Often, current Kaiser Members have to re-apply for individual medical plans. They may be leaving a group plan due to change of employment. Children who become adults or become ineligible for student health insurance under their parents’ plans may also need to re-apply. Currently, applicants in this situation must fill out the same 20 page application that new Kaiser Members must complete. In the future, Kaiser may provide a shorter application for these enrollees, but currently there is no such option.  

A customer recently complained about this issue: “I don’t understand the delay on applications for existing Kaiser Members who are forced to make a change due to age.  The applications are long and 95% of the information requested is information Kaiser already has access to and we do not.  Why are they asking for history from 10 years ago? This has been an annoying and frustrating experience.” 

I can sympathize with this applicant. She’s thinking, “I’ve been with Kaiser for years. They have all my medical records. They know the answers to all these questions. Why do I need to fill out this incredibly long application when the underwriters are just going to look at my medical records and make a decision based on what they have on file?” In light of this complaint, I sent a request up the line and found out that there is already discussion occurring on this issue. Kaiser Permanente may provide a shorter application in the near future for current members who are changing their coverage type. However, for now you must do the following:

• Are you changing from group coverage to individual? Re-Apply.
• Are you applying for individual coverage after becoming ineligible on your parents plan? Re-Apply.
• Are you upgrading your current individual coverage for a richer plan? Re-Apply.
• Are you downgrading your current individual coverage for a lesser plan? Fill out the plan change form.

Posted: January 30th, 2009 under California Individual.
Comments: none

We finally have some good news! Underwriting is starting to catch up on the back log of applications. In the next few weeks, Kaiser Permanente California plans to get caught up to the previous processing times of two to three weeks. In addition, once underwriters catch up, they plan to continue moving forward and decreasing the processing times even more.

Just yesterday I received another complaint from an applicant for private health insurance. “Hi, Kaiser has taken long enough and I plan on filing a complaint. Please accept this email as my request to withdraw my application. There are other insurance companies that respond in an acceptable manner.” This customer is not alone in her aggravation. We are feeling the frustration of many customers who have had to deal with long processing times in the last two months. For those who got stuck in the backlog, this is probably little consolation, but for those who still plan to apply, hope is on the way. 

The Kaiser underwriting crisis has gotten attention at the highest levels of the Kaiser Permanente Insurance Company. Additional staff have been added and systems have been improved. In a day and age when competitors are processing health insurance applications much faster, Kaiser Permanente realizes that they have to be competitive in processing times and not just in quality of product and pricing.  

The addition of fast processing times will make Kaiser Permanente one of the most competitive individual and family health insurance companies in California. Currently over 1 in 5 Californians are Kaiser members and this statistic is expected to increase. The combination of high quality care, preventive medicine, affordable pricing and fast processing times will make competition with Kaiser Permanente very difficult for Blue Cross, Health Net and other carriers in the near future.

Posted: January 28th, 2009 under California Individual.
Comments: none

A Kaiser Permanente California Individual customer recently commented, “I have been waiting for a response to my application for over a month.  I received a call yesterday stating that there was more info needed on my application. I was told that if I didn’t call back in 5 days my application would be canceled. I was on hold yesterday for 21 minutes and this morning for 30 minutes.  When I was able to get through to someone I was put on hold for 7 minutes.  She wasn’t able to help me and has put me on hold again.” During this busy time, customers are frustrated and Kaiser Permanente staff members are being pushed to the max.  

Where is the pain coming from?

1. Long Processing Times: Kaiser Permanente Underwriting is currently taking 6-8 weeks to process applications. New enrollment forms and processes along with increased interest in Kaiser health insurance has caused a huge back log.
2. I just found out that I was approved FOR LAST MONTH!!!: Due to the long processing times, applicants often are finding out a month or two after their effective date that they are approved and their coverage “began” weeks earlier. Not only that, they are expected to pay for this month of coverage that has come and gone. For example, a customer applied December 12^th for a January 1^st effective date. He found out on January 25^th that he has just been approved for January 1^st and he will have to pay for the entire month of January even though most of the month is passed (unless he changes his effective date, see below).
3. Difficulty Reaching Customer Service: Every year, this is a crazy time of year for Kaiser Permanente. However, this year things have been exceptionally difficult. Along with location changes and new hires, Kaiser has had to deal with the difficulties of launching a new online application. The application has over twice the amount of medical questions and as with any new software there have been plenty of kinks to work out.

How do I stop the pain?

