Kaiser Permanente HMO

Overview

You may use only Kaiser Permanente doctors and facilities except in emergencies.

Group #7145 (Northern CA)

Group #230178 (Southern CA)

Pre-Authorization Requirement

Pre-authorization required for all elective inpatient and outpatient procedures.

PENALTY for not pre-authorizing: not covered.

Office copay

$30 copay primary/$50 copay specialist

Deductible

No deductible

Out-of-Pocket Maximum

$3,500 per individual/$7,000 family

A single out-of-pocket maximum applies to all coverage under the plan, including medical and prescription drugs. (This will cover prescriptions and medical expenses at 100% once the out-of-pocket maximum is met.)

Kaiser Mobile Health Clinic (located at Campus Drive and Bonair Siding in the Maples Parking Lot)

Kaiser Mobile Health Clinic is back: Starting May 3, 2022, the mobile health vehicle will be onsite on the 1st and 3rd Tuesdays of the month from 9 a.m. - 4 p.m. at the Maples Pavilion parking lot. As a Kaiser Permanente member, you and your covered dependents will have access to convenient state-of-the-art care on the Mobile Health Vehicle every Tuesday. The mobile clinic has individual offices for confidential exams and consultations, a lab, and Internet connections to specialists throughout the Kaiser network.

For an appointment, call Kaiser toll-free at (877) 741-4648 or visit Kaiser's Mobile Health Vehicle website. Although walk-ins will be welcome, priority will be given to those with an appointment.* 

* In observance of Independence Day, the Mobile Health Vehicle will be closed on July 5, 2022. Regular operations will resume on July 19, 2022. 

Physical exams for adults

100%

Physical exams for children

100%

Pap smears

100%

Immunizations

100% Office visit copay applies if provided during the doctor office visit

Well-woman visits

100%

Pharmacy (Retail)

Kaiser Permanente Pharmacy
Generic: $10 for up to a 30-day supply, $20 for a 31- to 60-day supply, or $30 for a 61- to 100-day supply

Brand: $40 for up to a 30-day supply, $80 for a 31- to 60-day supply, or $120 for a 61- to 100-day supply

Mail order drug program

Kaiser Permanente Mail Order Pharmacy
Generic: $10 up to a 30-day supply; $20 for a 31-100 day supply 

Brand: $40 up to a 30-day supply; $80 for a 31-100 day supply

Birth Control Pills

Included in Prescription Drug benefit, covered at 100%