Your Benefits With the Trust

Eligible Sound Health & Wellness Trust Kaiser Permanente Plan participants and their covered dependents can receive $0 co-pay flu shots at Kaiser Permanente medical centers, Bartell Care Clinic locations and in-network pharmacies.

Medical

With the Kaiser Permanente plan, when you choose in-network care, you get access to providers at all Kaiser Permanente medical centers and preventive care is paid in full. In addition, you have access to a number of contracted community physicians in the area. If you choose out-of-network care, you can see First Choice Health Network or Beech Street providers at a discounted rate. Or you can see any licensed provider you want for most covered services. Your out-of-pocket costs will be higher than if you choose care inside the Kaiser Permanente network.

Find a provider online by using the Kaiser Permanente Provider Directory.

Get More Information in Your Benefits Booklet

Find the details of your medical coverage in your Summary Plan Description booklet in the sidebar at right. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. It is printed on the far left-hand side under the Trust logo.

Vision

With the Kaiser Permanente plan, when you choose in-network care, you get access to providers at all Kaiser Permanente facilities. Or you can see any licensed provider you want for most covered services. Your out-of-pocket costs will be higher than if you choose care inside the Kaiser Permanente network.

Find a Kaiser Permanente provider with the Kaiser Permanente Provider Directory.

Covered services:

  • Exam: 80% for Kaiser Permanente (In-Network) Providers / 60% for Out of Network Providers not subject to deductible or coinsurance; once each 12 consecutive months.
  • Lenses, frames and contact lenses: Up to $150; once each 12 consecutive months, subject to a 12-month benefit wait period.

Get More Information in Your Benefits Booklet

Find the details of your vision coverage in your Summary Plan Description booklet (choose the link below based on whether you are in the “Sound” or “SoundPlus” plan).

Dental

DDWA Preferred Program

This option allows you to see any licensed dental provider. Search for a dentist using the Delta Dental of Washington site. Your reimbursement will depend on the dentist’s contract with DDWA:

  • DDWA Preferred (PPO) Providers: Seeing a Preferred Dentist will provide the highest level of benefits and the lowest out of pocket costs.
  • DDWA Participating Providers: These dentists provide a discount, but your benefits percentage is lower, resulting in higher out of pocket costs vs. a Preferred Dentist.
  • Non-DDWA Dentist: If your dentist is not Preferred or Participating, your benefits will be lower, and you will have higher out of pocket costs. Reimbursement is made based on maximum allowable fees, which may leave you with higher patient responsibility.

Schedule Plan

This option allows you to see any licensed dental provider. Benefits will be paid according to the schedule of allowances. Dental charges in excess of the schedule will be your responsibility.

DeltaCare Program

DeltaCare is a dental HMO plan. This option requires you to choose from a smaller list of approved dentists and clinics. You MUST choose a DeltaCare primary care dentist who coordinates all of your care, including any referrals to specialists. Under this plan you cannot just see any licensed dentist for treatment. A list of DeltaCare providers can be found at www.deltadentalwa.com. Make sure you have a DeltaCare provider in your area and that they are accepting new patients before enrolling in this option.

Get More Information in Your Benefits Booklet

Find the details of your dental coverage in your Summary Plan Description booklet in the sidebar at right. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. It is printed on the far left-hand side under the Trust logo.

Mental Health/Substance Abuse

Kaiser Permanente provides mental health care and alcohol and drug treatment through the Kaiser Permanente Behavioral Health Services department. Sound Health & Wellness Trust participants are also able to use benefits for mental health and chemical dependency at the out of network benefit level.

Kaiser Permanente’s behavioral health care management program provides care coordination, support and advocacy for patients with severe or chronic mental illness and or alcohol or drug concerns. Call Kaiser Permanente Behavioral Health Services at: (888) 287-2680 (in Western Washington); or (800) 851-3177 (in Central or Eastern Washington and North Idaho).

