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KAISER PERMANENTE. <br />Date: January 12, 2024 <br />Southern California Mobile Health Vehicle Services <br />for <br />City of Santa Ana <br />Group wishes to engage Kaiser Foundation Health Plan, Inc. ("KP") to arrange for the <br />Kaiser Permanente Mobile Health Vehicle (MHV) to provide the services described below <br />at Group's worksite (the "Services"), and KIP wishes to provide such Services: <br />ZBiometric Screenings <br />❑Limited Screenings <br />❑Care Gap Closure to members of KIP <br />❑Community Event <br />❑Primary Care services to members of KID <br />fully -insured health plans <br />BY ENGAGING THE SERVICES DESCRIBED IN THIS CONFIRMATION, GROUP AGREES TO <br />AND INTENDS TO BE BOUND BY THE FOLLOWING TERMS AND CONDITIONS. <br />TERMS & CONDITIONS FOR KAISER PERMANENTE WORKSITE SERVICES <br />FEES: <br />Biometric Screenings (blood pressure, BMI glucose and cholesterol) <br />Biometric screenings are charged at $44 per participant for both KIP members and non- <br />members. <br />Limited Screenings (blood pressure. BMI and glucose) <br />• Limited screenings are at no cost to the employer. No fees apply. <br />Care Gap Closures to members of KP <br />• Care Gap Closures are at no cost to the employer. Standard member copayments may apply if <br />a non -preventive service is delivered on the mobile health vehicle. <br />Primary Care to members of KIP fully -insured health plans <br />• Primary Care services are at no cost to the employer. Standard member copayments and <br />deductibles apply and will be collected either at the time of service or via mailed invoice. <br />PARTICIPATION GUIDELINES: <br />Biometric Screenings <br />■ Minimum 6 participants per hour and at least 32 participants in total for biometric screenings, or <br />$1,408 will be assessed. <br />Limited Screenings <br />• Minimum of 6 participants per hour for limited screenings. <br />Care Gap Closures <br />■ Minimum 2 participants per hour for Care Gap services. Service includes a review of the <br />member's medical record to check if the member is up to date with recommended care, to close <br />any gaps in care and to provide limited biometric screenings. <br />Primary Care <br />■ Minimum 2 participants per hour for primary care services. <br />SCAL MHV LOA 09.28.2023 <br />