1. Keeping communities healthy
Kaiser Permanente Bridge Program
Keeping communities healthy
September 2016

2. Bridge Program Overview
Kaiser Permanente’s mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve.
The Kaiser Permanente Bridge Program is uniquely designed to help those who are actively enrolled in a training program with a participating community partner and who cannot afford health insurance pay for a standard Kaiser Permanente for Individuals and Families (KPIF) plan. The program will cover the cost of the monthly premium for up to 24 months. Coverage also includes preventative services, comprehensive pharmacy, and more.
Kaiser Permanente will cover medical and pharmacy visits at Kaiser Permanente facilities.*
*All covered health care services must be provided, authorized or prescribed by the Southeast Permanente Medical Group or an affiliated health care provider. The subsidy will not cover services outside of Kaiser Permanente or elective services.
September 2016

3. Community Partners
To assist in the identification and eligibility determination of potential members, Kaiser Permanente partners with local organizations, schools and workforce development agencies. All community partners must implement a training program requirement as criteria for applying for the Bridge Program.
Workforce Development Agencies
Colleges and Universities
Service Organizations
Response to growing workforce shortage
Strategically targets healthcare of professional students
Intended to reach individuals/families facing short-term issues
Atlanta Regional Workforce Board
Cherokee Career Resource Center
Clayton Career Resource Center
CobbWorks! Workforce Investment Act
DeKalb Workforce Development
Douglas & Rockdale Career Resource Centers
Fulton County Office of Workforce Development
Gwinnett Career Resource Center
Year Up Atlanta
Chattahoochee Technical College
Clayton State University, School of Nursing
Georgia Perimeter College
Georgia State University
Gwinnett Technical College/Workforce Investment Act
Atlanta Children’s Shelter
C4 Atlanta
East Lake Foundation
First African Community Development Corporation
Multi-Agency Alliance for Children, Inc. (MAAC)
New Hope Enterprises
Nicholas House
North Fulton Community Charities
Ser Familia
The Center for Working Families
Zion Hill Community Development Corporation
September 2016

4. Eligibility Requirements
The applicant must meet the following eligibility requirement in order to receive subsidized health care coverage under the Bridge Program:
The applicant must be actively enrolled in a training program with a participating community partner.
All applicants, and applying dependents, must live in Kaiser Permanente's metro Atlanta 20 county service area.*
The annual combined household income for the applicant must be less than the current income guidelines of 100% FPL for enrollment.
The applicant and all applying dependents cannot be eligible for or enrolled in any other health insurance program including Medicare, Medicaid, PeachCare for Kids, and employer-sponsored health care.
The applicant must be age 64 or younger, and all child dependents must be younger than 26.
No applicant and/or applying dependent(s) can be a previous member of the Bridge program.
*Bartow, Butts, Cherokee, Clayton, Cobb, Coweta, DeKalb, Douglas, Fayette, Forsyth, Fulton, Gwinnett, Henry, Lamar, Newton, Paulding, Pike, Rockdale, Spalding, and Walton counties.
September 2016

5. Income Guidelines Family size* Monthly gross income1
$990
$11,880 2
$1,335
$16,020 3
$1,680
$20,160 4
$2,025
$24,300 5
$2,370
$28,440 6
$2,715
$32,580
Family size*
Monthly gross income
Annual gross income
* Family Size = Self, Spouse and Dependents
For each additional person, add $4,160 to annual gross income.
Self, spouse, or dependents are defined by ACA as number of individuals for whom the taxpayer can claim a deduction under section 151 of the Internal Revenue Code.
September 2016

6. At our KP Medical Office Affiliated Community Provider
Bridge Program Highlights
Members in the Bridge Program will receive help with out-of-pocket expenses such as copayments and coinsurance for services provided at Kaiser Permanente medical facilities.
$0 PREMIUM PER MONTH
Benefit Description
At our KP Medical Office
Affiliated Community Provider
Annual Deductible
None
Primary Care Office Visit
$0 copay
$20 copay
Specialty Care Office Visit
$40 copay
Preventative Generic Drugs
$15 copay
Vision Exam – one exam per year
Urgent Care
$75 copay
Outpatient Hospital or Surgical Facility
30% Coinsurance
Laboratory Services
50% Coinsurance
Radiology Services
Mental Health/Behavioral Health Services
Emergency Room Visit
N/A
$250 copay (waived if admitted)
September 2016

