Kaiser HMO HI
The Kaiser Health Maintenance Organization (HMO) Plan is only available to employees who live within Kaiser’s Hawaiian region service area. With the Kaiser HMO HI plan, you must see providers within the Kaiser network (except in an emergency). The plan requires that you select a Primary Care Physician (PCP) to coordinate all your healthcare needs, including arranging for hospitalization and referrals to specialists. Visit Find a Doctor to see if your provider is in-network.
The Kaiser HMO HI plan includes prescription drug coverage. Visit the Pharmacy page for more information.
With the Kaiser HMO HI plan, you are eligible to enroll in the General Purpose Flexible Spending Account (GPFSA) for your out-of-pocket expenses.
Kaiser HMO HI Plan Details
|Annual Deductible||N/A||Not Covered|
|Annual Out-of-Pocket (OOP) Maximum1||Individual: $2,500
|Employee Coinsurance||Applies to certain medical procedures only||Not Covered|
|Preventive (Annual Physicals, Well Care Exams)||100% covered||Not Covered|
|Physician Visits||$15/visit||Not Covered|
|Lab and X-Ray||$10/visit
20% coinsurance for complex imaging
|Emergency Room2||$100/visit||Not Covered|
|Ambulance||20% coinsurance||Not Covered|
Up to a combined 30 visits/year with Acupuncture
Up to a combined 30 visits/year with Chiropractic
|Massage||Not Covered||Not Covered|
Short-term therapy only
20% IVF3 (1 cycle/lifetime)
1 OOP maximum includes Prescription Rx.
2 Available to those with conditions of medical necessity.
3 IVF is in-vitro fertilization.
Employee Contributions for 2022
|Plan||Employee Only||Employee +
|Employee + Child(ren)||Employee + Family|
|Kaiser HMO HI||$96.67||$193.21||$173.89||$289.81|
1 Per paycheck contributions are 24 times per year. Contributions are pre-tax (except for Domestic Partner coverage).
- Your spouse or domestic partner. Please note: after-tax contributions and imputed income may apply when covering a domestic partner. See the Domestic Partner Imputed Income Rate Table for details.
- Your child(ren), your spouse’s / domestic partner’s child(ren), the minor(s) you have legal guardianship of are eligible for medical coverage until age 26, regardless of marital or student status.
For more details see the Kaiser HI Summary of Benefits and Coverage (SBC).
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Last Updated: 26 Sep 2022, 3:11 PM