1. Move Your Effective Date: Currently, Kaiser Permanente California is allowing new applicants to move their effective date forward up to 60 days. Take advantage of this so you don’t have to pay for coverage you didn’t really receive.
2. If Applying, Choose a Later Effective Date: Apply for an effective date that is 6-8 weeks into the future. This will allow you to find out your status before or at least near your effective date.
3. Call the Right People: If you are looking to enroll or change plans with Kaiser Permanente, call 1-877-752-4737 and select Option 0 to go straight to a live representative. If an underwriter calls you for additional information, use the phone number that he/she gives you. If you are already enrolled, call Member Services at 1-800-464-4000. You may want to call during less busy hours so it’s easier to get a live person. Avoid Mondays and Tuesdays. Also, you may have better luck calling in the mornings or later in the afternoon. It can be harder to get a live person when calling between the hours of 9:30 AM and 2:30 PM

Posted: January 26th, 2009 under California Individual.
Comments: none

Yes, you can move your effective date to a date 30 days or 60 days later*. If you just found out that you were approved for December 1st or January 1st, you may want to move your effective date to February 1st so you don’t end up paying for December and/or January.

Posted: January 21st, 2009 under California Individual.
Comments: none

Customers often ask, “If I get one of the HSA plans, do I have to put money in a health savings account?” The answer is no. Many people purchase one of the Kaiser HSA plans and never open a health savings account. If a plan has HSA as part of the name, this simply means that this plan is government qualified, so that if you want, you can open a health savings account. If you are not on an HSA Plan, then you do not have this option. 

For most Kaiser members on the health savings account plans, we do recommend opening an HSA account. By doing so, you can deduct healthcare expenses from your federal taxes. A little tax savings never hurt anyone. You can open up an HSA account with as little as $100 and your money gains interest while it’s in the account. Be aware that some financial institutions charge a monthly fee for their health savings accounts. This fee may be somewhere between $3 and $6 a month. You may want to make sure that the interest and the tax savings you gain are enough to outweigh the monthly fee, or look around to find an HSA Plan that does not have a monthly fee. There are some out there. 

Whether you intend to open a health savings account or not, the Kaiser Permanente HSA Plans offer great coverage at affordable prices. I personally am on the $0/$1500 Deductible Plan with HSA and I have never opened a health savings account for myself. I love the low $1500 out-of-pocket maximum. It’s good to know that I have 100% coverage after my healthcare spending adds up to $1500 in one calendar year. My wife has the same plan, and I did open an HSA for her. She is pregnant and due to have our baby this month. I knew we would have a lot of medical expenses having to do with the pregnancy and I wanted to be able to deduct these expenses, so I opened an HSA for her.

Posted: January 19th, 2009 under Kaiser Permanente.
Comments: none

Chiropractic benefits are included in the $1500 Deductible Plan and can be added to many of the group plans. The copayment is $15 per visit, which is not subject to the deductible. Kaiser members get up to 20 visits per year. If members don’t have chiropractic coverage on their plan, they still get a 25% discount on chiropractors that are in the American Specialty Health (ASH) network. 

In a day when most chiropractors are asking $35 to $60 per visit, a $15 copayment isn’t so bad. Ask your chiropractor if they take Kaiser Permanente’s chiropractic coverage. My original chiropractor did not, so I had to Find a Chiropractor in the Network who was in my area. There were 24 who were within 5 miles of me, so it wasn’t too hard. My chiropractor hemmed and hawed about Kaiser not paying out much to the chiropractic offices, but he still seemed to think it was worth his while to take Kaiser chiro coverage in order to get more customers.  

When I changed to a different Kaiser health plan, I lost this chiropractic benefit, and the charge for my visits went up to $52, which made me much more hesitant to go to the chiropractor. When you have to pay out that kind of money, sometimes you feel like you can just live with a couple aches and pains. I found out later that chiropractors in the networks are supposed to give a 25% discount to Kaiser Permanente members. My chiropractor didn’t mention this to me, but charged me the regular $52. If you don’t ask, they may not give you the discount. From now on, since I know, my chiropractic visits will be around $40. That’s definitely not as good as $15, but at least it’s less than $52. 

If you’re on a group plan, I believe you can add chiropractic to all the plans except for the HSA plans. If you have one of the regular deductible or copayment plans, I highly recommend paying the $2 extra a month to add chiropractic coverage. That’s only $24 a year and you save a ton on your chiropractic visits. If you go to the chiropractor at least every once in a while, it’s totally worth it.

Posted: January 16th, 2009 under California.
Comments: none

When you apply with Kaiser Georgia, you are getting high quality care at affordable prices. Kaiser Permanente ranked the highest for health care in the state for three years in a row, according to U.S. News & World Report*. KPGA ranked #1 for its health plan and the #1 for its Medicare plan in the state of Georgia. In regarding to national statistics, the health plan was ranked 53^rd and the Medicare plan was ranked 21^st in the United Sates. 

Though consumers in the state of Georgia have looked less favorable on HMO plans in the past, preferring the greater options provided by a PPO, the tide is beginning to shift. Those looking for health insurance in Georgia are realizing that they get more coverage for their money when they go with a Kaiser Permanente HMO plan. A customer recently complained, “My husband and I are paying $1,000 a month for health insurance and we aren’t getting diddly.” She was pleasantly surprised that she could improve her coverage and lower her monthly premiums at the same time by enrolling with Kaiser Permanente Georgia. 

