Sep 18, 2024
Q1 2025 Rate and Product Updates
All medical plans have rate and plan name changes for January 2025.
Both Medical and Ancillary rates are available for January 1 – December 1, 2025 effective dates.
You can begin quoting January 2025 now!
Rate Increases:
- 5.1% for SoCal and 8.2% for NorCal HMO plans.
- 7.0% increase for SoCal and NorCal PPO plans.
Ancillary Rates:
No changes for 2025 (family dental, chiro, ancillary).
Plan Discontinuation:
KP will be discontinuing the Bronze 60 HMO 5400/60 Plan for 2025.
- At renewal, members who are in the 2024 Bronze 60 HMO 5400/60 + Child Dental Alt will be mapped into the 2025 Bronze 5800/60 PCP + Child Dental plan.
Renewal Notices:
Available to brokers starting October 3rd.
Plan Changes
Plan names: Primary Care Provider (PCP) has been added to all 2025 on- and off-exchange plan names
Discontinuation:
- Bronze 60 HMO 5400/60 will be replaced with Bronze 5800/60 PCP + Child Dental in 2025.
New Buy-Up Option:
- Silver 70 HMO 2900/65 PCP + Child Dental (includes self-referred acupuncture/chiro).
Primary Plan Changes:
- Gold HMO:
- Gold 80 HMO 1000/40: OOP max increased to $8,200/$16,400.
- Gold 80 HDHP HMO 1750/15%: Medical deductible increased to $1,750/$3,300.
- Silver HMO:
- Silver 70 HDHP HMO 2900/65: Medical deductible reduced to $2,900/$15,800.
- Silver 70 HDHP HMO 2850/25%: Medical deductible increased to $2,850/$3,300.
- Bronze HMO:
- Bronze 60 HMO 5800/60: Deductibles reduced to $5,800/$11,600.
- Bronze 60 HDHP HMO 6650/0%: Deductibles reduced to $6,650/$13,300.
- Bronze PPO:
- Bronze 60 PPO 5800/60: Deductibles and OOP max decreased for both in- and out-of-network.
Just for Brokers
Small Group Bonus
In 2024 through to January 31, 2025, you'll earn a bonus per enrolled member when you enroll at least 10 members from a new, qualified small group. This applies to new small groups through direct sales, General Agency, CaliforniaChoice®, and Covered California for Small Business.
ex: If you sell a new group with 30 full-time employees and enroll 21 new members with Kaiser Permanente, that's a bonus of $2,100
In 2024, you'll earn a one-time reward when Kaiser Permanente is the sole carrier for any of your new or renewing groups. The Total Replacement Reward is only available for each qualifying total replacement group sale or renewal made directly with Kaiser Permanente.
Key Market Insights
Virgin Groups Growth: 65% of new business comes from virgin groups (no prior insurance).
Strong Retention: 90% retention over the past several years—thanks to popular plans and flexible slicing options.
Competitive Slice Offering: 47% of business in California Choice involves slice arrangements with another carrier.
ACA and Market Dynamics: 71% of covered members are on ACA plans, with 22% in alternative plans. ICRAs are affecting the ACA marketplace, influencing risk pools and rates.
Participation Requirements (for Slice Groups, effective 1/2025)
1-20 eligible employees: At least 1 must enroll.
21-50 eligible employees: At least 3 must enroll.
51+ eligible employees: At least 5 must enroll.
Underwriting changes are still pending review and will be updated once complete.
Strategic Focus Areas for 2025
- AI and Digital Strategy: Investments in broker portal enhancements, payment management, and streamlined enrollment (DocuSign integration).
Member Perks
Expanding access to care in Monterey County, opening January 2025.
- New Salinas medical offices to offer outpatient care: adult and pediatric primary care, OB-GYN, labs, and pharmacy services.
- Inpatient care available at Watsonville Community Hospital, coordinated by Kaiser Permanente physicians.
Value Adds: Virtual care with $0 co-pay, integrated with in-person care. Telus Health partnership continuation for EAP services.
Kaiser will be continuing the current value add programs including
- ClassPass
- Calm App
- MyStrength
- Ginger
Contact your Amwins Connect Regional Sales Manager for more information.
