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Kaiser Permanente HMO

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 detailed information about the Kaiser Permanente HMO

Basics  

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  

Physical exams for adults

100%

Physical exams for children

100%

Pap smears

100%

Immunizations

 100% Office visit copay applies if provided during doctor office visit
Well-woman visits 100%
Prescription Drugs  

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.