Kaiser HMO

The Kaiser HMO medical plan features copays for most services with no deductible to satisfy before the plan pays for eligible services. The HMO does not include out-of-network coverage, so you’ll need to coordinate your care with a Primary Care Physician (PCP).

Kaiser is only available to California residents. There are two plans available, for Northern California and Southern California enrollees.

Kaiser HMO Medical Plan Northern CA (Group # 707505)

	In-Network Only
Annual Deductible	None
Accumulation Period	Time period to incur eligible expenses toward the deductible: Calendar Year
Annual Out-of-Pocket Maximum	$1,500 per individual, up to $3,000 per family
Office Visit	$15 copay for primary care physician or specialist
Chiropractic	$15 copay (coverage limited to 20 visits per calendar year)
Lab and X-ray	No charge
Urgent Care	$15 copay
Emergency Room	$100 copay (copay waived if admitted)
Hospitalization	$250 copay per admission
Outpatient Surgery	$100 copay per procedure

Plan Documents

Northern CA Kaiser Plan Benefit Summary

Kaiser HMO Medical Plan Southern CA (Group # 235801)

	In-Network Only
Annual Deductible	None
Accumulation Period	Time period to incur eligible expenses toward the deductible: Calendar Year
Annual Out-of-Pocket Maximum	$1,500 per individual, up to $3,000 per family
Office Visit	$15 copay for primary care physician or specialist
Chiropractic	$15 copay (coverage limited to 20 visits per calendar year)
Lab and X-ray	No charge
Urgent Care	$15 copay
Emergency Room	$100 copay (copay waived if admitted)
Hospitalization	$250 copay per admission
Outpatient Surgery	$100 copay per procedure

Plan Documents

Southern CA Kaiser Plan Benefit Summary

Prescription Drug Coverage

	In-Network Only
Deductible	N/A
Out-of-Pocket Maximum	Combined with medical;
Generic	$10 copay
Brand Name	$20 copay
Specialty	20% coinsurance up to $150 per script
Mail Order	100 days supply
Generic	$20 copay
Brand Name	$40 copay

Save on Prescriptions

Go Generic: If you’re looking to minimize your out-of-pocket costs, use generic drug options when possible. Generic drugs have the same active ingredients as their brand-name counterparts but your copay will be less.

Mail-Order: If you’re taking a medication for a chronic condition, you can also save money by utilizing mail-order options, offering convenience and a larger supply for the same copay.