Questions -- and Answers -- on Kaiser

A: McClatchy is implementing a new, company-wide health care strategy in 2006. We have had numerous discussions with Kaiser over the past several months, and we have determined that Kaiser is unable to offer a plan that fits within our strategy. McClatchy's new strategy relies on a national program that allows us to leverage our size, streamline administration, develop new care management and health advocate programs that focus on wellness and healthier lifestyles, and develop tools to help our employees manage their own health. Kaiser is not a national vendor and cannot offer coverage to employees at all of our newspapers. Carving out regional plans hampers our long-term health care objectives.

Considerable thought and evaluation has been given to this decision. We understand that moving away from Kaiser may be disruptive to some employees in the short term, but we are confident that the alternative offered through Aetna will continue to provide quality, comprehensive medical plan options for employees and their families.

2: What actions should I be taking now?

A: You should start planning for the transition to the new Aetna health care plans now. Tell your doctor that you will no longer be a Kaiser member and ask for recommendations of other doctors outside the Kaiser network. If you have any transition-of-care issues, such as an ongoing treatment plan, pregnancy or a series of scheduled surgeries that will continue into 2006, contact your newspaper's human resources department to facilitate the transition of your care. (See question #8 below.) Finally, if you take prescription drugs, plan ahead and make sure you have enough medication left at the end of the year so you do not run short while your prescriptions are being transitioned to Aetna.

3: How do I find a new doctor?

A: Ask your Kaiser doctor to recommend other doctors outside the Kaiser network. Or, you can ask family and friends to recommend doctors. Next, check to see if the recommended doctor is in the Aetna network by clicking on the Provider Search/Doc Find link at the Health Works Web site (http://healthworks.mcclatchy.com). Because the directory is only as accurate as the information provided by doctors' offices, call to confirm the doctor is taking new patients. If the doctor is not found in Aetna's network, you can complete a nomination form located on the first page of the Provider Search/Doc Find link and send it to Aetna. Please note that the provider list for Aetna Select doctors is not identical to the Aetna Choice or Routine Care list so your plan selection may affect your choice of doctors.

Schedule a new patient appointment for after Jan. 1, 2006, to meet the new doctor. Although this is not required, it is a helpful process for establishing your relationship and any health concerns or history with your new doctor.

4. How do I transition my medical records?

A: You should either send or take your medical records with you to your new doctor after Jan. 1, 2006. To transfer your Kaiser medical records to your new Aetna provider, you must go to the business office at the Kaiser facility you use and complete an Authorization for Release of Medical Information form. On this form, you can request your medical records to either be sent to your new doctor or directly to you. If you plan to have the records sent directly to you, indicate on the form that the reason for the request is to provide the documents to a new provider. The completed form should be submitted to the Kaiser Health Information Management Department at the address listed on the form. It will take Kaiser about 15 business days from the date the request was received to process your request and then Kaiser will mail the records to the address that you have designated on the form. Because of privacy issues, your human resources department cannot help with this process or accept the Authorization for Release of Medical Information form.

Kaiser does not charge a fee to the member or new provider when transferring medical records from provider to provider or when released to the member as long as the medical records release from indicates that the reason for the medical record request is to provide documents to a new provider. Kaiser does charge a fee of 25 cents per page after the ninth page for medical record requests for personal use.

5. What do I do about my prescriptions?

A: You should check to see if your current prescriptions are on the Aetna formulary list and if they require pre-certification (previously known as prior authorization). The formulary list will be posted on the HealthWorks Web site in early July. If your prescription currently requires pre-certification or step therapy, please contact your human resources department so we can work with you to get the required documentation from your doctor need to transition this prescription to Aetna.

6. How do I transfer my prescriptions from Kaiser to Aetna?

A: If you have a current Kaiser prescription with remaining refills, you may take your prescription container to have it refilled at an Aetna network pharmacy after Jan. 1, 2006. You can find a network pharmacy by clicking on the Provider Search/DocFind link at the HealthWorks Web site. The Aetna network pharmacy will contact the Kaiser pharmacy and have the prescription transferred in order to refill it.

