Frequently Asked Questions - Group Health Plans

Health is much more than just not being sick. It’s an attitude. A way of life. Whether it’s through Kaiser's health education classes or our online health tools, you can take advantage of a variety of resources to help you live a healthier life.

• Kaiser Permanente's approach to medicine is built around preventive care—so we work to detect potentially dangerous conditions before you get sick. We provide access to screenings, such as mammograms and cholesterol tests, which can detect problems early on. We work to make sure your children get the immunizations they need to grow strong and healthy through regular well-child visits.
• Kaiser Permanente's health education classes and programs can teach you how to make healthier lifestyle choices. We offer a variety of classes in most locations. Some classes may require a fee.
• Of course, Kaiser Permanente also here for you when you’re sick. You can also get advice by phone, learn to manage your chronic condition, and have peace of mind knowing Kaiser cover emergency care anywhere in the world.

Kaiser Permanente offers an optional Chiropractic Plan which provides members with up to 20 chiropractic visits per year for a $15 copayment per visit. In addition, all Kaiser Permanente members can access a select network of complementary health providers to receive a 25 percent discount off regular rates for chiropractic, acupuncture, and massage therapy services.

Note: Certain Kaiser Permanente benefit plans include coverage for some of these discounted services. Plan benefits must be used before those discounted services are available.

A physical would be the cost of a "preventative physical exam." Additional costs may apply for any lab or imaging work.

Vision exams are covered with a copayment. The $15 and $5 copayment plans offer a two-year allowance of $150 for eyewear. Kaiser Permanente California members on other small business plans receive a 20% discount on vision related services in the optical department.

This is the copayment amount a subscriber pays each time they go in to get X-rays. For example, if a subscriber went in one day and had six X-rays, they would pay $10. Then if the same subscriber went in the next day and had eight X-rays, they would pay another $10.

Yes. All Copayment Plans cover prescription drugs with a copayment. Regular (non HSA plans) Deductible Plans cover prescription drugs with a copayment before the deductible is met. The $0/$1500 and $0/$2700 Deductible Plans with HSA do not cover prescription drugs until the deductible is met. Then once the deductible is met, these plans offer 100% coverage for prescription drugs. The $0/$2700 Deductible Plan with HSA offers prescription drugs with a copayment after the deductible is met. For coverage comparison, please view Group Plan Highlights.

The $15 Copayment Plan and the $5 Copayment Plan (only offered for groups) cover 50% of infertility costs.

Yes, all plans cover maternity and pregnancy. Prenatal and first postpartum visits are covered, and the fee is based upon the rates of your chosen plan. Delivery is covered under hospitalization and rates vary according to your chosen plan.

Yes. You may switch to another Kaiser Permanente primary care physician for any reason.

Yes. You may choose your own personal physician from the Kaiser Permanente available primary care doctors in these specialties: internal medicine, family medicine, and pediatrics. Also, women may select an available obstetrician/gynecologist as their primary care physician.

Yes. Kaiser Permanente will cover you for emergencies and urgent care anywhere in the world. The deductibles and copayments associated with your plan will apply. For more information, please view the Traveling Member Brochure. In addition, to receive care in other Kaiser Permanente regions please view the Visiting Member Brochure.

HSA stands for "Health Savings Account". Groups that enroll in a high deductible plan with HSA have the option of opening up an HSA account with Wells Fargo or the financial institution of their choice. Having an HSA enables you to set aside money for medically related expenses and deduct these expenses from your taxes at the federal level. If an employee leaves the business, the money in the Health Savings Account remains with the employee. For more information on Kaiser Health Savings Accounts, click Understanding HSA's.

The acronym HMO stands for Health Maintenance Organization. An HMO is an organization where the insurance company, doctors, and medical facilities are networked together in the same company. HMO subscribers choose healthcare professionals from within that network. Kaiser Permanente is an HMO. With the exception of three group plans, Kaiser Permanente does not give the option of receiving medical coverage outside the network.

Once a subscriber has accumulated the annual out of pocket maximum amount, they will not be required to pay any more copayments for doctor visits, hospital stays, surgery, etc. for the remainder of the calendar year. The expenses the subscriber will have (for the remainder of the calendar year) are the monthly premiums.

Note: The annual out of pocket maximum does not apply to some specialty services such as drug rehabilitation and some preventative care services.

With a copayment plan, you pay a fixed dollar amount when you receive covered medical care, regardless of the type of treatment you receive. With a deductible plan, you pay a fixed dollar amount for certain services such as doctor visits and prescription drugs. However for other services you must meet the deductible before you will pay any copayment for services subject to the deductible. Your payment will vary depending on the treatment you receive, up to the amount of the deductible. Once your total medical costs for the calendar year meet your deductible, you'll pay a copayment for any additional covered services you receive. With a deductible HSA plan your payment will vary depending on the treatment you receive until your out-of-pocket dollars satisfy the deductible. Once the deductible is met, Kaiser will cover your treatment costs until the end of the calendar year.

For more information on deductibles, see the Understanding Deductible Plans Packet.

Please call one of our small group benefits specialists at 1-800-569-1156.

Note: For questions regarding your existing account, appointments, billing, and locations call 1-800-464-4000.

Dental can be added to any of the Kaiser Permanente plans when you enroll. If you choose not to sign up for dental when you apply, you may add dental coverage to your plan during open enrollment.

Yes, Kaiser Permanente offers supplemental Dental Coverage through Delta Dental of California. You can apply for coverage by selecting this option on your New Group Application. Seven different plans are offered for small groups. If the group decides to include dental coverage, all subscribers in that group will be enrolled and will be covered on the same dental plan.

No, physicals are not required. There is no medical underwriting to pass.

Subscribers in a small group are not denied coverage based on pre-existing conditions.

All new membership is limited to those individuals who live or work within the Kaiser Permanente service area.

Your rates are locked in one year from your effective date. Kaiser Permanente small group plans are on a month to month basis. You may choose to cancel at any time.

It varies case by case. Subscribers who are concerned they may be denied for a pre-existing health condition will often opt for group coverage because there is no medical underwriting. However, in the case that you may qualify for either, we recommend you get quotes for both and compare the rates and coverage options.

NOTE: There are different plans and rates offered for groups and individuals, and groups of six or more subscribers qualify for additional savings.

You will need a minimum of 2 eligible individuals. Combinations may include 2 owners, 1 owner and 1 employee, husband and wife, etc.*

* Exceptions may apply.

There is a required minimum company contribution of 50 percent of the employee only rate for the under 30-age category. However, if the company offers an alternate competitor plan, it is required to be the equal dollar amount; whichever is greater. Any part of the cost not paid by the employer must be collected from the employees through payroll deduction.

You will need a minimum of 2 eligible individuals to qualify. Combinations may include 2 owners, 1 owner and 1 employee, husband and wife, etc.* Your group must have between 2 and 50 subscribers to qualify for a small group plan.

* Exceptions may apply.

Group coverage begins the 1^st of each month. Documents must be received prior to the date of coverage in order for underwriting to process enrollment. If paperwork is received the week prior to the month of coverage there is a possibility of this coverage being delayed.

Small group policies are issued automatically upon submission of all correct documentation. This process may take up to two weeks or less, depending upon volume. No medical underwriting is required.

To begin the enrollment process, follow the seven easy steps outlined in the Small Group Enrollment Packet.

Please call one of our small group specialists at 1-800-569-1156 or e-mail us at dennisa@hcisinc.com.