Kaiser Medical

Kaiser Permanente HMO or HDHP plan

You and your family receive preventive care services at little or no cost and have access to online features that let you manage most of your care.

Your benefits include:

Your choice of doctor for each family member for routine medical care
Simple copays or coinsurance for most covered services, including office visits and prescription drugs
Little or no cost for preventive care like routine physical exams, mammograms, and cholesterol screenings
Little to no paperwork or bills for the services you receive
No referrals needed for certain specialties, like optometry and routine obstetrics/gynecology
Telehealth options that provides convenient access to safe and high-quality virtual care
Mental well-being support for anxiety, stress, sleep and more with the help of self-care, evidence based, free apps, including as Calm, Ginger and myStrength.

Learn more about Kaiser Permanente

Availability

Kaiser Permanente offers health care for participants and their families in California, Colorado, Georgia, the Mid-Atlantic (Maryland, Virginia, and Washington, D.C.), Northwest, and Washington.

Urgent care

Members can get urgent care anywhere in the world. And outside Kaiser Permanente states, you’ll pay only their copay or coinsurance at the following locations — no need to file a claim later:

Cigna PPO Network
MinuteClinic, including pharmacies
Concentra

Emergency care

Members can go to the nearest hospital anywhere in the world and file a claim with Kaiser for reimbursement. If it’s a Kaiser Permanente or Cigna PPO Network location, you’ll pay only normal copay or coinsurance — no need to file a claim later.

The enrollment options in Workday will show if you live in a service area for these medical plans.

You have the option of the Kaiser Permanente HMO or Kaiser Permanente $2,000 HDHP plan.

Medical plans

HMO plan services

Deductibles

	CA	CO, GA, MD, DC, VA, OR and WA
Annual Deductible: Individual/Family	N/A	N/A
Calendar or Contract Year	N/A	N/A
Calendar or Contract Year - Embedded or Aggregate	N/A	N/A
Maximum Out-of-Pocket	$1500/$3000	$1500/$3000
Maximum Out-of-Pocket - Embedded or Aggregate	N/A	N/A
Coinsurance Member Cost Share	N/A	N/A

Outpatient doctor visits

	CA	CO, GA, MD, DC, VA, OR and WA
Primary Care	$25	$25
Specialist	$25	$25
Telemedicine	100% Covered	100% Covered

Hospital inpatient

	CA	CO, GA, MD, DC, VA, OR and WA
Services rendered while hospitalized (Per admit)	$500	$500

Emergency department visit

	CA	CO, GA, MD, DC, VA, OR and WA
Cost Share (In and Out of Plan)	$50	$50

Outpatient surgery

	CA	CO, GA, MD, DC, VA, OR and WA
Outpatient surgery in hospital or ambulatory surgical facility	$25	$25
Office Surgery Cost Share	$25	$25

Drug retail

	CA	CO, GA, MD, DC, VA, OR and WA
Tier 1 Generic	$10	$10 ¹
Tier 2 Formulary Brand	$20	$20 ²
Tier 3 Non-Formulary Brand	Not Available	Not Covered
Specialty Rx	20% up to a max of $150	20% up to a max of $150
Day Supply	30 days	30 days

Mail order

	CA	CO, GA, MD, DC, VA, OR and WA
Tier 1 Generic	$20	$20
Tier 2 Formulary Brand	$40	$40
Tier 3 Non-Formulary Brand	Not Available	Not Covered
Day Supply	100 days	90 days

Drug variations

	CA	CO, GA, MD, DC, VA, OR and WA
Contraceptives	$0	$0
Growth Hormone	Equal to generic/brand cost share	Equal to generic/brand cost share
Infertility	50%	50%
Sexual Dysfunction Cost Share	50%	50%
Smoking Cessation Cost Share	0%	0%
Weight Control	Not Covered	Not Covered

Infertility treatment services

	CA	CO, GA, MD, DC, VA, OR and WA
Cost Share	50%	50%
IVF, GIFT and ZIFT	Not Covered	Not Covered

Ambulance services

	CA	CO, GA, MD, DC, VA, OR and WA
Cost Share	$0	$0

Lab and X-ray (outpatient non-preventative)

	CA	CO, GA, MD, DC, VA, OR and WA
Cost Share	$0	$0

CT, MRI, PET, nuclear medicine (outpatient, per procedure)

	CA	CO, GA, MD, DC, VA, OR and WA
Cost Share	$0	$0

DME base

	CA	CO, GA, MD, DC, VA, OR and WA
Cost Share	$0	$0

Prosthetics and orthotics (base)

	CA	CO, GA, MD, DC, VA, OR and WA
Cost Share	$0	$0

Vision hardware for adults (supplemental)

	CA	CO, GA, MD, DC, VA, OR and WA
Cost Share	$0	$0

Hearing aids (mandate)

	CA	CO, GA, MD, DC, VA, OR and WA
Cost Share	Not Covered (unless where mandated)	Not Covered (unless where mandated)³

Chiropractic (supplemental - self referred)

	CA	CO, GA, MD, DC, VA, OR and WA
Cost Share	Not Covered	Not Covered⁴
Limits	N/A	N/A⁵

Urgent care clinic/after hours

	CA	CO, GA, MD, DC, VA, OR and WA
Cost Share	$25	$25

HDHP plan services