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PARTNER | Kaiser Permanente
Traditional HMO Plan - CA Only Health Maintenance Organization
Kaiser is an HMO plan with a closed network of providers. The HMO plan is designed for you to choose a primary care physician from Kaiser’s network. The plan covers the cost of services only when authorized with simple copays and coinsurance and you do not need to pay an annual deductible.
Kaiser Traditional HMO Plan
California Only Network: Kaiser
Group/Policy #: Northern CA Region: 606131 Southern CA Region: 234268
- Deductible | $0 The amount you owe for health care services before your health insurance or plan begins to pay.
- Maximum Out of Pocket | $500 Individual ($1,000 Family) The money you pay for covered medical and pharmacy services counts toward your out of pocket maximum. Once you meet your designated out of pocket maximum, the plan will pay for all of your covered healthcare costs for the rest of the plan year.
- Primary Care Doctor | $15 copay A PCP is the person your child should see for a routine checkup or non-emergency medical care
- Specialist | $25 copay A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat a certain types of symptoms and conditions
- Telemedicine | $15 copay Telemedicine refers to the practice of caring for patients remotely when the provider and patient are not physically present with each other. Modern technology has enabled doctors to consult patients by using HIPAA compliant video-conferencing tools.
- Urgent Care | $15 copay Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.
- Hospital | $125 copay The portion of eligible expenses that plan members are responsible paying, most often after the deductible is met. It's usually determined as a percentage of the total cost.
- X-Ray and Labs | $0 copay The portion of eligible expenses that plan members are responsible paying, most often after the deductible is met. It's usually determined as a percentage of the total cost.
- Emergency Room | $50 copay The Emergency Room (ER) provides care for these critical or life-threatening conditions and not for routine health care.
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