We captured the questions from our Producer Forum breakout sessions and addressed them in the Individual and Family FAQs below and this Medicare FAQ PDF. Please use these resources to help you position and sell Kaiser Permanente Washington health plans in 2023. In addition, we encourage you to visit our producer website and connect with your Individual and Family and Medicare Sales Producer support team. See the Individual and Family and Medicare Sales Contact Sheet for more details.
Here are some Kaiser Permanente Individual and Family (KPIF) FAQs from this year’s Producer Forum:
KPIF FAQs
Are Providence primary care providers included in the CoreSelect and Connect networks?
Only Providence specialists are included in the CoreSelect and Connect networks, including in Spokane. See the related primary care and specialist provider overview of the CoreSelect and Connect networks.
Kaiser Permanente members and mutual clients enrolled on an HSA Bronze plan in King, Kitsap, Pierce, Snohomish, Spokane, and Thurston counties will no longer have access to an exchange HSA-compatible plan. Will Kaiser Permanente be notifying these members to inform them that the allocation of funds to their HSA accounts should be discontinued?
We greatly appreciate the support of producers and encourage you to connect with your clients who have HSA accounts. Please advise these members to discontinue making contributions as of January 1, 2023. In support of this outreach, we will identify the mutual clients affected by this change and share it with you in late October.
What is the average rate difference between the on-exchange Individual and Family plans Kaiser Permanente Washington will no longer offer on the exchange in 2023, like the Bronze — or in certain areas, the Flex Silver and Bronze HSA — to the plan they are being mapped to?
- On-exchange Flex Silver members in King, Kitsap, Pierce, Snohomish, Spokane, and Thurston mapped to the Kaiser Permanente Cascade Silver: 7.93% increase
- Off-exchange Flex Silver members in King, Kitsap, Pierce, Snohomish, Spokane, and Thurston mapped to the Flex Silver HD: 10.48% decrease
- On-exchange Bronze members in all 17 service area counties mapped to the Kaiser Permanente Cascade Bronze: 13.78% increase
- On-exchange Bronze HSA members in King, Kitsap, Pierce, Snohomish, Spokane, and Thurston mapped to the Kaiser Permanente Cascade Bronze: 10.39% increase
Disclaimers:
- Average rate adjustments do not take into consideration annual age-band changes.
- Any premium tax subsidies a member receives may change the net premium increase that a member realizes.
- The rate increases provided won’t vary by area or smoker/nonsmoker status.
- A change in the member’s rating area or smoker/nonsmoker status could change the premium increase a member realizes.
- The rate increases include the impact of plan benefit changes from 2022 to 2023.
The new 2023 reinstatement policy for Individual and Family will only be granted when Kaiser Permanente makes an error that results in member or mutual client plans being terminated for nonpayment. What are the premium payment due dates and associated grace periods for on- and off-exchange?
Off-exchange: Initial and ongoing premium payments are due by the last day of the month, prior to the coverage effective date. An account will go into delinquency if the premium isn’t paid by the 10th of the month. Members will have 45 days from when delinquency is run to get an account current. Note: Delinquency currently runs on the 15th of each month.
On-exchange: Initial premium payments are due within 30 days of the effective date. An account will go into delinquency if the premium isn’t paid by the 10th of the month. Unsubsidized members have 30 days to get their account current, and subsidized members have 90 days to get their account current.
Washington Healthplanfinder now allows a family unit to have a subset of the family enrolled on one plan and the rest on another. Has Kaiser Permanente Washington made improvements to the process and accuracy in how these enrollment types are set up and billed in the membership system?
Kaiser Permanente Washington continues to improve its processes for accurately setting up split-plan family enrollments that are received from the exchange. For example:
Applicant Jane Smith has a spouse and 3 dependent children.
- Jane enrolled as subscriber on Flex Gold, along with 2 of the dependent children.
- Jane enrolled her spouse and 1 dependent child on Kaiser Permanente Cascade Silver,
and she is listed as the non-enrolled subscriber. - The family will initially receive 1 bill for both plans, and then we’ll follow up to determine if they’d prefer 1 or 2 bills.
Does Kaiser Permanente Washington offer financial assistance programs for members who cannot afford to pay all or even a portion of their medical and prescription drug cost shares?
The Kaiser Permanente Medical Financial Assistance (MFA) program helps low-income, uninsured, or underinsured patients who need help paying for all or part of their medical care received from Kaiser Permanente. Patients who have experienced unusually high medical expenses may also be eligible for the program, regardless of household income. MFA covers medically necessary care or prescriptions provided at a Kaiser Permanente medical office, hospital, or pharmacy. MFA is not available for care given by other network providers. Please direct the member to the provider or drug manufacturer to see if financial assistance is something they offer. For more information about the MFA program, including how eligibility is determined, go to kp.org/mfa/wa.
Due to United States Postal Service staffing limitations, members in Island, Skagit, and Whatcom counties are experiencing long delays when it comes to receiving their mail. What steps are you taking to ensure these members receive their mail-order medications in time? Are there alternatives to driving to Kaiser Permanente Bellingham Pharmacy?
Kaiser Permanente is monitoring this issue very closely. Per our mail-order tracking process, we have not identified anything out of the ordinary for medication deliveries made to members in Island, Skagit, and Whatcom counties. That said, we also haven’t received any specific examples, including member name and identification numbers, that would allow more insight into the situation. If you have examples you can share, please contact the Individual and Family Producer Support team at 1-800-474-1079 or email ifsales@kp.org. Also, please encourage your clients to plan ahead when ordering their medication refills. If they have not received them within 3 to 5 days, they should call 1-800-245-7979. Members also have the option to obtain emergency prescription refills at an in-network pharmacy by requesting an override at the pharmacy — or they can call Member Services for assistance. Note: This issue applies to all lines of business, so please refer members to their ID cards so that they connect with the correct area within Member Services.