Kaiser CA Traditional
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 out-of-pocket maximum.
- 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 Traditional Plan
| Kaiser CA North & South HMO | |
|---|---|
| In-Network Only | |
| Annual Deductible | |
| Individual | None |
| Family | None |
| Out of Pocket Maximum | |
| Individual | $1,500 |
| Family | $3,000 |
| Coinsurance | None |
| Services | |
| Preventive Care | Covered at 100% |
| Office Visit - PCP | $10 per visit |
| Office Visit - Specialist | $10 per visit |
| X-ray | Covered at 100% |
| Laboratory | Covered at 100% |
| Diagnostic Complex Imaging | Covered at 100% |
| Inpatient Hospitalization | Covered at 100% |
| Outpatient - Ambulatory Surgical Center | $10 per procedure |
| Outpatient - Hospital | $10 per procedure |
| Urgent Care | $10 per visit |
| Emergency Room | $50 per visit; waived if admitted |
| Ambulance | $50 per trip |
| Physical Therapy | Inpatient: No charge Outpatient: $10 per visit |
| Chiropractic | Not covered |
| Pharmacy - Retail | |
| Generic | $10 |
| Preferred | $10 |
| Non-Preferred | $10 |
| Pharmacy - Mail Order | |
| Generic | $10 |
| Preferred | $10 |
| Non-Preferred | $10 |
| Specialty Drugs | |
| Applicable Preferred Brand cost shares may apply | |