Kaiser Southern California Only
Kaiser Permanente HMO
If you live or work in Southern California and are enrolled in the Kaiser HMO, you have the convenience of having all of your health care needs under one integrated group of physicians. A primary care physician provides routine services and refers you to other providers within the Kaiser network when you need to see a specialist or be hospitalized. You must receive non-emergency care and services from providers within Kaiser’s network.
Kaiser HMO Plan Summary
The deductibles and coinsurance below indicate the amounts for which you are responsible.
| Kaiser HMO Plan (Southern CA Area Only) | ||
|---|---|---|
| Plan Features | In-Network | |
| Plan Deductible (Indiv./Fam.) | None | |
| Out-of-pocket Maximum (Indiv./Fam.) | $1,500 / $3,000 | |
| Plan Coinsurance | None | |
| Lifetime Maximum | Unlimited | |
| Office Visit |
$20 Copay | |
| Preventive Care Office Visit | No charge | |
| Specialist Office Visit | $20 Copay | |
| Basic Lab & X-ray | No charge | |
| Complex Lab & X-ray | No charge | |
| Hospital Services | $250 Copay per admission | |
| Emergency Room | $100 Copay | |
| Durable Medical Equipment | 20% | |
| Infertility Treatment | 50% | |
| Prescription Drug (up to a 30 day supply) | ||
| Deductible | None | |
| Generic / Brand / Non-Formulary | $10 / $25 / Not Covered | |
| Mail Order Pharmacy (up to a 100 day supply) | $20 / $50 | |