1 | Copyright ©2020 Kaiser Foundation Health Plan, Inc.
Kaiser Permanente Care designed to help you thrive
County of Sacramento
High Deductible Health Plan Presentation
Choosing Benefits to fit your life
2 | Copyright ©2020 Kaiser Foundation Health Plan, Inc.
Kaiser Permanente Care designed to help you thrive
Today's Goal
Our goal is to get participants thinking about how and why you may
want to do things differently.
Paying for care now, may help you save more for your future.
This presentation will show how studying the two County of
Sacramento benefit plans might help with a decision to keep Kaiser
Permanente, but pay for services differently, helping with overall
budget savings.
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Kaiser Permanente Care designed to help you thrive
What’s in your top 5?
Life balance with health and financial stability can help you
focus more on your top 5.
Your Kids?
Your Aging Parents?
Your church or community activities?
Your interest in sports or hobbies?
Other special interests?
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Kaiser Permanente Care designed to help you thrive
• Same great doctors
• Same personalized care
• Same convenient locations
• Same online tools
• Same healthy resources
• Same Medical Record Number
A different way to pay for your care
Kaiser Health Plan Choices: Same care and convenience
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Kaiser Permanente Care designed to help you thrive
Plan Highlights
Plan deductible None $1,500 / $3,000
Out-of-Pocket Maximum $1,500 / $3,000 $3,000 / $3,000
Covered Service You Pay
Preventive care No Charge
No Charge (plan deductible doesn’t apply)
Primary Care $15 Copay
Pay service cost until deductible
met
X-rays and lab tests No Charge
Pay cost until deductible met
Outpatient surgery $15 copay per procedure
Pay cost until deductible met
Hospitalization No Charge
Pay cost until deductible met
Emergency care $35 per visit
Pay cost until deductible met
Prescription drugs (up to 100-day supply)
at Plan Pharmacy or through our mail order
service
$5 copay (generic)
$10 copay (brand)
Pay cost until deductible met
County of Sacramento – 1/1/2023 – 12/31/2023
Traditional HMO Plan
High Deductible Plan
*This is just a summary of some examples of covered services and their corresponding copay and coinsurance amounts. Please see your
Evidence of Coverage for information about coverage, limitations, and exclusions for all benefits, including those not listed in this summary.
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Kaiser Permanente Care designed to help you thrive
2023 KAISER MEDICAL PLAN PREMIUMS
(pending board approval)
• Tier B subsidy = Employee Only = $659.80/month, Family= $1,689.14/month
• Tier A 2 subsidy = $1,148.80/month (Frozen) $894.52 Cashback Cap (*indicates cashback still paid)
• Tier A 1 subsidy = $826.90/month (Frozen) $535.00 Cashback Cap
• Annual EE cost = (monthly premium – subsidy) x 12
EMPLOYEE-ONLY TIER
HMO HDHP
Monthly Employee-only
Premium
$990.50 $713.06
Annual EE Cost Tier B
$3,968.40 $639.12
Annual EE Cost Tier A2
$0.00 $0.00
Annual EE Cost Tier A1
$1,963.20 $0.00
FAMILY TIER
HMO HDHP
Monthly Family Premium
$2,532.90 $1,823.44
Annual EE Cost Tier B
$10,125.12 $1,611.60
Annual EE Cost Tier A2
$16,609.20 $8,095.68
Annual EE Cost Tier A1
$20,472 $11,958.48
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Kaiser Permanente Care designed to help you thrive
Real-Life Cost example – Family Tier - High-Cost Year
Traditional HMO Plan H.S.A. HDHP Plan
Subscriber
Baby delivery hospital stay
- 3 overnights
- DME
- C-section
- Prescriptions
$0
-Total charge: $14,000
1) Pay deductible: $3,000
2 non-preventive doctor appointments (level 3)
$30 ($15 copay) $300 ($150 per visit)
1 well-woman visit
$0 $0
Dependent
1
1 non-preventive doctor appointment (level 2)
$15 $90
2 maintenance generic medications
$60/year ($10 copay 100/day) $160 ($20 per Rx 100/day)
1 Specialty Prescription (30 day)
$20 $1,000 (30/day)
1 skin biopsy (outpatient)
$15 $200
Dependent
2
3 non-preventive doctor appointments (Level 1 and 4)
$45 ($15 copay) $480
1 minor injury ER visit
$35 $170
1 antibiotic generic prescription
$15 $10
Total Medical Expenses/ total paid out of pocket by
employee
$235 $16,410 / $3.000
(deductible/OOP at MAX)
Total Annual Premium (Employee + Family)
$10,125 (Tier B) $1,611 (Tier B)
Total Out of Pocket
$10,360 $4,611
In this example, you save $5,749 / year by switching to the
HDHP
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Kaiser Permanente Care designed to help you thrive
$1,611
$3,000 $4,611
$8,095 $3,000 $11,095
$11,958 $3,000 $14,958
Family
Premium
Max
Ded/OOP
HDHP
Maximum
Spend/year
$10,125
HMO yearly
Premium Only
Minimum Savings for
switching to the HDHP
$16,609
$20,472
$5,514/year by enrolling
in the HDHP
$5,514/year by enrolling
in the HDHP
$5,514/year by enrolling
in the HDHP
What would you do with an extra $5,000/year?
