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   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