It is always good to know what benefits you will be receiving and what responsibilities you have to make sure you receive them. As stated in your Kaiser Permanente Summary Plan Descriptions (SPD) (4), annual enrollment for your KP benefits usually occurs each fall (Ex. Oct. 24 – Nov. 15, 2019). Before it begins, you will be mailed enrollment materials and an upfront confirmation statement reflecting your benefit coverage to the address on file. You’ll find enrollment instructions and information about your benefit options and contribution amounts. You will have the option to keep the benefit coverage shown on your upfront confirmation statement or select benefits that better support your needs. You can choose to enroll in eBenefits and receive this information via email instead.
Kaiser Permanente’s life and accident insurance program provides financial protection for your beneficiaries in the event of your death.
Eligibility
If you were hired prior to January 1, 1997: If you meet the eligibility requirements for Retiree Medical, and you elected to continue the two times annual salary life insurance benefit, you will begin retirement with two times your annual salary in life insurance, up to a maximum of $750,000. This amount will continue in force for one month without reduction. Thereafter, it will taper by 1 percent of the original amount each month for 75 months until it reaches a minimum of 25 percent of the original amount. If you retire after age 65, your life insurance will begin tapering based upon the coverage amount in effect at age 65. If you did not elect to continue the two times annual salary life insurance plan, your life insurance benefit will be based on an original amount of $5,000 of life insurance coverage. This amount will be reduced by 1 percent each month until the life insurance amount reaches $2,000.
If you were hired on or after January 1, 1997: If you meet the eligibility requirements for Retiree Medical, your life insurance benefit will be based on an original amount of $5,000 of life insurance coverage. This amount will be reduced by 1 percent each month until the life insurance amount reaches $2,000.
If you were hired on or after January 1, 2014: You are not eligible for Retiree Life insurance coverage. TPMG still has the benefit for hires after 2014.
Disclaimer: KP contains many different groups of employees that are provided with similar but differing benefits. The following is information pertains to the Southern California Permanente Medical Group (SCPMG) SPD.
Retiree Medical (TPMG)
You will be offered retiree medical benefits if you retire from Kaiser Permanente at age 55 (or later) with at least 15 Years of Service.
Eligibility for Grandfathered Employees: If you were hired before February 1, 1986, you are eligible if you retire at age 55 with at least 15 Years of Service, or if your age and years of service equal 75 or more.
Your retiree medical benefits begin at age 65, or when you become eligible for and enroll in Medicare, whichever is later. If you are a Grandfathered employee, you will be offered retiree medical benefits effective the first day of the month following your retirement date.
You will receive Medicare-coordinated coverage equivalent to the high plan offered to active employees in effect at the time you receive services. Your benefit also includes Supplemental Medical Plan coverage. If your retiree medical benefits begin before age 65, then you will receive coverage equivalent to the high plan offered to active employees in effect at the time you receive services. Kaiser Permanente pays the cost of your retiree medical benefit premiums.
The Modified Retiree Medical (KFH/KFHP)
You will be offered retiree medical benefits if you retire from Kaiser Permanente at age 55 (or later) with at least 15 years of service.
Eligibility for Grandfathered Employees: If you were hired before February 1, 1986, you are eligible if you retire at age 55 with at least 15 years of service, or if your age and years of service equal 75 or more. You will be offered retiree medical benefits when you turn age 65 or when you become eligible for and enroll in Medicare, whichever is later. If you are a Grandfathered employee, you will be offered retiree medical benefits effective the first day of the month following your retirement date.
If you were hired before January 1, 2014, Kaiser Permanente will provide both you and your spouse or domestic partner with a Retiree Medical Subsidy to help pay for the Basic or Core Kaiser Permanente Senior Advantage Individual Plan monthly premium. In 2017, the subsidy was up to $186 per month to cover the premium costs for the Basic or Core Kaiser Permanente Senior Advantage Individual Plan only. Once you become eligible for and enroll in Medicare, you can access a Retiree Medical Health Reimbursement Account (HRA). The Retiree Medical HRA is a notional account, which is an account where funds are made available only when you present a reimbursement claim. The initial Retiree Medical HRA balance will be based on $2,500 for every year of service. For example, if you retire from Kaiser Permanente with 30 years of service, the initial Retiree Medical HRA balance will be $75,000.
