Kaiser HMO

With Kaiser Permanente HMO plan, you get a wide range of care and support to help you stay healthy. The Kaiser Permanente HMO  (group #101728) is a staff model HMO plan, which means that it owns its own facilities and employs physicians. You must choose a Kaiser doctor as your primary care physician to be your first point of contact, coordinate your care, and make referrals. You must receive services from Kaiser or obtain authorization from Kaiser before obtaining care outside the HMO. Visit the Kaiser Permanente Interactive Presentation and refer to the Kaiser Benefit Summary to learn more.

You pay a copayment at the time of service ($25 for a primary care visit; $50 for a specialty visit), then you are covered at 100% of authorized services with no deductibles. For additional details, see the Kaiser Evidence of Coverage.

You pay a $25 copayment for routine eye exams. Optical eyewear is not covered. Coverage for vision care services is provided only at Kaiser facilities. Participants may purchase additional vision care through Vision Service Plan.

Annual out-of-pocket medical and prescription maximums:

  • $3000 maximum – individual
  • $6000 maximum – family

Kaiser facilities are located throughout Southern California – see list on the Kaiser site. To enroll in Kaiser, you must reside within their Southern California service area.

Getting prescriptions

You pay $15 per generic prescription and $35 per brand name prescription for up to a 30-day supply at Kaiser Permanente pharmacies. An up to 100-day supply is available through mail order.

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Wellness programs and resources

Kaiser Healthy Resources
Care for the whole you
Self-care apps
Community resources

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Plan documents

Kaiser Evidence of Coverage
Kaiser Benefit Summary
Kaiser Summary of Benefits and Coverage (2023)
Right care, Right time
Away from home care

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Contact information

Kaiser Permanente | www.kaiserpermanente.org

(800) 464-4000
(800) 788-0616 en Español

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COVID-19 resources

  • For all Kaiser Permanente plans, cost sharing (deductibles, copayments, and coinsurance) will be reduced to zero ($0.00) for medically necessary screening and testing for COVID-19 including the visit, associated lab testing, and radiology services in a plan hospital, emergency or urgent care setting, or medical office. If a member is diagnosed with COVID-19, all treatment including but not limited to hospital, transportation, and pharmacy services will be covered in accordance with the terms and conditions set forth in the coverage document for the member’s health plan.
  • If you have any further questions, visit KP.org. We also recommend the Centers for Disease Control and Prevention website at cdc.gov for the most up-to-date health advisories and global coronavirus information.

Beginning Saturday, Jan. 15, 2022, members covered by private health insurance or a group health plan are now able to purchase over-the-counter (OTC) COVID-19 tests authorized by the U.S. Food and Drug Administration (FDA) at no cost without a prescription. The reimbursement of OTC COVID-19 tests will remain in effect until November 12, 2023.

Members can submit a reimbursement claim for tests purchased on or after January 15, 2022.

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