7. KP Member Experience
September 2016

8. KP Member Experience, cont.
Our Doctors, Your Advocates
We carefully screen and hire our own doctors (more than 500 of them), many from top schools like Emory and Harvard. You can review credentials on kp.org, choose your own doctor, and can switch at any time, for any reason.
From primary care to specialty care, our doctors are your advocates in health.  We’re recognized leaders in prevention — with an entire program based on keeping you healthy through routine appointments, preventive screenings, wellness coaching, healthy living programs, and more.
Medical Services Include:
Adult Medicine
Behavioral Health
Cardiology
Dermatology
Gynecology
Internal Medicine
Ophthalmology
Optometry
Podiatry
And much more!
September 2016

9. KP Member Experience, cont.
Coordinated Care You Can Count On
Having one of the largest and most advanced electronic medical system in the world also means your doctors and specialists are on the same real-time page when it comes to your care. You can count on your care team to communicate with each other and with you to help you be as healthy as possible — and stay that way.
Care the Way You Want
Call our advice nurses 24/7.
your doctor anytime.
Choose your appointment type.
See your doctor in person, or schedule either a telephone appointment or video visit.
Manage your care online at kp.org.
Schedule and cancel routine appointments, refill prescriptions, see lab test results, and more.
Use the Kaiser Permanente app.
Download our app and use all the online features of kp.org from your mobile device. Find locations near you, get directions, and more.
September 2016

10. My Health Manager
At kp.org you have secure 24-hour access to your health record online. Kaiser Permanente’s electronic patient health record system enables you to stay connected to your health, and it allows your doctor to view your information instantly right in the exam room.
Below are just some of the features available to you:
your doctor’s office
Review past office visits
Schedule, request, cancel, and view appointments
View lab test results
Order prescription refills and view current medications*
View immunization history
*Available to members receiving care/filling prescriptions at Kaiser Permanente Medical Centers.
September 2016

11. Total Health Assessment
Learning how to become healthier can be hard. Many do not know where to start. You can learn how to make changes to your health by taking a Total Health Assessment.
It only takes 30 minutes
During the assessment, you answer questions about yourself
After the assessment, you will have an action plan for a healthier lifestyle
Your action plan will help you make healthier
decisions, prevent future health problems, and feel
your very best. Members are encouraged to register
at and complete a Total
Health Assessment.
**Bridge members who complete the Total Health
Assessment will qualify for a prize!**
Learning how to become healthier can be hard. Many people are not sure where to start or what lifestyle changes to make.
September 2016

12. Learn more at kp.org/livehealthy
Health & Wellness
As a member of Kaiser Permanente, you have unlimited access to health programs and classes to keep a healthy lifestyle, free of charge. Fitness and educational classes are offered at our medical facilities and online.
Take advantage of a wide range of tools to help you stay well
Health classes: Choose from a large variety of fitness classes and support groups offered at our facilities.
Healthy lifestyle programs: Our free online programs can help you lose weight, reduce stress, quit smoking, and sleep better.
Wellness coaching: Our wellness coaches will work one-on-one with you by phone. It’s free and no referrals needed.
And many more resources: helpful articles, wellness podcasts, recipes, and more.
Learn more at kp.org/livehealthy
September 2016

13. Pediatric Medicaid: Family Healthcare in One Place
Did you know all of our available pediatricians accept patients with Medicaid?
Simply contact your Care Manangement Organization (Amerigroup, Peachstate, CareSource, or Wellcare) and ask them to switch your child’s provider to Kaiser Permanente.
September 2016

14. Application Received Date
Open Enrollment Schedule
Application Received Date
Effective Date
November 1, 2016 — December 15, 2016
January 1, 2017
December 16, 2016 — January 15, 2017
February 1, 2017
January 16, 2017 — January 31, 2017
March 1, 2017
Note: Applicants approved during 2017 Enrollment Period will term 12/31/2018, regardless of their effective date.
Special enrollment period is a time outside the open enrollment during which you have a right to sign up for health coverage because of a qualifying event such as marriage or a birth of Loss of eligibility under GA Code Section or
September 2016

15. Enrollment Process
Completion of the Kaiser Permanente Bridge Program enrollment process requires five easy steps:
Complete the Kaiser Permanente for Individuals and Families (KPIF) Gold 500/20 application.
Complete the Community Benefit Subsidy application
Submit the Gold 500/20 & Community Benefit Subsidy Applications, as well as supply all necessary supporting documents to the agency contact. The agency will attest that the applicant is currently a client/member or student.
The agency will send the applications and supporting documentation on your behalf to Charitable Health Coverage Operations (CHCO) for eligibility verification.
CHCO will process the applications and documents for coverage and eligibility including: identity, residency, income, access to other health insurance programs, and prior Bridge membership.
If approved, the applicant receives an acceptance letter with effective date. A member can use the letter with the effective date to verify insurance until membership card arrives.
Please make copies of your application in case you need proof of completion after it has been mailed
September 2016

