Small business service tips

Adding or losing employees

Call your account manager or our Small Business Account Management Support Team at 800-790-4661, option 3 at least 90 days before your group’s anniversary date to avoid delays.

Cal-COBRA information for employees who lose coverage

When your clients’ employees are no longer covered, it’s easy to have Cal-COBRA packets sent directly to them. Just write “Please send Cal-COBRA packets” at the top of the Subscriber Termination and Transfer form. Be sure to confirm the correct member mailing address is on file with us prior to submitting the form.

COBRA reporting

Under the federal Consolidated Omnibus Budget Reconciliation Act (COBRA), employees and their families can continue to get group health coverage for a period of time after the employee no longer works for the company. Your client’s employees and their families may qualify for COBRA coverage in these situations:

  • Voluntary or involuntary job loss
  • Reduction in hours worked
  • Divorce from the covered employee
  • Death of the covered employee

For more information on COBRA, please see the “COBRA regulations” section of the “Government guidelines” page.

 

1. How do my clients know who’s enrolled in COBRA?

Only clients with active COBRA members, will receive a Billed Federal COBRA Activity Report from Kaiser Permanente listing current COBRA members for that month.

The report also lists former employees who:

  • have missed COBRA payments
  • are being terminated from COBRA, either for nonpayment, or because they’ve reached the maximum period of COBRA continuation coverage

 

2. Who receives my clients’ COBRA activity report?

The person at a company who’s been specified as the contract signer will automatically receive the report.

 

3. What if my clients want someone other than the contract signer to receive the report?

To have the activity report sent to someone else at a company, ask your client to contact our Small Business Account Management Support Team at 1-800-790-4661, option 3.

 

4. Who can answer questions about the COBRA activity report?

Contact our California Service Center at 1-800-790-4661, option 1.

Separating 1 regional contract into 2

If your clients’ small business has locations in Northern and Southern California, and the non-headquarters region has at least 13 Kaiser Permanente subscribers, the group may need to separate its contract. This will give each location its own contract and customer identification number (CID).

To help make this transition easier, we’ve simplified our process:

  • Groups only need to separate at their renewal — not midyear.
  • Kaiser Permanente will separate and renew the group. Any members affected by the separation will get a new ID card.
  • Only groups that offer Kaiser Permanente Insurance Company (KPIC) plans (PPO) need to sign and submit a prepopulated Employer Application. For these groups, your Account Manager or a Small Business Account Management Support Team representative will reach out to help you with the process. If a group doesn't offer a PPO plan, no action is needed.

What if my clients’ group uses Electronic Data Interchange (EDI) to send files?

After separating their group, they must update their EDI file with the employees from each region. We recommend making updates by the end of their renewal month.

What if my clients’ group uses online account services?

The group with the original contract will need to add the new location on online account services by filling out our Online Account Services User ID Request Form. Be sure to include the CID of the group with the original contract and the new CID of the other region. After making the updates, they’ll be able to access both regions from one account.

How many bills will my clients get?

Your clients’ group may receive a bill for each contract. Billing may take 1 to 2 months to catch up after the separation. Until that happens, they may see a credit or retro charges on their bills. We recommend they pay as billed.

If my client offers one or more grandfathered plans, will the risk adjustment factor stay the same after the separation?

Yes, the grandfathered risk adjustment factor stays the same for both groups if your clients offer one or more grandfathered plans.

Do my clients’ employees’ deductible and out-of-pocket accumulations follow them if they’re moving to the new location?

Yes. After the member is transferred, we’ll transfer all deductible and out-of-pocket accumulations. This process can take 30 days or more to complete after the group’s renewal date.

Why do affected members receive a Certificate of Creditable Coverage letter?

Affected members who are terminated from the contract for the headquartered location must be mailed a Certificate of Creditable Coverage letter, but they can disregard the letter because they were immediately enrolled in the new group located in the opposite region.

How long does it take to separate a group?

It takes about 4 weeks, not including the time it takes to transfer any deductible or out-of-pocket accumulations.

Please contact your account manager or our Small Business Account Management Support Team at 800-790-4661, option 3.

Terminating a small group contract

How do I help a small group terminate their contract with Kaiser Permanente?

Contact our Account Management Support team at 800-790-4611, option 3, Monday through Friday, 8:30 a.m to 5 p.m Pacific time to assist you with this request.

Who's responsible for stopping autopay?

If your client pays their premium through autopay, it's their responsibility to turn it off once all premium owed has been paid. If you or your clients have questions on how to stop autopay, please call the California Service Center at 800-790-4661, option 1.

Can my client request reinstatement of their contract later?

Yes, your client can request reinstatement of their contract within 60 days of their termination date without lapse in coverage and without needing to go back through the underwriting process.

Can I use a Declination of Coverage form to request termination of a small group contract?

No. The Declination of Coverage form is for employees who want to decline group health coverage with Kaiser Permanente.

New member ID cards

Your clients’ employees will get new ID cards only when they:

  • Become new Kaiser Permanente members.
  • Switch to a plan that uses another type of card (for example, from small business coverage to Medicare coverage).
  • Have a gap in coverage that’s 396 days or more.
  • Lose their card and ask for a replacement through Member Services1.

1 Most members can also access their digital ID card through kp.org or the Kaiser Permanente app. This option is not available for Northern California, Medicare members, and some out-of-area plans.