit $15 copay, deductible and coinsurance apply

Group Health Options PPO Inpatient: $100 copay, per day for up to 5 days per admit

Maternity services

Mental health

Outpatient: $15 copay.

Routine care not subject to outpatient services copay.

Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $15 copay

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

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

Natropathy

12 visits per calendar year $15 copay

Shared with preferred provider visit limit$15 copay, deductible and coinsurance apply

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.

Obesity-related surgery (bariatric)

Not covered

Not covered

Unlimited, no waiting period Organ transplants

Inpatient: $100 copay, per day for up to 5 days per admit

Not covered

Outpatient: $15 copay Not covered

Covered in full

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

Rehabilitation services (Occupational, speech, physical including services for neurodevelopmentally disabled members) Rehabilitation visits are a total of combined therapy visits per calendar year Ref: RQ-92655

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

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 

Inpatient: Day limits shared with preferred provider benefit Inpatient: 60 days per calendar limit year $100 copay, per day for up to 5 $100 copay, per day for up to days per admit 5 days per admit Deductible and coinsurance apply Outpatient:60 visits per Outpatient: Visit limits shared calendar year with preferred provider benefit $15 copay limit Services does not pay for * Catholic Community $15 sterilization copay, deductible and contraceptive and services coinsurance apply

Group Health Options PPO Skilled nursing facility

Day limits shared with preferred provider benefit, deductible and coinsurance apply

Covered in full up to 60 days per calendar year

Inpatient: $100 copay, per day for up to 5 days per admit Sterilization (vasectomy, tubular ligation)*

Outpatient: $15 copay Women’s sterilization procedures are covered in full.

Temporomandibular Joint (TMJ) services

Tobacco cessation counseling

Routine vision care (1 visit every 12 months)

Optical hardware Lenses, including contact lenses and frames

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

Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $15 copay

Inpatient: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply

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

Quit for Life Program - covered in full

Applicable cost shares apply

$15 copay

$15 copay, deductible and coinsurance apply

Members under 19: 1 pair of frames and lenses per year or contact lenses covered at 50% coinsurance

Shared with preferred provider benefit

Members age 19 and over: $200 per 24 months

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* Catholic Community Services does not pay for contraceptive and sterilization services

KAISER PERMANENTE HMO - Benefit Summary Questions? 1-800-813-2000 or (503) 813-2000 www.kp.org

NOTE: This is a benefit summary, only, and is not intended to replace the specifics of the 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.

SEIU Healthcare NW Health Benefits Trust August 1, 2015 through July 31, 2016

Out-of-Pocket Maximum (Copayment, and Coinsurance amounts count toward the maximum, unless otherwise noted.)

You payper Calendar Year For one Member $1,250 For an entire Family

$2,500 per Calendar Year

Office visits Routine preventive physical exams

$0

Primary Care

$15

Specialty Care

$15

Urgent Care

$30

Tests (outpatient) Preventive Tests

$0

Laboratory

$0

X-ray, imaging, and special diagnostic procedures

$0

CT, MRI, PET scans

$50 per department visit

Medications Prescription drugs (outpatient)**

$5 generic/$25 preferred brand/$50 non-preferred brand. $0 for formulary contraceptives. You get up to a 30-day supply. When you use mail delivery, you get up to a 90-day supply of maintenance drugs for two Copayments.

Administered medications, including injections (all outpatient settings)

$0

Nurse treatment room visits to receive injections

$5

Maternity Care Scheduled prenatal care and first postpartum visit

$0

Laboratory

$0

X-ray, imaging, and special diagnostic procedures

$0

Inpatient Hospital Services

$100 per admission

Hospital Services Ambulance Services (per transport)

$75

Emergency department visit

$200 (Waived if admitted)

Inpatient Hospital Services

$100 per admission

* Catholic Community Services does not pay for contraceptive and sterilization services

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Continued on next page

Kaiser Permanente HMO Outpatient Services (other) Outpatient surgery visit

$50

Chemotherapy/radiation therapy visit

$15

Durable medical equipment, external prosthetic devices, and

20% Coinsurance

orthotic devices Physical, speech, and occupational therapies (up to 20 visits

$15

per therapy per Calendar Year) Alternative Care Alternative care (physician-referred, after 12 spinal and

$15

extremity manipulation therapy visits, prior authorization needed) Alternative care (self-referred)

$15

Vision Services Routine eye exam

$10

Vision hardware and optical Services (ages 18 years and younger)

No charge for one pair standard frames and lenses or contact lenses every 12 months.

Vision hardware and optical Services (ages 19 years and older)*

Balance after $200 allowance every 24 months

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

$0

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

Hearing Aids Hearing Aids for Children (ages 18 years and younger)

Not Covered

Hearing aids (ages 19 years and older)*

Not Covered

Student Out-of-Area Coverage Routine, continuing, and follow-up Services (up to $1,200 per Calendar Year; amounts do not count toward the maximum)

20% of the actual fee the provider, facility, or vendor charged for the Service

* Catholic Community Services does not pay for contraceptive and sterilization services ** Amounts do not count toward Out of Pocket Maximum.

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Kaiser Permanente 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 the Evidence of Coverage (EOC).

Acupuncture. Limited to the following: (a) when a Participating Physician makes a referral for Services in accord with Medical Group criteria or (b) the Alternative Care (self-referred Acupuncture Services) rider has been purchased.; Certain exams and Services; Chiropractic Services received without a referral.

Limited to the following: (a) when a Participating Physician makes a referral for Services in accord with Medical Group criteria or (b) Alternative Care Services or Chiropractic Services (self-referred Chiropractic Care) rider has been purchased.; 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 is subject to Utilization Review.; Designated blood donations; Detained or confined members; Employer responsibility; Experimental or investigational Services; Eye surgery. Radial keratotomy, photorefractive keratectomy, and refractive surgery, including evaluations for the procedures; 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; Intermediate Services; Massage therapy Services. Limited to when: (a) a Participating Physician makes a referral for Services in accord with Medical Group criteria or (b) Alternative Care (Massage Therapy) rider has been purchased.; Naturopathy Services. Limited to when: (a) a Participating Physician makes a referral for Services in accord with Medical Group criteria; or (b) Alternative Care (Naturopathy Services) rider has been purchased.; Non- Medically Necessary Services; Nonreusable medical supplies; Outpatient Prescription Drugs. Unless the Outpatient Prescription Drug rider has been purchased. Our drug formulary applies. We cover non-formulary drugs only when you meet exception criteria unless specifically covered by your prescription drug plan.; Professional Services for fitting and follow-up Services for contact lenses; Services performed by unlicensed people; Services related to a non-covered Service; Services that are not health care Services, supplies, or items; Supportive care and other Services; Surrogacy; Travel and lodging.

Limited to: (a) Medically Necessary ambulance Services, 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 and optical Services (ages 18 and younger). Unless the Pediatric Vision Hardware and Optical Services rider has been purchased.; Vision hardware and optical Services (ages 19 and older).

Unless the Adult Vision Hardware and Optical Services rider has been purchased.; Vision therapy and orthoptics or eye exercises.

Questions? Call Member Services (M-F, 8 am-6 pm) or visit kp.org Portland area..503-813-2000. All other areas..1-800- 813-2000. TTY..711.

Language Interpretation Services, all areas..1-800-324-8010 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 benefit coverage, claims review, and adjudication procedures, please see your EOC or call Membership Services. In the case of conflict between this summary and the EOC, the EOC will prevail.

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For Employees of Catholic Community Services Your employer has certified that your group’s health plan qualifies for an accommodation with respect to the federal requirement to cover all Food and Drug Administration-approved contraceptive services for women, as prescribed by a health care provider, without cost sharing. This means that your group will not contract, arrange, pay, or refer for contraceptive coverage. Instead, Group Health will provide separate payments for contraceptive services that you use, without cost sharing and at no other cost, for so long as you are enrolled in your group’s health plan. Your employer will not administer or fund these payments.

If you have any questions please contact your employer.

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WILLAMETTE DENTAL - Benefit Summary Questions? 1-855-433-6825 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.

COPAYS Annual Maximum

No Annual Maximum*

Deductible

No Deductible

General Office Visit

You pay $15 per Visit

DIAGNOSTIC AND PREVENTIVE SERVICES Covered with the Office Visit Copay

X-rays

Covered with the Office Visit Copay

Teeth Cleaning

Covered with the Office Visit Copay

Fluoride Treatment

Covered with the Office Visit Copay

Sealants (per tooth)

Covered with the Office Visit Copay

Head and Neck Cancer Screening

Covered with the Office Visit Copay

Oral Hygiene Instruction

Covered with the Office Visit Copay

Periodontal Charting

Covered with the Office Visit Copay

Periodontal Evaluation

Covered with the Office Visit Copay

RESTORATIVE DENTISTRY Fillings (Amalgam)

Covered with the Office Visit Copay

Porcelain-Metal Crown

You pay a $250 Copay

PROSTHODONTICS Complete Upper or Lower Denture

You pay a $400 Copay

Bridge (per Tooth)

You pay a $250 Copay

ENDODONTICS AND PERIODONTICS Root Canal Therapy - Anterior

You pay a $85 Copay

Root Canal Therapy - Bicuspid

You pay a $105 Copay

Root Canal Therapy - Molar

You pay a $130 Copay

Osseous Surgery (per Quadrant)

You pay a $150 Copay

Root Planing (per Quadrant)

You pay a $75 Copay

ORAL SURGERY Routine Extraction (Single Tooth)

Covered with the Office Visit Copay

Surgical Extraction

You pay a $100 Copay

ORTHODONTIA TREATMENT Pre-Orthodontia Treatment

Not Covered

Comprehensive Orthodontia Treatment

Not Covered

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Routine and Emergency Exams

Willamette Dental Group MISCELLANEOUS Local Anesthesia

Covered with the Office Visit Copay

Dental Lab Fees

Covered with the Office Visit Copay

Nitrous Oxide

You pay a $40 Copay

Specialty Office Visit

You pay a $30 Copay per visit

Out of Area Emergency Care Reimbursement

You pay charges in excess of $250

*TMJ has a $1000 annual maximum/ $5000 lifetime maximum **Copayment credited towards the Comprehensive Orthodontic Service copayment if patient accepts treatment plan.

