Kaiser HMO N. CA

The Kaiser Health Maintenance Organization (HMO) Plan is only available to employees who live within Kaiser’s Northern California region 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. 

You must meet your annual deductible before the plan begins to pay benefits. However, co-pays for office, specialist visits and prescription drugs do not apply to your annual deductible, but do apply to your annual 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 Individual: $250
Family: $500
Not Covered
Annual Out-of-Pocket (OOP) Maximum1 Individual: $1,500
Family: $3,000
Not Covered
Employee Coinsurance 10% after deductible Not Covered
Preventive (Annual Physicals, Well Care Exams) 100% covered, not subject to deductible Not Covered
Physician Visits Primary Care: $20/visit
Specialists: $30/visit
Not Covered
Lab and X-Ray 10% after deductible Not Covered
Emergency Room2 10% after deductible Not Covered
Ambulance 10% after deductible Not Covered
Hospitalization 10% after deductible Not Covered
Chiropractic $15/visit
Up to 30 visits/year
Not Covered
Acupuncture $20/visit
Referral required
Not Covered
Massage Not Covered Not Covered
Speech Therapy2 $20 after deductible Not Covered
Infertility/Fertility Preservation 50% coinsurance/visit
(Does not include GIFT, ZIFT or IVF)3
Not Covered

1 OOP maximum includes Prescription Rx.
2 Available to those with conditions of medical necessity.
3 GIFT is a gamete intrafallopian transfer. ZIFT is a zygote intrafallopian transfer. IVF is in-vitro fertilization.

Employee Contributions for 2019

Per Paycheck1

Plan Employee Only Employee +
Spouse/Domestic Partner
Employee + Child(ren) Employee + Family
Kaiser HMO N. CA $72.38 $159.23 $137.52 $231.61

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).