Important changes to California COVID-19 coverage
California’s mandatory waiver of all member cost sharing for the COVID-19 vaccine, COVID-19 home antigen tests, PCR tests, and COVID-19 drug therapies outside the Kaiser Permanente network ended on November 11, 2023.

Timing
Starting November 12, 2023, commercially-insured members can continue to get COVID-19 care at no cost when it’s provided in the Kaiser Permanente network.
This includes vaccines, testing (including PCR tests and up to 8 home antigen tests per month), and therapeutics.

If these members choose to get a COVID-19 vaccine, testing, or drug therapy outside of Kaiser Permanente, they'll be responsible for some cost sharing unless these services are delivered as part of covered urgent or emergency care. For many members, reimbursement could be less than 50% of the cost of the services provided.

Medi-Cal members: COVID-19 care is covered at no-cost when received from Kaiser Permanente or out-of-network providers.

Medicare members: In compliance with federal Medicare coverage requirements:

• COVID-19 vaccines are covered at no-cost.
• PCR tests and treatment is covered with applicable plan out-of-pocket costs.
• Home antigen tests are not covered.
• COVID-19 care received out-of-network will only be covered for emergency and urgent care situations, when legally required, or when out-of-network coverage is included in your plan.

Employer responsibility related to this change
California employees should be notified of the change to their Covid-19 coverage within 30 days of receiving notice about the updates. Please find this customizable email that you can send to your California employees to notify them about this change.

Claims Submission
Members may submit claims to get reimbursed for some of the costs paid for COVID-19 vaccines, testing, and therapeutics outside the Kaiser Permanente network. For many members, reimbursement could be less than 50% of the cost of the services provided.

California
To submit a claimfor reimbursement:

• Visit kp.org/billing.
• Go to the “Understand your costs” section.
• Click “Submit a claim.”

If online access is unavailable, members can call the Member Services number on the back of their membership card and ask to have a claim form mailed to them.

All other regions
Kaiser Permanente recommends members receive COVID-19 care at a Kaiser Permanente facility. The updated COVID-19 vaccines will be covered according to the coverage of routine vaccinations provided by your plan benefits when administered at a Kaiser Permanente facility. In most instances, out-of-network COVID-19 vaccinations will not be covered, unless your plan covers out-of-network services.

Medicaid
Until September 30, 2024, Medicaid health plan members may submit a claim to get reimbursed for the cost they paid to an out-of-network provider for the updated COVID-19 vaccine.

OON
Unless the member’s plan covers out-of-network services (most do not), they will have to pay for the vaccine administered by an out-of-network provider.

If your employees have questions, more information can be found at kp.org/covid

How Kaiser Permanente is notifying your employees of this benefit change
Those employees that have Cobra coverage or that have elected individual coverage through Kaiser Permanente were sent notification of the Covid-19 benefit changes.

All other members will be notified about this benefit update through kp.org and other COVID-19 communications.