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.
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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.
Plan Details
View 2026 Plan Details for Kaiser California
View 2026 Plan Details for Kaiser Hawaii
2025 Plan Details (CA and HI)
| 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 CA plan provides services in California only. The Kaiser HMO HI plan provides services for those living in Hawaii. You may also visit Kaiser locations in other states we are not contracted with on a guest basis. You receive no coverage for routine services outside the service area. 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 Documents
Summary of Benefits Coverage (SBC)
An SBC is an overview of plan benefits, deductibles, copays, and coverage levels for a variety of commonly used medical treatments and services. Summary of Benefits Coverage (SBC)
Evidence of Coverage (EOC) / Summary Plan Description (SPD)
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.
2026 Plan Documents:
SBCs
- 2026 Kaiser Permanente (Nor Cal) HMO Summary of Benefits and Coverage
- 2026 Kaiser Permanente (So Cal) HMO Summary of Benefits and Coverage
- 2026 Kaiser Permanente (Hawaii) HMO Summary of Benefits and Coverage
EOCs / SPDs: coming soon
2025 Plan Documents:
SBCs
- 2025 Kaiser Permanente (Nor Cal) HMO Summary of Benefits and Coverage
- 2025 Kaiser Permanente (So Cal) HMO Summary of Benefits and Coverage
- 2025 Kaiser Permanente (Hawaii) HMO Summary of Benefits and Coverage
EODs / SPDs
2025 Kaiser (Nor Cal) HMO Evidence of Coverage/Summary Plan Description (long document)
2025 Kaiser (So Cal) HMO Evidence of Coverage/Summary Plan Description (long document)
2025 Kaiser (Hawaii) HMO Evidence of Coverage/Summary Plan Description (long document)
Resources
- Kaiser's 2021 Transgender Care & Coverage flyer
- Kaiser's National Transgender Resource Guide
- Kaiser's Mental & Behavioral Health resources
- Stanford's Mental & Behavioral Health resources
- What Kaiser does to help our members with mental health care
- Kaiser Northern California Pharmacy Notice of Claim
- Kaiser Emergency Medical Services Claim Form
- Kaiser - Coverage When Traveling (MCI International Access) Brochure
- Kaiser - Domestic and International care when traveling
- Kaiser emergency claim form (for emergency care while overseas)
- Kaiser: Care options while you're away from home (flyer)
- Kaiser Northern CA Fertility benefits for 2023 (flyer)
- Kaiser Southern CA Fertility benefits for 2023 (flyer)
- Kaiser CA HMO Active & Fit flyer
- Kaiser Hawaii HMO Fit Rewards flyer
- Kaiser Hawaii HMO Out of Area Dependent Coverage brochure