The Minimum Coverage Plan by Keiser Permanente

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Table of Contents

Introduction
Major Coverage Exclusions
Major Coverage Inclusions
Costs to Consumer
Ratings, Consumer and Nurse Perspectives
Conclusion
References

Introduction

The Minimum Coverage plan, which is primarily health coverage that secures a person against worst-case situations, typically has the lowest premium with the largest deductible. A healthcare direct-service program is administered by a Kaiser Foundation Health Plan company and is present in several states. The District of Columbia, California, Colorado, Georgia, Hawaii, Idaho, Maryland, Oregon, Virginia, and Washington are considered geographic boundaries of the healthcare plan (Keiser Permanente, 2022). Thus, the Minimum Coverage plan by Keiser Permanente offers services that are beneficial in terms of age and location.

Major Coverage Exclusions

Services that are not medically required to address mental health issues are subject to exclusions or limits. For instance, certain tests and services, routine physical examinations and other non-medically necessary services, such as those required for employment, traveling, or court orders (Keiser Permanente, 2022). Moreover, chiropractic services are not covered unless the person there is additional coverage for it (Keiser Permanente, 2022). Additionally, services whose main goal is to alter or preserve one’s look are excluded (Keiser Permanente, 2022). Orthodontic and dental services, including X-rays, devices, implants, and massage treatment, are not included (Keiser Permanente, 2022). Usually, this program also does not pay for services received by Out-of-Network Dentists (Keiser Permanente, 2022). Another major exclusion is massage therapy, with the exception that services are offered as a part of a physiotherapy treatment plan (Keiser Permanente, 2022). Anyone involved in surrogacy may use the services of a surrogate, but these services are not covered.

Major Coverage Inclusions

There are additional significant inclusions in the plan, which make it advantageous. Among the major inclusions are administered medications and services, such as covered cancer therapy (Keiser Permanente, 2022). Moreover, ambulance services and autistic spectrum disorder behavioral health care are a part of the plan (Keiser Permanente, 2022). Home-based durable medical equipment, such as insulin pumps and Base DME, are covered by the plan (Keiser Permanente, 2022). Under coverage are also urgent care, hospitalizations, and emergency room visits. It is noteworthy that emergency and urgent care visits are subject to deductible and have no charge in copayment (Keiser Permanente, 2022). When admitted as an inpatient from the ER, such visits’ are covered by the plan (Keiser Permanente, 2022). Services related to hearing, including doctor visits and hearing tests, are covered (Keiser Permanente, 2022). Finally, imaging, lab, and other outpatient diagnostic and therapeutic services, prescription medicines, equipment, and supplements for outpatient use are covered.

Costs to Consumer

When it comes to the premiums, the coverage provided by this plan is only applicable to members for whom the company received Full Premiums. The organization states that for each month, a member must prepay the Premiums shown in the renewal documents by the last day of the month prior (Keiser Permanente, 2022). A $20 fee will be charged for returned cheques and card transfers with insufficient resources (Keiser Permanente, 2022). As for annual deductibles, the individual and family deductibles for this plan are $9,100 and $18,200, respectively (Health of California, n.d.). This implies that consumers pay the whole cost of all medical treatments up to the time they reach the deductible, if at all. The most that may be paid out-of-pocket is $9,100 for individuals and $18,200 for families (Health of California, n.d.). The insurance begins to pay 100% of the cost of all in-network operations after the deductible and out-of-pocket expenses have been satisfied (Health of California, n.d.). This coverage lasts through the end of the current calendar year.

It is noteworthy that in this plan, there are minimum copayments. This is the set cash amount consumers are required to pay while using a covered service provided by this plan. However, the copayment’s monetary value for this plan is $0 on the major inclusions list, which means that there are no charges for these services (Keiser Permanente, 2022). According to the standards in the company’s medication formulary, it provides coverage for outpatient prescription medicines, supplies, and supplements (Keiser Permanente, 2022). Whenever necessary, the plan covers items that the Plan Provider prescribed within the bounds of their profession and license. Moreover, among the prescriptions under coverage are the medication for oral care by dentists or non-plan doctors.

Ratings, Consumer and Nurse Perspectives

Regarding ratings, Keiser Permanente’s plans tend to have favorable rates. For instance, according to the NCQA 2022 findings, Keiser Permanente and its Minimum Coverage HMO received four stars (NCQA, 2022). Moreover, it has many benefits when reviewing this plan from the customer’s point of view. Since the first three primary healthcare appointments each year are free, the Minimum Coverage plan often has lower premium costs and offers superior services (Health of California, n.d.). However, when compared with other plans, if a patient has unforeseen high medical bills and reaches the deductible, the Bronze 60 plan would be a better option with $300 for a person (Health of California, n.d.). Additionally, if an individual selects the Bronze Plan, they could be eligible for premium support (Health of California, n.d.). When it comes to the perspective of a nurse, the healthcare plan might be preferable to people residing in areas with a higher cost of living since, with lower prices of the plan coverage, they can save money. Moreover, the plan might be capable of improving health outcomes since, despite there being major exclusions, the plan still covers all the necessary services, such as ER visits and others.

Conclusion

Hence, the Minimum Coverage plan often has the lowest premium and the highest deductible since it focuses primarily on providing health coverage to protect a person from the worst-case scenarios. Exclusions or restrictions may apply to services that are not medically necessary to address mental health disorders. For instance, some procedures, regular physical exams, and cosmetic, chiropractic, and surrogacy services that are not medically essential are not covered. The strategy is excellent since it also has other important components. Prescriptions, ER visits, imaging, lab work, and other outpatient diagnostic and therapeutic treatments are a few of the primary categories. A maximum of $9,100 for individuals and $18,200 for families may be paid out-of-pocket. The plan is advantageous from the client and nurse’s perspectives since it guards against worst-case scenarios and is affordable even for people who live in places with a high cost of living.

References

Health of California. (n.d.). Minimum coverage. Web.

NCQA. (2022). Health plans. Web.

Keiser Permanente. (2022). Minimum Coverage HMO. Web.

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