Healthy togetherSee how our care and coverage can help you thrive

kp.org/eutf

• Low caps for out-of-pocket costs

• No deductible

• Quality care from Hawaii's top doctors

Not a member yet? For more information, visit kp.org/eutf or call 808-432-5250 (Oahu) or 1-844-276-6628 (toll free from the neighbor islands).

Monday to Friday, 7 a.m. to 7 p.m., except holidays.

Saturday, 9 a.m. to 1 p.m.

Hawaii Employer-Union Health Benefits Trust Fund2018 Benefits

Why choose Kaiser Permanente?Because your total health matters. We have one mission — keeping you

healthy in mind, body, and spirit. And since we're both a care provider and

a health plan, you get everything you need in one convenient package.

Combining care and coverage is just one way we help you thrive. Here are

4 more.

Affordable, simple, and predictable plan options

You have peace of mind knowing that our plans offer great value for your

health care investment. You also have low caps for out-of-pocket medical

and prescription drug costs, and there's no deductible. So, whether you expect

to receive care often and prefer predictable costs, or you rarely go to the doctor

and prefer lower premiums, we've got you covered.

Quality care starts with over 600 of Hawaii's top providers

No matter which personal doctor you choose, you'll be in highly skilled hands.

You have exclusive access to physicians in our medical group, most of whom are

accepting new patients, so it's easy to choose or change doctors at anytime.

Learn more about our doctors at kp.org/searchdoctors.

Convenient and hassle-free care anywhere, anytime

Care with Kaiser Permanente is care that fits your life. We make managing your

health easy with most services under one roof, an electronic medical record and

mobile app that travel with you, 24/7 nurse advice, same-day and phone

appointments, after-hours care, emails to your doctor's office, worldwide urgent

and emergency care, and more.

Lots of healthy extras

Earn a free gym membership, plus get up to $100 in cash rewards, no charge

tobacco cessation programs and drugs, wellness coaches at no cost, podcasts,

and more. Visit kp.org/eutf to find out more.

With medical offices and hospitals close to where you work and live, you have options when it comes to getting care. To find a location near you, visit kp.org/doctorsandlocations or download our free Kaiser Permanente app for your smartphone or mobile device. Then just use our location finder to search by ZIP code or keyword.

See how our care and coverage can help you thrive

1

Support for better health

Assess your health and get rewarded

This program gives EUTF members the ability to earn up to $100 in rewards cards per contract year for taking steps to improve your health:

• $25 per year for completing a Total Health Assessment This online questionnaire gives you a picture of your overall health, plus an action plan that’s based on your answers.

• $25 for each online healthy lifestyle program, up to 3 programs per year Get help to reduce stress, quit smoking, lose weight, and more. You can take a program when it’s convenient for you, at your own pace. Visit kp.org/eutf to get started.

You are responsible for any taxes that may be due on the amounts received. Please talk to your personal tax adviser for specific tax information about this reward.

The rewards program runs from July 1, 2018 to June 30, 2019 and is open to all EUTF subscribers and your enrolled spouse/domestic partner, 18 years old and older, except for retirees and those enrolled in the HSTA VB Plan. Total health assessments and healthy lifestyle programs completed before July 1, 2018 may be eligible for Kaiser Permanente rewards under the rewards program for the plan year ending June 30, 2018. You can take the total health assessment as often as you like and as many healthy lifestyle programs as you like, but you can only earn up to $100 per contract period. You must complete the activities during the contract year. Rewards will be issued 4 to 6 weeks after you complete your activity. Rewards cards expire 12 months after activation.

Kaiser Permanente

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See how our care and coverage can help you thrive

The Kaiser Permanente Fit Rewards Program

• Join or renew at a participating gym and pay your $200 annual program fee. Work out at your gym at least 45 days for a minimum of 30 minutes per session in 2018 and you'll get your $200 back.

• Choose a participating gym from our full list at kp.org/fitrewards. You can switch to a different fitness center within the network each month.

The Active&Fit® Home Fitness Program

• If working out at a gym isn't for you, we also offer a home fitness program as an option. Choose up to 2 home fitness kits from a variety of dynamic workout kits, including strength exercise kit, yoga kit, pilates kit, and more, for just $10 per year.

• Kits may include a motivational DVD, instructional booklet, and quick start guide.

