As part of our commitment to certainty and transparency, Kaiser Permanente will begin providing your clients’ employees with an Advanced Explanation of Benefits (AEOB) for certain services. This document includes a detailed estimate of charges in advance of their scheduled appointments with Kaiser Permanente providers.
Supporting the provisions outlined in H.R. 133 enacted by Congress in late 2020, the AEOB is designed to prepare patients about their expected medical costs. It will help your clients’ employees plan ahead by delivering important cost-sharing information before they receive care from Kaiser Permanente.
The new AEOB is based on each employee’s plan benefits and is available for certain primary and specialty care appointments at a Kaiser Permanente facility. It is automatically generated and sent to the employee’s documents folder at kp.org.
In addition to providing a detailed cost estimate, the AEOB will also include information about the appointment or service, coverage levels, and any accumulations or deductibles that may apply.
Initially, an AEOB will be distributed to members (including minors) in all commercial fully insured and self-funded plans including grandfathered and non-grandfathered plans, as well as Federal Employee Health Benefit (FEHB) plans under the following plan types:
Based on the provisions of H.R. 133, an AEOB will be required for all scheduled services. However, for the initial phase, the following services/departments have been excluded and will NOT generate an AEOB:
Keep in mind, this is a programwide, multiyear initiative. Phone visits, virtual visits as well as additional services (i.e., lab, X-ray, surgery, care from external providers) will be introduced in later phases.
*Enhancements are coming to include metered benefits in a later phase to allow for the correct calculation of the cost estimate based on the visit limits.
