Kaiser Permanente HMO
Compare Medical Plans & Costs
Active employees and official retirees can use this tool to compare medical benefits, as well as plan costs.
Find More Information
Kaiser Permanente is a Health Maintenance Organization (HMO) that provides patient services, hospitalization, supplies and prescription drugs through its own network of doctors, hospitals and other Kaiser-affiliated health care facilities.
View plan information and resources for the Kaiser Permanente HMO
| BASICS | Benefit |
|---|---|
| Overview | You may use only Kaiser Permanente doctors and facilities except in emergencies. Group #7145 (Northern CA) Group #230178 (Southern CA) |
| Pre-Authorization Requirement | Pre-authorization required for all elective inpatient and outpatient procedures. PENALTY for not pre-authorizing: not covered. |
| Office copay | $30 copay primary/$50 copay specialist |
| Deductible | No deductible |
| Out-of-Pocket Maximum | $3,500 per individual/$7,000 family A single out-of-pocket maximum applies to all coverage under the plan, including medical and prescription drugs. (This will cover prescriptions and medical expenses at 100% once the out-of-pocket maximum is met.) |
| PREVENTATIVE CARE | Benefit |
|---|---|
| Physical exams for adults | 100% |
| Physical exams for children | 100% |
| Pap smears | 100% |
| Immunizations | 100% Office visit copay applies if provided during the doctor office visit |
| Well-woman visits | 100% |
| Reproductive Health | Kaiser Permanente provides the full range of comprehensive, integrated women’s health services including prenatal, maternity, family planning, contraception, and pregnancy termination services. In California and Hawaii, surgical and medical abortions remain protected under state laws and there are no restrictions on abortion benefits. This means that members do not need to access travel and lodging benefits at this time. The co-payment for pregnancy termination services is $50. |
| PRESCRIPTION DRUGS | Benefit |
|---|---|
| Pharmacy (Retail) | Kaiser Permanente Pharmacy Generic: $10 for up to a 30-day supply, $20 for a 31- to 60-day supply, or $30 for a 61- to 100-day supply Brand: $40 for up to a 30-day supply, $80 for a 31- to 60-day supply, or $120 for a 61- to 100-day supply |
| Mail order drug program | Kaiser Permanente Mail Order Pharmacy Generic: $10 up to a 30-day supply; $20 for a 31-100 day supply Brand: $40 up to a 30-day supply; $80 for a 31-100 day supply |
| Birth Control Pills | Included in Prescription Drug benefit, covered at 100% |
Traveling Outside the U.S.
Your Kaiser HMO plan provides services in California only. You receive no coverage for routine services outside the service area. However, Kaiser provides “Emergency Care” coverage anywhere you may experience an emergency that is life-threatening in nature.
- View the Kaiser - Coverage When Traveling (MCI International Access) Brochure
- Learn more about traveling outside the U.S.
If you need to file a claim for emergency care received while overseas, download the Kaiser emergency claim form or contact Kaiser to have an emergency claim form sent to you.
Plan Information and Resources for Kaiser Permanente HMO
2024 Plan Documents
- Kaiser Permanente Summary of Benefits and Coverage
An SBC is an overview of plan benefits, deductibles, copays, and coverage levels for a variety of commonly used medical treatments and services.
- Kaiser Permanente Summary Plan Description
An SPD or EOC is the official, detailed plan document for each plan outlining information about eligibility; costs and cost sharing; included and excluded services; claims process; procedures for filing grievances, complaints and appeals.
Plan Forms & Resources
Coming soon!