Kaiser California Medical Insurance Plans
Kaiser Permanente is the largest insurer in the state by enrollment, covering over 6.1 million Californians. Kaiser is unique among California insurance companies in that the doctors, hospitals and insurance company are all one entity. They share common incentives which is to keep patients healthy vs. other, decentralized systems where each person who treats a patient may try to maximize their profit in a visit. In the Kaiser system, the doctors share medical information in a cutting edge, multi-billion dollar electronic medical record system. This enables doctors to collaborate and consult on patient care and it eliminates the need for duplicate tests. Because Kaiser is a “comprehensive health care delivery system” it offers rich benefit plans at extremely low rates.
People feel passionately about Kaiser: they seem to either love it or they hate it. Regardless of your personal feelings, as someone considering benefits for your employees, you should take a close look at Kaiser. Also, Kaiser has made massive changes over the last decade; built dozens of hospitals and medical facilities; and it is a different company from what you may have known or heard from people who used the system years ago.
The Brookings Institution has an excellent overview of Kaiser, in its report, Kaiser Permanente – California: A Model for Integrated Care for the Ill and Injured. The short report begins with this description:
Kaiser Permanente (KP) is the nation’s largest nonprofit integrated health care system with over 9.6 million members (nationwide). KP-California consists of the Northern and Southern California Regions. KP is a pre-paid integrated system consisting of three distinctly separate, but related entities: a health plan that bears insurance risk, medical groups of physicians, and a hospital system. The financial incentive is to provide high quality, affordable care and manage population health rather than generating high volume of compensable services. Both the health plan and the medical group are aligned and accountable for a global budget, and only contract directly with one another for the provision of medical services. All three entities share in the goal, reflected in the organization’s capitated payment system, of keeping patients healthy while optimizing utilization. This alignment is crucial in KP’s effort to maintain affordability for their purchasers and members.
Love it or hate it, you should be glad that Kaiser is an option in California. Their rates are less than other HMO plans and they put downward pressure on the rates of other insurance companies.
Click here for a Kaiser group health insurance quote.
Kaiser Small Business Health Insurance FAQ
How many employees do you need for Kaiser small business health insurance?
A small employer must have at least 1 non-owner, W2 employee who works a minimum of 30 hours per week on average to qualify for California Kaiser small business health insurance. Kaiser excludes owners and the spouses of owners from this calculation. To qualify as a “W-2” employee a business deducts payroll taxes from the employee’s paycheck and covers the employee with worker’s compensation insurance. 1099 independent contractors don’t have the same relationship to a business, and they are not eligible for group medical insurance.
How do small businesses set up Kaiser health insurance?
The easiest way to set up Kaiser small business health insurance for your employees is to call the helpful staff at BenefitsCafe.com (800)746-0045. We can help you and your employees enroll. Most importantly, we assist you throughout the life of your coverage. So, if there are any questions or problems, we’re here to help. Just give us a call. Or, you can contact Kaiser directly. The rates and benefits are identical whether you work with a broker/agent like Benefits Café, or if you enroll directly with the insurance company.
What is Kaiser Traditional HMO Plans?
Kaiser Traditional HMO plans are the standard Kaiser Gold and Platinum level plans with no deductible. Members have access to care from a doctor or hospital that is part of the Kaiser network.
What is Kaiser Deductible HMO Plans?
These plans have a “deductible” or an amount of money that a member must pay before the insurance company pays. Kaiser small group Silver and Bronze level plans have deductibles and some Gold plans also have deductibles. The good thing about Kaiser’s plans is that on most plans, the deductible only applies to some services, such as in-hospital services. Some plans apply the deductible to medical services such as lab work, x-rays and MRIs (complex medical imagery.) On most Kaiser Bronze small business plans, members must pay the deductible before they pay co-payments for doctor office visits and other medical services. The plans with deductibles that apply to many services cost less on a monthly basis compared to plans where services are available with no deductible.
What is Kaiser HSA-Qualified Deductible HMO Plans?
These plans meet the legal requirements for a Health Savings Account Compatible plan, or HDHP, High Deductible Health Plan. By law, the plan won’t have copayments or co-insurance until a member has paid the full medical plan deductible. Congress intended for these plans to cover catastrophic illness and injury. Members on HSA qualified medical plans can put money into an IRA-like HSA account and withdraw money for qualified medical expenses without penalty. Kaiser offers inexpensive HSA-compatible plans. Also, Kaiser makes it easy for members to estimate the cost of medical services with their fee schedule or sample fee list.
What is Kaiser Deductible HMO with HRA Plans?
Health Reimbursement Arrangements (HRA) has a high deductible, and a small business employer can contribute a portion of the deductible to an employee’s plan. In 2022 Kaiser Permanente of California offers the Gold 80 HRA HMO 2250/35 + Child Dental plan. This plan has a $2,250 individual deductible and according to the benefits summary the employer must “establish and fund an HRA for each enrolled employee”. The employer can fund $100 to $400 per employee or $200 to $800 per family. An employee can use the employer’s money towards the deductible. The challenge with the HRA plans is that the monthly premium is higher than plans with much lower deductibles. Accordingly, the cost of the plan including the monthly premium plus the employer’s contribution to the deducible, these plans tend to be uncompetitive cost-wise.
What is Kaiser Copayment HMO plans?
As an HMO, every Kaiser plan has copayments for specific medical services. The Copay plans have no deductible, and these are Platinum and Gold level plans. Copayment means that you pay a specific amount for certain services, like doctor office visits, x-rays, and lab work. You may pay $10 or $20 for a doctor’s visit or lab work. A big benefit of the Kaiser copayment HMO plans is that they have fixed copayments for in-hospital care, such as $500 per admission, $250/day or $600 per day when you stay the night in a Kaiser hospital. Most other plans – from Kaiser or other insurance companies – require you to pay a percentage of the charge for in-hospital service, which is much higher than the in-hospital copayment.
What is Kaiser HRA and HSA-qualified plans?
HRA stands for Health Reimbursement Arrangement, and it is a small business medical insurance plan that Kaiser offers in California where the employer must fund a small portion of the employee’s deductible. HSA stands for Health Savings Account and these are medical insurance plans for small groups in California that meet the requirements as a High Deductible Health Plan (HDHP.) With an HDHP or HSA qualified health plan employees have medical coverage for major medical expenses that they can fund out of a separate savings account. HSA compatible plans don’t allow copayments for doctor visits or prescription medicine before the deductible. The premium or price savings of HRA and HSA plans is minimal in California. Call BenefitsCafe.com for more information (800)746-0045.
How do I know which Kaiser small business medical insurance is best for my business and employees?
A California small business should give its employees a few different plans to match their specific needs. Kaiser allows this. Some employees may want to start a family and want low in-hospital charges. Other employees may have a chronic illness like diabetes or heart disease and want low copayments for medications. Healthy employees may want the least expensive plans since they don’t go to the doctor very often. Employers want to give employees these options but also manage the cost of the plans. BenefitsCafe.com recommends that small businesses sponsor a specific plan and then allow employees to apply the amount that they pay towards the sponsored plan to the plan that works the best for the employee’s specific needs. You may sponsor or pay 100% or 90 percent of a Silver Kaiser HMO plan but also allow the employee to “buy up” to a Gold or Platinum plan. The employer pays the same amount regardless of the plan and the employee pays the additional cost of the better plan. Give us a call and we can help you set this up at no additional cost. Our number is (800)746-0045.