Headline: Deductible Plans
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Questions and Answers


Payments and deductibles 
Billing
Explantion of Benefits
Emergency care
Changing plans
HRA, HSA, and FSA


Payments and deductibles



Q. How much is my deductible?
A.
You can find the exact amount of your deductible in the benefit summary or Evidence of Coverage (EOC) that you received during your open enrollment period.

Q. Why do I seem to have a different copay each time I come in for a visit?
A.
The amount you pay at check-in will vary depending on the services you’re scheduled to receive. With a deductible plan, you'll pay the full charges for services covered by your plan until you reach your deductible. After you reach your deductible, you'll start paying less — just a copay or coinsurance for most covered services, depending on your plan benefits. In most cases, what you pay when you check in will only cover part of what you owe for your scheduled services. If so, you'll get a bill for the difference later.

Q. Do all payments count toward my deductible?
A.
 Not all payments count toward your deductible. Depending on your plan, some services only require a copay and those copays count toward your out-of-pocket maximum.

Q. Do copays, coinsurance, and deductible payments count toward my out-of-pocket maximum?
A.
 In most cases, yes. However, there may be certain exceptions, such as payments for infertility services, which typically do not count toward the out-of-pocket maximum.

If you have an HSA-qualified deductible plan, payments for all services covered by your plan will count toward your out-of-pocket maximum.

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Billing


Q. Before my visit, can I find out how much I’ll need to pay?
A.
 Yes. For your convenience, we offer a couple of ways to get an estimate of your expected charges: 

  • Use our Estimates tool, which provides online estimates for more than 300 common services and procedures.
  • Call the number on your Kaiser Permanente ID card.

Remember that estimates are based on the scheduled appointment type or service that you identify, and may not be exactly what you’ll owe for your visit — especially if your doctor decides that you need additional services that weren’t scheduled before your visit.

Q. Why can’t you tell me the total amount I owe for my visit prior to or when I check in?
A.
We may not know exactly which services you’ll receive until you see your doctor. If you receive services during your visit that weren’t already scheduled, the charges for these additional services will appear on the bill you get at home (minus the payments you made either prior to or when you checked in).

Q. I got a cost estimate before my visit, but was charged a different amount at check-in. Why?
A.
 The estimates you get from our Estimates tool or over the phone are based on the scheduled appointment type or service that you identify. However, the amount you pay at check-in may only cover part of what you owe, especially if you get unscheduled services during your visit. In that case, you'll get a bill for the difference later.

Q. I paid when I checked in for my appointment. Why did I get a bill later for additional charges?
A.
 What you pay at check-in may only cover part of what you owe, especially if you get unscheduled services during your visit. Your doctor may arrange for additional services (like a blood test or an X-ray) after seeing you, so the actual cost of your visit may be higher. If there are any additional charges, you’ll get a bill for the difference later.

Q. I went in for a preventive care visit that was supposed to have no charge. Why did I get a bill later?
A.
During a preventive care visit, you may receive both preventive and non-preventive care services. If so, you’ll probably be charged for these additional non-preventive services. For example, during a routine preventive exam your doctor might decide that a mole needs to be removed for testing. Because mole removal and testing are considered non-preventive care services, you’d probably have to pay an additional copay, coinsurance, or deductible payment for these services. These extra costs would appear on your bill later.

Q. I paid for care but I don’t see it on my bill. Why?
A.
Services and related payments may take up to 125 days to appear on your bill. If recent charges or payments don’t show up on your current bill, you’ll see them on a future bill. In most cases, our claims are processed on average within 45 days.

Q. Can I pay my bill on my mobile device?
A. Yes. You can securely view and pay medical bills using the Kaiser Permanente app. Check your bill history, make a payment, and manage payment methods all from your smartphone.

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 Explanation of Benefits

Q. What’s the difference between a bill and an Explanation of Benefits (EOB)?
A.
Your EOB isn’t a bill. It will show how your benefits were applied to the services you got. It will show the date you received the service, the amount billed, the amount covered, the amount we paid and any balance you’re responsible for paying. It also tells you how much has been credited toward your out-of-pocket maximum and any deductible you may have. You can view or print your EOB in the claims section at kp.org.

