Kaiser Permanente was founded in 1945. In addition to offering health insurance, Kaiser runs its own network of hospitals and health services providers, creating a unique offering for members of their health insurance plans. While Kaiser operates in eight states, most of its health services locations are in California.
Every health insurance plan is required to provide essential benefits, as defined by the Affordable Care Act. These essential benefits fall into ten categories of services:
The specific services offered within those categories may vary from state to state, but these categories represent the minimum that all health insurance plans are required to cover. No matter where you purchase your health insurance plan from – federal, state, or private marketplace – it must cover these ten essential benefits.
Plans may choose to cover additional services. State, federal, and private exchanges will give you the full list of the exact services each plan covers before you apply.
Kaiser Permanente provides a number of unique features for their members:
- Kaiser Permanente offers interpretation services by phone in 140+ languages and has multi-lingual doctors and staff.
- You can email your doctor’s office with routine questions.
- Trained nurses offer medical advice on a 24/7 Kaiser Permanente phone line.
Prescriptions & Drugs
Kaiser Permanente covers both generic and brand name drugs. Any prescription not available on their formulary is considered “non-formulary” and generally is available at a higher price. You can find Kaiser Permanente’s general HMO formulary here. You can also find the specific formulary for your state by visiting this page and selecting your coverage area in the top left.
PolicyGenius offers anonymous, no-obligation shopping of all marketplace health insurance plans, as well as “off-exchange” plans that you won’t find on Healthcare.gov or the state marketplaces. You can browse all plans, and sort and filter those plans based on your preferences and budget.
Once you’ve selected a health insurance plan, enrolling in that plan is easy. You fill out a short online form, then complete the final step with a quick enrollment phone call with a licensed agent. On that call, the licensed agent will verify your identity, double-check eligibility and answer any questions you may have. For certain insurers, who don’t permit private brokers (like PolicyGenius) to enroll customers, you’ll have to enroll directly with the insurer or on your state’s marketplace (these plans will be noted).
After you enroll in a health insurance plan, you will get your membership materials (including your member ID card) and the first premium bill directly from the health insurance company. You are responsible for paying the bill to ensure that your coverage goes into effect, and to keep current on those payments.
If you visit a Kaiser Permanente hospital, a Permanente Medical Group, or visit an affiliated provider, your claim should be automatically submitted by your provider. Kaiser Permanente generally does not cover services not provided by one of their providers or an affiliate provider. Like other HMOs, Kaiser may cover emergency services, such as an ambulance, regardless of the provider you used. You can make a claim directly to your regional Kaiser office – check out this page for the phone number of your appropriate patient account department.