Page 7 - Watermark 2022 Benefits Guide - CA

New
Benefit!
Medical and Pharmacy Coverage - Kaiser

This year, Watermark is pleased to extend an HMO medical plan option through Kaiser for associates residing

in California. Kaiser provides in-network coverage only, aside from true emergency situations, so it is very
important to utilize only Kaiser providers; otherwise you will be responsible for the cost of the service. Review
the providers in your area prior to making your selection. Once your benefits become effective, you will select
a PCP by logging into your Kaiser account and designating a provider. You will automatically be assigned a
provider if you do not designate a provider; however, this can be updated at any time by managing your
account.
HMO Prescription Drugs for Kaiser Plan Members

Medical Plan Provisions In-Network Pick up a preprinted mail-order form at any of Kaiser’s pharmacies
and drop it in the mail. For ordering refills, you can call the
Company contribution to HSA
Not applicable automated telephone system or log into your Kaiser account and
(Individual/Family)
select “Refill your prescriptions online,” 24 hours a day. For
Annual Deductible $2,500/$5,000 questions, contact Kaiser Member Services at 800-464-4000.
(Individual/Family)

Out-of-Pocket Maximum $5,000/$10,000 Kaiser’s Telephone Appointments
(Includes Deductible)
Do you have a minor health condition? If it doesn’t require an in-
Preventive Care Covered at 100% person medical exam, you may be able to address it with a doctor
by phone. Some examples of conditions for a phone
*Amount you pay after deductible
appointment*:
Primary Care Provider • Allergies
Office Visit $20 Copay, no deductible
• Colds and coughs
Specialist Office Visit $20 Copay, no deductible
• Certain follow-ups visits
X-Ray and Lab $10 Copay, No deductible
Inpatient Hospital Services 20%* • Upper respiratory infections

Outpatient Hospital Services 20%* Visit www.kasierpermanente.org.

Urgent Care $20 Copay *Members must have had at least 1 face-to-face visit with Kaiser
before using telephone appointments.
Emergency Room 20%*
My Health Manager
Pharmacy Provisions In-Network
This online tool provides secure email access to your doctor,
Retail Pharmacy (up to a 30-day supply) appointment scheduling, test results, prescription refills, doctor
visit and immunization history, plus your own Personal Action
Generic $10 Copay
Plan. Digital ID cards are accessible eliminating the need to always
Brand Preferred $30 Copay carry your ID card.

20% not to exceed $250,
Specialty Pregnancy Resources
deductible does not apply
Members can obtain information on pregnancy, childbirth, baby-
Mail Order (up to a 90-day supply) care, breastfeeding and other programs. “Mom-to-be” tools
include pregnancy week by week, new baby checklist, what to
Generic $20 Copay
bring the hospital, and more.
Brand Preferred $60 Copay

Brand Non-Preferred N/A

Note: This is a summary of your coverage only. Please refer to your summary plan description for the full scope of coverage.

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