24 2024 Evidence of Coverage for WA PEBB Kaiser Permanente Senior Advantage Chapter 1: Getting started as a member Learn more at hca.wa.gov/pebb-appeals. Fax: 360-763-4709 Mail: Health Care Authority Attn: PEBB Appeals Unit PO Box 45504 Olympia, WA 98504-5504 Hand deliver: Health Care Authority 626 8th Avenue SE Olympia, WA 98501 Any enrollee may appeal a decision regarding the administration of a PEBB medical plan by following the appeal provisions of the plan, except when regarding eligibility, enrollment, and premium payment decisions. Relationship to law and regulations Any provision of this Evidence of Coverage that is in conflict with any governing law or regulation of Washington State is hereby amended to comply with the minimum requirements of such law or regulation. PEBB customer service For questions about PEBB retiree eligibility and enrollment, please call the PEBB Program at 1-800-200-1004 (TRS: 711) or visit hca.wa.gov/pebb-retirees. For questions about Medicare, please call the Centers for Medicare and Medicaid Services (CMS) at 1-800-MEDICARE or visit www.medicare.gov. Section 2.3 – Here is our plan service area for Senior Advantage Our plan is available only to individuals who live in our plan service area. To remain a member of our plan, you must continue to reside in the plan service area. The service area is described below. Our service area includes these counties in Oregon: Clackamas, Columbia, Hood River, Lane, Marion, Multnomah, Polk, Washington, and Yamhill. Also, our service area includes these parts of counties in Oregon, in the following ZIP codes only: • Benton: 97321, 97330, 97331, 97333, 97339, 97370. • Linn: 97321, 97322, 97335, 97355, 97358, 97360, 97374, 97383, 97389. Our service area includes Clark, Cowlitz, and Skamania counties in Washington. Also, our service area includes parts of Wahkiakum County in Washington, in the following ZIP codes only: 98612, 98647. If you plan to move out of the service area, you cannot remain a member of this plan. Retirees and Continuation Coverage members need to contact the PEBB Program. It is also important that you call Social Security if you move or change your mailing address. You can find phone numbers and contact information for Social Security in Chapter 2, Section 5. kp.org