Kaiser medical plan
Kaiser Permanente offers members convenient, high-quality care designed to keep you healthy—all under one roof.
Kaiser plan features
Kaiser plan highlights include:
- Kaiser is available to California and Washington employees whose home ZIP codes are in Kaiser’s service area.
- Your per-paycheck contributions are higher than the Aetna plans, but when you get care, you pay low copays for most eligible services.
- You must use Kaiser doctors, specialists, pharmacies and facilities, and your care is subject to referrals from your primary care physician. Generally, out-of-network coverage is only available for medical emergencies.
- You can contribute to a Health Care Flexible Spending Account (FSA) with this plan.
|Plan Provisions||Kaiser HMO|
|Preventive care||Plan pays 100%|
|Office visit, outpatient services||You pay $20|
|Inpatient hospital||You pay $100 per admission|
|30-day retail prescriptions||
|Out-of-pocket maximum||Individual: $3,000
Care from anywhere
Get info, schedule appointments, and fill prescriptions by phone or on your computer. Even better, download the Kaiser app.App Store Google Play
You must use a Kaiser pharmacy or mail-order service to fill your prescription. Visit the Adobe Kaiser Microsite to find a pharmacy, sign up for mail service or refill your prescriptions.
For short-term prescriptions—up to a 30-day supply—you’ll pay $15 for generic drugs and $45 for brand-name or specialty medications.
The mail-order service offers a convenient and cost-effective delivery option for long-term and maintenance prescriptions—up to a 100-day supply. You can also order refills online and pick them up at a Kaiser pharmacy. You’ll still pay just $15 for generic drugs and $45 for brand-name or specialty medications.
Skip the in-person office visit, and get a virtual medical appointment by phone or video.
Phone visits are ideal for minor health issues like coughs, colds, flu symptoms and allergies.
Schedule a video visit to meet face to face with a doctor for a mental health consultation or treatment of nonemergency medical conditions such as rashes, skin infections, eye problems, cuts and sprains.
To access your virtual care options, call the phone number on the back of your ID card, 24/7. You can also log in to your Kaiser account or use the Kaiser app to make an appointment. You’ll need the Kaiser app to access a video appointment from your phone or tablet.
Registered nurses are on call to answer your health questions and provide general health tips anytime, anywhere, 24/7. Just call 800-464-4000 in California or 888-901-4636 in Washington.
Take advantage of a range of resources to help you stay well. Whether you’re looking for weight loss help, wellness coaching, or health and fitness classes, Kaiser offers convenient tools—from health classes at Kaiser facilities to one-on-one support from a wellness coach.
Your Kaiser Permanente medical plan covers the diagnosis and treatment of infertility, including artificial insemination, ovulation induction and assisted reproductive technology (ART), including IVF, GIFT and ZIFT. Services are covered if they are part of an active cycle to create pregnancy. The plan pays 90%, and you pay 10% for most covered services.
You’ll need a referral from your primary care physician to access these benefits so start by speaking with your physician and then visit a KP Center for Reproductive Health location within your area. Watch the Kaiser fertility video, and learn more about California Infertility Services [PDF] or Washington Infertility Services [PDF]. Get full details in your Kaiser Evidence of Coverage booklet.