2024 Evidence of Coverage for WA PEBB Kaiser Permanente Senior Advantage 7 Chapter 1: Getting started as a member Chapter 1 — Getting started as a member Section 1 — Introduction Section 1.1 – You are enrolled in Senior Advantage, which is a Medicare HMO Plan You are covered by Medicare, and you have chosen to get your Medicare health care coverage through our plan, Kaiser Permanente Senior Advantage. We are required to cover all Part A and Part B services. However, cost-sharing and provider access in this plan differ from Original Medicare. Senior Advantage is a Medicare Advantage HMO Plan (HMO stands for Health Maintenance Organization) approved by Medicare and run by a private company. This plan does not include Part D prescription drug coverage. The PEBB Program has determined that this medical plan has prescription drug coverage that is, on average, as good as or better than the standard Medicare Part D prescription drug coverage (it is "creditable coverage"). Coverage under this plan qualifies as Qualifying Health Coverage (QHC) and satisfies the Patient Protection and Affordable Care Act's (ACA) individual shared responsibility requirement. Please visit the Internal Revenue Service (IRS) website at www.irs.gov/Affordable-Care-Act/Individuals-and-Families for more information. Section 1.2 – What is the Evidence of Coverage document about? This Evidence of Coverage (EOC) document tells you how to get your medical care. It explains your rights and responsibilities, what is covered, what you pay as a member of our plan, and how to file a complaint if you are not satisfied with a decision or treatment. The words coverage and covered services refer to the medical care and services available to you as a member of our plan. It's important for you to learn what our plan's rules are and what services are available to you. We encourage you to set aside some time to look through this Evidence of Coverage document. If you are confused, concerned, or just have a question, please contact Member Services. Section 1.3 – Term of the Evidence of Coverage This Evidence of Coverage explains what our plan covers, in addition to your enrollment form and any notices you receive from us about changes to your coverage or conditions that affect your coverage. These notices are sometimes called riders or amendments. If your group renews on January 1, the Evidence of Coverage is in effect for the months in which you are enrolled in Senior Advantage between January 1, 2024, and December 31, 2024, unless amended. If your group's Agreement renews at a later date in 2024, the term of this Evidence of Coverage is during that contract period, unless amended. 1-877-221-8221 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.