Kaiser Small Group Health Insurance Rates

Thursday, March 21, 2024 15:08 Posted by Admin

Kaiser Permanente, known widely as simply ‘Kaiser,’ currently provides insurance coverage to roughly 12.5 million people. They are the largest managed care organization in the nation, operating in eight states. Whether you’re a small business owner looking to provide health insurance to your team or you’re an employee wondering what your group coverage options are, we’re here to help.

What is Small Group Health Insurance?

Small group health insurance is exactly as it sounds – health insurance coverage that is designed for small businesses, and organizations, that want to provide collective coverage to their employees and their employees’ dependents. Though, there are a number of eligibility requirements in order for your business to qualify to sign up for a small group health plan:

  • The employer has to pay a percentage of employee monthly premiums.
  • The business must have two to 50 full-time or full-time-equivalent employees. However, there are four states that allow small group plans to be purchased by business that have up to 100 employees.
  • The employer has to meet the participation requirements outlined by the chosen insurance company. For most, this means that at least 70% of all employees must enroll in the plan in order for it to be binding.

Kaiser Group Health Coverage

Whether your business has numerous locations across the country, or you’re a small entity that operates in one city, it’s important to have a variety of flexible options to accommodate your ever-evolving needs. Fortunately, Kaiser has a number of group health insurance plans that can be tailored to businesses of all sizes. Though, their coverage options vary slightly depending on whether your business is considered small or large.

So, the first step in getting small group health insurance for your employees is to determine if your business is, in fact, deemed ‘small’ in the insurance world.

Small Group vs. Large Group

According to the Affordable Care Act (ACA), whether a business is small or large varies based on where it is located:

  • California & Colorado – small business is 1 to 100 employees; large business is 100+ employees.
  • District of Columbia, Georgia, Hawaii, Maryland, Oregon, Virginia & Washington – small business is 1 to 50 employees; large business is 51+ employees.

By using this information, you can determine whether your business is eligible for a small group rate or if you must obtain coverage via the large group market.

Kaiser Small Group Insurance Plans

As the owner of a small business, it is in your best interest to provide your employees with health insurance. Ideally, you want their options to be adaptable, affordable, and easy to understand. For small businesses, Kaiser offers a wide array of plans to choose from and, depending on the number of qualified employees, you may be able to offer multiple options so they can select the plan that suits them best. With that said, let’s take a look at the main types of small group health plans that Kaiser has to offer:

Traditional HMO Plans

HMO, or ‘Health Maintenance Organization’ plans provide the insured with a whole network of doctors, hospitals, and other healthcare providers. However, in order to enjoy your plan’s benefits, you are only allowed to use in-network providers. HMO plans offered by Kaiser come with predictable cost sharing and out-of-pocket maximums, which make managing health care expenses easier for employees.

  • Healthcare costs that are constant and predictable.
  • No deductible and cheaper copays.
  • When receiving care from Kaiser facilities, employees don’t have to worry about managing claim forms.

Deductible HMO Plans

Kaiser’s Deductible HMO Plans still give you coverage at affordable rates, but with more options. With an employee out-of-pocket cost, monthly payments are lower than traditional HMO plans. As a result, employees will enjoy reduced premiums, while maintain the same excellent care and access to doctors and facilities.

  • More affordable premiums than traditional HMO plans.
  • Wide variety of deductible amounts, which can be chosen according to needs and preferences.
  • Can be paired with a health reimbursement arrangement (HRA) or a health savings plan (HSA), if desired.

HRA and HSA-Qualified Plans

With Kaiser’s HRA and HSA-Qualified Plans, premiums are lower than other plan types and there are tax benefits as well. With either the HRA or HSA option, employees get more control over their medical care expenses. They also enjoy convenient access to online tools and the same services as those provided by traditional HMO plans.

  • Tax-free earnings can be set assign to pay for future healthcare expenses.
  • HRAs give the most flexibility to employees
  • HSAs give the most control to employees.

Deductible HMO with HRA Plans

These Kaiser small group plans give you the best of both words, by combining traditional deductible HMO plans with a health reimbursement arrangement (HRA). With these plans, employees have more power over their health care spending, preventative care, and online support tools.

  • Lower premiums than traditional HMO plans.
  • Tax-deductible funds for employers; tax-free funds for employees.
  • Employees receive tax-free benefits for authorized out-of-pocket costs.

PPO Plans

PPO, or ‘Preferred Provider Organization,’ plans, unlike HMO plans, do not require you to choose a primary care physician (PCP) to manage your care. Overall, these plans give employees the most flexibility, as they benefit from referral-free access to contracted PHCS Network doctors or any licensed provider they desire. They the perfect option for employees who frequently end up outside of Kaiser’s service areas or simply want care from an out-of-network doctor from time to time.

  • Access to any physician, with no referral required.
  • Comprehensive health care coverage, in or out of Kaiser’s service areas.
  • Single-carrier administration.

Point-of-Service Plans

Kaiser’s point-of-service (POS) plans pair a Kaiser traditional HMO plans with a PPO to provide the most inclusive options within Kaiser service areas. These plans are best suited for those who want the option to go out-of-network but still with HMO level savings.

  • Combines flexibility and cost savings.
  • Employees have access to Kaiser providers, but also to any provider they choose.
  • Employees can choose to save money with a Kaiser provider or pay a slightly higher rate for out-of-network care.

Kaiser Health Plan Costs

Small business owners who choose to purchase small group health insurance must pay for a percentage of their employees’ monthly premiums. The minimum required employer contribution varies based on state, but most require no less than 50% contribution. Though, you can always pay more. In order to understand Kaiser small group health insurance rates, you must understand the different group health insurance costs involved.


Premiums are simply the monthly membership fee that employees pay to keep their coverage active. For employer-sponsored plans, the premium comes out of the employee’s paycheck. Premium costs vary from plan to plan and each plan is different.

Though, the average monthly premium for health coverage for an individual in the United States from 2018 to 2021 was $340 to $525. While premiums vary based on location and plan time, you can use these numbers to give you a general ideal of what employer contributions may be.

Out-Of-Pocket Costs

The services that are provided will depend on the specific health plan, thus, impacting your out-of-pocket costs. Out-of-pocket costs are simply how much you pay out-of-pocket for medical care on the day. The plan will outline how much is covered for certain medical services, and then how much you must pay. With that said, here are some out-of-pocket costs to be aware of:

  • Deductible: The deductible is the amount of money you must spend annually before your plan starts to cover additional costs. It’s possible, and common, to never reach your deductible – especially if you don’t receive care often.
  • Copay: Copays are flat fees that you must pay for services covered under your health plan at the time of care. For instance, you may have a $10 copay for prescriptions and a $15 copay for in-person doctor visits. Oftentimes, this fee is slightly higher for specialists.
  • Coinsurance: Coinsurance is a percentage you pay for qualified services after you’ve met your deductible. For example, if you have lab tests done that cost $100 and your coinsurance is 20%, you pay $20 and your plan pays the additional $80.

Have more questions about small group health insurance, what plans Kaiser has to offer, and what your coverage costs will be? The team at Taylor Benefits Insurance Agency can help! Contact us today to start developing the best plan for your small business.

Written by Todd Taylor

Todd Taylor

Todd Taylor oversees most of the marketing and client administration for the agency with help of an incredible team. Todd is a seasoned benefits insurance broker with over 35 years of industry experience. As the Founder and CEO of Taylor Benefits Insurance Agency, Inc., he provides strategic consultations and high-quality support to ensure his clients’ competitive position in the market.

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