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Kaiser HMO

Kaiser Permanente
Group Number: 979

Kaiser Permanente Health Maintenance Organization (HMO) Plan exists to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. This plan is ideal if you prefer a lower payroll deduction and are comfortable with a PCP directing your care. This is the only health care plan that included vision coverage. Kaiser HMO provides coverage only in Northern California.



Annual Deductible  
Individual None
Individual within Family None
Family None
Annual Out of Pocket Maximum  
Individual  $1,500
Family $3,000

Medical Services

Primary Care Visit $20 copay
Specialist Office Visit $20 copay
Basic X-ray and Laboratory No charge
Inpatient Hospital $250 copay per admission
Emergency Room $50 copay
Urgent Care $20 copay
Chiropractic/ Acupuncture $15 copay per visit to 
30 visits per year
Hearing Aid $2,500 per device, 2 devices every 3 years
Prescription Drugs  
Generic / Tier 1 $10 copay
Formulary / Tier 2 $25 copay
Specialty 20% coinsurance  up to $200/prescription
Semimonthly Employee Contribution    
Employee Only $36.84
Employee + 1 $205.37
Employee + Family $309.77