Small Groups
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Plan Information
Current Members
Answers:
- Who do I contact if I have questions?
Note: For current Kaiser members who have questions regarding existing accounts, appointments, billing, and locations call 1-800-464-4000.
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- Who do I contact if I have questions regarding enrollment?
Please call one of our small group representatives at 1-877-752-4737 or e-mail us at support@kaiserquotes.com.
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- How do I enroll?
To begin the enrollment process, follow the eight easy steps outlined in the Small Group Enrollment Packet.
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- How long does the enrollment process take, and how will I know if I am accepted?
Small group policies are issued automatically upon submission of all correct documentation. This process may take up to two weeks or less, depending upon volume. No medical underwriting is required.
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- What is the deadline for enrollment?
Group coverage begins the 1st of each month. Documents must be received prior to the date of coverage in order for underwriting to process enrollment. If paperwork is received the week prior to the month of coverage there is a possibility of this coverage being delayed.
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- How many employees do I need to qualify for coverage?
You will need a minimum of 2 eligible individuals to qualify. Combinations may include 2 owners, 1 owner and 1 employee, husband and wife, etc.* Your group must have between 2 and 50 subscribers to qualify for a small group plan.
* Exceptions may apply.- Back to Top
- What is your minimum employer contribution requirement?
There is a required minimum company contribution of 50 percent of the employee only rate for the under 30-age category of the least expensive plan that is enrolled for. However, if the company offers an alternate competitor plan, it is required to be the equal dollar amount; whichever is greater. Any part of the cost not paid by the employer must be collected from the employees through payroll deduction.
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- If I'm self-employed do I qualify for group coverage?
You will need a minimum of 2 eligible individuals. Combinations may include 2 owners, a husband and wife- providing both of their names are reflected on the business license or other official business document, 1 owner and 1 employee, , etc.*
* Exceptions may apply.- Back to Top
- Should I choose a group or an individual plan? Which is less expensive?
It varies case by case. Subscribers who are concerned they may be denied for a pre-existing health condition will often opt for group coverage because there is no medical underwriting. However, in the case that you may qualify for either, we recommend you get quotes for both and compare the rates and coverage options.
NOTE: There are different plans and rates offered for groups and individuals, and groups of six or more subscribers qualify for additional savings.- Back to Top
- How long are my rates good for?
Your rates are locked in one year from your effective date. Kaiser Permanente small group plans are on a month to month basis. You may choose to cancel at any time.
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- Do my employees need to reside in a specific area?
All new membership is limited to those individuals who live or work within the Kaiser Permanente service area.
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- What if I have a pre-existing condition?
Subscribers in a small group are not denied coverage based on pre-existing conditions.
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- Are physicals required?
No, physicals are not required. There is no medical underwriting to pass.
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- Is dental coverage available?
Yes, Kaiser Permanente offers supplemental Dental Coverage through Delta Dental of California. You can apply for coverage by selecting this option on your New Group Application. Eleven different plans are offered for small groups. If the group decides to include dental coverage, all subscribers in that group will be enrolled and will be covered on the same dental plan
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- When can I add dental?
Dental can be added to any of the Kaiser Permanente plans when you enroll. If you choose not to sign up for dental when you apply, you may add dental coverage to your plan during open enrollment.
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- Who do I contact if I have questions?
Please call one of our small group benefits specialists at 1-877-752-4737.
Note: For member-related questions, such as appointments, billing, and locations, please call Member Services at 1-800-464-4000.- Back to Top
- What is the difference between a copayment plan, deductible plan, and deductible HSA plan?
With a copayment plan, you pay a fixed dollar amount when you receive covered medical care, regardless of the type of treatment you receive.
With deductible group plans there are two types. Some deductible plans provide immediate benefit for office visits and prescription drugs in which you pay a fixed dollar amount (copay). For all other services your payment will vary depending on the treatment up to the deductible amount. Beyond the deductible you will pay a copayment or coinsurance up to the annual out of pocket maximum.
Other deductible plans provide only immediate coverage for an annual preventative care visit at no charge. Then for all other services your payment will vary depending on the treatment up to the deductible amount. Once your total medical costs for the calendar year meet your deductible, you will pay a copayment or coinsurance up to the annual out of pocket maximum, depending on the plan selected.
For more information on deductibles, see the Understanding Deductible Plans Packet
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- What is an annual out of pocket maximum?
The annual out-of-pocket maximum is the most that you will pay for covered services in a calendar year. This includes *copayments, the deductible, as well as the coinsurance amounts, if any, that you paid after the deductible was satisfied.
Once a subscriber has accumulated the annual out of pocket maximum amount, 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.
*Note: In some states, copayments for doctor visits and prescriptions, if covered, do not go towards the annual out of pocket maximum, unless they were initially subject to a deductible.
