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Below is a brief outline of benefits provided under the Kaiser HMO plan. Refer to the official benefits booklet for a comprehensive description of plan benefits. Under all circumstances, the benefits booklet will take precedence over information contained on this website. Contact Kaiser Permanente for questions of coverage.
| Deductible | None |
| Annual Out of Pocket Max | $2,000 individual/$4,000 family |
| Lifetime maximum benefit | Unlimited |
| Office Visits | 100% after $25 copay |
| Immunizations | 100% |
| Adult physicals | 100% |
| Well-woman exams/screenings | 100% |
| Well-baby exams | 100% |
| Emergency Room (copay waived if admitted) |
$100 copay |
| Inpatient hospital services | 100% |
| Outpatient hospital services | 100% after $25 copay |
| Outpatient surgical center | 100% after $25 copay |
| 30-day supply | |
|---|---|
| Generic | $10 copay |
| Brand formulary | $30 copay |
| Nonformulary | N/A |
| 90-day supply | |
|---|---|
| Generic | $20 copay |
| Brand formulary | $60 copay |
| Nonformulary | N/A |