Underwritten by Willamette Dental of Washington, Inc. This plan provides extensive coverage of services and supplies to prevent, diagnose, and treat diseases or conditions of the teeth and supporting tissues. Presented are just some of the most common procedures covered in your plan. Please see the Certificate of Coverage for a complete plan description, limitations, and exclusions.

Services or supplies for which coverage is available under any federal, state, or other governmental program, unless required by law.

Services or supplies not listed as covered in the contract. Services or supplies where there is no evidence of pathology, dysfunction, or disease other than covered preventive services.

Limitations If alternative services can be used to treat a condition, the service recommended by the Willamette Dental Group dentist is covered.

Services or supplies listed in the contract, which are provided to correct congenital or developmental malformations which impair functions of the teeth and supporting structures will be covered for dependent children if dental necessity has been established.

Orthognathic surgery is covered as specified in the contract when the Willamette Dental Group dentist determines it is dentally necessary and authorizes the orthognathic surgery for treatment of an enrollee, under age 19, with congenital or developmental malformations. Crowns, casts, or other indirect fabricated restorations are covered only if dentally necessary and if recommended by the Willamette Dental Group dentist.

When initial root canal therapy was performed by a Willamette Dental Group dentist, the retreatment of such root canal therapy will be covered as part of the initial treatment for the first 24 months. When the initial root canal therapy was performed by a non-participating provider, the retreatment of such root canal therapy by a Willamette Dental Group dentist will be subject to the applicable copayments.

General anesthesia is covered with the copayments specified in the contract if it is performed in a dental office; provided in conjunction with a covered service; and dentally necessary because the enrollee is under the age of 7, developmentally disabled or physically handicapped. The services provided by a dentist in a hospital setting are covered if medically necessary; pre-authorized in writing by a Willamette Dental Group dentist; the services provided are the same services that would be provided in a dental office; and applicable copayments are paid.

The replacement of an existing denture, crown, inlay, onlay, or other prosthetic appliance or restoration denture is covered if the appliance is more than 5 years old and replacement is dentally necessary.

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Exclusions Bridges, crowns, dentures or any prosthetic devices requiring multiple treatment dates or fittings if the prosthetic item is installed or delivered more than 60 days after termination of coverage.

The completion or delivery of treatments, services, or supplies initiated prior to the effective date of coverage Dental implants, including attachment devices and their maintenance.

Endodontic services, prosthetic services, and implants that were provided prior to the effective date of coverage. Endodontic therapy completed more than 60 days after termination of coverage.

Exams or consultations needed solely in connection with a service or supply not listed as covered.

Experimental or investigational services or supplies and related exams or consultations.

Full mouth reconstruction, including the extensive restoration of the mouth with crowns, bridges, or implants; and occlusal rehabilitation, including crowns, bridges, or implants used for the purpose of splinting, altering vertical dimension, restoring occlusions or correcting attrition, abrasion, or erosion.

Hospital care or other care outside of a dental office for dental procedures, physician services, or facility fees.

Maxillofacial prosthetic services.

Nightguards.

Personalized restorations.

Plastic, reconstructive, or cosmetic surgery and other services or supplies, which are primarily intended to improve, alter, or enhance appearance.

Prescription and over-the-counter drugs and premedications.

Provider charges for a missed appointment or appointment canceled without 24 hours prior notice.

Replacement of lost, missing, or stolen dental appliances; replacement of dental appliances that are damaged due to abuse, misuse, or neglect.

Replacement of sound restorations.

Services or supplies and related exams or consultations that are not within the prescribed treatment plan and/ or are not recommended and approved by a Willamette Dental Group dentist.

Services or supplies and related exams or consultations to the extent they are not necessary for the diagnosis, care, or treatment of the condition involved.

Services or supplies by any person other than a licensed dentist, denturist, hygienist, or dental assistant.

Services or supplies for treatment of injuries sustained while practicing for or competing in a professional athletic contest.

Services or supplies for the treatment of an occupational injury or disease, including an injury or disease arising out of self-employment or for which benefits are available under workers’ compensation or similar law.

Services or supplies for treatment of intentionally self- inflicted injuries.

Delta Dental PPO Plan Benefit Summary Questions? (800) 554-1907, Monday – Friday 8 a.m. to 5 p.m., Pacific Time 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.

Plan #: 00018

Name: Delta Dental PPO

Plan Summary

Effective Date: August 1, 2015

Payment Levels Delta Dental PPO Dentist

Delta Dental Premier Dentist

Nonparticipating Dentist

100%

80%

80%

100%

60%

60%

80%

40%

40%

$2000*

$2000*

$2000*

$0

$50

$50

Class I – Diagnostic & Preventive Exams, Prophy X-rays, Fluoride and Sealants Class II – Restorative Restorations, Endodontics, Periodontics, Oral Surgery Class III – Major Crowns, Dentures, Partials, Bridges and Implants Annual Maximum Per Person Benefit Period: (January 1 – December 31) Deductible (Waived on Class I) In Network – no deductible Out of Network $50 per benefit period

*Effective 8/1/2015 Annual Maximum will increase from $1,000 to $2,000 per benefit period.

MySmile® Personal Benefits Center, available on our website at DeltaDentalWA.com, is coverage secure, personalized toolbox where you can easily manage your dental benefits.

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 or visit our website at www.DeltaDentalWA.com Delta Dental of Washington PO Box 75983 Seattle, WA 98175-0983 Customer Service toll-free (800) 554-1907, Monday – Friday 7 a.m. to 5 p.m., Pacific Time

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Delta Dental PPO ACCESSING CARE

How to use your Delta Dental PPO Plan

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, your benefits will likely be paid at a higher level and your out-of-pocket expenses may be lower.

Delta Dental of Washington will handle all customer service and claims processing for your plan. Tell your dentist you are covered by Delta Dental of Washington and give them your member identification number, the plan name and plan number.

Delta Dental PPO Dentists

Delta Dental PPO Dentists complete claim forms and submit them directly to Delta Dental of Washington. PPO Dentists receive payment based on their pre-approved, discounted PPO fees and they cannot charge you more than these fees. You are responsible only for your stated deductibles, coinsurance and/or amounts in excess of the plan maximums.

Delta Dental Premier Dentists are members of our traditional fee-for-service plan, but they are not part of the PPO network; therefore, your out-of-pocket costs may be higher. Delta Dental Premier Dentists will still submit claims for you and receive payment directly from Delta Dental of Washington. Their payment will be based upon their pre-approved fees with Delta Dental of Washington. They also cannot charge you more than these fees. You are responsible only for your stated deductibles, coinsurance and/or amounts in excess of the program maximums.

Finding a dentist

You can find a participating dentist in your area by visiting the Delta Dental of Washington website at DeltaDentalWA.com. Click on the Patients tab and then on the Find A Dentist tab to begin your search. Be sure to select the appropriate plan — Delta Dental PPO or Delta Dental Premier — and follow the prompts.

Nonparticipating dentists

You are not limited to visiting a Delta Dental of Washington dentist. If you choose a nonparticipating dentist, you will be responsible for having the dentist complete and sign claim forms. It will also be up to you to ensure that the claims are sent to Delta Dental of Washington.

Claim payments will be based on actual charges or Delta Dental of Washington’s maximum allowable fees for nonparticipating dentists, whichever is less. You will be responsible for any balance remaining. Please be aware that Delta Dental of Washington has no control over nonparticipating dentists’ charges or billing procedures.

NOTE: For information on out-of-state dentists, please refer to your benefits booklet.

Predetermination (estimate) of benefits

If your dental care will be extensive, you may ask your dentist to complete and submit a request for an estimate, sometimes called a “predetermination of benefits.” This will allow you to know in advance what procedures are covered, the amount Delta Dental of Washington will pay and your financial responsibility. A predetermination of benefits is not a guarantee of payment.