• By enrolling in the HDHP you can save about $671/month
• If you invest $233 / month into your High Deductible Health Plan to save for medical expenses, you
will have about $430 / month EXTRA
B
A2
A1
vs
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Kaiser Permanente Care designed to help you thrive
How your Family deductible plan works
You’ll pay full charges for covered services, including doctor’s office visits, hospital care,
X-rays, prescription drugs, and lab tests, before reaching your plan deductible.
After reaching your plan deductible and Out of Pocket Maximum of $3,000 – you will pay
$0 for services and prescriptions for the rest of the plan year.
Each calendar year resets your deductible accumulation cycle.
*For a small number of services, you may need to keep paying copays or coinsurance after you reach your out-of-pocket maximum.
1/1/2023
12/31/2023
(continues)
You Pay Full Charges
Up to $3,000 Deductible
NO Charges after $3,000
spend for services
Start Date
$3,000 Deductible/Out of Pocket Maximum
Start Date
$3,000
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Kaiser Permanente Care designed to help you thrive
What to expect when paying for care with a
High Deductible Health Plan
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Kaiser Permanente Care designed to help you thrive
Have questions or need help paying for care?
Member Services
1- 800-464-4000
Deductible Team
1-800-390-3507
Get information about financial
assistance and payment options
Visit kp.org/deductibleplans
• Learn how deducible plans work
• Use online cost estimates tool
• Understand your bills
• Pay your bill
• Track your expenses
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Kaiser Permanente Care designed to help you thrive
Preventive care at no cost
Finding and treating problems before they get serious is an important part of
staying healthy. That’s why you get most preventive care at no cost —
even before you reach your deductible.
Preventive care includes:
Routine physical exams
Cancer screenings
Cholesterol and high blood pressure
screenings
Diabetes screenings
Immunizations
Routine prenatal care
Well-child visits
Routine Women's Exam
Breastfeeding Support
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Kaiser Permanente Care designed to help you thrive
• An HSA or health savings account (HSA) is an account owned by you, the
employee, and can be used to pay for all qualified medical expenses as
defined by the IRS.
• Contributions can be made by the employee, employer, or both.
• You can contribute any amount up to the annual maximum set by the IRS
each year.
• Your account stays with you even if you change jobs, health plans, or retire.
• You cannot be enrolled on a second non-H.S.A. plan per IRS guidelines
*The tax references in this document relate to federal income tax only. Consult with a qualified professional for tax, investment, or legal advice.
†
To view the list of qualified medical expenses defined under the Internal Revenue Code Section 213(d), download IRS Publication 502,
Medical and Dental Expenses, at irs.gov/publications.
What’s an HSA?
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Kaiser Permanente Care designed to help you thrive
With this plan, you may be eligible to open a health savings account (HSA) and
take advantage of triple federal tax savings.*
• Tax-free contributions and withdrawals for qualified medical expenses†
• Tax-free interest earned on the money in your account
• Tax-free investment earnings through multiple investment options
*The tax references in this document relate to federal income tax only. Consult with a qualified professional for tax, investment, or legal advice.
†
To view the list of qualified medical expenses defined under the Internal Revenue Code Section 213(d), download IRS Publication 502,
Medical and Dental Expenses, at irs.gov/publications.
How your HSA plan works
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Kaiser Permanente Care designed to help you thrive
Thank you
