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  (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 and overview of coverage 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 have access to no-cost routine eye exams. Coverage for eye exams is provided only at Kaiser facilities. Optical eyewear is not covered. 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 and overview of coverage
Kaiser Summary of Benefits and Coverage
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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