Earn a free gym membership*

* Please consult with your own tax adviser about the taxability of the reimbursement. Kaiser Permanente Fit Rewards is a value-added service and not part of your medical benefits. Your annual program fee of $200 does not count toward your health plan’s annual out-of-pocket maximum. For details, including conditions, limitations, and exclusions, please see your Benefit Summary or kp.org/fitrewards. Kaiser Permanente Fit Rewards is administered by American Specialty Health Fitness, Inc. through its Active&Fit® program. American Specialty Health Fitness, Inc. (ASH Fitness) is asubsidiary of American Specialty Health Incorporated (ASH). Active&Fit and the Active&Fit logo are trademarks of ASH and used with permission herein. All Kaiser Permanente Hawaii members 16 years and older, except Medicare and QUEST Integration (Medicaid) members, are eligible. Gym availability varies by island.

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Services Standard Plan Comprehensive Plan HSTA VB Plan

Annual out-of-pocket maximumThe most you'll pay for covered medical and prescription drug costs per calendar year*

$2,500/$7,500 $2,000/$6,000 $2,000/$6,000

Gym membership or home fitness kits

Join or renew at a participating gym and pay your $200 annual program fee. Work out at that gym at least 45 days for 30 minutes per session in 2018 and you'll get your $200 back. Or, choose any 2 home fitness kits for $10 instead.

$10 per year for 2 home fitness kits or reimbursable $200 per year for

participating gym membership

$10 per year for 2 home fitness kits or reimbursable $200 per year for

participating gym membership

$10 per year for 2 home fitness kits or reimbursable $200 per year for

participating gym membership

Up to $100 in reward cards per year

Receive $25 for completing a health assessment and an additional $25

per healthy lifestyle program, up to 3 programs per contract year

Receive $25 for completing a health assessment and an additional $25

per healthy lifestyle program, up to 3 programs per contract year

Not covered

Chiropractic services Provided through American Specialty Health$15 copay per visit

(up to 20 visits per calendar year)$15 copay per visit

(up to 20 visits per calendar year)$12 copay per visit

(up to 20 visits per calendar year)

Preventive careRoutine physical exams, well-child preventive care, and immunizations

No charge No charge No charge

Outpatient office visits Primary, specialty, and mental health office visits $20 copay $15 copay $15 copay

Prescription drugs

Tier 1 generics $5 copay up to a 30-day supply $5 copay up to a 30-day supply

$10 copay up to a 30-day supplyTier 2 generics $15 copay up to a 30-day supply $10 copay up to a 30-day supply

Tier 3 brand name $50 copay up to a 30-day supply $35 copay up to a 30-day supply

Tier 4 specialty $75 copay up to a 30-day supply $75 copay up to a 30-day supply

Delivered by our mail-order service (not available out-of-state and for certain medications, including specialty drugs) Two copays for a 90-day supply Two copays for a 90-day supply Two copays for a 90-day supply

Outpatient labs, X-rays, and imaging$10 copay per department per day for basic; 20% coinsurance for specialty

$15 copay per department per day $15 copay per department per day

Outpatient surgery 15% coinsurance $15 copay $15 copay

Maternity careRoutine prenatal visits (after confirmation of pregnancy) and first scheduled postpartum visit, delivery, and inpatient care for the newborn

No charge for prenatal and postpartum care; 15% coinsurance for delivery and

inpatient care for the newbornNo charge No charge

Hospitalization Inpatient services including mental health inpatient services 15% coinsurance No charge No charge

Emergency care Covered services are provided in and out of the service area $100 copay $50 copay $50 copay

Ambulance Medically necessary transport in a licensed ambulance 20% coinsurance 20% coinsurance 20% coinsurance

This is a summary of some benefits and their copayments and/or coinsurance. Please see your Evidence of Coverage for information about coverage, limitations, and exclusions for all benefits, including those not listed in this summary.

Kaiser Permanente

Your 2018 benefit summary (July 1, 2018 to June 30, 2019) Your 2018 benefit summary (July 1, 2018 to June 30, 2019)

* Covered medical and prescription drug costs are for medically necessary "Basic Health Services."

See how our care and coverage can help you thrive

We know that keeping Hawaii state, city, and county employees healthy keeps our communities healthy. So, whether you fight fires or teach students how to prevent them, we'd like you to choose the right plan.

Why choose us? Here are just a few reasons:

• Low caps for out-of-pocket medical and prescription drug costs

• No deductible

• Affordable, simple, and predictable plan options

• Quality care from top doctors

• Convenient and hassle-free care anywhere, anytime

• Easy online access 24/7

• Lots of healthy extras, such as earning a free gym membership. Learn more on pages 2 and 3.

Visit kp.org/eutf to find out more.

Kaiser Foundation Health Plan, Inc.711 Kapiolani Blvd., Suite 400Honolulu, HI 96813

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