Large Group Carrier Spotlight: Kaiser Permanente
Partnering with the right carrier – and the right General Agent – for your Large Group cases can make a big difference. From start to finish (RFP, quote, and enrollment to service after the sale), you can count on Word & Brown. We work with a large roster of carriers and administrators, so it’s easy for you to find coverage to address your groups’ needs.
Kaiser Permanente, a pioneer in employee health care, offers Large Group employees and their enrolled dependents an easy way to get high-quality care at medical groups, hospitals, labs, pharmacies, and other facilities throughout California. The state is Kaiser Permanente’s largest service area.
Paired with the support you get from Word & Brown, Kaiser Permanente may help increase your business and address more of your Large Group clients’ needs.
Kaiser Permanente Overview
- Participation Requirements: Kaiser Permanente must be offered on conditions that are no less favorable than those for other health care plans. Examples include, but are not limited to, the following:
- Offered to all eligible employees;
- Access to the employer and to the employees on the same basis as all other health care plans offered;
- Employer’s contribution formula does not put Kaiser Permanente in a disadvantaged position (formulas include fixed employer dollar or percentage contribution);
- Kaiser Permanente must NOT be offered alongside an age-rated health care plan;
- Rate tier ratios and their definitions should be the same among all health plans offered by the group (employer).
- Minimum enrolled: Kaiser Permanente prefers that the number of employee subscribers enrolled in Kaiser Permanente must be the greater of 5 or 5% of the total number of employees enrolled in all health plans in regions where Kaiser Permanente is offered.
- Participation Alongside Another Carrier: See above.
- Networks: HMO (traditional HMO plans, Deductible HMO plans); Health Savings Account (HSA) plans; and Health Reimbursement Account (HRA) plans; Kaiser Permanente uses its own network of hospitals, medical offices, and physicians
- National: 39 Hospitals, 723 Medical offices, and 23,597 physicians in California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, and Washington, DC
- Southern California: 15 Hospitals, 235 Medical offices, and 7,820 physicians in Coachella Valley, Kern County, Inland Empire, Metro LA, West LA, Orange County, San Diego County, Tri-Central Area, and West Ventura/Valleys
- Northern California: 21 Hospitals, 262 Medical offices, and 9,547 physicians in Central Valley, Diablo, East Bay, Fresno, Greater San Francisco, Greater Southern Alameda, Marin/Sonoma, Napa/Solano, Redwood City, Roseville, Sacramento, San Jose, Santa Clara, Santa Cruz, and South Sacramento
- Traveling Care: Beginning August 1, 2022, Kaiser Permanente is launching a new feature that will give members access to Cigna’s national network of physicians and providers, when members need emergency or urgent care while traveling. Members can also visit Minute Clinic (in select CVS and Target stores) or a Concentra Urgent Care Center with or without an appointment at their standard copays. Download the program flyer.
- POS/PPO: For Total Replacement scenarios (not applicable for Slice/Alongside offerings), Kaiser Permanente uses Private Healthcare Systems (PHCS), the nation's leading health care cost management company. To locate participating providers (Tier 1 of PPO and Tier 2 of POS plan), visit www.multiplan.com/kaiser.
PHCS is a national PPO and currently has direct agreements with close to 670,000 providers and 4,300 acute care facilities in all 50 states. The PHCS California network consists of more than 59,000 providers and 230+ acute care hospitals. PHCS also develops and manages 3-Tiered Point-of-Service health benefit plans: Tier 1: Kaiser Permanente; Tier 2: participating network of providers (PHCS Network); or Tier 3: any licensed non-participating provider.
With PPO health benefit plans, covered persons are encouraged to utilize the services of PHCS providers through the provision of financial incentives such as lower co-insurance payments and deductibles. Covered persons with the POS Plans are encouraged to utilize the HMO Tier (Tier 1), but are allowed to obtain services from the Participating Provider Tier (Tier 2), which consists of providers contracted by the PHCS Network. Please note: neither PHCS nor the insurance carrier provides health care services.
- Plan Offerings: Groups can offer up to three plans. In a Total Replacement scenario, a PPO or POS plan can also be added.
- Preferred Industries: At Kaiser Permanente, firms engaged in Electronic Equipment, Publishing, Semi-Conducting Machinery, and Computer Programming are preferred.
- Value Adds: Kaiser Permanente offers a variety of value-added features and benefits:
- Telemedicine – telephone and video appointments (100% free/no copay on all plans except HSA plans (to follow IRS guidelines)
- 24/7 Nurse Advice Line – free
- Email answers in 48 hours – email a physician and get a response in 48 hours or less – free
- Award-winning chronic care prevention and disease management – free
- Wellness tools and resources – free
- Discounts – access discounted Acupuncture and Chiropractic care, fitness center memberships, and massage therapy at www.kp.org/choosehealthy
- Get Care Now (24/7 Virtual Care Center)
- Kaiser Permanente now offers members 24/7 access to a clinician in a fast, flexible way on kp.org and the Kaiser Permanente mobile app. This makes it even easier to get high-quality care without an appointment – at no cost to members on most plans.
- 24/7 virtual care is accessible through kp.org or the mobile app. Services include primary care, specialty care, urgent care, etc. More Information is available at kp.org/getcare.
- Download the 24/7 Virtual Care flyer.
- Virtual Complete Plans
- Primary emphasis on virtual care with low out-of-pocket costs for common in-person services: $0 virtual care with a lower monthly rate for employers and employees.
- Three in-person visits included at a copay before the deductible and copay for labs and generic prescriptions.
- HRA compatible.
- Deductibles range from $2,000 to $5,000.
- Download the Virtual Complete plans flyer.
Kaiser Permanente’s integrated care system, industry-leading technology, consumer engagement tools, clinical and engagement reports, and health and wellness resources set it apart from other plans you may be considering. If you have any questions about offering Kaiser Permanente to your Large Group clients, don’t hesitate to call or email us.
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