Kaiser Health Family Plans 2022- Pay Bill &  Enrollment

8 comments on “Kaiser Permanente – Enrollment – Pay Premium ONLINE”

1. https://capitalandmain.com/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

   https://khn.org/news/article/california-medicaid-contract-kaiser-permanente-key-details-missing/

   Reply

2. 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?

   Reply

   • 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

     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?

     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

     Reply

3. 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?

   Reply

   • 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.

     Reply

4. 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.

   Reply

5. 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?

   Reply

   • 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

     Reply

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