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BENEFITS POLICIES

Delta Dental Premier® Dentists — (non-PPO)

English Version on Page 5

培训快速入门指南 1.培训标准如第88页所示。 ■ 个体供应方 根据您所提供的保健类型，设置不同的培训标准以供选择。如需了 解培训类型，请查阅第30页的图表。 ■ 机构供应方您的雇主可以帮助您了解适合您的培训标准。请与您的雇主联系，以 获得您的培训标准相关信息。 2.请观看培训与安全光碟或在线观看 您可在第30页的培训一览表中 了解您的需求。 3.提前安排培训 在受聘的前两周内安排培训，确保做出最佳选择。 ■ 个 体提供者创建用户名及密码以登陆培训门户网站并在www.myseiubenefits.org 上进行班级登记。（步骤见第8页。）若想获得更多帮助，请拨打会员资源中心 电话1-866-371-3200。 ■ 机构提供者与您的雇主联系，寻求最佳登记方式。您的雇主对培训安排有规定。

网上课程提供粤语版本 登录门户网站，寻找网上的粤语课程：

全，第2部分

• 消费者导向护理之常见医疗状况： 脱水

• 帮助患有精神疾病的消费者，第1 部分

• 消费者导向护理之常见医疗状况： 充血性心力衰竭

• 帮助患有精神疾病的消费者，第2 部分

• 消费者导向护理之常见医疗状况： 慢性阻塞性肺病（COPD）

• 消费者导向护理之常见医疗状况： 泌尿道感染（UTI）

• 相关消费者损害、疏忽和经济剥削 的识别和报告

• 消费者导向护理之常见医疗状况： ：癫痫

• 通过缓和暴力保护工作人员的安 全，第1部分

• 消费者导向护理之常见医疗状况： ：中风

• 通过缓和暴力保护工作人员的安

• 通过标准的预防措施，减少传染病 的传播

基础培训课程提供粤语版本注册粤语课程，请登录门户网站或拨打会员资源中心电话 1-866-371-3200。对于其他课程，请携带一名社区口译员（朋友或亲戚）。若通过门户 网站或拨打会员资源中心电话1-866-371-3200注册课程, 请通知您的培训合伙人。

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MYSEIUBENEFITS.ORG

English Version on Page 45

您的健保计划选项 我们希望您和您的家人得到合适的保险计划。在此计划列表中了解更多您可选择的健保 选项，通过健康受益信托（ Health Benefits Trust）、医疗补助计划（Apple Health）或 华盛顿州健康计划（Washington Health Plan Finder）寻找您有资格申请的健保选项。

健康受益信托 您的成本

(Health Benefits Trust) 每月25美元

医疗补助计划/

华盛顿州健康计划

免费，取决于您的家庭

因情而异，取决于您选

收入。

择的计划方案。对大多

APPLE HEALTH

(Washington Health Plan Finder)

数人来说，白银等级的

资格

保险覆盖范围

计划方案价值最高。 所有内科、牙科、眼科

包括配偶与孩子。

包括配偶与孩子。

连续3个月内，每

• 取决于家庭收入。

• 若不能通过雇主获得保

月至少工作80小时

• 符合条件的即可登记。

和医药处方。

个体提供者可随时 登记。

险资格，您可选择交易 所保险计划。 • 开放日期：2015年11月 1日 - 2016年1月31日。

机构提供者需联系

• 或者，通过某一“合格事

您的雇主，以获得

件”，您获得保险资格，

更多信息。

例如结婚、生小孩或失

申请

去保险。 登录

请查看第48页进行登记。

登录

更多信息 请登录网站 ：

www.wahealthplanfinder.org访 www.wahealthplanfinder.org

www.myseiubenefits.org

问华盛顿州健康计划，获取 访问华盛顿州健康计划， 更多 信息。

获取更多信息。 2015-2016 BENEFITS BOOK

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English Version on Page 47

您的2015-2016乳腺肿瘤计划呈现惊喜变化 若您每月工作80小时，您就能获得乳腺肿瘤保险资 格 为让您通过健康福利信托获得保险资格，我们已经将您的每月工作时间从 86小时减少到80小时。您现在可能符合我们的保险资格，我们希望您能更 容易地达到我们各个月的要求。 更多信息和有关我们的保险申请，见第48页。

每个月降到80小时以下？我们已将您纳入该范围！ 若在健康保健年度内，我们的会员在某个月工作时间降到60-80小时，我 们的新保险拨款试验基金仍可为他们提供额外一个月的保险，直到拨款试 验基金用完后。这笔款项只针对在某一个月工作时间下降到60-80小时的 会员。会员可通过拨打会员资源中心电话1-866-371-3200 或提交第51页 的申请表来获取这一保险。

每年的牙科保险（Delta Dental）最高已增至2000 美元！ 根据您的反馈信息，我们了解到，最高1000美元不足以涵盖您的基本牙科 护理。在自付费之前，您已经获得2000美元的牙科保健。您的总体计划概 要，见第96页。 2015-2016计划的变更 年度计划最大值 牙科保险（Delta Dental）

牙科保险年度最大受益从1000美元上升为2000美元。

变性服务 团体保险

相关变性人服务的规定已经获得修订。修订后的版本规定，根据 华盛顿州反歧视法（Washington Law Against Discrimination） ，保险中包括性别改造手术中必要的内科和外科手术。

凯瑟医院（Kaiser Permanente）

根据华盛顿州反歧视法，解除了对性别改造手术的禁止。

心理健康服务 团体保险

在心理健康规定的说明中，将住院病人的住院治疗服务（由保险 监理处规定）以及性机能障碍或身份认同障碍（根据经营决策） 从禁止列表中移除。

心脏康复 团体保险

100

心脏康复的保险范围现已包括至每一心血管事件36次访问。解除 了对心脏康复的禁止。

MYSEIUBENEFITS.ORG

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교육 퀵 스타트 1. 88쪽에서 당신의 교육 기준을 찾으십시오.

■ 개인 제공자 어떤 종류의 의료서비스를 제공하느냐에 따라 다른 교육 기준이 있 습니다. 당신의 교육 필요사항은 30쪽의 차트를 참고하십시오.

■ 의료서비스 에이전시 고용주가 교육 기준의 이해를 도울 수 있습니다. 교육 기준 정보를 위해서는 고용주에게 연락하십시오.

2. 오리엔테이션과 안전사항을 DVD혹은 온라인으로 시청하십시오 자격 요건을 확인하기 위해서는 30쪽의 훈련 기준 정보표를 참조하십시오.

3. 교육 일정을 일찍 잡으십시오 최고의 일정을 선택하려면 입사 첫 2주내에 일정을 잡으십시오.

■ 개 인 의료서비스 제공자 www.myseiubenefits.org에서 교육 포탈에 로그인 하여 수업에 등록하기 위한 사용자명과 비밀번호를 만드십시오. (절차는 8쪽을 보세 요.) 도움이 더 필요하시면 회원 지원 센터에 1-866-371-3200로 전화하십시오.

■ 의료서비스 에이전시 최적의 등록 방법에 대해서는 고용주와 상의하십시오. 당 신의 고용주에게 교육 일정에 대한 정책이 있습니다.

온라인 과정 한국어 강좌 교육 포탈에 로그인 하시고 한국어가 제공 되는 아래의 강좌들을 검색하십시오:

• 폭력 감소를 통한 노동자 안전 보 호, 2부

• 보편적인 의학적 질환에 대한 소비 자 중심 치료: 탈수

• 정신질환 소비자 지원, 1부

• 보편적인 의학적 질환에 대한 소비 자 중심 치료: 울혈성 심부전

• 보편적인 의학적 질환에 대한 소비 자 중심 치료: 요로 감염증

• 보편적인 의학적 질환에 대한 소비 자 중심 치료: 만성 폐색성 폐질환

• 보편적인 의학적 질환에 대한 소비 자 중심 치료: 발작

• 소비자 학대, 방치, 재정적 착취에 대한 인식 및 보고

• 보편적인 의학적 질환에 대한 소비 자 중심 치료: 뇌졸중

• 폭력 감소를 통한 노동자 안전 보 호, 1부

• 표준 예방조치를 통한 전염병 확 산 줄이기

• 정신질환 소비자 지원, 2부

기초 교육강좌는 한국어로 제공됩니다. 교육 포탈을 이용하여 혹은 회원 지원 센터에 1-866-371-3200로 전화하여 한국어 강좌에 등록하십시오. 모든 타 강좌에는 통역사를 동반하십시오(친구 혹은 친척). 교육 포탈을 이용하여 혹은 회원 지원 센터에 1-866371-3200로 전화하여 강좌에 등록 시 훈련 파트너에게 알리십시오.

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의료보험 옵션 당신과 가족이 필요한 보험 보상범위에 가입할 수 있기를 바랍니다. 이 보험을 통해 선 택가능한 의료보험 옵션에 대해 더 알아보고 의료 혜택 신탁, 메디케이드(애플 의료보 험), 혹은 워싱턴 주 의료보험 설계사를 통한 보건 서비스 자격 요건을 만족시키는지 확 인하십시오.

의료 혜택 신탁

자격 규정

보험범위

비용

(HEALTH BENEFITS TRUST)

메디케이드(MEDICAID) 워싱턴 주 의료보험 / 애플 의료보험 설계사(WASHINGTON (APPLE HEALTH)

월 $25

가구 소득에 따라 무료입니다.

선택하는 보험에 따라 달라집니다. 실버 레벨 보험이 대부분의 경우 최고의 가치를 제공합니다.

의료, 치과, 안과, 처방전 전액 지원.

배우자 및 자녀 보장.

배우자 및 자녀 보장.

3개월 연속으로 80 시간 근무하십시오.

• 자격 요건은 가구 소득에 따라 달라집니다.

개인 제공자는 언제든지 등록할 수 있습니다.

