Kaiser is one of the largest (if not the largest) health insurers in the California small group market. It is unique and quite different from the other health insurance carriers such as Anthem Blue Cross, Blue Shield, Health Net, and Pacificare in many ways.
Kaiser dominates certain areas of California so let's take a look at the pro's and con's of insuring your employees with Kaiser group health.
First, a quick introduction.
Kaiser dates back to the depression and is quite unique in California.
Traditionally, it has been an HMO provider but is different from the other California carriers in that it employs the actual doctors and owns the hospitals. The other carriers contract with individual medical groups and hospitals to provide HMO coverage to their enrollees. With Kaiser, the insurer is also the provider.
There are pro's and con's to this type of delivery.
For one, people may be concerned about financial concerns affecting medical decisions. To some extent, this is an issue relating to HMO's in general and not specific to Kaiser but with Kaiser, the proximity of insurance carrier and provider might further the concern. Again, HMO's by their design have this concern as even independent medical groups and doctors are paid a fixed amount per enrollee.
The medical group then must balance care options with a fixed budget in order for the HMO relationship to remain viable.
The other major difference with Kaiser is that they own the actual hospitals and medical facilities.
This affects where Kaiser is available.
The facilities tend to be in more populous areas which is true also for most HMO's. You need a larger population to support the HMO model. If you live outside a Kaiser area, you may not be able to take advantage of their HMO plan benefits. This can be an issue for California companies that have employees in different areas and especially employees outside the State altogether.
A new twist on this is the roll-out of Kaiser's PPO plans. They have contracted with a nationwide network to provide PPO benefits as part of their suite of plans.
Kaiser is traditionally, not thought of as a PPO carrier, and the PPO rates are typically higher than carriers such as Blue Cross which have a long track record with PPO
There are three main reasons that Kaiser is a dominant carrier in the California health insurance landscape.
1. Cost. This is the biggest driver as Kaiser is very difficult to beat cost-wise. It's rare to find cheaper California health plan alternatives for equivalent benefits on the market...either HMO or PPO.
If cost is the main concern for an employer,
Kaiser is an option to look at.
2. Ease of Use. If choosing your own doctor is not an issue, some people like the feel of Kaiser.
When you go to a Kaiser facility, the process
can be pretty smooth as all the needed
information lies within one "umbrella". Your
medical history and information is available
throughout the system.
3. Day to day medical. Kaiser is great for your basic health care needs with a focus on prevention. Maternities can be handled very well. The only issue (as with all HMO's) is when you have something more exotic health-wise.
You may want to go to a particular specialist who concentrates on your ailment. Within an HMO type of plan, this might not be an option. For the majority of medical services, however, Kaiser can be very cost-effective and user-friendly.
There is an option called the "Kaiser Wrap" where you can split employees between Kaiser plans and those of another carrier such as Anthem Blue Cross.
There are certain eligibility requirements in
terms of numbers of employees on each plan but
this allows those that like Kaiser to go there,
and those that do not, to choose another
Kaiser will continue to be a strong carrier going forward in the California small group health insurance market.
HMO's in general have been under pressure as their rates have increased at a quicker clip than less-rich plans but Kaiser is probably the best at cost-containment and efficiency to help offset this premium pressure going forward.
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