Frequently Asked Questions
Who do I contact if I have questions regarding eKaiserInsurance?
Please call one of Kaiser Permanente©s representatives at 1-800-915-0501 or e-mail eKaiser Insurance at Kaiser@eKaiserInsurance.com.
Note: For questions regarding existing individual accounts, appointments, billing, and locations call 1-800-464-4000.
What is the difference between HMO and HSA?
Kaiser©s individual/family plans are all HMO plans. An HSA, is simply an added options to these plans, which allows you to open a Health Savings Account. See The ABC's of HSA's (Health Savings Account)
Does Kaiser offer dental?
Kaiser only offers dental along with the medical plans. For individual/families, you have the option to add the Dental Assistance Plan, administered through Delta Dental. For small business plans, you have a number of dental options through Delta (PPO, Premier, DeltaCare). For more information, call 800-915-0501.
Can I cancel my plan at anytime?
Yes, there is no contract. You may cancel your individual/family or small business plan at anytime.
What is the difference between a Kaiser Permanente deductible plan and a Kaiser Permanente copayment plan?
With a Kaiser Permanente copayment plan, you pay a fixed amount when you receive covered medical care, regardless of the type of treatment you receive. With a Kaiser Permanente deductible plan, you must pay out of pocket for services until you meet a 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.
What is an annual out of pocket maximum (OOP limit)?
Once a subscriber has accumulated the annual out of pocket maximum amount on a Kaiser Permanente plan, 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 and the copayments for prescription drugs.
Note: The annual out of pocket maximum does not apply to some specialty services such as drug rehabilitation and some preventative care services.
What is an HMO?
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, although Kaiser does offer small businesses the POS/PPO plan, which gives you the option of receiving medical coverage outside the network.
Am I covered when I travel?
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 contact eKaiser Insurance at Kaiser@eKaiserInsurance.com. If you are a current member and need travel information, call 800-464-4000.
What does Kaiser consider an emergency?
Either (1) a medial or psychiatric condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs, or (2) active labor when there isn©t enough time for safe transfer to a Plan Hospital (or designated hospital) before delivery or if transfer poses a threat to your (or unborn child©s) health or safety.
Can I choose my own Kaiser Permanente primary care physician?
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.
Can I switch to a different Kaiser Permanente primary care physician?
Yes. You may switch to another Kaiser Permanente primary care physician for any reason.
Is maternity/pregnancy covered in all Kaiser Permanente plans?
Yes, most Kaiser Permanente plans cover maternity and pregnancy. The only plans that do not cover maternity are the new $30/4000, $40/4000, and $50/5000 deductible plans. Prenatal and first postpartum visits are covered, and the fee is based upon the rates of your chosen Kaiser Permanente plan. Delivery is covered under hospitalization and rates vary according to your chosen plan. For copayment amounts, please view Plan Highlights.
Which Kaiser Permanente plan is best for maternity coverage?
For individuals and families, the $25 copayment plan and the $20/500 Deductible plan offer the most coverage. For this reason, those who are thinking of having children often opt for one of these Kaiser Permanente plans. For coverage comparison, please view Plan Highlights.
Is infertility covered?
No, Kaiser Permanente only offers coverage for infertility on two of the small group plans ($5 copayment and $15 copayment plans).
What is covered under preventative care services?
Kaiser offers a variety of preventative care services to help keep you healthy or to prevent illness, which includes: family planning visits, flexible sigmoidoscopies, health education, vaccines, mammograms, routine preventative retinal photography screening, routine preventative physical exams (including well-woman visits and eye refraction and hearing exams), scheduled prenatal visits and first postpartum visit, tuberculosis test, well-child preventative care visits (0-23 months). The following lab tests are also covered under preventative services: cervical cancer screening (including HPV screening), cholesterol tests, diabetes screening, fecal occult blood tests, HIV tests, prostate specific antigen tests, STD tests.
Are prescription drugs covered?
