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
Emotional Wellness
Kaiser HMO N. CA Chiropractic and Acupuncture Evidence of Coverage (EOC)
Kaiser HMO N. CA Evidence of Coverage (EOC)
Kaiser HMO N. CA Preventive Care Services
Kaiser HMO N. CA Summary of Benefits and Coverage (SBC)
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