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. ÈËÆÞÓÕ»ó currently pays 100% of the cost of the Kaiser plan for employee-only coverage and 60% of the Kaiser cost for eligible dependents. ÈËÆÞÓÕ»ó 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 ÈËÆÞÓÕ»ó'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 | ÈËÆÞÓÕ»ó 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 |
ÈËÆÞÓÕ»ó College 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 |
$2,250/member |
$3,000/member |
$8,000/member |
| Annual deductible |
$0 |
$750/member |
$1,000/member |
$3,000/member |
| 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/ |
$20 generic/ |
At MedImpact Pharmacy: $30 generic/ |
At MedImpact Pharmacy: $30 generic/ |
| Rx mail order |
generic: |
$30 generic/ |
At MedImpact Pharmacy: $60 generic/ |
At MedImpact Pharmacy: $60 generic/ |
| 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