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Kaiser Permanente HMO

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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.

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.)

Kaiser Mobile Health Clinic (located at Campus Drive and Bonair Siding in the Maples Parking Lot)

NOTE: Due to a low utilization rate, Dec. 20, 2022, will be the last day the Kaiser Mobile Health Clinic will be on Stanford Campus. If you have questions or need care, browse through Kaiser Permanente’s telehealth options or call 1-866-454-8855 (TTY 711) to get care advice. 

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. 

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.