• 자격이 되면 언제든지 등록하십시오.

신청하기

의료서비스 에이전시의 경우 고용주에게 추가 문의하십시오.

102

HEALTH PLAN FINDER)

등록하려면 48쪽을 보시 고, 정보를 더 원하시면 www.myseiubenefits.org 를 방문하십시오.

MYSEIUBENEFITS.ORG

• 고용주를 통한 보험 가입 자격을 만족하지 못하는 경우 거래소를 통해 보험 가입을 할 수 있습니다.

• 2015년 11월 1일부터 2016년 1월 31일까지 개방 • 그 외 결혼, 자녀 출산, 보험 상실 등과 같은 “ 자격 요건이 되는 일”이 있다면 가능합니다.

정보를 더 원하시면 www.wahealthplanfinder.org

으로 워싱턴 주 의료보험 설계사에 방문하세요.

정보를 더 원하시면 www.wahealthplanfinder.org 으로 워싱턴 주 의 료보험 설계사에 방문하 세요.

English Version on Page 47

2015-2016년 HBT 보험의 신나는 변화! 매월 80시간씩 일하시면 HBT 보험가입의 자격이 있습니다 의료 혜택 신탁을 통한 보험의 자격 요건을 만족시키기 위해서 월 필수 근 무시간을 86시간에서 80시간으로 낮추었습니다. 저희 보험의 가입 자격 을 새로이 만족시키게 되셨을 수도 있습니다. 매월 자격 요건을 갖추는 것 이 조금 더 쉬워지길 바랍니다. 더 많은 정보와 보험 가입 신청을 위해서는 48쪽을 보십시오.

한 달에 80시간에 살짝 못 미치십니까? 저희가 보 험을 제공해 드립니다! 저희의 새 보험 파일럿 보조금은 자금이 소진되기 전까지 보험 기간 해 동 안 한 번 60시간에서 80시간 근무하여 자격을 충족한 회원들에게 추가 한 달의 보험 보장 기간을 제공하겠습니다. 이 보조금은 한 달에 60시간에 서 80시간 근무하는 회원들을 도울 것입니다. 회원들은 1-866-371-3200 으로 회원 지원 센터에 연락하거나 51쪽에 있는 신청서를 제출하여 신청 할 수 있습니다.

델타 치아 보험의 최대 연 혜택이 $2,000까지 올라 갔습니다!

$1,000의 최대 연 혜택이 기초 치아 보험을 보장하기 위해 충분하지 않다 는 회원 분들의 피드백을 반영하였습니다. 이제 직접 비용을 지불하시기 전에 $2,000의 치아 보험이 있습니다. 전체 보험의 요약은 96쪽을 보세요.

2015-2016년 보험 변화 연 최대 보험 델타 치아 보험

델타 치아 보험의 최대 연 혜택은 $1,000에서 $2,000까지 올라갑 니다.

성전환자 서비스 단체 의료

성전환자 서비스 제공은 워싱턴 주의 차별 금지 법에 따라 성확 정 수술을 위해 의학적으로 필요한 의료 및 성적 서비스의 보험보 장을 반영하기 위해 수정되었습니다.

카이저 퍼머넌트

성확정 수술 제외 조항은 워싱턴 주의 차별 금지 법에 따라 삭제 되었습니다.

정신건강 서비스 단체 의료

(보험담당사무국의 요구에 따라) 제외 조항 목록으로부터 입원환 자 거주 치료 서비스및(사업상 결정에 근거하여 결정된) 성적/주 체성 장애를 제거하여 정신건강 의료제공을 분명하게 설명하였 습니다.

심장 재활 단체 의료

심장 재활 보상은 매 심장 관련 사건 당 총 36회의 방문까지 포함 합니다. 심장 재활 제외 조항은 삭제되었습니다.

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Capacitación de inicio rápido 1. Encuentre las normas de capacitación en la página 88.

■ P roveedores individuales Existen diferentes estándares de capacitación dependiendo del tipo de atención que ofrezca. Vea el cuadro en la página 30 para encontrar sus necesidades de capacitación.

■ Proveedores

de agencia Su empleador puede ayudarlo a comprender sus normas de capacitación. Póngase en contacto con su empleador para recibir la información de su norma de capacitación.

2. Vea los DVD o videos en línea de Orientación y Seguridad Vea la cuadrícula de capacitación en la página 30 para ver sus requisitos.

3. Programe su capacitación con tiempo Prográmela dentro de las primeras dos semanas de la contratación para asegurar las mejores opciones.

■ P roveedores individuales Cree su nombre de usuario y contraseña para acceder al portal de capacitación y registrarse para clases en www.myseiubenefits.org. (Vea la página 8 para conocer los pasos). Para recibir más ayuda, llame al Centro de recursos para miembros al 1-866-371-3200.

■ P roveedores de agencia Consulte con su empleador sobre la mejor manera para registrarse. Su empleador tiene políticas sobre la programación de capacitaciones.

Nuevos cursos en línea disponibles en español

Acceda al Portal de capacitación y busque

estos nuevos cursos disponibles en español:

medio del desescalamiento de la violencia, parte 2

• Atención dirigida al consumidor para condiciones médicas comunes: Deshidratación

• Apoyo a los consumidores con enfermedades mentales, parte 1

• Atención dirigida al consumidor para condiciones médicas comunes: Insuficiencia cardíaca

• Apoyo a los consumidores con enfermedades mentales, parte 2

• Atención dirigida al consumidor para condiciones médicas comunes: EPOC • Reconocimiento y reporte de abuso, negligencia y explotación financiera al consumidor • Proteger la seguridad del trabajador por medio del desescalamiento de la violencia, parte 1

• Atención dirigida al consumidor para condiciones médicas comunes: IU • Atención dirigida al consumidor para condiciones médicas comunes: Convulsiones

• Atención dirigida al consumidor para condiciones médicas comunes: Derrame cerebral • Reducir el contagio de la infección a través de precauciones habituales

• Proteger la seguridad del trabajador por

Los cursos de Capacitación básica se ofrecen en español. Regístrese para los cursos en español por medio del Portal de capacitación o contacte al Centro de recursos para miembros al 1-866-371-3200. Para el resto de los cursos, traiga a un Intérprete comunitario (amigo o pariente). Notifique a la Asociación de capacitación cuando se registre para el curso por medio del Portal de capacitación o llamando al Centro de recursos para miembros al 1-866-371-3200.

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Sus Opciones de Planes Médicos Queremos que usted y su familia reciban la cobertura que necesitan. Conozca más sobre las opciones de atención médica disponibles para usted en este desglose de planes y averigüe si califica para la atención médica por medio de Health Benefits Trust, Medicaid (Apple Health) o el Washington Healthplanfinder.

SU COSTO

WASHINGTON HEALTH PLAN FINDER

$25 /mes

Gratis, dependiendo de su ingreso familiar.

Varía dependiendo del plan que elija. Los planes nivel plata proporcionan el mejor valor para la mayoría de las personas.

COBERTURA

MEDICAID / APPLE HEALTH

Médica completa, dental, de visión y recetas.

Cónyuge e hijos cubiertos.

Cónyuge e hijos cubiertos.

ELEGIBILIDAD

HEALTH BENEFITS TRUST

Trabaje durante 80 horas por 3 meses seguidos.

Los Proveedores individuales pueden inscribirse en cualquier momento.

SOLICITAR

Proveedores de agencia, contacten a su empleador para más información.

Vea la página 48 para inscribirse y para más información, visite www.myseiubenefits.org

• Depende de su ingreso familiar.

• Inscríbase en cualquier momento cuando sea elegible.

• Si no califica para el seguro a través de un empleador, es elegible para la cobertura en la bolsa de salud.

• Abierto desde el 1 de noviembre de 2015 hasta el 31 de enero de 2016.

• O cuando tenga un “evento calificador” como contraer matrimonio, tener un hijo o perder la cobertura.

Visite el Washington Visite el Washington Healthplanfinder para Healthplanfinder para más más información en el sitio información en el sitio www.wahealthplanfinder.org

www.wahealthplanfinder.org

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¡Emocionantes cambios en su plan HBT 2015-2016!

Ahora califica para el seguro HBT si trabaja 80 horas al mes Para calificar al seguro a través de Health Benefits Trust, hemos reducido sus horas por mes necesarias de 86 a 80 horas por mes. Puede ser que ahora sea elegible para nuestro seguro y esperamos que le sea más fácil cumplir con los requisitos mes a mes.

Vea la página 48 para obtener más información y solicitar nuestro seguro.

¿Tiene menos de 80 horas en un mes? ¡Lo tenemos cubierto!

Nuestro nuevo Fondo piloto de subvención de cobertura les proporcionará un mes adicional de cobertura a miembros calificados que tengan entre 80 y 60 horas, una vez durante el año del plan médico hasta que el Fondo piloto se agote. La Subvención ayudará a los miembros que tengan entre 80 y 60 horas en un solo mes. Los miembros pueden solicitar esta cobertura contactando el Centro de recursos para miembros al 1-866-371-3200 o enviando el formulario de solicitud de la página 51.

¡El máximo anual de Delta Dental ha aumentado a $2,000!

Escuchamos sus comentarios indicando que un máximo anual de $1,000 no era suficiente para cubrir sus necesidades básicas de atención dental.