Kaiser Foundation Health Plan
Kaiser Foundation Health Plan (KFHP) coverage is provided to all full-time physicians and enrolled eligible spouses/domestic partners as well as dependent children (up to age 26).
KFHP coverage is comprehensive and includes basic and major medical care at Kaiser Permanente medical facilities, such as hospitalization, surgery, maternity care, diagnostic imaging and laboratory expense, durable medical equipment, and emergency care.
Your KFHP coverage includes:
• $0 co-payment for doctor office visits
• $5 co-payment for each prescription
• $175 vision care allowance toward the purchase of eyeglass lenses, frames and contact lenses every 24 months
• $0 co-payment for mental health visits, and unlimited inpatient and outpatient visits per calendar year (with a diagnosis of psychosis)
• $2,500 hearing aid allowance per device, per member, every 3 years
Supplemental Medical
Supplemental Medical provides additional coverage by reimbursing a percentage (100%, 80% or 50%) of certain medically necessary expenses that are not covered by KFHP coverage or that exceed plan limits. Reimbursable services covered by Supplemental Medical include acupuncture, chiropractic care, custodial care and convalescent care. You must first meet your annual deductible before the plan begins to pay:
Individual Coverage = $100 Annual Deductible
Family Coverage= $200 Annual Deductible
Alternate Mental Health
Your health care benefits also include coverage for mental health services received outside of Kaiser Permanente. Alternate Mental Health includes coverage for hospitalization, outpatient visits, alcohol/drug dependency and day/night care treatment.
Special Dependent Coverage
You may enroll Special Dependents in KFHP coverage, similar to what you receive. Coverage is available to your parents, parents-in-law, parents of your domestic partner and over-age children. Special Dependents are eligible for coverage if they live in the Northern or Southern California service area, are not hospital-confined at the time of enrollment and do not have end-stage renal disease. Premiums for Special Dependent coverage may be deducted from your paycheck or may be billed to the Special Dependent. Special Dependent coverage includes KFHP coverage only.
Long Term Care Insurance
Upon attaining Partnership, physicians are eligible to purchase Long Term Care insurance to help reimburse expenses associated with care needed if you or a covered family member are chronically ill. Long Term Care insurance is provided by Genworth Financial.
Employee Assistance Program (EAP)
The Employee Assistance Program (EAP) is a free and confidential service available for active physicians and their dependent family members. EAP counselors are licensed, trained clinicians with years of experience and are available for short term problem-solving on a wide range of issues at no charge.
Employee Discounts
Access the online Employee Discounts web page to purchase discounted entertainment tickets or travel. You may also be eligible for discounts on child care services, health and fitness programs, mobile phone services, computers and more.
Short-Term & Long-Term Disability
Short-Term: Depending on where you work, you may have access to short-term disability (STD) benefits.
Long-Term: Your long-term disability (LTD) benefits are designed to provide you with income if you are absent from work for six consecutive months or longer due to an eligible illness or injury.
What Happens If Your Employment Ends
Your life insurance coverage and any optional coverage you purchase for your spouse/domestic partner and/or children ends on the date your employment ends, unless your employment ends due to disability. If you die within 31 days of your termination date, benefits are paid to your beneficiary for your basic life insurance, as well as any additional life insurance coverage you elected.
If you are looking for more details about your benefits, reach us at TechStaffer.
Sources:
- The Retirement Group or www.theretirementgroup.com
- “Retirement Plans-Benefits & Savings.” U.S. Department of Labor, 2019, www.dol.gov/general/topic/retirement.
- “Generating Income That Will Last throughout Retirement.” Fidelity, 22 Jan. 2019, www.fidelity.com/viewpoints/retirement/income-that-can-last-lifetime.
- Kaiser Permanente Summary Plan Description, 2017
