The basic answer is that this the way Kaiser designed the plans. The higher the out-of-pocket maximum is, the lower the premium will be. Kaiser Permanente of California wants to give members a variety of plan options with varying premiums. The more coverage you get, the higher your monthly premiums will be. Some enrollees would rather have a lower monthly bill, and they are willing to deal with a higher out-of-pocket maximum.

The plans are designed for different needs. Some people need medications covered on a monthly basis and cannot afford to pay full price. Others focus on doctor visits. They want the comfort of knowing they will be paying $30 to see a physician rather than $75-$125. On the $30/$1500 Deductible Plan you receive benefits like doctor visits and prescription drugs with a copayment from the very beginning and with the $0/$1500 Deductible Plan with HSA you pay much less should you have a medical emergency. If you want the best of both worlds, you could opt for the $25 Copayment Plan with no deductible, but then you would have to pay a higher monthly premium.

Posted: April 30th, 2009 under California.
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When a Kaiser Permanente California group wants to add dental at open enrollment, there are several things to be aware of. First, you will need to wait approximately five weeks before new members can use the dental plan. Also, it takes about 2 months before the invoice will reflect the additional premium. If there’s an emergency, the dentist will need to file a claim, and the member will need to pay the dentist. The dentist can later reimburse the member. Be aware that there are no “Temporary Membership ID’s” for group dental like there are for group medical. 

When applying for group health insurance in California, social security numbers are not required unless you are adding dental to the group medical plan. However, if a small business enrolls in a dental plan, Delta Dental requires social security numbers to verify membership.

Posted: April 28th, 2009 under California Group.
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Recently, we had a customer claim that she was impressed with the Kaiser Permanente California Individual and Family 20-page application.  She was happy that it was “very clear” and gave well-defined parameters for how far back they wanted to know about her medical conditions. According to her, this is unlike Aetna’s application which asks if you have ever had any conditions in your lifetime. Kaiser limits the scope of the questions by adding a time frame. The application includes questions like, “Have you had _______ in the past 5 years.” This makes it easier for customers to complete their enrollment forms.  

Also, this happy customer was very appreciative of the service team at KaiserQuotes.com. She commented that other places she’d called just didn’t spend the time helping her with her concerns.

Posted: April 17th, 2009 under California Individual.
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Customer Questions:

I have an existing Kaiser health insurance 30/1000 Deductible Plan at work. I just want to add a maternity coverage on my existing policy, would that be possible? How long is the waiting period before the maternity coverage takes effect? I want to see different plans for this. I want the good maternity coverage with low monthly premium and deductible. What will happen to my coverage if in case the company will close down, can I still pay for the same premium?

Answer:

You may not need to change plans. The $30/$1,000 Deductible Plan includes coverage for maternity. Also, with small group plans there is no waiting period for maternity or any other benefits. Regarding changing plans, you can do that each year at open enrollment. Contact your companies HR person for details regarding open enrollment and the plans your company is offering.

If your insurance is lost because the business closes before you deliver the baby, it would be a good idea to consider Kaiser’s conversion plan. 

Posted: April 16th, 2009 under California Group.
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Customer Questions:

I have an existing Kaiser health insurance 30/1000 Deductible Plan at work. I just want to add a maternity coverage on my existing policy, would that be possible? How long is the waiting period before the maternity coverage takes effect? I want to see different plans for this. I want the good maternity coverage with low monthly premium and deductible. What will happen to my coverage if in case the company will close down, can I still pay for the same premium?

Answer:

You may not need to change plans. The $30/$1,000 Deductible Plan includes coverage for maternity. Also, with small group plans there is no waiting period for maternity or any other benefits. Regarding changing plans, you can do that each year at open enrollment. Contact your companies HR person for details regarding open enrollment and the plans your company is offering.

If your insurance is lost because the business closes before you deliver the baby, it would be a good idea to consider Kaiser’s conversion plan. 

Posted: April 16th, 2009 under California Group.
Comments: none

Kaiser Permanente no longer does retro changes for small business plans.  Formerly, Kaiser would backdate plan changes up to 2 months back. Now, they will only go back to the first of the current month. For example, if on 3/2/09 a group asks to backdate a plan change, we can only go back to 3/1/09.  Basically, Kaiser Permanente will need to receive the request by the end of the month in order to backdate a change to the 1^st of that month.