Ahora cuentan con $2,000 de atención dental antes de tener que cubrir gastos de su bolsillo. Vea la página 96 para encontrar su resumen de plan completo.

Cambios de planes 2015-2016 Máximo de plan anual Delta Dental

El beneficio anual de cobertura máxima de Delta Dental aumenta de $1,000 a $2,000.

Servicios transgénero Salud de grupo

La disposición de Servicios transgénero ha sido revisada para reflejar la cobertura de servicios médicos y quirúrgicos médicamente necesarios para Cirugía de reasignación de sexo para cumplir con la Ley de Washington contra la discriminación.

Kaiser Permanente

La exclusión de Cirugía de reasignación de sexo ha sido eliminada para cumplir con la Ley de Washington contra la discriminación.

Servicios de salud mental Salud de grupo

Se ha hecho una aclaración a la disposición de Salud mental al eliminar los servicios de tratamiento residencial para pacientes internados (según lo requiere la Oficina del comisionado de seguros) y los desórdenes de identidad y sexuales (con base en una decisión de negocios) de la lista de exclusiones.

Rehabilitación cardiaca Salud de grupo

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Ahora la cobertura de rehabilitación cardiaca está incluida en hasta un total de 36 visitas por evento cardiaco. La exclusión de rehabilitación cardiaca también ha sido eliminada.

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Обучение «Быстрый старт» 1. Ознакомьтесь со стандартами обучения на странице 88.

■ И ндивидуальные поставщики услугВ зависимости от типа предоставляемых Вами услуг доступны различные стандарты обучения. На странице 30 указано Вы можете ознакомиться с информацией относительно потребностей в обучении.

■ Сотрудники компаний Ваш наниматель поможет Вам понять Ваши стандарты обучения. Для получения информации о стандартах обучения обратитесь к своему нанимателю.

2. Посмотрите ролики по ориентации и безопасности на DVD-дисках или онлайн. На странице 30 в таблице указаны требования.

3. Запланируйте раннее обучение Чтобы сделать наилучший выбор, запланируйте для себя обучение в течение двух первых недель после устройства на работу.

■ И ндивидуальные поставщики услуг Выберите себе имя пользователя и пароль для входа в обучающий портал, зарегистрируйтесь для прохождения обучения на сайте www.myseiubenefits.org. (Список действий указан на странице 8.) Для получения дополнительной помощи звоните в Центр ресурсов по телефону: 1-866-371-3200.

■ Сотрудники компаний Ваш наниматель поможет Вам выбрать наилучший способ регистрации. У Вашего нанимателя имеются свои графики прохождения обучения.

Доступны новые онлайн-курсы на русском языке Зайдите на обучающий портал для прохождения новых курсов на русском языке: • Ориентированный на клиента уход при общих медицинских показаниях: Обезвоживание •

•

•

•

Ориентированный на клиента уход при общих медицинских показаниях: Застойная сердечная недостаточность Ориентированный на клиента уход при общих медицинских показаниях: ХНЗЛ Выявление случаев ненадлежащего обращения с клиентом, невыполнения обязательств в отношении него или финансовой эксплуатации и предоставление информации о подобных случаях Забота о безопасности работника за счет снижения уровня жестокости, часть 1

•

Забота о безопасности работника за счет снижения уровня жестокости, часть 2

•

Поддержка клиентов с психическими заболеваниями, часть 1

•

Поддержка клиентов с психическими заболеваниями, часть 2

•

Ориентированный на клиента уход при общих медицинских показаниях: ИМП

•

Ориентированный на клиента уход при общих медицинских показаниях: Конвульсии

•

Ориентированный на клиента уход при общих медицинских показаниях: Инсульт

•

Сокращение масштабов распространения инфекции путем применения стандартных мер предосторожности

Базовые обучающие курсы доступны на русском языке. Зарегистрируйтесь для прохождения курсов на русском языке на обучающем портале или обратитесь в Центр ресурсов по телефону: 1-866-371-3200. Для прохождения других курсов воспользуйтесь помощью знакомого переводчика (друга или родственника). Сообщите о регистрации для прохождения обучения через обучающий портал или по телефону Центра ресурсов: 1-866-371-3200.

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План медицинских услуг Мы предоставляем медицинские услуги Вам и Вашей семье. Узнайте больше о доступных Вам вариантах медицинского и о том, соответствуете ли Вы критериям для получения услуг по планам Health Benefits Trust, Medicaid (Apple Health) или Washington Healthplanfinder.

ТРЕБОВАНИЯ

ПОКРЫТИЕ

ВАШИ РАСХОДЫ

HEALTH BENEFITS TRUST

MEDICAID / APPLE HEALTH

$25 / месяц

Бесплатно в зависимости от доходов Вашей семьи.

В зависимости от выбранного плана. Планы серебряного уровня наилучшим образом подходят большинству людей.

Полные медицинские услуги, включая стоматологию, офтальмологию и прописывание медикаментов.

Распространяется на супругов и детей.

Распространяется на супругов и детей.

Работа в течение не менее 80 часов 3 месяца подряд.

• В зависимости от доходов семьи.

Индивидуальные пользователи могут зарегистрироваться в любое время.

• Начало в любое время в случае соответствия условиям

На странице 48 можно зарегистрироваться и ознакомиться с дополнительной информацией, посетите сайт www.myseiubenefits.org

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• Если Вы не можете получать страховку через нанимателя, Вы имеете право на компенсацию расходов.

• Открыто с 1 ноября 2015 по 31 января 2016.

• Или если происходит событие, делающее вас подходящим кандидатом,

Сотрудникам компании следует обращаться для получения дополнительной информации к своему нанимателю.

ПОДАЧА ЗАЯВКИ

WASHINGTON HEALTH PLAN FINDER

например, вступление брак, рождение ребенка или потеря страховки. Посетите сайт Washington Healthplanfinder для получения дополнительной информации по адресу www.wahealthplanfinder. org

Посетите сайт Washington Healthplanfinder для получения дополнительной инфорации по адресу www.wahealthplanfinder. org

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Впечатляющие изменения плана HBT в 2015-2016! Теперь Вы соответствуете критериям для получения страховки HBT страховки, если работаете хотя бы 80 часов в месяц.

Количество часов работы, необходимых для страхования через Health Benefits Trust, было уменьшено с 86 до 80 часов в месяц. В свете новых требований теперьВы можете соответствовать критериям для получения страховки, и мы надеемся, что с каждым месяцем это будет становиться все проще и проще. На странице 48 Вы найдете дополнительную информацию и можете подать заявку на получение страховки.

Отработали менее 80 часов в месяц? Вы можете иметь страховку! Наш новый фонд страхования (Coverage Grant Pilot Fund) будет предоставлять один дополнительный месяц страхования подходящим участникам, которые отработали от 60 до 80 часов в течение одного из месяцев годичного плана медицинского обслуживания до тех пор, пока не будет исчерпан фонд возмещения Pilot Fund. Участникам, отработавшим от 60 до 80 часов за месяц, будет доступен грант. Участники могут подать заявку на получение страховки, обратившись в Центр ресурсов по телефону 1-866-371-3200 или заполнив форму странице 51.

Максимальный годовой размер стоматологической страховки Delta Dental увеличен до 2000 долларов! Мы учли Ваши отзывы, согласно которым годового максимума в 1000 долларов недостаточно для того, чтобы покрыть базовые расходы на стоматологию. Теперь Вам будет доступна сумма в 2000 долларов для оплаты стоматологических услуг, и только свыше этой суммы Вам придется платить деньги из своего кармана. Полное описание плана на странице 96.

Изменения плана в 2015-2016 гг. Годовой максимум плана Delta Dental

Максимальная сумма покрытия расходов на стоматологические услуги выросла с 1000 до 2000 долларов в год.

Трансгендерные услуги Групповое здоровье

Предоставление трансгендерных услуг было пересмотрено в сторону возмещения расходов на необходимые медицинские и хирургические услуги в рамках операций по изменению пола в соответствии с законодательными положениями штата Вашингтон в сфере борьбы с дискриминацией.

Kaiser Permanente

В целях обеспечения соответствия антидискриминационному законодательству штата Вашингтон отменено исключение из списка доступных услуг хирургических операций по изменению пола.

Психиатрические услуги Групповое здоровье

Внесены изменения в процедуру предоставления психиатрических услуг. Лечение в стационаре (согласно требованию Службы страховых экспертов) и лечение сексуальных расстройств и нарушений самоидентификации (на основании решения компании) больше не входят в список исключений.

Реабилитация кардиологических больных Групповое здоровье

Возмещение расходов на реабилитацию кардиологических больных теперь включает до 36 посещений на одно кардиальное событие. Также удалено исключение относительно реабилитации кардиологических больных.

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Giới Thiệu Nhanh về Chương Trình Đào Tạo

1. Tìm Tiêu Chuẩn Đào Tạo của Quý Vị trên trang 88.

■ N hà Chăm Sóc Sức Khỏe Là Cá Nhân Có các tiêu chuẩn đào tạo khác nhau tùy thuộc vào loại hình dịch vụ chăm sóc sức khỏe mà quý vị cung cấp. Xem bảng trên trang 30 để tìm nhu cầu đào đạo của quý vị.