Kaiser Georgia members are highly satisfied. They find that the options within the Kaiser network are more than sufficient. The service is good and the care is high quality. 

*. As published in the November 5, 2007 issue of U.S. News & World Report.

Posted: January 14th, 2009 under Georgia.
Comments: none

Kaiser Permanente has introduced four new private health insurance plans for 2009. Individuals and families looking for more affordable medical insurance may be interested in these plans. All four are deductible plans with deductibles ranging from $3,000 up to $5,000. Three of the plans do not include maternity. All four plans have a lifetime maximum of $5,000,000. These features allow Kaiser Permanente to be competitive in the low cost health insurance market.

•  $40/$3,000 Deductible Plan NM: This plan is very similar to the $1500 Deductible Plan. It covers doctor visits and prescription drugs for a copayment before the deductible is reached.
• $50/$5,000 Deductible Plan NM: This plan does not include RX coverage, and covers doctor visits at $50 per visit only after the deductible. This is a major medical plan just to cover the big stuff. For most age groups and rate areas this plan offers the most affordable monthly premiums.  
• $40/$4,000 Deductible Plan NM with HSA: This plan covers doctor visits and prescription drugs after the deductible is reached. This is a major medical plan offering low cost monthly premiums. Also, this plan, along with the $0/$5000 Deductible Plan with HSA, gives members the opportunity to open a health savings account, which allows them to deduct health care expenses from their federal taxes.
• $0/$5,000 Deductible Plan WM with HSA: This plan is similar to the $0/$1500 and the $0/$2700 Deductible Plans with HSA. This plan offers only preventative coverage until the deductible is met. Once the member reaches the deductible, this plan offers 100% coverage for the remainder of the calendar year.

Currently, to apply for one of these plans you will need to Print a Paper Application to apply by fax or mail, or you may use our Secondary Online Application. 

Posted: January 9th, 2009 under California Individual.
Comments: none

We recommend choosing an effective date that is at least six weeks away. If you were applying today (January 8^th), you would probably want to choose a March 1^st effective date. This gives underwriting time to process your application and notify you before your effective date arrives.

Technically, you could apply for January 15^th, since today is the official deadline for a January 15^th effective date. However, your application most likely will not end up being processed until near the end of February, which puts you in a position where you have to either pay for a month of coverage you did not receive or go through the hassle of changing your effective date to the next month.

Ultimately, Kaiser Permanente aims at processing applications in ten business days or less. However, presently this is not happening. Underwriting is currently taking between five and eight weeks to process applications on average. Kaiser Permanente receives around 500 applications for private health insurance each day. In the last couple months, the individual and family application has increased in size from eight pages up to twenty pages. Kaiser has added a 15^th of the month effective date alongside the 1^st of the month, so customers now have two effective dates to choose from. Also, underwriting has had to deal with the launch of a new online application (KPAOL), moving offices and the bumpy schedule of the holiday season. We look forward to speedier processing times for Kaiser Applications, but we’re not there yet.

Posted: January 8th, 2009 under California Individual.
Comments: none

Upon occasion, we get asked about surrogate pregnancies. Couples that have difficulty getting pregnant or carrying a baby, often seek out someone to become a surrogate parent and carry their baby for them. The question then becomes, “Is this surrogate pregnancy covered?”  

So is it covered? We get many questions around this issue. “If we are already Kaiser members, would the pregnancy be covered under our plan?” “Do we have to purchase a plan for the surrogate mother who is going to carry the baby?” However, in either case, the surrogate pregnancy is not covered. A customer recently asked, “On an individual plan would Kaiser cover a surrogacy pregnancy?” We do not have good news for those looking to undergo a surrogate pregnancy. Kaiser covers neither the process (fertility issues) of the woman becoming pregnant, the prenatal visits, nor the birth of the child. 

Why not? Kaiser Permanente does not cover surrogate pregnancy most likely due to the financial risk. When you buy any type of insurance, you are buying a hedge against possible risk. The more likely you are to cost the insurance company money, the higher your premiums will be for that insurance. Health insurance prices go up as people get older because of the simple fact that older people tend to use health care services more often. If a woman tries to apply for health insurance while pregnant, she will almost always (or perhaps always) be denied coverage. The risk to the health insurance company is extremely high that they will have to provide health care services for prenatal visits and the birth of this child. Similarly, surrogacy pregnancy creates a situation where the medical insurance company is very likely to incur a financial loss. The premiums paid for the health insurance are likely to be less than the value of the health care provided for the surrogate pregnancy. 

Will other carriers cover surrogate pregnancy? For the reasons listed above, most carriers will not cover surrogate pregnancy. For more information on surrogate pregnancy, visit http://www.surrogateparenting.com.

Posted: January 5th, 2009 under California.
Comments: none