Kaiser HMO

Below is a brief outline of benefits provided under the Kaiser HMO plan. Refer to the official benefits booklet for a comprehensive description of plan benefits. Under all circumstances, the benefits booklet will take precedence over information contained on this website.  Contact Kaiser Permanente for questions of coverage.  


Deductible   2023: $250 individual/$500 family; 2022: none
Annual Out of Pocket Max $2,000 individual/$4,000 family
Lifetime maximum benefit Unlimited
Office Visits 100% after $25 copay

Preventive Care

Immunizations 100%
Adult physicals 100%
Well-woman exams/screenings 100%
Well-baby exams 100%

Other Care

Emergency Room
(copay waived if admitted)
$100 copay
Inpatient hospital services 100%
Outpatient hospital services 100% after $25 copay
Outpatient surgical center 100% after $25 copay

Prescription drugs (retail/pharmacy)

  30-day supply 
Generic $10 copay
Brand formulary $30 copay
Nonformulary N/A

Prescription drugs (mail order)

  90-day supply
Generic $20 copay
Brand formulary $60 copay
Nonformulary N/A