Medical Care

All of the available options give you access to high-quality, comprehensive care. They differ largely in the way the cost of care is structured and in the strategies you can use to control your expenses:

  • PPO/POS Plans: these plans let you choose care inside or outside of the network you selected, but you will incur a higher out-of-pocket cost for services. 
  • HMO Plans: these plans offer a comprehensive, convenient approach, but require that you seek care within the network you selected.
  • HDHP HSA Plans: these plans are high deductible insurance plans that help protect against large claims as well as to cover preventive care at 100% (deductible is waived for preventive services). If you enroll in this plan, you are eligible to open a Health Savings Account (HSA) which can be used to help pay for qualified medical expenses. (Available to all employees) 


Employees who work in the city of San Francisco, please visit:
https://sfgov.org/olse/health-care-security-ordinance-hcso
for more information on the San Francisco Health Care Security Ordinance.

See comparison tables below for coverage details.


United HealthCare (UHC) - Group #909417

  • myuhc.com
  • 1-866-633-2446 (POS & PPO)
  • 1-866-314-0335 (HDHP)
UHC OTC At Home COVID Testing

CEI employees can now visit the nearest MinuteClinic and pay their standard copay if they get sick or injured while traveling in a state where Kaiser Permanente does not operate.  All that is needed is a photo ID and their membership card or health/medical record number. 

MinuteClinics are located in select CVS Pharmacy and Target locations, and are staffed by non-Kaiser Permanente nurse practitioners and physician assistants who can treat a range of simple urgent care services for conditions and symptoms. Members can visit a MinuteClinic with or without an appointment. The improved experience when paying for care at MinuteClinic gives Kaiser Permanente members one more convenient alternative for urgent (non-emergency) care.

Kaiser Permanente members who get sick or injured while traveling have multiple options — review the attached infographic to see the many ways members are covered while traveling.

As a reminder, here are the resources and services that make getting care away from home easier than ever:

  • Away from Home Travel Line — A single number to call about getting care away from home: 951-268-3900. Available anywhere in the world, anytime. *
  • kp.org/travel — The site covers many questions about getting care that come up before, during, or after travel.
  • Early refill of eligible prescriptions — To help keep travel stress-free, members can request early refills of their prescriptions to ensure they last throughout their whole vacation. 

Kaiser - Group #9680

  • kp.org
  • 1-800-464-4000 (English)
  • 1-800-788-0616 (Spanish)

New Federal Guidance

The highly contagious omicron variant continues to spread throughout our communities. Vaccination and boosters provide the best protection against severe illness from COVID-19.  Testing is also an important tool in slowing the spread of COVID-19. While Kaiser Permanente has provided over 68,000 daily tests, demand currently exceeds capacity. Rapid antigen home tests, also called rapid COVID tests or self tests, offer another way to help reduce the spread. Health plans are now reimbursing members for these at-home tests.

Kaiser Permanente to cover cost of COVID-19 rapid antigen home tests

Following guidance from the Biden administration, Kaiser Permanente will now reimburse members for FDA-approved rapid antigen home tests. Members can submit a reimbursement claim for tests purchased on or after January 15, 2022.

Currently, there is a nationwide shortage of rapid antigen home tests. Kaiser Permanente, like other health care organizations, has access to a very limited supply of tests. We are working to get tests and make them available to our members through a number of outlets, including mail-order. We will share details as they become available.

How to get FDA-approved rapid antigen home tests

  • Starting January 19, members can request free rapid antigen home tests, without shipping fees, from the federal government. [https://www.covidtests.gov/]
  • Rapid antigen home tests are also available at local drugstores or online. Kaiser Permanente will reimburse members for FDA-approved rapid antigen home tests purchased on or after January 15th.
  • In the coming days, as supply of tests increases, we will make more rapid antigen home tests available to members. Visit kp.org for the most up-to-date information on supply, testing, and vaccinations.

