Kaiser Permanente California group health insurance plans are undergoing many changes due to the passage of the Patient Protection and Affordable Care Act (PPACA). We want to help you keep informed about how the federal health reform law affects your health coverage. We are pleased to announce the following positive changes to your KP California Group Plans, effective October 1, 2010. Preventive care services are now available for no charge from the first day of coverage. Also maximum benefit levels have been raised or eliminated entirely in some plans.

Copayment Plans
This group of plans includes the $50 Copay Plan, the $30 Copay Plan, the $20 Copay Plan, the $15 Copay Plan and the $5 Copay Plan. For preventative exams, formerly members had to pay the doctors copay, but now there is a $0 charge for preventative exams. With Regard to maternity/prenatal care, the $50 Copay Plan formerly required a $15 copay, but now there is a $0 charge for this service. For all other Copay Plans, there was and continues to be a $0 charge for maternity/prenatal care. Be aware that this is not referring to the hospitalization charges that are required upon delivery of the baby. Those same charges for in-patient care still apply according to the terms of your plan. For well-child preventative care visits, the $50 Copay Plan formerly charged $15, but now it is a $0 charge like the other Copay Plans. For vision exams, Kaiser Permanente formerly charged the same copay as for doctor visits on these plans, but now there is a $0 charge on all the Copay Plans for vision exams.

HSA-Qualified Deductible HMO Plans
The $30/$3,000 Deductible Plan with HSA is the only plan in this category that will be undergoing changes. The other HSA-qualified HMO plans will remain the same. On the $30/$3,000 Plan, formerly preventative exams cost $30 while maternity/prenatal care and well-child preventative care visits cost $10. As of October 1, 2010 there will be a $0 charge for these services on the $30/$3,000 Plan with HSA.

Deductible HMO Plans
This category includes three plans: the $40/$2,000 Deductible Plan, the $30/$1,500 Deductible Plan, and the $30/$1,000 Deductible Plan. All three of these plans will have improved coverage for preventative exams and vision exams starting on October 1st. Formerly, these exams required the payment of a doctors copay; however, on October 1st these Deductible Plans will have a $0 charge for both vision exams and preventative exams.

Posted: August 16th, 2010 under California Group.
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On January 1, 2014, health insurance carriers will no longer be able to deny coverage for pre-existing health conditions. However, for many with pre-existing health conditions this is simply too long to wait to get California health insurance coverage. Perhaps, they are unable to qualify for group insurance and they would be denied if they applied for an individual health insurance plan. Help is on the way. As of this September 23, 2010, health insurance carriers will no longer be able to deny coverage to minors ages 18 and under. Also, for those 19 and above, states will be offering Pre-Existing Condition Insurance Plans beginning this August, 2010. This program will be run by MRMIB (the Managed Risk Medical Insurance Board).

Qualifications for Enrollment
In order to qualify for health insurance coverage with the Pre-Existing Condition Insurance Program, you must meet the following criterion:
• You must be a United States citizen or national or be lawfully present in the USA.
• You must have gone without health insurance for a minimum of six months before applying.
• Due to a pre-existing condition, you must have had a problem getting health insurance coverage.

This medical insurance coverage under the Pre-Existing Condition Insurance Plan covers a wide range of benefits. These health benefits include primary and specialty doctor visits, hospitalization, and prescription drug coverage. These medical benefits will be available to all on the Pre-existing Condition Insurance Plan regardless of whether the care is being received for new medical conditions or for conditions present on or before the time of enrollment. Thus approval will not be denied for pre-existing conditions nor will coverage be withheld to treat medical conditions that existed before enrollment.

Benefits & Pricing Example
The following example describes the type of coverage and pricing you might receive. A 50 year old living in San Francisco would be placed on a $1500 Deductible Plan with a $2,500 Out of Pocket Limit. The premium for this plan would be $575 a month.

How do I Apply?
Please send an email to FHRP@mrmib.ca.gov to request enrollment forms. In your email, be sure to include the following:
• your name
• your mailing address

Or, you may mail this information to the address below:

Pre-Existing Condition Insurance Plan
California Managed Risk Medical Insurance Board
P.O. Box 2769
Sacramento, CA 95812-2769

Posted: July 5th, 2010 under California.
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Rates are going up next month on Kaiser Permanente Group Health Insurance Plans. New groups who submit forms this month can begin coverage on June 1, 2010 and lock in the current rates for one year. Rates are going up on average 5% to 12%, so for many groups looking to get business health insurance, now is the time to buy. Interested businesses may get Kaiser Permanente Group Health Insurance Quotes instantly online with no obligation to buy. For questions related to enrollment and group plan benefits, call 1-877-752-4737.