Your call will be answered by a trained and licensed counselor who will ask you a few questions to best direct you to the services that meet your needs and preferences. Phone lines are open Monday-Friday, 8 a.m. to 5 p.m. After-hours crisis care is provided by a strong system of Consulting Nurses and on-call psychiatrists.

For additional information, visit www.kp.org/wa. The website is an excellent resource for information on behavioral health topics.

Get More Information in Your Benefits Booklet
Find the details of your mental health & substance abuse coverage in your Summary Plan Description (choose the link below based on whether you are in the “Sound” or “SoundPlus” plan).

Prescriptions

The Trust’s four-tier therapeutically based prescription plan is designed to promote the use of proven, cost-effective medications. Costs are the same for both in- and out-of-network.

Tier 0-Some highly cost-effective medications: Co-pay per 30-day supply $0.

  • Cholesterol Lowering Medications (Simvastatin)
  • Proton Pump Inhibitors (Prilosec OTC, with physician prescription)
  • Non-sedating Antihistamines: Generic Claritin (Loratadine and Loratadine D)
  • Metformin
  • Lancets

Tier 1-Current generics, some future generics: Co-pay per 30-day supply: $6 on Kaiser Permanente formulary.

Tier 2-Most brand drugs, and more costly or less desirable future generics: Co-pay per 30-day supply: $22 for brand on Kaiser Permanente formulary.

Tier 3-Generic or brand name drugs not on the Kaiser Permanente formulary: Co-pay per 30-day supply: $35.

Mail Order:

Co-pays for a 90 day supply listed below. (Must use Kaiser Permanente Order Program)

  • Tier 0 – $0
  • Tier 1 – $18 for generic if on Kaiser Permanente formulary
  • Tier 2 – $66 for brand if on Kaiser Permanente formulary
  • Tier 3 – $70 if not on Kaiser Permanente formulary (brand or generic)
  • Brand Name Drug with Generic Available – Generic co-pay plus the actual difference in cost between the generic and the brand name drug

Download Kaiser Permanente mail order form (PDF)

Get More Information in Your Benefits Booklet

Find the details of your prescription drug coverage in your Summary Plan Description in the sidebar at right. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. It is printed on the far left-hand side under the Trust logo.

Annual Flu Shots

Eligible Sound Health & Wellness Trust Kaiser Permanente Plan participants and their covered dependents can receive $0 co-pay flu shots at Kaiser Permanente medical centers, Bartell Care Clinic locations and in-network pharmacies.

Getting a flu shot is the single best way to protect against the flu. Children from 6 months to 19 years of age, pregnant women, people 50 and older, and people with certain chronic medical conditions are especially encouraged to get a flu shot.

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Download the full list of what counts toward your Jan. 1, 2019 HRA

Life Insurance

Employee Life Insurance—The employee life insurance benefit is $15,000. This amount will be paid to your beneficiary in the event of your death from any cause.

Dependent Life Insurance—The spouse or State Registered Same Sex Domestic Partner’s benefit is $1,000. This amount will be paid to you in the event of your spouse or partner’s death from any cause.

Employee Accidental Death or Dismemberment—This benefit is payable to your beneficiary in the event of your death, or to you in the event of your loss, if your death or loss is caused by an accidental injury while you are covered under the Plan.

Get More Information in Your Benefits Booklet

Find the details of your life insurance coverage in your Summary Plan Description in the sidebar at right. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. It is printed on the far left-hand side under the Trust logo.

Short Term Disability

If you are totally disabled because of your injury or sickness, you may be eligible for weekly disability benefits. To qualify, you must have worked at least 80 hours during your eligibility month (which was two months before the onset of your disability). Your time-loss payments will range from $135 to $225 per week (less Social Security taxes), depending on the number of hours you worked during your eligibility month.

Get More Information in Your Benefits Booklet

Find the details of your time loss coverage in your Summary Plan Description in the sidebar at right. To determine whether you are covered under the “Sound” or “SoundPlus” plan, look at the front of your Sound Health & Wellness Trust ID card. It is printed on the far left-hand side under the Trust logo.