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Emergency care


Q. If I’m out of my home area and need emergency care, will this be covered?
A.
Yes. Emergency care is covered outside your usual service area. You’ll pay a deductible payment or, if you’ve met your deductible, a copay or coinsurance for emergency services. See your Evidence of Coverage for details. 

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Changing plans


Q. What happens to my deductible if I change plans mid-year?
A.
If you switch from a group plan to an individual plan, move from a traditional plan to a deductible plan, change deductible plans, or start working for a new employer mid-year, your calendar year deductible and out-of-pocket maximum will be reset to $0 and any amounts you’ve previously paid toward your deductible and out-of-pocket maximum will no longer apply. For more details, call the number on the back of your Kaiser Permanente ID card.

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HRA, HSA, and FSA


Q. How do I use the money in my health reimbursement arrangement (HRA), health savings account (HSA), or flexible spending account (FSA)to help pay for care?
A.
 You can use the money in your HRA, HSA, or FSA to help pay for qualified medical expenses,* either when you check in for a visit or when you receive your bill. You’ll usually be able to make your payment with a debit card connected to your account. Depending on the amount in your account, you can use HRA, HSA, or FSA funds to pay the full charges for care, or you can make a partial payment with your HRA, HSA, or FSA funds in your account and cover the rest using another payment method. Learn about your payment options with an HRAHSA, or FSA.

Q. What if I use all the money in my HRA, HSA, or FSA before the end of the plan year?
A.
 After you’ve used all the money in your account, you’ll need to use a different payment method to cover additional health care expenses for the rest of the year. These expenses may include copays, coinsurance, and deductible payments. If you have an HSA, you can contribute additional money up to the maximum contribution limit, and continue using your account.

Q. Do I have to use my HRA, HSA, or FSA funds to pay for all services?
A.
 No. You can always choose to use a different payment method — like a credit card or a banking debit card — to pay for health care services. You can also pay for part of your qualified medical expenses* with HRA, HSA, or FSA funds, and cover the rest with another payment method, depending on your needs and the amount of funds in your account.

Q. What if there’s money left in my HRA, HSA, or FSA at the end of the plan year?
A.
 If you have an HSA, any unused money in your account at the end of the plan year will roll over to the next plan year. You can continue to grow your account from year to year, and you can take it with you if you retire or change jobs or health plans. If you have an HRA, some or all of your unused funds may roll over to the next plan year, as long as you’re still enrolled in the plan. Your employer will determine whether your HRA will roll over, and if so, how much will roll over. Contact your HRA administrator for details about how money will roll over. If you have an FSA, your money will not roll over to the next plan year — you must use your money or you will lose it.

Q. Can my HSA funds grow through investments?
A.
 Depending on your account, you may be able to increase your HSA money through investment opportunities. Your HSA may offer opportunities for investment, like a 401(k) or retirement fund, and any earnings or interest earned will be non-taxable. For details, contact your HSA administrator.

Q. Do bills and Explanation of Benefits (EOBs) show information about my HRA, HSA, or FSA balance?
A.
 No, you can get that information from your HRA, HSA, or FSA administrator. If your HRA, HSA, or FSA is administered through Kaiser Permanente, you can access your account information by phone, online, or with our KP HRA/HSA/HIA/FSA Balance Tracker app:

Kaiser Permanente 
1-877-761-3399
Monday through Friday, 5 a.m. to 7 p.m. (Pacific time) Closed holidays.
kp.org/healthpayment

For more information

Q. Where can I get more information about my health plan?
A. 
For additional information about your deductible plan or your benefits, just call Membership Services at 1-503-813-2000 Monday through Friday, 8 a.m. to 6 p.m. Pacific time (PT)

Q. Where can I get more information about my HRA, HSA, or FSA?
A.
 For specific information about your HRA, HSA, or FSA, call Kaiser Permanente Health Payment Services at 1-877-761-3399, Monday through Friday from 5 a.m. to 7 p.m. (Pacific time). Closed holidays.

*A qualified medical expense is defined under Internal Revenue Code Section 213(d). If your employer offers you an HRA, the qualified medical expenses that you can pay for with your HRA, may vary.  Check with your employer's plan administrator for details. To view the entire list of qualified medical expenses download IRS Publication 502, Medical and Dental Expenses, at irs.gov/publications. 

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