If you have a mail-order prescription, you should ask your Kaiser doctor for a new prescription toward the end of the year. You can send this new prescription in to the Aetna mail-order pharmacy to be filled. Mail-order prescriptions are not transferable from Kaiser to Aetna.

If your doctor prescribes a new maintenance drug for you at the end of the year, ask for two copies of the prescription. Fill the first prescription at the Kaiser pharmacy and send the second prescription in to the Aenta mail-order pharmacy after Jan. 1, 2006.

7. Is there a waiting period for pre-existing conditions?

A: No, there is no waiting period for pre-existing conditions.

8. What if I’m in the middle of treatment?

A: Employees and/or their covered dependents who are undergoing an acute treatment plan, are in the middle of a series of surgeries, or are in the third trimester of pregnancy in September 2005 should contact their human resources department in order to coordinate the transition of care with Aetna. We want to ensure your care is transitioned smoothly to Aetna so your treatment is not disrupted at a crucial stage. Typically, the transition of care to a new doctor will not occur until after the birth of the child or the treatment plan is completed.

However, any elective surgery scheduled for a date on or after Jan. 1, 2006, must be with a doctor and/or hospital facility in the Aetna network in order for you to receive the highest level of benefit.

To begin the transition of care process, complete a Transition of Care form, which can be obtained in your human resources department. It also will be available soon on the HealthWorks Web site under the "Forms" link at the top of the page. Complete the employer and employee sections on the form, sign the authorization and then have your doctor complete the last section and fax it to Aetna. We recommend that you notify your local human resources department if you have a transition of care issue so that we can monitor the process on your behalf to ensure it goes smoothly.

9. My dependent has some special health care needs that are being handled well at Kaiser. I am concerned about losing Kaiser coverage and finding another provider that can handle the care needed.

A: You should contact your local human resources department and/or McClatchy Human Resources. They can help find the appropriate Aetna representative to assist you with locating the right resources to address these special needs.

10. Can I drop my McClatchy group health coverage and convert to an individual plan?

A: If you are a current Kaiser participant who continues to be eligible for McClatchy group health care coverage, Kaiser will not automatically convert your coverage to an individual plan. The Kaiser customer service representative may tell you that you can join an individual plan, but this acceptance is subject to medical underwriting. This means you will have to quality for an individual plan Kaiser may not accept you on an individual basis if you have significant on-going healthcare needs.

Please note that you will be solely responsible for the cost of an individual plan as the company’s policy is to share premium costs for company-sponsored health care plans only.

11. Since I have been in an HMO with Kaiser, is the Aetna Select plan my best option for a smooth transition?

A: Not necessarily. The new plan designs and monthly employee premium contributions are designed to allow employees to select plans that will best fit their individual health and financial needs. The PPO plans, Aetna Choice or Aetna Routine Care, may provide the most cost-effective alternative for employees who do not have extensive health care needs.

12. I have heard that PPO plans like the Aetna Choice and Aetna Routine Care plans will require a lot of paperwork and filing of claim forms. Is this true?

A: Most doctor offices are equipped to process your portion of the payment or collect a co-pay when you visit. If you are using an in-network provider, the doctor or facility will bill Aetna directly. Any balance that you are required to pay will be billed to you. Aetna will send you an Explanation of Benefits ("EOB") after they have processed your claim that shows what charges are counted against the deductible, what portion is paid by insurance and what portion is owed by you. You may have to submit your claim to Aetna only if you are using an out-of-network provider.

13. I like the "one-stop shopping" approach that many Kaiser facilities offer with pharmacy, labs and imaging centers all in one location. Does Aetna offer the same approach?

A: Some Aetna doctors do practice in medical centers that offer additional services. However, if your doctor’s office is not in a medical center, the large number of Aetna-affiliated pharmacies, labs and imaging centers in our area should provide convenient access to the services you need.

14. Where can I get more information?

A: More information about the health care strategy, the Aetna doctor and pharmacy directory, and educational presentations can be found on the HealthWorks Web site. Or you may always contact your local human resources department for assistance.

You can also attend monthly informational meetings on pertinent health care topics relating to the new health care strategy that are taking place at all McClatchy businesses and newspapers across the country. Contact your human resources department for more information about these meetings.