Kaiser Medical/Prescription (California & Hawaii Residents)

Better care from a connected team

If you live in California or Hawaii, you have the option to select medical plans through Kaiser Permanente. Kaiser takes an integrated managed care approach to health care. That means Kaiser is more than an insurance company; they also operate the hospitals and medical offices where you receive care.

Kaiser’s doctors, hospitals and health plans are all part of one team. That means your eye doctor can remind you if you’re overdue for a cancer screening. If you need to see a specialist, that specialist will have important information about your health before they even meet you in person. When you fill a new prescription, your pharmacist can make sure it’s safe to take with your other medications.

The app you use to view your lab results is the same one you use to pay your bills.

Although coverage outside the Kaiser network is limited to emergency room visits only, this model enables Kaiser to deliver the right care faster—and help members avoid unnecessary visits, serious health conditions and many of the hassles associated with other kinds of medical plans.

Kaiser California Plan Coverage Detail

In-network coverage

Plan	$1,000 Deductible	$2,000 Deductible	$4,000 Deductible
Annual deductible (employee only/family)	$1,000/$2,000	$2,000/$4,000	$4,000/$8,000
HSA eligible	No	Yes	Yes
Annual HSA contribution from Chubb (employee only/family)	N/A	$500/$1000	N/A
Coinsurance	You pay 20%, plan pays 80%	You pay 20%, plan pays 80%	You pay 30%, plan pays 70%
Out-of-pocket maximum	$4,800/$9,600	$5,000/$10,000	$8,500/$17,000
Medical care: Your costs
Preventive care	You pay $0 when you get services in-network
Office visit (primary care/specialist)	20% coinsurance	20% coinsurance	Primary care: $30/visit Specialist: $50/visit
Urgent care visit	20% coinsurance	20% coinsurance	$30/visit
Emergency room visit	20% coinsurance	20% coinsurance	30% coinsurance
Prescription drugs
Generic drugs	30% coinsurance up to $20/prescription	Retail: $10/prescription Mail order: $20/prescription	Retail: $15/prescription Mail order: $30/prescription
Preferred and non-preferred	30% coinsurance up to $50/prescription	Retail: $35/prescription Mail order: $70/prescription	Retail: $30/prescription Mail order: $60/prescription
Specialty	30% coinsurance up to $50/prescription	$35/prescription	20% coinsurance up to $250/prescription
Out-of-network coverage is limited to emergency room visits only! If you need out-of-network emergency room care, the plans provide the following coverage.
Emergency room visit	20% coinsurance	20% coinsurance	30% coinsurance

Covering dependents?

Learn how your family's expenses accumulate toward your annual deductibles and annual out-of-pocket maximums.

True Family vs. Traditional Deductibles

True Family ($2,000 Deductible Plans): The entire family deductible ($4,000) must be met before insurance pays benefits for any covered family member. There is no individual deductible in this plan when you have family coverage.

Traditional ($1,200 Deductible Aetna/Horizon or $1,000 Deductible Kaiser and $4,000 Deductible Plans): Once a covered family member meets the individual deductible, insurance begins paying benefits for that family member. Charges for other family members continue to count toward the family deductible.

How do I...	If I'm covering dependents... Kaiser California members
In the $2,000 Deductible Plan	In the $1,000 and $4,000 Deductible Plans
Meet the annual deductible?	You must spend $4,000 toward in-network expenses before the plan begins to pay coinsurance for any family member OR the plan begins to pay coinsurance for each family member when the family deductible ($4,000) is met.	The plan begins to pay coinsurance for each family member when their individual deductible is met, or for everyone when the family deductible is met.
Meet the annual out-of-pocket maximum?	You must spend $10,000 toward in-network expenses (your entire family out-of-pocket maximum) before the plan begins to pay 100% of covered expenses for any family member. The individual out-of-pocket maximum does not apply.	The plan begins to pay 100% of covered expenses for each family member when their individual out- of-pocket maximum is met, or for everyone when the family out-of-pocket maximum is met.

How do I...

If I'm covering dependents...

Kaiser California members

In the $2,000 Deductible Plan

In the $1,000 and $4,000 Deductible Plans

Meet the annual deductible?

You must spend $4,000 toward in-network expenses before the plan begins to pay coinsurance for any family member OR the plan begins to pay coinsurance for each family member when the family deductible ($4,000) is met.

The plan begins to pay coinsurance for each family member when their individual deductible is met, or for everyone when the family deductible is met.

Meet the annual out-of-pocket maximum?

You must spend $10,000 toward in-network expenses (your entire family out-of-pocket maximum) before the plan begins to pay 100% of covered expenses for any family member. The individual out-of-pocket maximum does not apply.

The plan begins to pay 100% of covered expenses for each family member when their individual out- of-pocket maximum is met, or for everyone when the family out-of-pocket maximum is met.

Kaiser Hawaii Plan Coverage Detail

Plan Detail	Kaiser Hawaii HMO
Annual deductible (employee only/family)	$0
HSA eligible	No
Annual HSA contribution from Chubb (employee only/family)	N/A
Medical care: Your costs
Preventive care	You pay $0 when you get services in-network
Office visit (primary care/specialist)	$15/visit
Urgent care visit	$15/visit
Imaging (CT/PET scans, MRIs)	You pay 20%, plan pays 80%
Outpatient surgery (facility fees, physician/surgeon fees)	You pay 10%, plan pays 90%
Hospital stay	You pay 10%, plan pays 90%
Prescription drugs
Generic drugs	Retail: $10/prescription Mail order: $20/prescription
Preferred and non-preferred	Retail: $35/prescription Mail order: $70/prescription
Specialty	$200/prescription

Find in-network providers

Visit kp.org

Click “Find doctors and locations,” choose your region and enter your search criteria.

Premium Rates

View medical premium rates

California/Hawaii Medical and Prescription