■ Nhà

Chăm Sóc Sức Khỏe Là Tổ Chức Hãng sở của quý vị có thể giúp quý vị hiểu các tiêu chuẩn đào đạo của mình. Liên hệ với hãng sở của quý vị để nhận thông tin về tiêu chuẩn đào tạo của quý vị.

2. Xem các DVD về Định Hướng và An Toàn hoặc xem Trực Tuyến Xem mạng lưới đào tạo trên trang 30 để xem yêu cầu của quý vị.

3. Lên Lịch Đào Tạo Sớm Lên lịch trong vòng hai tuần đầu tiên kể từ khi được tuyển dụng để đảm bảo có những lựa chọn tốt nhất.

■ Nhà Chăm Sóc Sức Khỏe Là Cá Nhân Tạo Tên Đăng Nhập và Mật Khẩu của quý vị để đăng nhập vào cổng thông tin đào tạo và đăng ký lớp học tại địa chỉ www.myseiubenefits.org. (Xem các bước trên trang 8.) Để được hỗ trợ thêm, vui lòng gọi Trung Tâm Nguồn Lực Thành Viên theo số 1-866-371-3200.

■ N hà Chăm Sóc Sức Khỏe Là Tổ Chức Kiểm tra với hãng sở của quý vị về cách đăng ký tốt nhất. Hãng sở của quý vị có các chính sách về lên lịch đào tạo.

Khóa Học Trực Tuyến Được Cung Cấp bằng Tiếng Việt Đăng nhập vào Cổng Đào Tạo và tìm kiếm các khóa học được cung cấp bằng Tiếng Việt này:

•

Bảo Vệ An Toàn Lao Động Qua Việc Giảm Tình Trạng Bạo Lực, Phần 2

•

Hỗ Trợ Người Tiêu Dùng mắc Bệnh Tâm Thần, Phần 1

•

Hỗ Trợ Người Tiêu Dùng mắc Bệnh Tâm Thần, Phần 2

•

Chăm Sóc Sức Khỏe Hướng Đến Người Tiêu Dùng dành cho các Bệnh Trạng Thường Gặp: Mất Nước

•

Chăm Sóc Sức Khỏe Hướng Đến Người Tiêu Dùng dành cho các Bệnh Trạng Thường Gặp: Suy Tim Xung Huyết

•

Chăm Sóc Sức Khỏe Hướng Đến Người Tiêu Dùng dành cho các Bệnh Trạng Thường Gặp: Nhiễm Trùng Đường Tiết Niệu (UTI)

•

Chăm Sóc Sức Khỏe Hướng Đến Người Tiêu Dùng dành cho các Bệnh Trạng Thường Gặp: Bệnh Phổi Tắc Nghẽn Mãn Tính (COPD)

•

Chăm Sóc Sức Khỏe Hướng Đến Người Tiêu Dùng dành cho các Bệnh Trạng Thường Gặp: Co giật

•

Nhận Biết và Báo Cáo Hành Vi Lạm Dụng, Bỏ Mặc và Bóc Lột Tài Chính đối với Người Tiêu Dùng

•

Chăm Sóc Sức Khỏe Hướng Đến Người Tiêu Dùng dành cho các Bệnh Trạng Thường Gặp: Đột quỵ

•

Bảo Vệ An Toàn Lao Động Qua Việc Giảm Tình Trạng Bạo Lực, Phần 1

•

Giảm sự lây nhiễm thông qua các biện pháp phòng ngừa tiêu chuẩn

Các khóa Đào Tạo Cơ Bản được cung cấp bằng tiếng Việt. Đăng ký tham gia các khóa học Tiếng Việt thông qua Cổng Thông Tin Đào Tạo hoặc liên hệ với Trung Tâm Nguồn Lực Thành Viên theo số 1-866-371-3200. Đối với tất cả các khóa học khác, hãy mang theo Thông Dịch Viên của Cộng Đồng (bạn bè hoặc người thân). Thông báo cho Đối Tác Đào Tạo khi quý vị đăng ký tham gia khóa học thông qua Cổng Thông Tin Đào Tạo hoặc bằng cách gọi tới Trung Tâm Nguồn Lực Thành Viên theo số 1-866-371-3200.

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Các Lựa Chọn Chương Trình Bảo Hiểm Y Tế của Quý Vị Chúng tôi muốn quý vị và gia đình nhận được bảo hiểm mà quý vị cần. Hãy tìm hiểu thêm về các lựa chọn dịch vụ chăm sóc sức khỏe được cung cấp cho quý vị trong tóm tắt chương trình này và tìm hiểu xem quý vị có đủ tiêu chuẩn được chăm sóc sức khỏe thông qua Quỹ Tín Thác Phúc Lợi Y Tế, Medicaid (Apple Health) hoặc Công Cụ Tìm Kiếm Chương Trình Bảo Hiểm Y Tế Washington.

NỘP ĐƠN ĐĂNG KÝ

TÍNH ĐỦ ĐIỀU KIỆN

BẢO HIỂM

CHI PHÍ CỦA QUÝ VỊ

QŨY TÍN THÁC PHÚC LỢI Y TẾ

CÔNG CỤ TÌM KIẾM CHƯƠNG TRÌNH BẢO HIỂM Y TẾ WASHINGTON

MEDICAID / APPLE HEALTH

25$ / tháng

Miễn phí, tùy thuộc vào thu nhập hộ gia đình của quý vị.

Thay đổi tùy theo chương trình mà quý vị chọn. Chương trình cấp bạc cung cấp giá trị tốt nhất cho hầu hết mọi người.

Toàn bộ chi phí y khoa, nha khoa, nhãn khoa và toa thuốc.

Bảo hiểm cho vợ/ chồng và con cái.

Bảo hiểm cho vợ/ chồng và con cái.

Làm việc đủ 80 giờ trong 3 tháng liên tiếp.

• Phụ thuộc vào thu nhập hộ gia đình.

Nhà Chăm Sóc Sức Khỏe Là Cá Nhân có thể ghi danh bất kỳ lúc nào.

• Ghi danh bất kỳ lúc nào khi đủ điều kiện.

• Nếu quý vị không đủ tiêu chuẩn nhận bảo hiểm thông qua hãng sở, quý vị có đủ điều kiện được bảo hiểm trên trung tâm trao đổi.

• Mở từ ngày 1 tháng 11 năm 2015 – 31 tháng 01 năm 2016.

Nhà Chăm Sóc Sức Khỏe Là Tổ Chức, liên hệ với hãng sở của quý vị để biết thêm thông tin.

Xem trang 48 để ghi danh và để biết thêm thông tin, vui lòng truy cập www.myseiubenefits. org

• Hoặc khi quý vị có "sự kiện đủ tiêu chuẩn" như kết hôn, có con, hoặc mất khoản bao trả.

Truy cập trang web của Công Cụ Tìm Kiếm Chương Trình Bảo Hiểm Y Tế Washington để biết thêm thông tin tại www.wahealthplanfinder. org

Truy cập trang web của Công Cụ Tìm Kiếm Chương Trình Bảo Hiểm Y Tế Washington để biết thêm thông tin tại www.wahealthplanfinder. org

2015-2016 BENEFITS BOOK

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English Version on Page 47

Những thay đổi thú vị trong chương trình HBT 2015-2016 của quý vị!

Bây giờ quý vị đã đủ tiêu chuẩn tham gia bảo hiểm HBT nếu quý vị làm việc 80 giờ/tháng

Để hội đủ tiêu chuẩn nhận bảo hiểm thông qua Quỹ Tín Thác Phúc Lợi Y Tế, chúng tôi đã giảm số giờ làm việc hàng tháng bắt buộc của quý vị từ 86 xuống 80 giờ mỗi tháng. Bây giờ quý vị đã có thể đủ điều kiện tham gia bảo hiểm của chúng tôi và chúng tôi hy vọng việc đáp ứng điều kiện này từ tháng này qua tháng khác sẽ dễ dàng hơn. Xin xem trang 48 để biết thêm thông tin và nộp đơn đăng ký bảo hiểm của

chúng tôi.

Không đủ 80 giờ làm việc trong một tháng? Chúng tôi đã bảo hiểm cho quý vị!

Quỹ Thí Điểm Cấp Bảo Hiểm mới của chúng tôi sẽ cung cấp thêm một tháng bảo hiểm cho các thành viên đủ tiêu chuẩn nhưng có một tháng có số giờ làm việc từ 80 đến 60 giờ trong năm bảo hiểm y tế cho đến khi Quỹ Thí Điểm hết. Quỹ Grant sẽ hỗ trợ các thành viên có số giờ làm việc từ 80 đến 60 giờ chỉ trong một tháng.

Thành viên có thể nộp đơn đăng ký bảo hiểm này này bằng cách liên hệ với Trung Tâm Nguồn Lực Thành Viên theo số 1-866-371-3200 hoặc gửi mẫu đơn đăng ký tại trang 51.

Mức bảo hiểm tối đa hàng năm của Delta Dental đã tăng lên $2.000!

Chúng tôi nhận được thông tin phản hồi của quý vị cho biết rằng mức bảo hiểm tối đa hàng năm $1.000 là không đủ để bao trả dịch vụ chăm sóc nha khoa cơ bản của quý vị. Hiện tại quý vị có $2.000 cho dịch vụ chăm sóc nha khoa trước khi quý vị phải tự thanh toán các chi phí. Xem trang 96 để biết bản tóm tắt toàn bộ chương trình của quý vị.

