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Kaiser HMO Plan - (Post Sept. 1, 2004 Retirees)
Note: The information on this page applies to retirees on the Kaiser HMO Plan who retired on or after Sept. 1, 2004.

The Kaiser HMO Plan provides Medical & Vision coverage for Peralta Retirees.

Kaiser HMO Plan
Group Number: 65
Customer Service: 800-464-4000
Website: www.kp.org

Dependents are covered up to age 25 with no full time student status (dependent child must be an IRS dependent). Same and opposite sex domestic partner coverage is available.
Announcements

Read the flyers below for dates and locations of the free Kaiser Flu Shot clinics in the San Francisco Bay area:
             Kaiser Flu Shot Clinics - San Francisco
             Kaiser Flu Shot Clinics - South San Francisco

Kaiser has “clarified” the following language under the prescription drug program:
Resources
Kaiser HMO Downloads (Post Sept. 1, 2004 Retirees)
 Traditional Benefit Plan  
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32862550.gifThis summary is for Kaiser retirees who retired on or after September 1, 2004,  are under the age of 65 or have not assigned their Medicare to Kaiser.  If you are eligible for Medicare, you must enroll on Medicare and request paperwork from the benefits office to move to the Senior Advantage plan.

  File size: 30 K

 Senior Advantage Benefit Summary  
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DOWNLOAD

32807475.gifThis summary is for Kaiser retirees who reside in the Kaiser service area, who retired on or after September 1, 2004, over the age of 65, and assigned their Medicare to Kaiser.  Note, this plan includes limited HMO dental benefits under DeltaCare USA.  Refer to the DeltaCare USA plan documents for additional details.
  File size: 30 K

 DeltaCare USA Dental Plan (Senior Advantage Members Only)  
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DOWNLOAD

This is the DeltaCare USA Plan Summary for Senior Advantage Members Only.
  File size: 1246 K

 Kasier HMO Student Certification  
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 This form is to be completed at least once per year by the member and returned to Human Resources. The form applies to Dependent Student coverage under the Kasier HMO Plan.
  File size: 24 K

Kaiser HMO Forms
 Senior Advantage Enrollment Form  
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DOWNLOAD

This is the Senior Advantage Enrollment Form.
  File size: 784 K

 Kaiser ER Claim Form  
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This is the Kaiser HMO ER Claim Form.
  File size: 101 K

 Kaiser HMO Expense Reimbursement Form  
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This is Kaiser HMO Expense Reimbursement Form.
  File size: 27 K

 Kaiser Office Visit and Copay Form  
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 This is the Kaiser Office Visit and Copay Form.
  File size: 14 K

Kaiser HMO Brochures
 Kaiser HMO - Feed Your Health  
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 CHECK IT OUT - Extra benefits for simply being a Kaiser member.  Members are eligible for 25% off regular rates for complementary health services (including massage therapy, acupuncture, chiropractic), featured health topics, message boards, health calculators, discounts at fitness centers ( members must call K-Plus Fitness Line at 1-800-234-6985 or visit www.kp.org) , plus much more.
  File size: 98 K

 Kaiser HMO - Healthy Roads Benefit Brochure  
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 This is the Kaiser Healthy Roads Benefit Brochure.
  File size: 94 K

 Kaiser HMO - Travel Information Brochure.  
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 This is the Kaiser HMO Travel Information Brochure.
  File size: 575 K


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