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Kaiser has released an updated Plan Highlights brochure. The brochure was updated to cover effective dates January 1st through December 1st 2017, and it is available on the LISI website to download. There are no benefit or plan changes. Kaiser has a 3% increase on Q3 rates for HMO plans. The rates for PPO and ancillary plans stayed the same.

A quick reminder that Kaiser has a new out-of-state PPO guideline that went into effect March 2017. The new guideline states that a group cannot have more than 30% of out-of-state employees enrolled in a PPO plan. This guideline is specific to out-of-state employees – it should not be confused with the “old” 70/30 rule, which allowed no more than 30% employees in California and outside of California to enroll in a PPO plan. Here are two examples:

  • A client has 50 employees enrolling with Kaiser Permanente. 25 are out-of-state employees and 10 among them choose a PPO plan. That means 40% of the client’s out-of-state Kaiser Permanente members have chosen a PPO. That’s above 30%, so the group doesn’t qualify for Kaiser Permanente coverage.
  • A client has 50 employees enrolling with Kaiser Permanente. 25 are out-of-state employees and 5 among them choose a PPO plan. That means only 20% of the client’s out-of-state Kaiser Permanente members have chosen a PPO. That’s below 30%, so the group qualifies for Kaiser Permanente coverage.

The 2017 Sample Fee List is also available on the LISI website. The Sample Fee List provides a general estimate out-of-pocket cost for many of the most common medical exams, tests, and procedures. Use this to help your client’s employees to better manage the health care costs.