Những Thay Đổi Chương Trình Trong Năm 2015-2016 Mức Bảo Hiểm Tối Đa Hàng Năm Delta Dental

Phúc lợi bảo hiểm tối đa hàng năm của Delta Dental tăng từ $1.000 lên $2.000.

Dịch Vụ Chuyển Giới Tính Y Tế Theo Nhóm

Quy định về Dịch Vụ Chuyển Giới Tính đã được điều chỉnh để đưa bảo hiểm cho các dịch vụ y tế và phẫu thuật cần thiết về mặt y tế vào Phẫu Thuật Chuyển Giới nhằm tuân thủ Luật Chống Phân Biệt Đối Xử của Washington.

Kaiser Permanente

Những loại trừ đối với Phẫu Thuật Chuyển Giới đã bị hủy bỏ nhằm tuân thủ Luật Chống Phân Biệt Đối Xử của Washington.

Dịch Vụ Y Tế Tâm Thần Y Tế Theo Nhóm

Đã làm rõ quy định về Sức Khỏe Tâm Thần bằng cách loại bỏ các dịch vụ cư trú điều trị của bệnh nhân nội trú (theo yêu cầu của Văn Phòng Ủy Viên Bảo Hiểm) và các rối loạn tình dục và nhân cách (dựa trên quyết định kinh doanh) ra khỏi danh mục các loại trừ.

Phục Hồi Chức Năng Tim Y Tế Theo Nhóm

112

Bảo hiểm cho phục hồi chức năng tim hiện tăng lên đến tổng số 36 lần thăm khám cho mỗi trường hợp mắc bệnh tim. Loại trừ đối với phục hồi chức năng tim đã bị hủy bỏ.

MYSEIUBENEFITS.ORG

English Version on Page 5

Tababarka Bilowga Dhakhsaha Ah 1. Ka Raadi Heerarkaaga Tababarka bogga 88.

■ D aryeel bixiyayaasha Shaqsiga ah Waxaa jira heerar tababar kala duwan oo ku xiran nooca daryeelka aad bixiso. Fiiri jadwalka ku qoran bogga 30 si aad u oggaato baahiyadaada tababarka.

■ Daryeel

bixiyayaasha Wakaalada ah Qofka aad u shaqayso wuxuu kugu caawin doonaa in aad fahanto heerarkaaga tababarka. La xiriir qofka aad u shaqayso si aad u hesho macluumaadka heerkaaga tababarka.

2. Daawo Fiidiyowyada DVD-ga ee Wacyi gelinta iyo Badbaadada ama Online-ka Fiiri xariiqaha tababarka ee ku yaala bogga 30 si aad u aragto shuruuda lagaa rabo.

3. Xilli hore Jadwaley Tababarka Jadwaley gudaha labada todobaad ee ugu horeeya ee laga jooga marka aad shaqada qabatay si aad u hubsato doorashooyinka ugu fiican.

■ Daryeel bixiyayaasha Shaqsiga ah Abuur Magacaaga isticmaalaha iyo Lambarka sirta ah si aad ugu gasho bogga internetka iskuna diiwaan geliso fasallada boggaan internetka www.myseiubenefits.org. (Ka eeg bogga 8 wixii ku saabsan tallaabooyinka.) Hadaad rabto taageero badan, ka wac Xarunta Macluumaadka Xubinka lambarkan 1-866-371-3200.

■ D aryeel bixiyayaasha Wakaalada La eeg qofka aad u shaqayso qaabka ugu fiican ee la isku diiwaan geliyo. Qofka aad u shaqayso wuxuu leeyahay siyaasado ku saabsan jadwalaynta tababarka.

Ku qaado Aasaasiyaadka Tababarka luuqada Soomaaliga ama keen Turjumaanka Jaaliyadda Koorsooyin Tababar Aasaasiga ah waxaa lagu soo bandhigaa luuqada Soomaaliga.

1. Isku diiwaan geli koorsooyin Soomaali ah tooska Bogga Tababarka ama kala xiriir Xarunta Macluumaadka Xubinka lambarkan 1-866-371-3200.

Wixii ku saabsan koorsooyinka kale, keen Turjumaanka Jaaliyada (saaxiib ama qaraabo) 1. Ku wargeli Iskaashiga Tababarka marka aad isaga diiwaan gelinaysid koorsada tooska Bogga Tababarka ama adiga oo ka waca Xarunta Macluumaadka Xubinka lambarkan 1-866-371-3200.

2. Raadi kadibna la wadaag adiga turjumaankaaga Naseexooyinkeena aynu ugu talogalnay Turjumaanka Jaaliyada. Gal www.myseiubenefits.org kadibna raadi “Turjumaanka Jaaliyada” ama wac Xarunta Macluumaadka Xubinka haddii aad u baahato taageero.

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English Version on Page 45

Doorashooyinka Qorshahaaga Caafimaadka Waxaan kaa rabnaa adiga iyo qoyskaaga in aad heshiin caynsanaanta aad u baahan tihiin.

Ka baro in baddan oo ku saabsan doorashooyinka daryeelka caafimaadka adiga aad heli karto gudaha qaybta qorshahan kadibna oggoow haddii aad ugu qalanto daryeelka caafimaadka tooska Kalsoonida Dheefaha Caafimaadka, Medicaid (Apple Health), ama Washington Healthplanfinder.

RAADIYAHA QORSHAHA

QIIMAHAAGA

$25 / bishii

Waa lacag la'aan, iyada oo ku xiran dakhligaaga qoyska.

Waa mid kala duwan iyada oo ku xiran qorshaha aad dooratid. Qorshooyinka heerka macdanta waxay siiyaan qiimaha ugu fiican in baddan oo dadka ka mid ah.

Caafimaad buuxa, ilko, aragga ama rijeeto daawo.

Xaasaska iyo caruurta la caymiyay.

Xaasaska iyo caruurta la caymiyay.

Shaqeeya 80 saacadood oo 3 bilood isku xigta ah.

• Ku tiirsan dakhliga qoyska.

• Haddii aadan u qalmin caymis loo marayo qofka loo shaqeeyo, waxaad u-qalantaa caynsanaanta exchange.

U-QALMIDA

MEDICAID / APPLE HEALTH

CAYNSANAAN

AAMINAADDA DHEEFAHA CAAFIMAADKA

• Isqor waqti kasta marka aad u-qalantid.

Daryeel bixiyayaasha Qofka waxaa dhici karta in ay qoraan waqti kasta.

• Waxay furantahay laga bilaabo Nofeembar. 1, 2015 - Jan. 31, 2016.

Daryeel bixiyayaasha Wakaalada, kala xiriir qofka aad u shaqaysid wixii ku saabsan macluumaad dheeri ah.

CODSASHO

Fiiri bogga 48 si aad isku qortid iyo si aad u heshid macluumaad dheeri ah, booqo bogga internetka www.myseiubenefits.org

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CAAFIMAADKA WASHINGTON

• Ama marka aad qabtid “dhacdada u-qalmida” sida guurka, ilmo, ama waayid caymis ku jirid.

Ka booqo bogga internetka Washington Healthplanfinder wixii ku saabsan macluumaad dheeri ah www.wahealthplanfinder. org

Ka booqo bogga internetka Washington Healthplanfinder wixii ku saabsan macluumaad dheeri ah www.wahealthplanfinder. org

English Version on Page 47

Isbedelo wanaagsan oo ku dhaca gudaha qorshahaaga HBT 2015-2016!

Adiga hadda waxaad u-qalantaa caymiska Aaminaadda Dheefaha Caafimaadka haddii aad shaqaysid 80 saacadood/bishii

Si aad ugu qalantid caymiska loo marayo Aaminaadda Dheefaha Caafimaadka, waxaan ka soo yareynay saacadahaaga bilaha loo baahanyahay 86 illaa 80 saacadood bil kasta. Adiga hadda waxaa dhici karta in aad si cusub ugu qalantid caymiskeenna waxaana ku rajo weynahay in ay noqoto mid fudud si aad u buuxisid shuruuda bil ilaa bisha kale.

Fiiri bogga 48 si aad u aragtid macluumaad badan una codsatid caymiskeenna.

Dhex gal wax ka hooseeya 80 saacadood hal bil? Waxaanu ku cayminay!

Sanduuqeenna Deeqda Tijaabada Caysanaanta ee cusub waxay siinaysaa ha bil caynsanaan dheeri ah xubnaha u-qalma kuwaas oo dhexgala inta u dhaxeysa 80 iyo 60 saacadood halmar inta lagu guda jiro sannadka qorshaha caafimaadka ilaa Sanduuqa Tijaabada laga dhammeeyo. Deeqda waxay caawin doontaa xubnaha dhexgala inta u dhaxeysa 80 iyo 60 saacadood hal bil. Xubnaha waxay ka codsan karaan caynsanaan ayaga oo kala xiriira Xarunta Macluumaadka Xubinka lambarkan 1-866-371-3200 ama ayaga oo soo gudbiya foomka codsiga ku qoran bogga 51.

Lacagta sannadlaha Ilkaha Delta ee ugu badan waa mid sii korortey waxayna gaartay $2,000!

