Overview of Our Kaiser Permanente Medical Plans
If you reside in Washington, Oregon or California, you have an additional medical plan provider to choose from, Kaiser Permanente.
Kaiser California Plans
|
HMO Plan |
HSA High Deductible Plan |
|
|---|---|---|
|
In-Network Only |
In-Network Only |
|
Calendar Year Deductible |
No deductible |
$2,000 Employee Only; |
Maximum Out-of-Pocket |
$1,500 Individual |
$3,200 Employee Only; |
Preventive Care |
$0 |
$0 (deductible waived) |
Preventive Lab Work |
$0 |
$0 (deductible waived) |
Virtual Visits |
$0 |
$0* |
Office Visits/Urgent Care |
$20 |
$30* |
Naturopathy Visits |
Not covered |
Not covered |
Diagnostic Lab & X-rays |
$5 |
$10* |
Well Baby Care (screenings, immunizations & vaccinations) |
$0 |
$0 (deductible waived) |
Emergency Room |
$100 |
$100* |
Hospitalization |
$100/day |
$250/admission* |
Outpatient Surgery |
$20 |
$150* |
Pregnancy & Maternity |
$0** |
$10 (deductible waived) |
Rehabilitative Therapy |
$20 |
$30* |
Chiropractic & Acupuncture |
$15 up to 20 visits |
$15* for chiropractic & |
Prescriptions: Mail order available under all plans (up to a 90- or 100-day supply) |
$10 Generic |
$10 Generic* |
*Co-pay rate applies after the deductible has been met.
**For office visits and for inpatient stay, refer to hospitalization benefit.
HMO Plan
The Kaiser Permanente Plan provides complete medical services from an exclusive network of Kaiser providers. An all in-network facility means Kaiser employs their own doctors and nurses, builds their own hospitals and runs their own emergency rooms. The doctors spend less time focusing on insurance forms and more time focusing on you. With this plan, you are required to stay within the Kaiser network for all non-emergency care.
There is no annual deductible before the plan begins to pay benefits. You’ll pay a fixed amount (copayment) each time you receive non-preventive, in-network care until you reach the annual out-of-pocket limit ($1,500 individual/$3,000 family). This plan has lower copayment amounts than the other medical plan options.
-
You’ll pay $10 for tier-1 drugs (generic), $20 for preferred brand name drugs, and $20 for non-preferred brand name drugs at a preferred retail store.
HSA High Deductible Plan
The Kaiser Permanente Plan provides complete medical services from an exclusive network of Kaiser providers. An all in-network facility means Kaiser employs its own doctors and nurses, builds its own hospitals and runs its own emergency rooms. The doctors spend less time focusing on insurance forms and more time focusing on you. With this plan, you are required to stay within the Kaiser network for all non-emergency care.
The High-Deductible HMO plan works the same as the traditional Kaiser HMO, but with a much higher out-of-pocket deductible amount ($2,000 individual/$4,000 family). All medical costs are your responsibility up until you meet the annual deductible. If you meet the deductible amount, you would then be responsible for the copays and/or coinsurance amounts (20% in some instances) up until you reach the out-of-pocket maximum ($3,000 individual/$6,000 family).
-
After your deductible, you’ll pay $10 for generic drugs, $30 for preferred brand name drugs, and $30 for non-preferred brand name drugs at a preferred retail store.
-
The high-deductible medical plan qualifies you to open a Health Savings Account (HSA). The Health Savings Account not only allows you to contribute pre-tax dollars for current and future medical expenses (no “use it or lose it”), but it also allows you to take advantage of the company’s dollar-for-dollar matching monthly contribution.
Each year, you could receive up to $1,000 for individual coverage and $2,000 for family coverage in company contributions. This covers half of your deductible amount. Your Health Savings Account dollars can then be used to pay for eligible medical expenses tax-free! For more information on what the IRS considers an eligible medical expense, see Publication 502.
Kaiser Northwest Plans
HMO Plan |
HSA High Deductible Plan |
|
|---|---|---|
In-Network Only |
In-Network Only |
|
Calendar Year Deductible |
No deductible |
$2,000 Employee Only; |
Maximum Out-of-Pocket |
$1,500 Individual |
$3,000 Employee Only; |
Preventive Care |
$0 |
$0 (deductible waived) |
Preventive Lab Work |
$0 |
$0 (deductible waived) |
Virtual Visits |
$0 |
$0 (deductible waived) |
Office Visits/Urgent Care |
$20 |
20%* |
Naturopathy Visits |
$20 |
20%* |
Diagnostic Lab & X-rays |
$10 |
20%* |
Well Baby Care |
No charge |
$0 (deductible waived) |
Emergency Room |
$100 |
20%* |
Hospitalization |
$100/day up to $500/adm |
20%* |
Outpatient Surgery |
$50 |
20%* |
Pregnancy & Maternity |
No charge** |
$0 prenatal care |
Rehabilitative Therapy |
20%* up to 20 visits |
20%* up to 20 visits |
Chiropractic |
$20 up to 20 visits |
20% up to 20 visits |
Acupuncture |
$20 up to 20 visits |
20% up to 20 visits |
Prescriptions: |
$10 Generic |
$10 Generic* |
*Coinsurance/co-pay rate applies after the deductible has been met.
**For office visits and for inpatient stay, refer to hospitalization benefit.
HMO Plan
The Kaiser Permanente Plan provides complete medical services from an exclusive network of Kaiser providers. An all in-network facility means Kaiser employs their own doctors and nurses, builds their own hospitals and runs their own emergency rooms. The doctors spend less time focusing on insurance forms and more time focusing on you. With this plan, you are required to stay within the Kaiser network for all non-emergency care.
There is no annual deductible before the plan begins to pay benefits. You’ll pay a fixed amount (copayment) each time you receive non-preventive, in-network care until you reach the annual out-of-pocket limit ($1,500 individual/$3,000 family). This plan has lower copayment amounts than the other medical plan options.
-
You’ll pay $10 for tier-1 drugs (generic), $20 for preferred brand name drugs, and $20 for non-preferred brand name drugs at a preferred retail store.
HSA High Deductible Plan
The Kaiser Permanente Plan provides complete medical services from an exclusive network of Kaiser providers. An all in-network facility means Kaiser employs its own doctors and nurses, builds its own hospitals and runs its own emergency rooms. The doctors spend less time focusing on insurance forms and more time focusing on you. With this plan, you are required to stay within the Kaiser network for all non-emergency care.
The High-Deductible HMO plan works the same as the traditional Kaiser HMO, but with a much higher out-of-pocket deductible amount ($2,000 individual/$4,000 family). All medical costs are your responsibility up until you meet the annual deductible. If you meet the deductible amount, you would then be responsible for the copays and/or coinsurance amounts (20% in some instances) up until you reach the out-of-pocket maximum ($3,000 individual/$6,000 family).
-
After your deductible, you’ll pay $10 for generic drugs, $30 for preferred brand name drugs, and $30 for non-preferred brand name drugs at a preferred retail store.
-
The high-deductible medical plan qualifies you to open a Health Savings Account (HSA). The Health Savings Account not only allows you to contribute pre-tax dollars for current and future medical expenses (no “use it or lose it”), but it also allows you to take advantage of the company’s dollar-for-dollar matching monthly contribution.
Each year, you could receive up to $1,000 for individual coverage and $2,000 for family coverage in company contributions. This covers half of your deductible amount. Your Health Savings Account dollars can then be used to pay for eligible medical expenses tax-free! For more information on what the IRS considers an eligible medical expense, see Publication 502.