Can You Have Dual Kaiser Coverage? A Guide to Double Kaiser Plans

Having double health insurance coverage can provide more comprehensive benefits and greater cost savings. A common question that comes up is whether you can be covered by two Kaiser Permanente insurance plans at the same time.

The answer is yes, you can have dual Kaiser coverage – also known as double Kaiser. Here’s an in-depth look at how it works, the advantages, and who is eligible for double Kaiser insurance.

What is Dual Kaiser Coverage?

Dual Kaiser coverage refers to being enrolled in two separate Kaiser Permanente health plans simultaneously. This could include:

• Two employer group Kaiser plans

• One employer and one individual Kaiser plan

• A Kaiser Medicare Advantage plan plus a Medigap or Part D Kaiser plan

• Any combination of two Kaiser policies

Double Kaiser coverage is possible when you have multiple options for enrollment. The two plans coordinate benefits following insurance industry rules and Kaiser guidelines.

How Does Dual Kaiser Work?

Here’s an overview of how having two Kaiser plans works:

• Each Kaiser plan has its own membership, ID cards, cost sharing, and guidelines

• One plan is deemed primary based on coordination of benefits order rules

• The primary plan pays covered claims first up to allowable amounts

• The secondary Kaiser plan pays further costs based on its benefits

• You pay applicable copays, deductibles, and coinsurance for each plan

• Claims should be submitted to the primary plan first, then the secondary

• Pre-approvals, referrals, and network providers apply to both plans

Coordinating dual Kaiser plans requires understanding how benefits, billing, and member responsibilities work between the two policies.

Advantages of Double Kaiser Coverage

There are a number of potential advantages to having two Kaiser plans including:

• Paying less out-of-pocket for medical expenses

• Access to a wider range of Kaiser providers and facilities

• Coverage when traveling out of network areas

• Lower costs for prescription medications

• Dual coverage for dependents or spouse

• Option to switch plans for primary coverage

• More benefits like dental, vision, and mental health

• Financial protection from unexpected medical costs

For many members, the cost savings and enhanced benefits make dual Kaiser plans an appealing way to get fuller health insurance.

Who is Eligible for Double Kaiser?

In order to have dual Kaiser Permanente coverage, you must meet eligibility requirements for enrolling in two separate plans:

• Employer Group Plans: Get coverage from two employers, or an employer plus spouse’s employer

• Individual Plans: Enroll in two individual Kaiser policies (not available in all states)

• Medicare: Get a Kaiser Medicare Advantage plan plus a Kaiser Medigap or Part D plan

As long as the two plans are through Kaiser with separate membership, you can coordinate dual Kaiser coverage when eligible. Having overlapping group and individual plans may require coordination to prevent duplication.

Examples of Dual Kaiser Plan Combinations

Here are some common examples of pairing two Kaiser policies:

• Employer group plan + Individual Kaiser plan

• Spouses each on separate employer Kaiser plans

• Retiree coverage + Kaiser Medicare Advantage

• Kaiser Medicare plan + Kaiser Medigap

• Students: University health plan + parent’s Kaiser plan

• Northern CA Kaiser plan + Southern CA Kaiser plan

Any combination of individual, group, or Medicare Kaiser plans can make up dual coverage as long as enrollment criteria is met.

Coordinating Dual Coverage with Kaiser

To maximize benefits when you have double Kaiser insurance, be sure to follow these guidelines:

• Notify Kaiser when you enroll in a second plan and want to coordinate coverage

• Understand rules for determining primary vs secondary payer order

• Have member ID cards for both plans handy

• Know provider networks, pre-approval and claim submission processes for each

• Get referrals from primary plan first if required before seeing specialists

• Check explanation of benefits (EOBs) from each plan for reimbursements

• Reach out to Kaiser member services with any coordination questions

Proper coordination when using dual Kaiser ensures maximum reimbursement and prevents confusion or denied claims.

