Kaiser HMO

The Kaiser HMO is available to associates living in California and is administered by Kaiser Permanente. This option enables participants to receive care at any of Kaiser Permanente's medical facilities or from their affiliated physicians. As a Kaiser HMO participant, you can choose your own primary care physician. If you need to see a specialist, your doctor can easily refer you or, depending on the specialist, you may not need a referral.

To find doctors and facilities, visit the location search form(opens in a new tab) and choose your region from the drop-down menu in the top right corner of the page.

Getting started

If you elect to participate, you may also want to review the Getting Started brochure. It provides information on selecting your personal physician, registering for secure access to the Kaiser Permanente website(opens in a new tab) and other resources. Simply choose the appropriate link below, depending on whether you are in Kaiser Permanente's northern or southern California region:

Evidence of coverage and summary of benefits

For detailed information about the Kaiser HMO, you can consult the Evidence of Coverage (EOC). Choose the appropriate link below based on your location in California:

You can also read the summary of benefits for highlights:

Kaiser HMO Features

  • No deductibles with the Kaiser HMO when you receive routine care (for example, doctors' office visits, inpatient hospitalization and after-hours care)—all you pay is your co-payment (The co-payment is higher for inpatient hospitalization and emergency care. Emergency care co-payments are waived if you are re-admitted.)
  • Professional or outpatient services are generally covered with a $25 co-payment per visit/procedure.
  • Some services, including home health care (up to 100 visits per calendar year) and ambulance services, are provided at no charge.
  • Prescription drug coverage from a plan pharmacy or mail order service.

Professional or outpatient services covered for a $25 or less co-payment per visit/procedure

  • Primary and specialty care visits (includes routine and urgent care appointments)
  • Routine preventive physical exams
  • Routine preventive refraction exams
  • Physical, occupational and speech therapy visits
  • Family planning visits
  • Outpatient surgery and certain other outpatient procedures
  • Allergy testing visits

Note: The services above are covered for a $25 or less co-payment per visit/procedure if the following conditions are satisfied:

Prescription drug coverage

  • Generic items from a plan pharmacy:
    $10 for up to a 30-day supply
    $20 for a 31- to 60-day supply
    $30 for a 61- to 100-day supply
  • Generic refills from the Kaiser Permanente mail order service:
    $10 for up to a 30-day supply
    $20 for a 31- to 100-day supply
  • Brand-name items from a plan pharmacy:
    $20 for up to a 30-day supply
    $40 for a 31- to 60-day supply
    $60 for a 61- to 100-day supply
  • Brand-name refills from the Kaiser Permanente mail order service:
    $20 for up to a 30-day supply
    $40 for a 31- to 100-day supply

Chemical dependency services

  • Outpatient individual visits: $25 per visit
  • Outpatient group visits: $5 per visit

Various services provided at no charge

  • Covered Durable Medical Equipment (DME) for home use in accord with Kaiser Permanente's DME formulary guidelines
  • Home health care (up to 100 visits per calendar year)
  • Hospice care
  • Ambulance services

Other

  • Skilled Nursing Facility care (up to 100 days per calendar year): $500 per admission
  • All covered services related to infertility treatment: 50% co-insurance

Services subject to the maximum

  • For self-only enrollment (a Family of one Member): $1,500 per calendar year
  • For any one Member in a Family of two or more Members: $1,500 per calendar year
  • For an entire Family of two or more Members: $3,000 per calendar year

Related information

Kaiser Permanente Website

Find a doctor, take advantage of member discount programs or access My Health Manager features.

2019 Flexible Benefit Premiums

Who you can cover and how much it costs.

Find a Doctor or Facility

Find a Kaiser Permanente doctor or medical facility by searching by region, address or GPS location.

Online Tools Brochure

Listing of online tools available to Kaiser HMO participants.

Explanation of Coverage (EOC) - Southern California

Detailed reference information for Kaiser HMO participants in the Southern California Region.

Explanation of Coverage (EOC) - Northern California

Detailed reference information for Kaiser HMO participants in the Northern California Region.

Summary of Benefits

Highlights of the Kaiser HMO benefits available to participants in California.

Quick Reference Guide

Important phone numbers, websites and resources related to the Kaiser HMO.

EXCELLENCE Associate Handbook

View the entire handbook or individual sections.

Summary Plan Descriptions

Summaries for your benefits, retirement and more.

No personal or confidential associate information is contained within BBTBenefits.com.

Information contained within BBTBenefits.com applies to eligible associates residing in the United States, unless otherwise specified.

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