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Human Resources

Medical plans

Eligibility

All regular (non-temporary) full-time and part-time employees who work at least half time (.5 FTE) are eligible for coverage on the first of the month following date of hire. If hired on the first day of the month, benefits begin immediately. Coverage is available for spouses, domestic partners and dependent children of eligible employees.

Description

The college, at its sole discretion, may offer more than one plan. At this time there are two medical plans: Kaiser HMO and Kaiser Added Choice.

Contribution

Each year during the budgeting process, the college determines the amount it will contribute to the cost of employees' health insurance. ºìÌÒÊÓƵ currently pays 100% of the cost of the Kaiser plan for employee-only coverage and 60% of the Kaiser cost for eligible dependents. ºìÌÒÊÓƵ pays this same dollar amount towards the Kaiser Added Choice plan and employees pay the difference. Employees who have family coverage with the Kaiser plan will not be expected to contribute more than 9.5% of the full-time equivalent of their base salary/wage on the first date of the benefit plan year. Any changes in salary/wages during the year will not affect ºìÌÒÊÓƵ's contribution until the following benefit plan year.

Employees pay their portion of the cost of their health insurance by pre-tax paycheck deductions. Cost for domestic partner coverage is deducted after tax.

Cost

Medical cost per pay period as of January 1, 2024

Plan Coverage ºìÌÒÊÓƵ contribution per pay period (2x per month) Cost to employee per pay period
Kaiser HMO**

Individual

$385.66

$0

You plus child(ren)

$570.77

$123.41

You plus spouse/partner

$617.05

$154.26

Family

$848.44

$308.53
Kaiser Added Choice

Individual

$385.66

$95

You plus child(ren)

$570.77

$294.42

You plus spouse/partner

$617.05

$344.27

Family

$848.44

$593.54

ºìÌÒÊÓƵ Medical Plan Comparison

This is an overview only. Please refer to the plan documents on the bottom of this page for detailed information about coverage.

Services Kaiser HMO
Kaiser Provider Network HMO
Specialist referral required		 Kaiser Added Choice
Network In-network only

Tier 1 (service at Kaiser)

Tier 2 (service in First Choice Health network)

Tier 3 (out of network)
Annual out of pocket limit

$1,500/member
$3,000/family

$2,250/member
$4,500/family

$3,000/member
$9,000/family

$8,000/member
$24,000/family
Annual deductible

$0

$750/member
$2,250/family

$1,000/member
$3,000/family

$3,000/member
$9,000/family
Preventive care

100% covered/no co-pay

100% covered

100% covered

40% cost share after deductible
Primary care

First 3 visits: $5*, then $25 

First 3 visits: $5*, then $25 

First 3: $5* then $30

40% cost share after deductible
Specialty care

$30

$35

$50

40% cost share after deductible
Lab & x-ray

$15

$15

20% cost share

40% cost share after deductible
Inpatient surgery

15% cost share

subject to deductible

subject to deductible

subject to deductible
Outpatient surgery

$25 per visit

20% cost share after deductible

20% cost share after deductible

20% cost share after deductible
Urgent care

$25

$35

$50

40% cost share after deductible
Emergency room

$250

$250

$250

$250
Ambulance services

$75

20% cost share after deductible

20% cost share after deductible

20% cost share after deductible
Chiropractic, acupuncture, massage

$25 for using providers

$25 using providers

$25 using network providers

40% coinsurance out of network
Naturopath

$20 or using providers

$15 copay using providers

$25 copay using network providers

40% coinsurance out of network
Osteopathic spinal manipulations

Covered with $20 co-pay if done by a DO (doctor of osteopathy) at Kaiser

$20 using providers

$20 using network providers

40% coinsurance out of network
Rx

$20 generic/
$40 preferred brand/
$60 non-preferred brand

$20 generic/
$40 preferred brand/
$60 non-preferred brand

At MedImpact Pharmacy: $30 generic/
$60 preferred brand/
$80 non-preferred brand

At MedImpact Pharmacy: $30 generic/
$60 preferred brand/
$80 non-preferred brand
Rx mail order

generic:
up to 90 day supply for $40
preferred brand:$80
up to 90 day supply for $120

$30 generic/
$60 preferred brand/
$100 non-preferred brand (up to 90 day supply)

At MedImpact Pharmacy: $60 generic/
$120 preferred brand/
$180 non-preferred brand (up to 90 day supply)

At MedImpact Pharmacy: $60 generic/
$120 preferred brand/
$180 non-preferred brand (up to 90 day supply)
Vision

$25 co-pay for eye exams plus $150 hardware allowance per 24 months

$25 co-pay for eye exam. Hardware not covered

$30 co-pay for eye exam. Hardware not covered

40% cost share after deductible
Annual limit of what the plan pays

No limit

No limit

No limit

No limit

Kaiser self-referred alternative care benefit

Kaiser plan members have access to chiropractic, massage, acupuncture and naturopathic medicine. To find a provider in their network, visit .

Note that there are visit limitations per calendar year as follows:
Acupuncture: limit of 12 visits per year
Chiropractic: limit of 20 visits per year
Massage Therapy: limit of 12 visits per year

Kaiser Added Choice

Kaiser Added Choice members have access to all the services and facilities that Kaiser members have, plus the option to seek services from providers outside of Kaiser.

Overview of Added Choice
List of contacts for Added Choice members
Transition of care to Added Choice
Added Choice summary of benefits

Kaiser has set up a dedicated concierge team to answer your questions and to help you make the transition to Added Choice:

Added Choice concierge team:
Ph: 503-813-1299 or 503-813-3613
kpconcierge-nw@kp.org

Care while traveling

Kaiser HMO and added choice members have access to care when traveling.

Additional information


Kaiser infertility benefits flyer
Kaiser mental health and wellness

Forms

Submitting a claim to Kaiser for care outside of Kaiser

Plan documents

Kaiser HMO summary of benefits
Kaiser HMO summary of benefits and coverage
Kaiser HMO evidence of coverage
Kaiser Added Choice summary of benefits
Kaiser Added Choice summary of benefits and coverage
Kaiser Added Choice evidence of coverage