Kaiser CA 500 HMO
Depending on where you live, a Health Maintenance Organization (HMO) plan may be available to you. This plan provides coverage only when you receive care from providers within the HMO network. Your Primary Care Provider (PCP) will coordinate your care to help manage costs.
How it works:
You pay the plan per-paycheck cost from your paycheck to have coverage.
- Copay: You pay a small fee at the time of service for doctor visits and prescriptions. Copays do not count toward your deductible.
- Deductible: For care that doesn’t charge a copay, such as hospital services, you pay 100% of the costs until you meet the annual deductible.
- Coinsurance: After meeting the deductible, you and the plan share the cost of certain services, with the plan paying the majority.
- Out-of-Pocket Maximum: You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.
Keep in mind
You pay nothing for in-network preventive care — it’s covered in full.
Do you have a PCP?
With an HMO, you should select a Primary Care Provider (PCP) who will manage your care and provide referrals if you need to see a specialist.
Contact Info
Documents
Kaiser CA 500 HMO Plan
| Kaiser CA 500 HMO | |
|---|---|
| In-Network Only | |
| Annual Deductible | |
| Individual | $500 |
| Family | $1,000 |
| Out of Pocket Maximum | |
| Individual | $3,000 |
| Family | $6,000 |
| Coinsurance | 20% |
| Services | |
| Preventive Care | Covered at 100% |
| Office Visit - PCP | $20 per visit; deductible waived |
| Office Visit - Specialist | $20 per visit; deductible waived |
| X-ray | $10 per encounter; after deductible |
| Laboratory | $10 per encounter; after deductible |
| Diagnostic Complex Imaging | 20% coinsurance up to a maximum of $50 per procedure, after deductible |
| Inpatient Hospitalization | 20%; after deductible |
| Outpatient - Ambulatory Surgical Center | 20%; after deductible |
| Outpatient - Hospital | 20%; after deductible |
| Urgent Care | $20 per visit; deductible waived |
| Emergency Room | 20%; after deductible |
| Ambulance | $150 per trip; after deductible |
| Physical Therapy | Inpatient: 20% coinsurance per admission, after deductible Outpatient: $20 per visit, after deductible |
| Chiropractic | Not covered |
| Pharmacy - Retail | |
| Generic | $10 |
| Preferred | $30 |
| Non-Preferred | $30 |
| Pharmacy - Mail Order | |
| Generic | $20 |
| Preferred | $60 |
| Non-Preferred | $60 |
| Specialty Drugs | |
| Same as preferred brand | |