Yes, most Kaiser Permanente plans cover prescription drugs with the exception of the individual/family $50 copayment plan, $30/2700 deductible with HSA, and the $50/5000 deductible plan which do not. Refer to Plan Highlights for details.
What does $250 deductible for brand name prescription drugs mean?
This is the amount of expenses a subscriber is required to pay (the amount is accumulated) before their copayment of $35 becomes effective.
Note: This deductible only applies to brand name prescription drug costs and is calculated separately from other health insurance deductibles or copayments related to the plan.
Do the Kaiser Permanente plans cover vision exams, and optical eyewear?
Preventative eye exams are covered with a copayment. Eyewear is not covered. Kaiser offers a discounts on vision services for members at the Kaiser optical centers.
Are alternative medicine and chiropractic care covered?
For individuals and families, the $30/1,500 Deductible Plan is the only plan that includes chiropractic. This plan provides 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. For small business plans, you may add a chiropractic benefit to your plan. For more information, call 800-915-0501.
Note: Some Kaiser Permanente benefit plans include coverage for certain of these discounted services. Plan benefits must be used before those discounted services are available.
What is meant by "per encounter"?
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.
What is the cost for a physical exam?
A physical would be the cost of a "preventative physical exam." This service is not subject to deductible. Additional costs may apply for any lab or imaging work.
Are there special Kaiser Permanente plans for seniors on Medicare?
The Senior Advantage program combines Medicare and Kaiser Permanente coverage into one, which means more benefits, more convenience, and more services than traditional Medicare. Seniors who are currently on Medicare may apply for Kaiser Permanente's Senior Advantage program. For more information, you may contact Senior Advantage at 1-800-579-7085 or go to www.kp.org/seniors.
Does Kaiser Permanente have any programs for low-income families?
Kaiser Permanente offers the Step Program for low-income families. For more information on qualification criteria and application process to the Kaiser Permanente Step Program, please call toll free at 1-800-464-4000. Kaiser Permanente also offers the Child Health Plan program for those 18 and under. For more details on qualification criteria and the application process, please call 1-800-464-4000.
What is a Health Savings Account (HSA)?
An HSA account is an IRA-like savings account established for the purpose of paying qualified medical expenses. It allows you to pay for current health care expenses and save for future qualified medical expenses and retiree health expenses on a tax-free basis. The money you invest in an HSA is tax deductible and any earnings on HSA contributions accumulate on a tax-deferred basis. The money in the account can be withdrawn tax free and without penalty at any time to pay for qualified medical expenses. Unused balances roll over from year to year. Before the employee reaches age 65, if money is withdrawn for reasons other than a qualified medical expense, it is taxable and subject to an additional 20 per cent penalty by the IRS. After age 65, there is no penalty for non qualified withdrawals, but the amounts withdrawn are taxable. Please also see The ABC's of HSA's (Health Savings Account)
How do I set up an HSA?
HSAs can be established at any approved HSA financial provider. For added convenience, Kaiser Permanente members can set up a CarePay HSA through Wells Fargo, our preferred HSA trustee and administrator. To set up a Kaiser Permanente HSA with Wells Fargo, you can log onto Wells Fargo website for enrollment at www.wellsfargo.com/hsa or call a Wells Fargo customer service representative toll free at 1-866-890-8308, Monday-Friday, 6 a.m. - 7 p.m. (Mountain).
What provider network can I access with Kaiser Permanente©s HSA-qualified plans- Deductible plans with HSA option or the PPO pans with HSA option?
Kaiser Permanente is currently offering HSA qualified plans as part of Kaiser Permanente©s HMO and PPO portfolio of products.
With Kaiser Permanente©s HMO product, you can access the Kaiser Permanente HMO network of providers. With Kaiser Permanente©s PPO product, you can choose who provides your health care-either one of the providers affiliated with our preferred provider network, Private Healthcare Systems (PHCS) or any other licensed physician you choose. To find a doctor within our preferred provider network, PHCS, simply call 1-888-514-7427 toll free or go to phcs.com and click on ©search for provider©.