Deadline Extended to June 7th
Kaiser Permanente has extended the deadline so that new groups can get their enrollment forms in as late as June 7, 2010 and still be eligible for a June 1st effective date. All missing forms must be submitted by June 11, 2010.

Coverage is month to month and can be cancelled at any time. As long as the New Group Application is submitted by June 7, 2010, your group will be eligible for a June 1st effective date and can lock in the current rates. Group plans are issued automatically without medical underwriting as long as your business qualifies for group coverage.

Mid-Year Rate Changes
Owners and employees who age up into a higher age band can experience rate changes mid-year. For instance, if an employee is age 44 and turns 45, the month after her birthday she will have a rate increase because she will have left the less expensive 40-44 age band and entered the more expensive 45-49 age band. Age bands are in five year increments. Employees and owners whose age currently ends in a 4 or a 9 should be aware that upon their next birthday, their rates will be increasing.

Posted: May 25th, 2010 under California Group.
Comments: 1

The Kaiser Permanente California deadline for Individual and Family sales is this Sunday, May 23, 2010. This is the last chance individual and family health insurance applicants have to lock in rates for the first of the month (June 1st). Rates are going up next month (for those who apply for a July 1st effective date or later) on average around 5.3% in Northern California and 9.5% in Southern California (when compared to the current rates). Those who apply now will lock in their rates until January 1, 2011.

For applicants who do not mind starting their coverage mid-month, the last chance to lock in the current rates before they go up will be June 8th. Those who apply for a Kaiser Permanente Individuals and Families Plan for California by the 8th of June will be eligible to begin their coverage on June 15th. This will be the last chance to lock in the rates before they go up. These applicants will also lock in their rates until January 1, 2011.

Note: When comparing the new July 2011 Kaiser Permanente rates with the rates from July 2010, the rate increases are on average 12.5% for Northern California and 11.5% for Southern California.

Posted: May 21st, 2010 under California Individual.
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When planning for maternity services you may want to choose your plan carefully. I chose a $0/2700 deductible plan with HSA from Kaiser Permanente. The monthly premium fit best into our budget. Although the monthly premium was the right price, having to pay full price for all of the blood work, sonograms and other pre-natal care was a bit overwhelming.

However, I was pleasantly surprised to discover the scheduled pre-natal care visits with my OBGYN were free. When you check in at the counter they are very clear about describing your benefits. They graciously let you know that you may be billed for additional services preformed during your OB visit.

I was a bit concerned about all of the “additional” charges so I called 1-800-390-3507 and spoke with the Kaiser Permanente Deductible Products Team. Their number was conveniently listed on my bill. They were very helpful with describing how the billing system works.

When I asked about the “additional” charges, they promptly mailed me a print out of each maternity service I had received and the fees. This was very beneficial in planning to save for the up-coming labor/delivery services.

Posted: May 19th, 2010 under California.
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Kaiser Permanente’s online application, KPAOL, is undergoing upgrades this week. Due to these upgrades, the medical questions on any incomplete applications will be erased at 9:00 PM Pacific Standard Time on May 7, 2010. Anyone who has started an individual health insurance online application is encouraged to complete it by May 6th in order to avoid having their medical questions erased. Accounts with incomplete applications will still exist after May 7th and customers may still log back into their accounts to complete the application. However, if they have begun answering the medical questions, the answers to those questions will be erased, and they will have to re-enter the information in order to submit their application.

The official deadline is May 8th to submit applications for a May 15th effective date. However, we recommend submitting your application by May 7th before 9:00 PM Pacific Standard Time to avoid any trouble that may be caused due to the system upgrade on the Kaiser Permanente Apply Online System. We apologize for the inconvenience.

Posted: May 4th, 2010 under California Individual, Colorado Individual.
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Don’t forget about this new plan, the $40/$2000 Deductible Plan! Our top selling California Individual Medical Insurance Plans have been the $25 Copayment Plan and the $30/$15000 Deductible Plan. When customers have found the $1500 Deductible Plan too pricy, we have recommended the $40/$3000 Deductible Plan, which is more affordable. However, there is a new plan in 2010 that has benefits and pricing that fall in between these two plans, the $40/$2,000 Deductible Plan.

