Kaiser HMO N. CA

The Kaiser Health Maintenance Organization (HMO) Plan is available to employees who live within Kaiser’s Northern California or Southern California service area. With the Kaiser HMO N. CA 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. 

This option allows S.CA and N.CA eligible members to enroll under the Kaiser N.CA medical plan and receive services in both N.CA and S.CA.

Enrollees will receive two membership ID cards (prefix 00 for S.CA and prefix 11 for N.CA). Carry both cards with you as it may be necessary to present when using services in different regions.

Kaiser is moving to laminated ID cards and digital ID cards – review Resources section on ID cards.

There is no plan deductible. However there are copays for office visits, emergency visits and prescription drugs which count towards the out of pocket maximum.  For more information refer to the Kaiser HMO N.CA Summary of Benefits and Coverage (SBC). Visit the Pharmacy page for more information on your prescription drug benefits.

With the Kaiser HMO N. CA plan, you are eligible to enroll in the General Purpose Flexible Spending Account (GPFSA) for your out-of-pocket expenses.

Kaiser HMO N. CA Plan Details

In-Network Out-of-Network
Annual Deductible N/A Not Covered
Annual Out-of-Pocket (OOP) Maximum1 Individual: $2,000
Family: $4,000
Not Covered
Employee Coinsurance 20% Durable Equipment Not Covered
Preventive (Annual Physicals, Well Care Exams) 100% covered Not Covered
Physician Visits Primary Care: $20/visit
Specialists: $20/visit
Not Covered
Lab and X-Ray 100% covered Not Covered
Emergency Room2 $150 / visit Not Covered
Ambulance $50 / trip Not Covered
Hospitalization $250 / admission Not Covered
Chiropractic $15/visit
Up to 30 visits/year
Not Covered
Acupuncture $15/visit
Up to 30 visits/year
Not Covered
Massage Not Covered Not Covered
Speech Therapy2 $20 Not Covered
Assisted Reproductive Technology (ART) 50% coinsurance/visit
One treatment cycle per lifetime of member under any group – Review Resources for Kaiser EOC for details
Not Covered

1 OOP maximum includes Prescription Rx.
2 Available to those with conditions of medical necessity.

Employee Contributions for 2021

Per Paycheck1

Plan Employee Only Employee +
Spouse/Domestic Partner
Employee + Child(ren) Employee + Family
Kaiser HMO N. CA $93.02 $204.64 $176.74 $297.66

1 Per paycheck contributions are 24 times per year. Contributions are pre-tax (except for Domestic Partner coverage).

Dependent Eligibility

  • 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 HMO N.CA Summary of Benefits and Coverage (SBC).

Contact Us

HR Source
ASK HR [VMware network access required]
Phone: 1-888-VMWARE8, option ‘US Benefits’
Internal Phone: ext. 29200


Kaiser
Phone: 1-800-464-4000
Visit website

Resources

Benefits Vendor Contact Information


Domestic Partner Imputed Income Rate Table


Kaiser HMO N. CA Benefit Summary

Kaiser Overview 2021


Emotional Wellness

myStrength App


Kaiser CALM App


Kaiser HMO N. CA Chiropractic and Acupuncture Evidence of Coverage (EOC) 2021


Kaiser HMO N. CA Evidence of Coverage (EOC) 2021


Kaiser HMO N. CA LGBTQ
Health


Kaiser HMO N. CA Preventive Care Services


Kaiser HMO N. CA Summary of Benefits and Coverage (SBC)


Kaiser HMO N. CA Video Visits


Kaiser Mobile Health Vehicle


Kaiser Digital ID card


Sample Laminate ID card


Key Benefit Terms


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