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Kaiser - VIDEO How does a High Deductible Plan Work

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Dental & Vision 

#Dental

• KPIC Adult Dental Plan Brochure
  • Benefits
• See dental offering in main brochure for Kaiser – scroll or search with CTRL – F
• Delta Dental Ins Main Website  – Services Kaiser Plans
• Dental Dental Plan Guide
• Delta Dental PPO Find Dentist
• Our webpage on ALL Companies for Adult Dental
• Mandatory Pediatric  Child Vision & Dental

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Steve talks about International Travel Insurance

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FAQ’s

• Question – I’m interested in KP Gold 80 HMO, but I do have a few questions.
  • How much would I be responsible for if I had a hospital stay of more than five days?
  • If I want to add a dental & vision plan do I have to enroll now because of my “qualifying event” or can I do that at any time or must I wait for an open enrollment period?
• Answer — There is no charge after 5 days. See brochure above or excerpt below
  • You can enroll in dental and vision, anytime when going direct. If you do Covered CA, they only allow at Open or Special Enrollment.
  • See the site map or links above for dental coverage
• Question If I have a medical condition that affects my eyes, like
  • Keratoconus (KC) is a disorder of the eye which results in progressive thinning of the cornea.[3] This may result in blurry vision, double vision, nearsightedness, irregular astigmatism,[4] and light sensitivity leading to poor quality-of-life.[3][5] Usually both eyes are affected.[3] In more severe cases a scarring or a circle may be seen within the cornea.[6] wikipedia.org
    mayoclinic.org
  • Will the Kaiser Medical Policy cover it or do I need a vision plan?
• Answer See our vision page where we deal with Medicare and vision issues
  • Here’s the summary of benefits for the Blue Shield Vision Deluxe 15/25/150 plan that you also purchased. So, yes, glasses and a comprehensive exam are covered 100% if you use a participating doctor and facility. Do NOT go by our summary, click the link and see what the actual brochure says.
  • See the Gold 80 EOC page 15
  • So, eye disease is covered by Kaiser Medial, but not routine eye exams. For routine, see your Blue Shield Vision Policy
• Question my son is undergoing a medical condition and needs to be seen through the Children’s Hospital of Orange County https://www.choc.org/
  • Kaiser said they won’t pay out of network.
  • What can I do?
• Answer Here’s the full EOC – Membership Agreement for the Silver Kaiser Plan. I don’t see a clear answer there on how they might refer you to an out of network hospital. Kaiser will refer you to their own specialists.
• Here’s a Q & A on a Kaiser site that says for rare conditions Kaiser can send you to an affliated provider.
• I guess it boils down to Medical Necessity, if you truly feel Kaiser can’t treat the illness, try Independent Medical Review with CA Department of Health Care.
• KUDOS  Steve,
  • I’m liking the Kaiser experience.
  • The Kaiser cardiologist I was assigned to is an upgrade to the one I was previously seeing. She recv’d her training at three of the best US medical facilities for the treatment of cardiovascular disease.
  • Kaiser is built for efficiency and their prescription drug prices are 40% less than what I was paying previously.
  • So far, so good.
• Question I am trying to decide between the Bronze and Silver. I need to understand what the percentage copays look like. 15% or 40% of what??
  • I was on the phone with Kaiser for an hour and no one could give me an answer. Then they sent me to a cost estimator website that has been retired.
  • Recommendations?
• Answer You can do a side by side comparison in our quote engine. If you go to the top of this page, you can get the brochure for your rating area – in your case San Diego. There you can get a side by side comparison, right from an official Kaiser brochure.
  • The Bronze Plan has the highest deductible. In the plan you’re looking at, it’s $6,000. When your expenses go over the deductible then Kaiser will pay 60% of your bills and you pay 40%. When your deductible and the 40% reaches $6,650 then Kaiser pays 100%. That’s what OOP or Out of Pocket Maximum is.
  • HDHP means High Deductible Health Plan so it qualifies for an HSA – Health Savings Account so that you can use a tax advantaged savings fund to pay claims under the deductible.
  • You might consider the Bronze 60 HMO so that you get three doctor visits/year for $75 without a deductible.
  • If you click on the link where it says “Plan Details” that will explain the terms and coverage in more detail. Then of course there is the official Kaiser brochure above.
  • I’m not sure about a real cost estimator tool, but see above for sample fee lists

Kaiser & Blue Shield

Treatment Cost #Estimator Tool
requires sign in

The tool is for all Kaiser Members that are enrolled on Deductible or  Health Savings Account Plans.  The cost estimates are for services that are marked "after deductible" to give members an idea of the cost of  those services.

• 2021 Kaiser Sample Fee List 
  • How do I know what level of service I will get billed for?
    • find a code.com 
    • kaiser permanente.org/standard-charges
    • South Bay Medical Center
      •  All Services and Items
      • Shoppable Services
    • very well health.com/finding-icd-codes
    • cms.gov/Medicare/Coding/ICD10
• BLUE SHIELD Treatment Cost Estimator – for PPO Members
• Cost Helper.com what people are paying for health services

News, Resources & Links

Therapists Flee Kaiser as Mental Health Patients Languish

https://www.sandiegouniontribune.com/news/california/story/2022-07-19/newsom-administration-criticism-medi-cal-contract-kaiser-permanente

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Medi Cal with Kaiser 

FYI we don’t get compensated to help you with Medi Cal