Kaiser HMO CA

The Kaiser Health Maintenance Organization (HMO) Plan is available to employees who live within Kaiser’s California service area. With the Kaiser HMO 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 Southern California and Northern California eligible members to enroll under the Kaiser CA medical plan and receive services in both Northern and Southern California.

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 CA Summary of Benefits and Coverage (SBC). Visit the Pharmacy page for more information on your prescription drug benefits.

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

Kaiser HMO 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: $20/visit
Specialist: $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% 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 2023 Per Paycheck1

Plan Employee Only Employee +
Spouse/Domestic Partner
Employee + Child(ren) Employee + Family
Kaiser HMO N. CA $96.98 $213.35 $184.26 $310.33

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), and the minor(s) you have legal guardianship of are eligible for medical coverage until age 26, regardless of marital or student status.

Fo more details see the Kaiser HMO CA Summary of Benefits and Coverage (SBC).

Contact Us

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ASK HR [VMware network access required]
Phone: 1-888-869-2738

Phone: 1-800-464-4000
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Benefits Vendor Contact Information

Domestic Partner Imputed Income Rate Table

Kaiser HMO CA Benefit Summary

Kaiser Overview 2023

Emotional Wellness

myStrength App

Kaiser CALM App

Kaiser HMO CA Chiropractic and Acupuncture Evidence of Coverage (EOC) 2022

Kaiser HMO CA Evidence of Coverage (EOC) 2023


Kaiser HMO CA Preventive Care Services

Kaiser HMO CA Summary of Benefits and Coverage (SBC) 2023

Kaiser HMO California Arbitration Agreement

Kaiser HMO California Arbitration Agreement Fact Sheet

Kaiser HMO CA Video Visits

Kaiser Mobile Health Vehicle

Travel Outside Kaiser Areas

Kaiser Digital ID card

Sample Laminate ID card

Key Benefit Terms

Workday [VMware network access required]

Last Updated: 2 May 2023, 2:43 PM