16. Only if you report zero income Only for domestic partners
Applying for the Bridge Program
John Smith X X X X X
Only if self-employed X
Only if you report zero income X
Only for domestic partners X X
September 2016 X

17. KPIF Application
September 2016

18. KPIF Application, cont.
ALL PAGES: Once you flip over to the second page of the application, you’ll notice you’re asked to list the ‘Primary Applicant’ at the top of each page. Please write your name on all SEVEN pages.
John Smith
Once you’ve written your name at the top of all SEVEN pages of the KPIF application, please stop and await instructions for Step 1.
September 2016

19. KPIF Application, cont.
STEP 1: Select Open enrollment if applying between 11/1/2016 – 1/31/2017.
September 2016

20. KPIF Application, cont.
STEP 2: Select KP GA Gold 500/20 Plan. Do NOT Select any other plan.
September 2016

21. KPIF Application, cont.
STEP 3: Complete only for family members requesting coverage; including yourself.
J o h n
X X X X X X X X X
S m i t h D X
M a i n S t r e e t
A t l a n t a
G A
F u l t o n
j o h n . s m i t g m a i l . c o m
September 2016 X

22. KPIF Application, cont.
STEP 3: (continued): Add spouses or domestic partners here if applicable & disregard parent or legal guardian section (applicant should be over 18 because he or she would otherwise qualify for Medicaid).
J a n e
X X X X X X X X X
S m i t h R X X
September 2016

23. KPIF Application, cont.
STEP 3: (continued): List dependents here if applicable.
J e r e m y D
S m i t h
X X X X X X X X X X
C h i l d
September 2016

24. Jane Smith KPIF Application, cont.
STEP 4: This step is required only of you would like someone to act for you in matters related to this application.
J a n e R
S m i t h
Jane Smith
September 2016

25. John Smith Jane Smith Jeremy Smith KPIF Application, cont.
STEP 5: All applicants age 19 or over must sign and date. Failure to do so will delay the processing of your application.
John Smith
Jane Smith
Jeremy Smith
September 2016

26. KPIF Application, cont. STEP 6: Please disregard payment details.
September 2016

27. KPIF Application, cont.
STEP 7: Please disregard.
September 2016

28. Bridge Subsidy Application
September 2016

29. Bridge Subsidy Application, cont.
September 2016

30. Envelopes with pre-paid postage will be provided to all CPs.
Bridge Subsidy Application, cont.
Envelopes with pre-paid postage will be provided to all CPs.
September 2016

31. Bridge Subsidy Application, cont.
September 2016

32. Bridge Subsidy Application, cont.
September 2016

33. Bridge Subsidy Application, cont.
September 2016

34. Bridge Subsidy Application, cont.
September 2016

35. Bridge Subsidy Application, cont.
September 2016

36. Bridge Subsidy Application, cont.
Note: Additional information is requested for those who select self-employed
September 2016

37. John Smith John Smith Bridge Subsidy Application, cont.
Note: Only complete this section if you would like someone to represent you on your behalf
John Smith
September 2016

38. Applying for the Bridge Program Recap
Kaiser Permanente for Individuals and Families (KPIF) Application for health coverage (black ink)
ALL PAGES: Please fill in ‘Primary Applicant’ at the top of each page.
STEP 1: Select Open enrollment if applying between 11/1/2016 – 01/31/2017.
STEP 2: Select KP GA Gold 500/20. Do NOT select any other plan.
STEP 3: Complete only for family members requesting coverage; including yourself. Disregard ‘Parent or legal guardian’; the primary applicant for the Bridge Program must be age 18 or above.
STEP 4: This step is required only if you would like someone to act for you in matters related to this application.
STEP 5: All applicants age 18 or over must sign and date. Failure to do so will delay the processing of your application.
STEPS 6 & 7: Please disregard.
Kaiser Permanente Community Benefit Subsidy Application (blue ink)
SECTION 1: Parent or legal guardian – please disregard
SECTION 2: Primary applicant information
SECTION 3: Family information (if any)
SECTION 4: Household income – verify family size, income and expenses
Family size includes all members in household; including those that my not apply for coverage.
Household income includes “all income from the family (self, spouse, minor dependents/those claimed on tax return)”.
Additional information regarding self-employment is included in section 4.
SECTION 5: Certification
Primary applicant sign and date.
Include an authorized representative only if you would like someone to act on your behalf for matters pertaining to enrollment in the Bridge Program.
September 2016