With this high deductible health plan from Kaiser Permanente, you have access to the same doctors and facilities and the same great and convenient care you’ve come to expect from the Kaiser HMO.
With the Kaiser HDHP 3 Signature, you first pay a predetermined amount each plan year for most covered health care services before the health plan begins to cover services for a copay or coinsurance. This predetermined amount is called the deductible. Once you reach your deductible, you’ll pay only the applicable copays and coinsurance for covered services you receive for the rest of the plan year. Most preventive health care services are offered at no cost whether or not you have met the deductible.
With the Kaiser HDHP, you have the opportunity to open a Health Savings Account (HSA) with Kaiser. An HSA allows you to save pre-tax dollars to use to help offset your deductible or other eligible medical expenses.
If you enroll in a Kaiser HSA, Georgetown University will contribute to your HSA account:
$750/year for Employee Only coverage
$1,500/year for all other coverage tiers (+Spouse, +Children, Family)
These annual contribution amounts will be made to your HSA according to when you enroll in the plan and your pay frequency. So, for example, if you enroll in Employee Only coverage effective January 1st and are paid biweekly, GU will contribute $31.25 to your account each pay period over the course of the year. You must be enrolled in a Kaiser HSA and be actively at work in order to receive GU contributions toward your HSA.
The IRS limits the amount that you can contribute to an HSA each year. In 2024, the maximum contribution is $4,150 (individuals) and $8,300 (family) and an additional $1,000 catch-up contribution for those over age 55. These include limits are inclusive of the Georgetown University contribution to your account.
With the exception of life threatening emergency treatment, participants must receive care through Kaiser centers. Hospitalization coverage is included at area hospitals associated with Kaiser.
You must select a PCP in order to obtain care within the network
As needed, your PCP will refer you to specialists within the network
Except in emergency situations, coverage is not provided for care received outside the network. Referrals are typically valid up to 3 years. Referrals are not necessary for obstetrics/gynecology, mental health and substance use disorder, and vision services
Most services are available under one roof – you can see your doctor, get a lab test and pick up a prescription all in one visit
You will pay $0 for most preventive care services
You will pay out of pocket until you reach your deductible ($1,500 for individual / $3,000 for all other tiers)
Once your deductible is met, you will pay a 10% coinsurance for most services
Once you’ve met your deductible, Kaiser covers prescription drugs with a copayment for prescriptions purchased at a Kaiser center and at participating community pharmacies. No reimbursement is made for prescriptions purchased outside of a Kaiser center or participating community pharmacy. Mail order pharmacy is also available for 90-day supply.
There are no claim forms for this plan. If you pay for any services (including prescription expenses) out-of-pocket, Kaiser will not reimburse you for those expenses.
