Kaiser HI 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 count towards 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.
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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.

Find a Doctor

Contact Info

Documents

Kaiser HI HMO Plan

Kaiser HI 2500
In-Network Only
Annual Deductible
IndividualNone
FamilyNone
Out of Pocket Maximum
Individual$2,500
Family$7,500
Coinsurance10%
Services
Preventive CareCovered at 100%
Office Visit - PCP$20 per visit
Office Visit - Specialist$20 per visit
X-ray$10
Laboratory$10
Diagnostic Complex Imaging20% coinsurance
Inpatient Hospitalization10%
Outpatient - Ambulatory Surgical Center10%
Outpatient - Hospital10%
Urgent Care$20 / 20% if out of area
Emergency Room$100 per visit
Ambulance20%
Physical TherapyInpatient: 10% coinsurance
Outpatient: $20 per visit
ChiropracticNot covered
Pharmacy - Retail
Generic$10
Preferred$45
Non-Preferred$45
Pharmacy - Mail Order
Generic$20
Preferred$90
Non-Preferred$90
Specialty Drugs
$200