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Kaiser Medical

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 $101
Tier 2 Formulary Brand $20 $202
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

Deductibles

  CA CO, GA, MD, DC, VA, OR and WA
Annual Deductible: Individual/Family $2000/$2800/$4000 (due to state law CA AB 1305) $2000/$4000
Calendar or Contract Year Calendar Calendar
Calendar or Contract Year - Embedded or Aggregate Embedded Aggregate
Maximum Out-of-Pocket $4000/$4000/$7900 $4000/$7900
Maximum Out-of-Pocket - Embedded or Aggregate Embedded Aggregate
Coinsurance Member Cost Share 20% 20%

Outpatient doctor visits

  CA CO, GA, MD, DC, VA, OR and WA
Primary Care 20% coinsurance after deductible 20% coinsurance after deductible
Specialist 20% coinsurance after deductible
20% coinsurance after deductible
Telemedicine 100% after deductible 100% after deductible

Hospital inpatient

  CA CO, GA, MD, DC, VA, OR and WA
Services rendered while hospitalized (Per admit) 20% coinsurance after deductible 20% coinsurance after deductible

Emergency department visit

  CA CO, GA, MD, DC, VA, OR and WA
Cost Share (In and Out of Plan) 20% coinsurance after deductible 20% coinsurance after deductible

Outpatient surgery

  CA CO, GA, MD, DC, VA, OR and WA
Outpatient surgery in hospital or ambulatory surgical facility 20% coinsurance after deductible 20% coinsurance after deductible
Office Surgery Cost Share 20% coinsurance after deductible 20% coinsurance after deductible

Drug retail

  CA CO, GA, MD, DC, VA, OR and WA
Tier 1 Generic 20% coinsurance after deductible up to per script max of $50 20% coinsurance after deductible 6
Tier 2 Formulary Brand 20% coinsurance after deductible up to per script max of $100 20% coinsurance after deductible 6
Tier 3 Non-Formulary Brand Not Available Not Covered
Specialty Rx 20% coinsurance after deductible up to per script max of $100 20% coinsurance after deductible
Day Supply 30 days 30 days

Mail order

  CA CO, GA, MD, DC, VA, OR and WA
Tier 1 Generic 20% coinsurance after deductible up to per script max of $50 20% coinsurance after deductible
Tier 2 Formulary Brand 20% coinsurance after deductible up to per script max of $100 20% coinsurance after deductible
Tier 3 Non-Formulary Brand Not Available Not Available
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% coinsurance after deductible 50% coinsurance after deductible
Sexual Dysfunction Cost Share 50% coinsurance after deductible 50% coinsurance after deductible
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% coinsurance after deductible 50% coinsurance after deductible
IVF, GIFT and ZIFT Not Covered Not Covered

Ambulance services

  CA CO, GA, MD, DC, VA, OR and WA
Cost Share 20% coinsurance after deductible 20% coinsurance after deductible

Lab and X-ray (outpatient non-preventative)

  CA CO, GA, MD, DC, VA, OR and WA
Cost Share 20% coinsurance after deductible 20% coinsurance after deductible

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

  CA CO, GA, MD, DC, VA, OR and WA
Cost Share 20% coinsurance after deductible 20% coinsurance after deductible

DME base

  CA CO, GA, MD, DC, VA, OR and WA
Cost Share 20% coinsurance after deductible 20% coinsurance after deductible
Out of Network Worldwide Emergency Coverage only (same as in Network) Worldwide Emergency Coverage only (same as in Network)

Prosthetics and orthotics (base)

  CA CO, GA, MD, DC, VA, OR and WA
Cost Share 20% coinsurance after deductible 20% coinsurance after deductible

Prosthetics and orthotics (base)

  CA CO, GA, MD, DC, VA, OR and WA
Cost Share 20% coinsurance after deductible 20% coinsurance after deductible

Vision hardware for adults (supplemental)

  CA CO, GA, MD, DC, VA, OR and WA
Cost Share Not Covered Not Covered

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 Covered7
Limits N/A N/A8

Urgent care clinic/after hours

  CA CO, GA, MD, DC, VA, OR and WA
Cost Share 20% coinsurance after deductible 20% coinsurance after deductible

Summary of Benefits and Coverage by region

View the Kaiser Permanente Summary of Benefits and Coverage (SBC) document for your region to help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) can be found on the Medical Premiums page.

California SBC

View the Kaiser Permanente SBC for teammates in California. 

Colorado SBC

View the Kaiser Permanente SBC for teammates in Colorado. 

Georgia SBC

View the Kaiser Permanente SBC for teammates in Georgia. 

Mid-Atlantic States SBC

View the Kaiser Permanente SBC for teammates in Mid-Atlantic states. 

Northwest SBC

View the Kaiser Permanente SBC for teammates in the Northwest.

Washington SBC

View the Kaiser Permanente SBC for teammates in Washington. 

Contact us

Members can contact their Regional Member Services Department with any questions or comments about their coverage.

California

800-464-4000 (toll free)

Colorado

Georgia

888-865-5813 (toll free)

Mid-Atlantic States (DC, MD and VA)

Outside D.C. metro area: 800-777-7902 (toll free)

Northwest (Oregon)

800-813-2000 (toll free)

 

Washington

888-901-4636 (toll free)

View enrollment requirements for Washington State (PDF)

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1For GA, MD, DC and VA: Community Pharmacy $30

2For GA, MD, DC and VA: Community Pharmacy $30

3For CO: Mandated Coverage for children up to 18 years

   For GA: Pediatric hearing aids are mandated for children up to age 19, one hearing aid per ear when medically necessary every 48 months up to $3000     per ear

4For WA: Covered as part of base benefit (mandated);
   Must match Primary OV cost share (regional standard)

5For WA: 20 visits (regional standard)

6For CO and GA: Community Pharmacy 30% coinsurance after deductible

7For WA: Covered as part of the base plan.
   Plan coinsurance after deductible (regional standard)

8For WA: 20 visits

No personal or confidential teammate information is contained within Benefits.Truist.com.

Information contained within Benefits.Truist.com applies to eligible teammates residing in the United States, unless otherwise specified.

Not all subsidiaries and affiliates of Truist participate in the benefit programs and policies presented within Benefits.Truist.com.

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