Health Care Coverage
Kaiser Foundation Health Plan (KFHP)
KFHP coverage for retirees is comprehensive and includes basic and major medical care, durable medical equipment and emergency care. To be eligible for KFHP in retirement, you must reside within the KFHP California service area, and:
- Reach age 55 with 15 or more years of Common Plan Qualifying Service, or
- Reach age 65* with at least 10 years of Common Plan Qualifying Service, or
- Have age plus years of Common Plan Service equal at least 75 (with 10 or more years of Qualifying service), or
- Be a participant of the Early Separation Program (ESP)
* You must enroll in Senior Advantage once you reach age 65 and stop working.
For more information on Health Care coverage available to retirees who live outside of the Southern California service area, see Comprehensive Medical Coverage or the Kaiser Permanente Multi-Site Plan.
If you decide to waive KFHP Coverage, you will automatically be disenrolled from Supplemental Medical, Medicare Part B Reimbursement, and Special Dependent coverage. If you waive coverage and elect to re-enroll in KFHP coverage at a future date, you must provide a certificate of credible coverage from the date coverage was originally cancelled with SCPMG. If you are not continuously covered under another health plan, you will not be able to re-enroll in coverage in the future.
Medicare
Medicare is a federal health insurance program that pays for hospital and medical care for:
- Individuals who are age 65 or older
- Individuals who are under 65 with certain disabilities
- Individuals of any age with End-Stage Renal Disease (ESRD)
Eligibility for Medicare also requires that an individual is a U.S. citizen or permanent legal resident for five continuous years and is eligible for Social Security benefits with at least ten years of payments contributed into the system.
The timing of your Medicare enrollment depends on when you decide to retire. Medicare enrollment is not automatic. You must contact the Social Security Administration directly to enroll.
Senior Advantage
On or after age 65, you and your eligible dependents are required to enroll in Senior Advantage. As part of Senior Advantage enrollment, you and your eligible spouse/domestic partner must enroll in Medicare and assign Medicare Parts A and B to Kaiser Foundation Health Plan.
- Senior Advantage Group Online Enrollment Instructions
- Senior Advantage Disenrollment Form
- Medicare & Senior Advantage Guide for Retiring Physicians
Special Dependent
You can enroll Special Dependents in KFHP coverage at your own expense. Premiums can be billed to you or your Special Dependent. Special Dependents may retain their KFHP coverage upon your retirement or death. Enrollment in the Special Dependent program is for 7 months or longer.
Special Dependents are limited to:
- Your parents
- Your spouse/domestic partner’s parents, and
- Your over-age or married children and their eligible dependents.
Eligibility and Requirements:
- Special Dependents receive KFHP coverage only (does not include Supplemental Medical, Alternate Mental Health or Dental coverage)
- Must live in a California service area
- Applicants must not be hospital confined and not have end-stage renal failure
- Applicants cannot be enrolled in another health care plan
Coverage becomes effective the first of the following month, upon receipt and processing of the required documents. Completed enrollment forms must be faxed to PHR Shared Services at 626-628-3789, or emailed to PHRSharedServices@kp.org.
To enroll a Special Dependent, complete the three forms below:
- Enrollment Application or Change Form
Complete Section C with the Special Dependent’s information. This form to be signed by the Special Dependent, not the physician.
- Special Dependent Enrollment/Deletion Form
Premium deduction election is made on this form. Signature from the physician is required on the top section.
- Special Dependent Physician Affidavit
Both Special Dependent and physician signatures are required on this form.
Special Dependents 65 years old or over (and eligible for Medicare) must complete the additional form below (4 forms total):
- Senior Advantage Election Form
Special Dependent must complete this form and return with the other forms listed above.
To Cancel or Disenroll a Special Dependent, complete the forms below. You can only disenroll a Special Dependent upon completion of 7 months of coverage.
- Special Dependent Enrollment/Deletion Form
Complete bottom section, physicians signature required.
- Senior Advantage Disenrollment Form
Additional form to be completed by Special Dependent if 65 years old or over.
Supplemental Medical
The Supplemental Medical Plan provides additional coverage to the medical benefits provided by Kaiser Foundation Health Plan coverage. This benefit reimburses physicians for certain medical expenses that either are not covered by Health Plan coverage, or that exceed Health Plan coverage limitations.
** Please note: Maximum Lifetime Limits noted in these documents were eliminated as of January 1, 2011
- Submit your receipts with the Meritain Health Claim form.
- For assistance, contact Meritain Health at 1-888-711-7876 from 5 a.m. to 6 p.m. Pacific Time, or visit http://www.mymeritain.com.
Comprehensive Medical Coverage (outside KFHP service areas)
The Comprehensive Medical Plan is an alternative to KFHP or Senior Advantage and provides health care benefits to eligible retirees who reside outside of a Kaiser Permanente Service area. If you are eligible for health care benefits in retirement and you move out of a Kaiser Permanente service area, you are required to elect the Comprehensive Medical Plan in place of KFHP or Senior Advantage.
Enrollment in the Comprehensive Medical Plan is not automatic. Contact PHR Shared Services at 1-877-608-0044 or PHRSharedServices@kp.org to request enrollment materials.
Kaiser Permanente Multi-Site Plan (within another KFHP service area)
The Kaiser Permanente Multi-Site Plan (KFMP) is an alternative to KFHP, Senior Advantage, and the Comprehensive Medical Plan for eligible retirees. The Plan is available to eligible retirees who reside outside of the Southern California Kaiser Permanente service area but reside in another Kaiser Permanente service area (i.e., certain areas of Hawaii, Oregon, Colorado, Northern California, the Mid-Atlantic region or the Northwest).
Enrollment in the Multi-Site Plan is not automatic. Contact PHR Shared Services at 1-877-608-0044 or PHRSharedServices@kp.org to request enrollment materials.
Travel/Emergency Services
As Kaiser Permanente members, you and your covered dependents can take advantage of health plan coverage even when you’re traveling outside of Southern California.
Complete the form and send to the Kaiser Foundation Health Plan, Inc. address listed on the form. If you have questions, contact Member Services at 1-800-390-3510.
COBRA Coverage
COBRA continuation coverage is available to eligible family member(s) who were covered at the time of the loss of coverage due to:
- Your death*,
- Divorce, or
- A dependent child exceeding the age limit
* A surviving spouse of a retired physician will retain their group health coverage upon the retired physician’s death. Should the surviving spouse subsequently remarry, the surviving spouse’s eligibility for group health coverage through SCPMG shall end and COBRA continuation coverage will be available.
Premium rates are subject to change. COBRA continuation coverage does not apply to Special Dependent coverage.
For more information on how to obtain COBRA coverage, contact PHR Shared Services at 1-877-608-0044 or PHRSharedServices@kp.org.
Dental Coverage
Dental benefits cease at the end of the month you retire or terminate due to disability. Although you lose your dental coverage upon retirement, once you are enrolled in Senior Advantage you will have dental coverage provided to you by Kaiser Permanente through DeltaCare USA, an HMO program. You and your spouse must be enrolled in Senior Advantage to receive dental benefits. If you and/or your spouse/domestic partner do not qualify for Senior Advantage, you will not receive dental benefits.
Separate dental coverage is available for purchase through the Kaiser Permanente Retiree Association, or through two prepaid dental plans -- DeltaCare USA and United Concordia. AARP also has a dental care plan available for retirees to purchase.