Potential Downsides of Double Kaiser Insurance

While dual Kaiser coverage has advantages, there are some potential drawbacks to consider:

• Higher combined premium costs for two plans

• Hassle of coordinating benefits between plans

• Still limited to using Kaiser providers and facilities

• Paying multiple copays or coinsurance amounts

• Remembering different plan allowances and rules

• Possible overpayment and need to reimburse if not coordinated properly

• Could be redundant coverage if plans are very similar

Dual insurance may not make sense from a cost and convenience standpoint for some members.

Do You Really Need Double Kaiser Coverage?

With the disadvantages above, it’s reasonable to question whether dual Kaiser plans are necessary. Here are some factors to think about:

• If your two plans offer similar coverage, dual insurance may be redundant

• Consider your expected healthcare expenses and what’s covered in each plan

• Compare out-of-pocket costs like copays and deductibles in each plan

• Look at premium costs for having double coverage vs a single plan

• Check if your providers are in-network for both plans

• See if one plan offers perks like vision, dental, or wellness benefits you value

Unless the dual coverage provides major benefits you require, consolidating to one Kaiser plan may be a simpler and more affordable option.

How Does Billing Work with Double Kaiser?

Submitting claims with dual Kaiser coverage involves:

• Presenting both Kaiser plan ID cards when receiving medical services

• The provider bills the primary Kaiser plan first

• Primary plan pays covered amount according to benefits

• Provider bills leftover balance to the secondary Kaiser plan

• Secondary plan pays according to its allowable benefits

• You pay any remaining copays, coinsurance, or deductibles

• Each plan sends you an Explanation of Benefits (EOB)

Using this billing order ensures proper coordination for maximum reimbursement under both plans.

Can You Coordinate Kaiser with Non-Kaiser Insurance?

In addition to dual Kaiser coverage, it’s also possible to coordinate Kaiser with a non-Kaiser plan:

• Kaiser can act as primary or secondary payer

• Claims should be submitted to primary plan first

• Must follow Kaiser network and coverage rules

• You pay Kaiser deductibles and cost-sharing when it’s secondary

• Can maximize overall benefits with Kaiser alongside other major carriers

Check with Kaiser Member Services on proper coordination procedures when pairing with a separate primary insurer.

Do Dual Kaiser Plans Cover Out-of-Area Care?

Kaiser’s coverage is based on geographical service areas. With two plans:

• Each plan covers emergency care nationwide

• Only the plan associated with the area covers routine care

• Having different regions covered can allow broader access to providers

• Urgent or follow-up care out-of-area may require payment upfront and reimbursement

For non-emergency services, dual coverage extends to providers in network for each specific plan’s region.

Frequently Asked Questions about Double Kaiser

Here are answers to some common questions about dual Kaiser Permanente plans:

Do I have to hit two deductibles or out-of-pocket maximums?

Yes, each Kaiser plan has separate cost-sharing that applies exclusively to that plan’s coverage.

Can I switch my primary and secondary Kaiser plans each year?

Yes, you may be able to alternate primary coverage annually during open enrollment depending on your situation.

Does my primary Kaiser plan have to authorize referrals first?

Yes, services like specialists often require advance approval from the primary Kaiser plan covering those services.

What if only one Kaiser plan covers a given procedure?

If a service is covered exclusively by one plan, that plan will be solely responsible based on its benefits and authorization rules.

Can I enroll in two Kaiser plans with the same coverage regions?

Having two Kaiser plans in the same geographic area may result in redundant coverage depending on benefits, so this scenario usually does not make sense.

What if I’m not sure which plan should be paying as primary?

Contact Kaiser Member Services if ever unsure about which plan is considered primary – they can help resolve coordination issues.

The Bottom Line on Dual Kaiser Coverage

Having two Kaiser Permanente health plans can provide advantages like lower costs and more access if coordinated properly. Consider plan benefits, provider access, premiums, and administrative effort to see if dual coverage makes sense for your healthcare needs and budget.