The Kaiser Foundation group health insurance is part of the Kaiser Permanente foundation. A non-profit organization, Kaiser is the largest HMO insurance provider in the United States. HMO plans focus on providing low-cost healthcare to members through utilizing a network of doctors who agree to work for prices set out by the insurance company. Kaiser healthcare plans are available to individuals, and there are also group health insurance plans for employers.
In 1997, Kaiser affiliated with Group Health, an insurance cooperative serving Washington and northern Idaho. This health insurance is run by a board of directors elected by insurance consumers. Both Kaiser and Group Health provide HMO coverage and are available in a myriad of plans depending upon the needs of the insured.
Group health plans do not exclude consumers due to preexisting conditions and may be available to individuals who are unable to receive insurance through another company. Instead, all individuals in a given group — such as employees in one industry — can receive coverage.
What is an HMO?
HMO insurance differs from other types of coverage in that it is more closely involved with the healthcare. HMO providers work closely with hospitals and doctors to provide low-cost health insurance. Because of this partnership, an insured will usually be required to have medical care provided through a pre-approved clinic or hospital. Additionally, HMO coverage will often only cover medical care that is determined medically necessary and effective. Patients may not be able to obtain coverage for experimental treatments or treatments that are considered elective.
Despite the limitations, HMO coverage comes with the advantage of very low cost healthcare for an affordable premium. Kaiser hospitals have received many commendations for quality of care, and save the insured from needing to find a new doctor: Any Kaiser-approved hospital or clinic will provide approved treatments.
What Group Health Plans Are Available?
Kaiser group health insurance plans for employers are divided into coverage packages for small businesses, medium-sized companies, and multi-state or national businesses. Because Kaiser and Group Health are only available in certain states, not all employers may choose to use these services, but it is a popular choice of insurance for many employers in qualifying states. The majority of employees in California, for example, use HMO plans including Kaiser.
Plans are available with a variety of deductible options. High-deductible plans can be coupled with a health savings account, while some plans with lower deductibles can be made more affordable by including a higher co-pay. Kaiser Group Health plans also incorporate a flat-fee co-payment plan where the co-pay for any type of office visit is agreed upon in advance. These policies are usually very affordable but may have more limitations than other types of policies.
Benefits of Kaiser Group Health Plans:
- Focus on preventative care
- Immunizations and diagnostics are covered
- Group Health offers maternal care, although some Kaiser policies do not
- Prescription drug coverage available from pre-approved pharmacies and drugs
- Large network of doctors available
- No claim forms to fill out
- Office visits are covered with a small co-pay
- Emergency care is available and does not require use of a Kaiser emergency room
- HSAs are available for high-deductible plans
Although HMO plans are very affordable and a popular choice among employers in areas that support Kaiser and Group health, there are some drawbacks. If you are a business-owner looking to provide coverage for your employees, or an employee trying to decide between choosing the group health insurance plan at you employer or receive benefits through your spouse’s provider, it’s important to understand the shortcomings of Kaiser Group Insurance coverage.
Disadvantages of Kaiser Group Health Insurance
The major drawback of Kaiser Group Health insurance is the HMO structure of the policy. Patients must receive approval for treatments before receiving them and may be ineligible for certain treatments if they are experimental or not proven effective. Additionally, patients must select a doctor from within the Kaiser network. Individuals who have an existing general practitioner may be unwilling to change doctors, but coverage may not be available under the current physician.
Additionally, Kaiser insurance is unavailable in several states. Consumers outside of the covered states are unable to receive this insurance, but may qualify for other group health policies through different companies. HMO plans are a more popular option in some states than others. If your employer offers group health coverage through Kaiser, this will probably be an excellent and affordable option for you unless you have excellent existing coverage through another provider.
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