Waxaan ma qalnay in jawaabcelintaada ah in ugu badnaan sannadkii $1,000 aysan ku filnayn in lagu caymiyo daryeelkaaga aasaasiga ah ee ilkaha . Adiga hadda waxaad haysataa $2,000 oo daryeelka ilkaha ah inta aadan bixin kharashaadka jeebka-ka-baxsan. Ka fiiri bogga 96 wixii ku saabsan gunaanadka qorshahaaga buuxa.

Isbedelada Qorshaha 2015-2016 Lacagta ugu Baddan ee Qorshaha Sannadlaha ah Ilkaha Delta

Dheefaha sannadlaha ugu baddan ee caynsanaanta Ilkaha Delta wuxuu u sii kordhayaa $1,000 illaa $2,000.

Adeegyada Labeebka Caafimaadka Kooxda

Bixinta Adeegyada Labeebka waxaa lagu sameeyay muraajaco si ay u muujiso caynsanaanta caafimaad ahaan daruuriga u ah adeegyada qaliinka iyo caafimaadka loogu talogalay Qalliinka Dib-u habbeynta Nooca Jinsiga si ay ugu hoggaansanto Qaanuunka Washington ee Lidka ku ah Midab takoorka.

Kaiser Permanente

Kareebida Qalliinka Dib-u habbeynta Nooca Jinsiga waa mid la tir-tirey si ay ugu hoggaansanto Qaanuunka Washington ee Lidka ku ah Midab takoorka.

Adeegyada Caafimaadka Maskaxda Caafimaadka Kooxda

Caddeyn loogu talogalay bixinta Caafimaadka Maskaxda ayaa las ameeyay si looga saaro adeegyada daaweynta deegaanka bukaanka (sida loogu baahan yahay Xafiiska Ceymiska Wakiilka Hay'ada) iyo xanuunada aqoonsiga iyo galmada (ku salaysan go'aan ganacsi) ee ka ahaaday liiska kareebida.

Baxnaaniska Xanuunka Wadnaha Caafimaadka Kooxda

Caynsanaanta baxnaaniska xanuunka wadnaha waa mid hadda lagu darey oona gaara illaa iyo 36 booqashooyin guud ee dhacdo wadno kasta ah. Kareebida baxnaaniska wadnaha sidoo kale waa laga saarey.

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GLOSSARY AAA – Area Agency on Aging.

ABT – Accelerated Basic Training.

ADSA – See “ALTSA.” ALTSA – Aging and Long-Term Support Administration. Formerly ADSA. annual deductible – The amount you have to pay each year before you’re able to use any of your health insurance benefits.

AP – Agency Provider. A worker who works for an agency.

ARC – See “The Arc.” ARNP – Advanced Registered Nurse Practitioner. Can be a Primary Care Provider (PCP).

AT – Advanced Training.

BT – Basic Training.

BHP – Basic Health Plan of Washington.

CE – Continuing Education. Supplemental training required for skills development.

CEU – Continuing Education Unit.

CNA – Certified Nursing Assistant.

COBRA – A private-pay insurance that covers you if you have a lapse in coverage or you are between jobs. co-pay –The amount you will pay at the time of your visit. cultural competency – An awareness of the customs, beliefs, and religious practices of others.

DDA – Developmental Disabilities Administration. Formerly DDD. DDD – Acronym no longer used. See “DDA.” 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. diagnostic imaging – MRI (Magnetic Resonance Imaging), X-rays, mammograms.

DME – Durable Medical Equipment. Walkers, crutches, etc.

DSHS – Department of Social and Health Services. health insurance provider – The company that manages your health insurance. For example, Group Health or Kaiser Permanente.

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

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 DSHS. LPN – Licensed Practical Nurse.

MRC – Member Resource Center.

NDC – Nurse Delegated Core.

NDD – Nurse Delegation Diabetes.

O&S – Orientation and Safety. orthopedic appliances – Braces, splints, etc.

PCP – Primary Care Provider. The doctor or ARNP you choose to oversee your care. out-of-network – A bigger group of providers where you may access care but your out-ofpocket expenses will be higher than with in-network providers.

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. premium – The amount of money that you and/or your employer pay monthly, quarterly, or yearly for your health insurance.

RN – Registered Nurse.

RNA – Registered Nurse’s Assistant.

The Arc – National organization serving consumers with intellectual and developmental disabilities. Formerly known as “ARC.” TBI – Traumatic Brain Injury.

Value-based – Value-based drugs are generic brands that treat: diabetes, high blood pressure, high cholesterol, and heart failure.

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118

MYSEIUBENEFITS.ORG

Completed prior to providing care

Completed prior to providing care

Not applicable

Completed prior to providing care

Completed prior to providing care

Completed prior to providing care

Completed prior to providing care

Completed prior to providing care

Standard HCA IP or AP hired before 1/7/2012

Parent Individual Provider (HCS/AAA)*

Parent DD Individual Provider (DDD)*

Limited Service Provider*

Adult Child Individual Provider*

Respite

Within 120 days of starting to provide care

Within 120 days of starting to provide care

Within 120 days of starting to provide care

Not required

Within 120 days of starting to provide care

Not applicable

Not applicable

Not applicable

Not required

Not required

Not required

Not required

Not required

Not applicable

Not applicable

Within 120 days of starting to provide care

Basic Training 70 Hours

BASIC TRAINING

Not required

Not required

No

No

No

No

Within 120 days of starting to provide care Not required

No

No

Yes

Yes

HCA Credential Required?

Not required

Not applicable

Not applicable

Not required

Parent Provider (DDD Only) Class 7 Hours

CREDENTIAL

By your birthday

By your birthday in next calendar year after completing Accelerated Basic Training

Not required

Not required, unless you voluntarily obtain your HCA credential

Not required, unless you voluntarily obtain your HCA credential

Not required

Not required, unless you voluntarily obtain your HCA credential

Not required, unless you voluntarily obtain your HCA credential

Not required, unless you voluntarily obtain your HCA credential Not required, unless you voluntarily obtain your HCA credential

By your birthday

By your birthday

By your birthday

Continuing Education 12 Hours

ONGOING CE

By your birthday in next calendar year after completing Basic Training

By your birthday following your last HCA credential renewal date

If your first renewal period is less than a full year from the date of certification, no CE will be due for the first renewal period**

Continuing Education 12 Hours

INITIAL CONTINUING EDUCATION (CE)

*NOTE: If you work for multiple employers or have multiple roles or multiple consumers, you may have different training standards than the chart indicates below. ** If you are credentialed on your birthday then your CE is due on your first birthday following your Current NAC Credential issuance date.

Completed prior to providing care

Completed prior to providing care

Completed prior to providing care

Not applicable

Not applicable

Not applicable

Standard HCA IP or AP hired on/after 1/7/2012 renewed certification

Completed prior to providing care

Completed prior to providing care

Safety Training 3 Hours

Standard HCA Individual Provider (IP) & Agency Provider (AP) hired on/after 1/7/2012 in process or Newly Issued HCA credential

Orientation 2 Hours

Accelerated Basic Training 30 Hours

UPDATED JULY 2015

ORIENTATION AND SAFETY

TRAINING STANDARDS

2015-2016 BENEFITS BOOK

119

Not required

Providers with a new NAC or Special Education Endorsements

Not required

Not required

Not required

Not required

Not required

Not required

Not required

Not required

No

No

By your birthday

By your birthday

If CE is required in table above, then your CE is due by your first birthday after you start working as an HCA IP or AP. If CE is required in the table above, then your CE is due by your second birthday following your NAC Credential issuance date.**

Provides care to a consumer living in his or her home. Employed by a private, Medicaid homecare agency or DSHS.

A worker who has successfully passed a test and been credentialed by the Department of Health as a Home Care Aide.

This is an HCA with a current healthcare credential, such as a Registered Nurse (RN), Licensed Practical Nurse (LPN), or Nursing Assistant Certified (NAC).

Home Care Aide (HCA) employed by a private, Medicaid homecare agency.

Home Care Aide (HCA) whose employer of record is DSHS.

Home Care Aide who does not work with their own parent or child. Works more than 20 hours a month or has more than one consumer.

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). This is often referred to as a non-DDD Parent Provider.

This is an IP who provides care to his/her own adult child with a developmental disability and is contracted through the Developmental Disability Administration.

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

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

This is an IP that provides DDA Respite services at 300 hours or less in a calendar year.

Home Care Aide (HCA)

HCA Credentialed

Non-HCA Credentialed

Agency Provider (AP)

Individual Provider (IP)

Standard HCA

Parent Individual Provider (HCS/AAA)

Parent DD Individual Provider (DDA)

Limited Service Provider

Adult Child Individual Provider

Respite

HOME CARE AIDE DEFINITIONS

***If you are currently certified as an LPN or RN, CE is not required for your role as an Individual Provider (IP) or Agency Provider (AP). You must maintain your LPN or RN credential and be in good standing with the state of Washington. Note: A provider may fall into more than one of these definitions. They must meet the higher requirements for training and certification.

Not required

Providers with a renewed NAC or Special Education Endorsements

For Workers Who Have a Current NAC Credential, the Chart Below Applies (Not LPN or RN)***

PRSRT STD US POSTAGE 215 Columbia, Suite 300, Seattle, WA 98104

PAID PERMIT NO. 1632 SEATTLE WA

FIFTH EDITION STP000GK0BB05ENGA

101 110 98 107 113 104

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TP-HBT-BB-104