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 [1] 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) [2]. Visit the Pharmacy [3] 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) [4] 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
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 2020

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 [5] coverage).

Dependent Eligibility

For more details see the Kaiser HMO N.CA Summary of Benefits and Coverage (SBC) [2].