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
|Annual Deductible||Individual: $250
|Annual Out-of-Pocket (OOP) Maximum1||Individual: $1,500
|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
|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|
Up to 30 visits/year
|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
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
|Plan||Employee Only||Employee +
|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).
- 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).
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