The Kaiser Permanente HMO (group #101728) is a staff model HMO plan which means that it owns its own facilities and employs physicians (Kaiser contracts with Permanente Medical Group). Kaiser Permanente healthcare providers exclusively serve Kaiser plan members. You must choose a Kaiser doctor as your primary care physician to be your first point of contact, and coordinate your care and make referrals. You must receive services from Kaiser, or obtain authorization from Kaiser before obtaining care outside the HMO.
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 2018 Evidence of Coverage.
Kaiser facilities are located throughout Southern California. A list of their locations is available on the Kaiser site. To enroll in Kaiser, you must reside within their service area.
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.
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.
Annual out-of-pocket medical and prescription maximums
- $3000 maximum – individual
- $6000 maximum – family
Kaiser Permanente | www.kaiserpermanente.org
(800) 788-0616 en Español