Additional plan information and resources
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Kaiser HMO Base & Buy-Up Plans (California Only) Overview
With these plans, you select a primary care physician (PCP) from the participating network of providers who will coordinate your health care needs, refer you to specialists (if needed) and approve further medical treatment. Services received outside of the HMO’s network are not covered, except in the case of emergency medical care.
Kaiser Plan Features
| Plan Feature | HMO Base Plan | HMO Buy-Up Plan |
|---|---|---|
| In-Network Only | In-Network Only | |
| Annual Deductible | ||
| Employee only | $750 | $250 |
| Family | $1500 | $500 |
| Annual Out-of-Pocket Maximum | ||
| Employee only | $3000 | $3000 |
| Family | $6000 | $6000 |
| Services | ||
| Office visit copays or coinsurance will be waived for mental health and substance abuse office and virtual visits | ||
| Preventive Care | Plan pays 100% | Plan pays 100% |
| Primary Care Physician Office Visit | $25 copay | $10 copay |
| Specialist Office Visit | $25 copay | $10 copay |
| Emergency Room Visit | Plan pays 80% after deductible | Plan pays 90% after deductible |
| Inpatient Hospital Stay | Plan pays 80% after deductible | Plan pays 90% after deductible |
| Prescription Drugs (Tier 1/Tier 2/Tier 3/Tier 4) | ||
| Retail (up to a 30-day supply) | $10/$30/$30/20% with a maximum of $250 | $10/$30/$30/20% with a maximum of $250 |
| Mail Order (up to a 90-day supply) | $20/$60/$60/20% with a maximum of $250 | $20/$60/$60/20% with a maximum of $250 |
How to Find a Provider
Medical
- Visit KP.org and
- Select Doctors & Locations
- Select either California-Northern or California – Southern
- Click to search by Doctors or Locations type
- Enter Zip Code or City and choose HMO in the Health Plan drop-down menu
- Click Search