Guidance on types of COVID-19 tests

Rapid antigen home tests are a fast, easy way to get a quick result if members have symptoms, think they have been exposed to someone with COVID-19, or plan to gather indoors with those who may be at risk including unvaccinated children, older individuals, and those who are immunocompromised. Results are typically available within 30 minutes. < https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/in-vitro-diagnostics-euas-antigen-diagnostic-tests-sars-cov-2>

PCR tests are usually processed in a lab and results are typically available in 1-3 days. At Kaiser Permanente, PCR tests are required for members who are coming in for certain clinical procedures that require a negative test in advance. For more detail, visit our COVID-19 testing FAQs. [https://healthy.kaiserpermanente.org/health-wellness/coronavirus-information/testing#faqs ]

How Kaiser Permanente members get reimbursed for rapid antigen home tests

While home self-tests are still in very short supply throughout the world, everyone can now order up to 4 free rapid tests from the federal government at covidtests.gov. Kaiser Permanente members can also purchase FDA-approved rapid antigen home tests at their local drugstore or online and get reimbursed. To get reimbursed for self-tests purchased on or after January 15, 2022, members should go to “Coverage & Costs” on kp.org, sign-in to their account, and select “Submit a medical claim.”

The claim must include:

  • An itemized purchase receipt with test name, date of purchase, price, and number of tests.
  • A photo of the QR or UPC bar code cut out of the rapid antigen home test box. 

Visit our COVID-19 testing FAQ for details.

 

What to do if you get a positive COVID-19 self-test result

A positive COVID-19 self-test result means that a person likely has a current infection, even if they don’t have symptoms. What should they do next?

For more details on self-tests and how members can order a test, go to kp.org/covidtesting.

 


Deductible 
- The amount you must pay for medical services, before the plan pays a benefit. Preventative care is always covered at 100% with no deductible required.

Coinsurance - This is the percentage of the cost you pay for certain services after the deductible has been met. You can think of this as “cost sharing”. For example, once your deductible has been met you could pay 20% for the cost of certain services and the plan could pay 80%.

Copay - The flat fee paid by the member when a medical service is received, i.e. $20 for a doctor's visit or $20 for a prescription.

In Network Provider - An in-network provider is a hospital, doctor, medical group, and/or other healthcare provider contracted to provide services to insurance company customers for a discounted fee. Using these providers will lessen your medical expenses when using your benefits.

Out of Network Provider - An out of network provider is a hospital, doctor, medical group, or other healthcare provider who are not contracted to provide services to insurance company customers. Because the fees are not negotiated in advance with the insurance company, the provider can charge the member as much as they wish.

Out of Pocket Maximum - The maximum amount a  member would have to pay out of their pocket for medical expenses for the year, with the exception of benefit premiums (which come out of your paycheck). Your out-of-pocket maximum includes your deductible, any coinsurance paid and all co-payments (medical and prescription drug).

PLAN COMPARISON  |  AT A GLANCE


 

 


UHC PPO


UHC HDHP HSA


UHC POS


Kaiser HMO

In-Network*

In-Network*

In-Network*

In-Network Only

Annual Deductible

(Individual / Family)

$500 / $1,000

 $1,500 / $2,800

$250 / $500 

None

Out-of-Pocket Maximum

(Individual / Family)

$3,000 / $6,000

 $6,000 / $6,000

$1,250 / $2,500

$1,500 / $3,000

Office Visits
(Primary / Specialist)

$20 copay

10%

$10 copay

$30 copay

Preventive Care

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Outpatient Surgery

10%

10%

10%

$30 / procedure

Inpatient Hospital

10%

 10%

10%

$250 copay

Emergency Room

(Waived if admitted)

$100 copay + 10%

10%

$100 / visit

$100 / visit

Retail Prescriptions

(Up to 30 day supply)

30 day supply

Tier 1: $15

Tier 2: $35

Tier 3: $50

30 day supply

Tier 1: $10

Tier 2: $30

Tier 3: $50

30 day supply

Tier 1: $15

Tier 2: $35

Tier 3: $50

30 day supply

Tier 1: $10

Tier 2: $25

Tier 3: $25

*Out of Network benefits available

Please keep in mind that this summary describes only the highlights of the benefits plans and policies available to you. The details of these plans and policies are contained in the official plan and policy documents. If there is a question about one of these plans or policies, or a conflict between this summary and the official plan and policy documents, the official documents will govern.