Kaiser Medical Plans
Kaiser Medical Plan Comparison
Below is a summary of the benefits included with our Kaiser HMO Plans. Both plans require you to stay in the Kaiser network for non-emergency benefits and are only available to our California employees.
Telemedicine coverage is available through My Doctor Online.
| Plan Feature | In-Network |
| Plan Deductible (Indv./Fam.) | None |
| Out of Pocket Maximum (Indv./Fam.) | $4,000 / $8,000 |
| Lifetime Maximum | Unlimited |
| Plan Coinsurance | 30% |
| Preventative Care Office Visit | No charge |
| Office Visit | $40 copay |
| Specialist Office Visit | $50 copay |
| My Doctor Online Televisit | No charge |
| Mental Health (Outpatient) | Office Visit: $40 copay |
| Basic Lab & X-ray | $15 copay per encounter |
| Complex Lab & X-ray | 30% up to $150 |
| Inpatient Hospital Services | 30% coinsurance |
| Outpatient Services | 30% coinsurance |
| Urgent Care | $40 copay |
| Emergency Room | 30% coinsurance |
| Prescription Drug | |
| Deductible | None |
| Generic / Brand / Non-Formulary (up to 30-day supply) |
$15 / $40 / $40 copay |
| Specialty (up to 30-day supply) | 30% up to a $250 copay |
| Mail Order Rx (up to 100-day supply) | $30 / $80 / $80 copay |
| Plan Feature | In-Network |
| Plan Deductible (Indv./Fam.) | $3,000 / $6,000 |
| Out of Pocket Maximum (Indv./Fam.) | $6,000 / $12,000 |
| Lifetime Maximum | Unlimited |
| Plan Coinsurance | 30% after deductible |
| Preventative Care Office Visit | No charge |
| Office Visit | $40 copay |
| Specialist Office Visit | $50 copay |
| My Doctor Online Televisit | No charge (deductible waived) |
| Mental Health (Outpatient) | Office Visit: $40 copay (deductible waived) |
| Basic Lab & X-ray | $15 copay per encounter |
| Complex Lab & X-ray | 30% up to $150 |
| Inpatient Hospital Services | 30% after deductible |
| Outpatient Services | 30% after deductible |
| Urgent Care | $40 copay |
| Emergency Room | 30% after deductible |
| Prescription Drug | |
| Deductible | None |
| Generic / Brand / Non-Formulary (up to 30-day supply) |
$10 / $30 / $30 copay |
| Specialty (up to 30-day supply) | 20% up to a $250 copay |
| Mail Order Rx (up to 100-day supply) | $20 / $60 / $60 copay |
Mail Order
Home delivery is a convenient option when you’re taking a medication on a regular basis. To get started using home delivery, go to kp.org/pharmacy and follow the online instructions for how to move your prescription from your retail pharmacy.
View the Mail Order Pharmacy Flyer for more details.
Contact Kaiser
Group Number:
37065 (Northern CA)
234255 (Southern CA)
Member Services
(800) 464-4000
kp.org
Resources
Travel Emergency and Urgent Care Away From Home
To view a more detailed description of the plans, visit the Plan Documents & Notices.
Coverage When Abroad
Emergencies can happen anywhere. As a Kaiser member, you’re covered for emergencies and urgent care when traveling internationally. Please view the Away from Home Care flyer and the Emergency Care brochure to learn more.