California/Hawaii Medical and Prescription
California/Hawaii Medical and Prescription
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.
Compare the plans (Kaiser California)
In-network coverage
Plan |
$900 Deductible |
$1,800 Deductible |
$3,300 Deductible |
|
|---|---|---|---|---|
Annual deductible (employee only/family) |
$900/$1,800 |
$1,800/$3,600 |
$3,300/$6,600 |
|
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% |
|
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 |
|
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 |
Retail: $15/prescription |
|
Preferred and non-preferred |
30% coinsurance up to $50/prescription |
Retail: $35/prescription |
Retail: $30/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.
How do I... | If I'm covering dependents... Kaiser California members | |
|---|---|---|
In the $1,800 Deductible Plan |
In the $900 and $3,300 Deductible Plans |
|
Meet the annual deductible? |
You must spend $3,600 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 ($3,600) 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 $6,250 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. |
View the Plan (Kaiser Hawaii)
| 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 |
Preferred and non-preferred |
Retail: $35/prescription |
Specialty |
$200/prescription |
Find in-network providers
Visit kp.org
Click “Find doctors and locations,” choose your region and enter your search criteria.