Kaiser Permanente HMO Medical Plan
The Health Maintenance Organization (HMO) medical plan is offered through Kaiser Permanente. The plan offers low copayments for primary care and specialist office visits, but care is only covered when you see in-network providers.
Kaiser HMO Medical Plan Overview
Deductibles and Out-of-Pocket Maximums
The Kaiser HMO Medical Plan does not have an annual deductible. The plan starts sharing the cost of care with you from day one. You will pay a copay or coinsurance when you receive care until you meet your out-of-pocket maximum.
If you enroll in family coverage, the out-of-pocket maximum is embedded, meaning each family member has their own individual out-of-pocket maximum to meet. Once a family member meets their out-of-pocket maximum, the plan begins covering 100% of eligible services for that person. Once any combination of family members meets the family out-of-pocket maximum, the plan starts paying for all covered family members.
Medical Plan Benefits
| Plan feature or covered service | In-network only |
| Annual deductible Individual / Family | None / None |
| Annual out-of-pocket maximum Individual / Family | $2,500 / $7,500 |
| Coinsurance | Not applicable |
| Preventive care | No cost |
| Primary care physician visit | $15 copay for adults age 18+ $0 copay for children through age 17 |
| Specialist office visit | $15 copay for adults age 18+ $0 copay for children through age 17 |
| Urgent care | $15 copay per visit |
| Emergency room | $75 copay per day |
| Inpatient hospital | $75 copay per day |
| Outpatient surgery | $15 copay per visit |
| Outpatient laboratory tests and X-rays | 90% |
Register Online
Create an online account with Kaiser Permanente to access helpful tools and resources for managing your health care. You can view lab results, choose a doctor, manage your explanations of benefits, and explore tips for healthy living.
Visit https://www.kp.org/thrive to get started. You will need the member identification number assigned by Kaiser Permanente to register for online services and the mobile app.
Kaiser Permanente Prescription Drug Coverage
What you pay for prescription drugs depends on the type of medication. The costs below apply to an in-network retail pharmacy for a 30-day supply. A 90-day supply is available via mail order. A mail-order 90-day supply costs two times the retail amount.
| Medication type | In-network retail cost (30-day supply) |
| Generic maintenance medication | $3 |
| Other generic medication | $10 |
| Preferred brand-name medication | $45 |
| Non-preferred brand-name medication | $45 |
| Specialty medication | $200 |
Using Your Prescription Drug Coverage
Refer to Kaiser Permanente’s drug formulary to check which medications are covered. On the Kaiser Permanente website, you can also review cost estimates, find an in-network pharmacy, register for mail-order delivery, and learn more about your prescription drug benefits. If you have questions about prescription drugs coverage, call 800-966-5955.