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Frequently Asked Questions
Plan Information
Who do I contact if I have questions regarding eKaiserInsurance?
Please call one of Kaiser Permanente’s individual/family
plan representatives at 1-800-915-0501 or e-mail eKaiser Insurance
at Kaiser@eKaiserInsurance.com.
Note: For questions regarding existing accounts, appointments, billing, and locations call 1-800-915-0501.
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 meet a deductible before you will pay any copayment for services subject to the 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?
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 and does offer the $35 POS group plan that 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.
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, all Kaiser Permanente plans cover maternity and pregnancy. 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 $250 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.
Are prescription drugs covered?
Yes, all Kaiser Permanente plans cover prescription drugs with the exception of the $50 copayment plan which does 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?
Vision exams are covered with a copayment. Eyewear is not covered. Please refer to the Plan Highlights for copayment amount.
Are alternative medicine and chiropractic care covered?
The $1,500 Deductible Kaiser Permanente Plan is the only plan that includes chiropractic. Members with this plan have up to 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.
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." 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 1-800-915-0501. 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 1-800-915-0501.
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 wfhbs.com/kaiserpermanente 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”.
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