Posted: April 14th, 2009 under California Group.
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The answer to this question depends on several factors: whether or not you have pre-existing health conditions, the size of your business and whether or not you want to cover dependents.

Have Pre-Existing Conditions?
If you or your employees have pre-existing health conditions, we recommend going with group coverage. Group health plans in California are issued automatically with no medical underwriting. This means that there are no health/medical questions and that you will not be denied for pre-existing conditions. Individual health plans, on the other hand, do go through medical underwriting and you can be denied for pre-existing conditions.

Are You a Smaller Business?
If your group is small, we often recommend getting both individual and business quotes. There are differences in plan offerings and rates for group and individual plans.

Including Dependent Coverage?
If you plan on including dependents, sometimes it is to your advantage to put the dependents on their own individual plan. Often, group members can save money by putting their children on a separate individual health plan.

Posted: April 8th, 2009 under California.
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Concern in the Air for Small Business Owners
Some of our small groups have expressed concern about the COBRA-related bill that was recently passed by President Obama, the American Recovery and Reinvestment Act of 2009. If a business is apprehensive about buying group health insurance because they’re concerned about the new bill, we can assure them it won’t actually cost them anything. 

Why Business Owners Don’t Need to Worry
When employees involuntarily are terminated, they are eligible for COBRA. Formerly, the ex-employee paid 100% of the premium. Under the new bill, employers will be required to pay 65% of the premium for the first 9 months. The government will reimburse the employer each month for the 65%, so it’s actually not going to cost the employer anything. The 65% will be based on the premium for the whole family unit, not just the employee’s portion. The bill affects employees who were involuntarily terminated between 9/1/08 and 3/1/09.  If they haven’t already applied for COBRA, it’s not too late. The reimbursement is not backdated to 9/1/08; it just means those folks can qualify.

Posted: April 6th, 2009 under Kaiser Permanente.
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A friend of a friend contacted me about her health insurance situation. She is currently pregnant and wondering whether she should stay with her current private health insurance or consider switching plans.

For right now, I encouraged her to stay with what she has. If she were to try to apply for individual coverage while pregnant, she would get denied. So, for now I encouraged her to wait it out and have the baby with her current health insurance. Then, after the baby is born, she can change coverage if she wants.

On the other hand, if she had the opportunity to get group medical insurance through her work or her husband’s work, that would be an option for her. You can get group health insurance while pregnant. Group plans are not subject to medical review. You don’t have to fill out medical questions and you won’t be denied for pre-existing conditions.

Posted: April 3rd, 2009 under Kaiser Permanente.
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Before my wife got pregnant, I hadn’t even heard about the placenta. This is a sack inside the womb that gives nourishment to the baby. A week and a half after our due date, we went in to a Kaiser California facility for a “Non-Stress Test.” The doctor told us that babies who are born too early and too late face certain risks.  Late babies are more at risk after being about two weeks late. Sometimes the placenta runs out of steam and late babies can become malnourished or even die. Since we were late, we took a “Non-Stress Test.” It was on a Friday. We were thinking of inducing labor the next day, but since the non-stress test showed that everything was fine with our baby, we decided to wait to induce labor until Monday. It wasn’t extremely urgent to induce, but our doctor didn’t want to wait too long either.

After our baby was born, my wife had to deliver the placenta as well. This was much easier than the delivery of the baby. The placenta has no bones. It’s just a squishy sack like a jelly fish. After three hours of pushing to get the baby out, the placenta came out in just a minute or two without much trouble. The nurses caught it in a metal pan and showed it to us. It was gray, red and blue if I remember correctly. You could see veins and there was lots of blood, definitely not the prettiest sight. 

Apparently, some people save the placenta for its stem cells. If later a family member needed stem cells having ones with similar DNA might be helpful. It costs about $1,500 to preserve the placenta so it can be used in this way. Also, I’ve heard that some people will take it home and use it in the back yard as fertilizer to plant a tree. Then years later you can tell your child that the tree was planted for her. Kind of sweet! In another tradition, people eat the placenta. Apparently, it’s quite nutritious!

Posted: April 2nd, 2009 under California.
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