This new plan is very similar to the $30/$1500 Deductible Plan. Doctor visits and prescription drugs are covered right away with a copayment. Doctor visits are $10 more and obviously the deductible is $500 more (for individuals and $1,000 more for families). Individuals can save a little more money by going with the $40/$3000 Deductible Plan.

Families, especially larger families, may want to steer clear of the $40/$3000 Deductible Plan and opt for the $40/$2000 Deductible Plan. The $40/$3000 Plan is not offered as a family plan. You can apply for it for you family, but you will have to enroll separately for each member of your family. That’s a lot more paperwork and often more cost. You will billed separately for each member of your family.

If you have multiple children, you may find that the $40/$2000 Deductible Plan allows you to get better coverage at a lower price. Let me explain. On this plan you pay one price if you have one child and little bit higher price for two or more children. If you have one or two kids, you may wish to save money by choosing the $40/$3000 Plan. However, if you have more children, you may save money and increase benefits by going with the $40/$2000 plan because after adding two children there are no increased costs for additional children. On the $40/$2000 Plan, a family with two children pays the same price as a family with ten children.

Posted: February 16th, 2010 under California Individual.
Comments: none

In response to population growth, increase in membership and growing demand, Kaiser Permanente has added more hospitals and medical facilities in Northern and Southern California.

Vacaville Medical Center
The Vacaville Medical Center in the Napa-Solano County service area, in Northern California, opened October 6, 2009. The new hospital in the Kaiser Permanente Vacaville Medical Center incorporates the latest in technology and innovation for a growing population of Kaiser members.

Anaheim-Kraemer Medical Office Building 1
This medical facility opened up in the Orange County service area, in Southern California, on September 22, 2009.

Downey Medical Center
This medical facility is located in the Tri-central service area, in Southern California, and opened on September 15, 2009.

Rancho Bernardo Medical Offices
These medical offices opened up on August 30, 2009 in the San Diego service area, in Southern California.

Pinole Medical Offices
Kaiser Permanente in the East Bay service area, in Northern California, opened the Pinole Medical Offices on January 12, 2009.

Posted: February 10th, 2010 under California.
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There has been a change that affects how long a newborn can stay covered under the parent’s group insurance. In the past, a newborn was covered for the first 30 days but only until the end of the month. So, a baby born on the 28th is covered for only 2-3 days, until the 30th or 31st of that month.

Effective 1/1/2010, newborns will be covered for the first 30 days, without the end of the month rule. So, a baby born on January 28th will remain covered until February 28th.

Coverage will be free the first 30 days, but if they enroll the baby with Kaiser, coverage will be backdated to the first of the month. This means they’ll pay for the coverage- just like they would have done before the rule changed. This helps improve KP sales, but also lifts the pressure off of parents from having to make a snap decision, which is often the case when the baby is born at the end of the month.

Tip: When enrolling in a California group health insurance plan due to a pregnancy, especially for your first child, call 1-877-752-4737 after the baby is born. Then, we can look into enrolling the child under the cheaper IFP plan. If you have other children, then, keeping all the kids on the group plan tends to be more cost-effective because there are no extra charges for additional children.

Posted: January 19th, 2010 under California Group.
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Preventive care services are not subject to the deductible. Only the services that are intended to diagnose or treat an existing illness, injury, or a condition that has already been diagnosed or for which you have symptoms are subject to the deductible. Any non-preventative services you receive during a preventative care exam will be subject to the deductible.

The following are included and are exempt from the deductible:
o Flexible sigmoidoscopies
o Health education
o Vaccines
o Mammograms
o Routine preventive retinal photography screenings
o Routine preventive physical exams, including well-woman visits and eye refraction and hearing exam
o Tuberculosis tests

The following laboratory tests are also included and not subject to the deductible:
o Cervical cancer screening including screening for human papillomavirus (HPV)
o Cholesterol tests (lipid panel and profile)
o Diabetes screening (fasting blood glucose tests)
o Fecal occult blood tests
o HIV tests
o Prostate specific antigen tests
o STD tests

In an OBGYN visit, the following are included:

o Pelvic Exam
o Pap Smear
o Mammogram (depending on what the doctor advises)

Posted: November 9th, 2009 under California.
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