Kaiser Permanente Announces 2023 Portfolio, Rates, and Policies

9/28/2022
California
Kaiser Permanente announces 2023 portfolio updates for their Small Group line of business. They have provided the following summary of rate changes for Q1 2023.
 

Average Rate Change

January 2023 over January 2022
New Business Northern California Southern California
HMO metal plans +6.7% +6.7%
PPO metal plans +7.0% +7.0%

January 2023 over January 2022
Existing Business Northern California Southern California
HMO metal plans +6.7% +6.7%
PPO metal plans +7.0% +7.0%
  • HMO plans include CCSB and CalChoice
  • Premium weighted average increase reflecting benefit changes and anticipated sales distribution or renewal distribution by rate area
  • Actuarial Value (AV) did change from 2022 to 2023 so some plan benefit changes have been made.
  • There is no differentiation in the rate increases between rate areas

January 2023 over January 2022
Product Statewide
Family Dental plans +2.0%
Child Dental with metal HMO medical plans 0.0%
Grandfathered HMO medical plans +8.0%
Chiropractic / acupuncture rider for grandfathered non-HSA plans +2.0%
 
There will be a rate pass on child dental and small increases in family dental and ancillary plans.
 

Policy Reminders

Renewal date change requests

Existing groups, may only change their renewal date to align with another health plan’s renewal
date if the new renewal date will be on or after January 1 of the following year.

New groups written alongside an existing health plan with another carrier with a different renewal
date, may request to align their renewal date with the existing carrier’s renewal date. A request
must be submitted within 30 days of the new group’s original effective date, and for a renewal
effective date within 6 months of the original effective date.


Out of state (OOS) PPO Coverage Increase

Up to 49% of subscribers may enroll in out of state PPO coverage which is up from 30%.


Multiple plan options

For greater product availability, groups with 1 to 5 enrolled subscribers can now offer a choice of up
to 4 Kaiser Permanente HMO plans plus 1 PPO plan for a maximum of 5 plans.


Making it easier to set up new groups

Employers no longer need to submit eligibility documentation when they enroll a new group in
coverage. We will no longer collect business eligibility validation documents. Payroll attestation
forms are no longer required for startup groups with 1 to 5 eligible employees.

 

Digital Health Resources That Help Kaiser Members Pursue Wellness On Demand 

Healthy Lifestyle Programs

Online programs that offer tools for healthy living and personalized tips to help employees reach their health goals.
 

ClassPass

ClassPass offers no-cost access to thousands of on-demand workout videos, plus reduced rates and in person classes.
 

MyStrength

myStrength provides personalized programs for managing depression, stress, anxiety, and more. Employees can set their own goals and work at their own pace.
 

Calm

Calm is an app for meditation, mindfulness, mental resilience, and sleep - designed to help lower stress, reduce anxiety, and more.
 

Ginger

The Ginger app offers 1 on 1 emotional support coaching by text 24/7 to help you cope with many common challenges - from stress and low mood to issues with work, relationships, and more.
 

Getting Care While Traveling Is About To Get A Lot Easier

Kaiser Permanente now gives members outside of Kaiser Permanente states access to Cigna’s National PPO Network* of physicians and providers, should they need emergency or urgent care during their travels.

This new access will be available to Kaiser Permanente HMO and exclusive provider organization members who get coverage through an employer or through a Kaiser Permanente Individual or Family Plan they purchase on their own.

This new access to Cigna’s U.S. provider network is one more option to make getting that care easier and more convenient.

*The Cigna PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna PPO for Shared Administration.
 

Updates in Northern California

Care Essentials by Kaiser Permanente in downtown San Francisco

Located at the Salesforce Transit Center to meet members where they are, this innovative new facility will have extended hours. Services include same-day appointments, pharmacy, lab tests, vaccines, injections, and treatment of minor illnesses and injuries. 
 

Now open:

•    Redwood City Marshall Medical Offices
•    Berkeley Medical Offices
•    San Rafael Los Gamos Medical Offices
•    Lathrop Mental Health and Wellness Center
•    San Francisco Center for Reproductive Health
•    Modesto-Enterprise Mental Health and Wellness Center
•    Santa Cruz Medical Offices (opened in July 2022)
 

Updates in Southern California

Now open:

•    Playa Vista Medical Offices
•    Clairemont Mesa Medical Offices
•    Hesperia Medical Offices
•    Tri-City Medical Center (North San Diego County Affiliated Hospital)


Scheduled to open in 2023

•    New Watts Medical Offices and Remodeled Learning and Counseling Center (Q1 2023)
•    Ambulatory Surgical Center in Murietta (Q1 2023)
•    San Marcos Medical Center (Q4 2023)

For more Kaiser Permanente small group plan highlights click here.