26 2024 Evidence of Coverage for WA PEBB Kaiser Permanente Senior Advantage Chapter 1: Getting started as a member unreasonable or not possible to obtain services in-network), out-of-area dialysis services, and cases in which our plan authorizes use of out-of-network providers. The most recent list of providers and suppliers is available on our website at kp.org/directory. If you don't have your copy of the Provider Directory, you can request a copy (electronically or in hardcopy form) from Member Services. Requests for hard copy provider directories will be mailed to you within three business days. Section 4 — Costs Your costs may include the following: • Plan premium (Section 4.1). • Monthly Medicare Part B premium (Section 4.2). Section 4.1 – Plan premium Your coverage is provided through a contract with your current employer or former employer or union. Please contact the PEBB Program at 1-800-200-1004 online at hca.wa.gov/pebb-retirees for information about your plan premium. Section 4.2 – Monthly Medicare Part B premium Many members are required to pay other Medicare premiums You must continue paying your Medicare premiums to remain a member of the plan. This includes your premium for Part B. It may also include a premium for Part A, which affects members who aren't eligible for premium-free Part A. Section 5 — Keeping your plan membership record up-to-date Your membership record has information from your enrollment form, including your address and telephone number. It shows your specific plan coverage, including your primary care provider. The doctors, hospitals, and other providers in our network need to have correct information about you. These network providers use your membership record to know what services are covered and the cost-sharing amounts for you. Because of this, it is very important that you help us keep your information up-to-date. Let us know about these changes: • Changes to your name, your address, or your phone number. • Changes in any other health insurance coverage you have (such as from your employer, your spouse or domestic partner's employer, workers' compensation, or Medicaid). • If you have any liability claims, such as claims from an automobile accident. • If you have been admitted to a nursing home. • If you receive care in an out-of-area or out-of-network hospital or emergency room. kp.org