Note: The annual out of pocket maximum does not apply to some specialty services such as drug rehabilitation and some preventative care services.- Back to Top
- 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. With the exception of the POS and PPO plan options, Kaiser Permanente does not give the option of receiving medical coverage outside the network.
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- 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 view the Traveling Member Brochure. In addition, to receive care in other Kaiser Permanente regions please view the Visiting Member Brochure.
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- Can I choose my own 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.
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- 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.
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- Is maternity/pregnancy covered?
Yes, all plans cover maternity and pregnancy. Scheduled routine prenatal care exams and the first postpartum visit are covered at no charge on most of the small group plans. Delivery is covered under hospitalization and rates vary according to your chosen plan. For copayment amounts, please view Plan Highlights.
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- Is infertility covered?
The $15 Copayment Plan and the $5 Copayment Plan (only offered for groups) provide limited benefits for infertility.
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- Are prescription drugs covered?
Yes. All Copayment Plans cover prescription drugs with a copayment. Regular (non HSA plans) Deductible Plans cover prescription drugs with a copayment before the deductible is met. The $0/$2000, $0/$2700 and $30/$3000 Deductible Plans with HSA do not cover prescription drugs until the deductible is met. After the deductible is met, these plans offer prescription drugs with a copayment. For coverage comparison, please view Plan Highlights.
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- What is meant by "per encounter"?
On Copayment Plans, this is the *flat fee a subscriber pays each time they go in to for labwork or X-ray. 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 still only pay the per encounter copay of $10.
*Note: On non-Copayment Plans, the charge for most labwork and X-rays is subject to the deductible.
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- Do the plans cover vision exams and optical eyewear?
An eye exam for refraction is covered without a charge under the Copayment Plans and the HMO Deductible Plans. Under the HSA Deductible Plans, all eye exams are subject to the deductible.
Optical eyewear is covered under the $15 and $5 Copayment Plans, which offer a two-year allowance of $150 for eyewear. Otherwise, members enrolled under a small group plan are eligible for a 20 percent discount for eyewear purchased from Kaiser Permanente.
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- What is the cost for a physical exam?
A routine, annual physical exam is covered at no charge under the Copayment, HMO Deductible, and HSA Deductible Plans.
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- Are alternative medicine and chiropractic care covered?
Kaiser Permanente offers an optional Chiropractic Plan which provides members with 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.- Back to Top
- How do HSA's work for groups?
HSA stands for "Health Savings Account". When you enroll in one our higher deductible plans, you have the option of opening up an HSA with any bank of your choice. The benefits of having an account is that you are able to set aside money for medically related expenses, and it is tax free (at the federal level). For more information view Understanding HSA’s.
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- Can I pay my monthly premiums with an automatic bank withdrawal?
Yes. Fill out and mail the Electronic Funds Transfer Form.
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- What if I move?
If you move, you will need to contact Kaiser Permanente and change your address on file. This may affect your rates and eligibility.
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- How do I replace a membership card?
Call Member Services at 1-800-464-4000.
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- Why are my rates going up?
Like many other health care organizations, Kaiser Permanente faces the challenge of keeping health care affordable when medical costs are soaring. While they constantly work to keep costs under control, the reality is that they must raise their rates in order to continue delivering quality care. During open enrollment your rates will change based upon number of members enrolled, the age of the subscribers, and the risk adjustment factor (RAF). The RAF for 5 or fewer employees will be 1.10, and for 6 to 50 employees will be 0.09.
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- Who do I contact for questions related to my existing account?
Please call Small Business Accounts at 1-800-731-4661 for questions concerning:
- Membership reporting/processing
- Monthly billing
- Payment information/issues
- COBRA and Conversion
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- Who do I or my employees contact for member-related questions?
For member-related questions, please call the Member Service Call Center at 1-800-464-4000. Member Services can assist with concerns related to:
- Benefits
- Claims
- Identification cards
- Available services
- Name and address changes
- Adding or dropping dependents
- Complaints
- Brochures and publications
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- Can I pay my monthly premiums with an automatic bank withdrawal?
Yes. Once you enroll as a group with Kaiser Permanente, you have the option of setting up an Online Account. Within this Online Account Service, you may request to have payments transferred automatically from your business bank account.
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- What is open enrollment?
Open enrollment occurs each year. It is the month prior to your plan anniversary or renewal date. Kaiser Permanente will send you a renewal proposal packet approximately two months before your renewal date. During open enrollment, you can switch plans, or add employees or dependents who previously opted out, for example. If no changes are needed, no action is required. If you are interested in making a change or need more information, complete the Renewal Change Instruction form found in the renewal proposal packet, or contact KaiserQuotes.com at 1-877-752-4737.
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