Medical Plan

Kaiser Permanente HMO Plan†

Enjoy a $0 deductible and low annual out-of-pocket maximum. Benefit Tip: This plan does not provide out-of-network coverage, and you must designate a Primary Care Physician before visiting the doctor. Kaiser HMO Plan Summary of Benefits

† Available to employees in the following states only: California, Colorado, Mid Atlantic, Georgia, Northwest and Washington.
Kaiser Permanente†*
In-Network Only
Calendar Year Deductible
Individual$0
Family$0
Calendar Year Out-of-Pocket Maximum (Includes Deductible)
Individual$1,500
Family$3,000
Coinsurance/CopaysYou Pay
Preventive Care$0
Primary Care Physician$25
Specialist$40
Urgent Care$25
Emergency Room$100
Inpatient Hospital$25
Mental Health & Substance AbuseYou Pay
Inpatient$12
Outpatient$5
Pharmacy Retail Rx (up to 30-day supply)You Pay
PreventiveN/A
Generic$10
Preferred Brand$35
Non-Preferred BrandN/A
SpecialtyN/A
Mail Order Rx (up to 90-day supply)You Pay
PreventiveN/A
Generic$20
Preferred Brand$70
Non-Preferred BrandN/A
Specialty (30-day supply only)N/A
*The benefits for Colorado are as follows: Inpatient Hospital is $250 copay. Inpatient Mental Health & Substance Abuse is $250 copay.
† Available to employees in the following states only: California, Colorado, Mid Atlantic, Georgia, Northwest and Washington.