Kaiser HMO Medical Plan
If you live in California, in addition to the three BCBS medical plans, you can also enroll in the Kaiser HMO plan. When enrolled with Kaiser, you must use a network provider to receive coverage. If you do not use a network provider, your visit is not covered under the plan. See below for more details about coverage under the plan.
The HMO plan coverage is the same no matter where you live in California. The premium rates to participate in the plan will differ between the Northern and Southern California regions.
Kaiser HMO Summary
|
Individual Coverage |
Family Coverage (each member) |
Family Coverage (entire family) |
|
|---|---|---|---|
|
Annual Plan Deductible |
None |
None |
None |
|
Annual Prescription Drug Deductible |
None |
None |
None |
|
Out-of-Pocket Maximum |
$1,500 |
$1,500 |
$3,000 |
For services that apply to the out-of-pocket maximum, you will not pay any more cost share for the rest of the year once you have reached the maximum.
|
Services |
You Pay |
|---|---|
|
Plan Provider Office Visits |
|
|
Most primary care and specialist visits |
$25 per visit |
|
Routine physical exams (including well-woman exams) |
No charge |
|
Well-child preventive exams (through age 23 months) |
No charge |
|
Family planning counseling and consultations |
No charge |
|
Scheduled prenatal care exams |
No charge |
|
Routine eye exams with a plan optometrist |
No charge |
|
Urgent care consultations |
$25 per visit |
|
Most physical, occupational and speech therapy |
$25 per visit |
|
Outpatient Services |
|
|
Outpatient surgery and certain other outpatient procedures |
$25 per procedure |
|
Allergy antigens |
$5 per visit |
|
Most immunizations |
No charge |
|
Most X-rays and lab tests |
No charge |
|
Hospitalization and Emergency Services |
|
|
Room and board, surgery, anesthesia, X-rays, lab tests, and drugs |
$100 per admission |
|
Emergency room visits |
$100 per visit |
|
Prescription Drug Coverage |
|
|
Most generic items at a plan pharmacy |
$15 for up to a 30-day supply |
|
Most generic refills through mail order |
$30 for up to a 100-day supply |
|
Most brand-name items at a plan pharmacy |
$35 for up to a 30-day supply |
|
Most brand-name refills through mail order |
$70 for up to a 100-day supply |
|
Most specialty items at a plan pharmacy |
30% coinsurance (not to exceed $150) for up to a 30-day supply |
Health Plan Decision Support
When you go online to the ZONE to enroll, be sure to check out Zebra’s health plan decision support tool. The tool is easy to use and will help you make the right medical enrollment election for you.
ID Cards
If you are enrolling in the Zebra Kasier HMO plan for the first time, you will receive a new medical ID card mailed to your home. You may also access your ID card on the Kaiser mobile app.