Kaiser Permanente HMO Plan

Kaiser Permanente provides medical care through its own hospitals and health care facilities. All Kaiser Permanente HMO members are encouraged to select a personal care physician (PCP) for preventive care, treatment of illness, and referral to a specialist when needed. You may change or choose your personal care physician (PCP) at any time. You must live in a Kaiser Permanente service area in CA, CO, DC, GA, MD, OR, VA or WA to enroll in the plan.

All medical care is provided by Kaiser Permanente providers at Kaiser Permanente facilities. Out-of-network care is not covered unless referred by a Kaiser Permanente provider or in the case of an emergency. Emergency care is covered 24/7, worldwide, no referral needed.

MEDICAL PLAN BENEFITS CALIFORNIA ONLY CO, DC, GA, MD, OR, VA OR WA

Deductible

• Individual • Family

Coinsurance (you pay) Out-of-Pocket Maximum

• Individual • Family

Physician Services

• Primary Physician Visit • Specialist Visit • Preventive Care $1,000 $2,000 20%

$2,000 $4,000

$20 copay $30 copay No charge $1,000 $2,000 20%

$2,000 $4,000

$20 copay $30 copay No charge

Inpatient Hospital Care

20% after deductible 20% after deductible

Outpatient Surgery 20% after deductible 20% after deductible Emergency Room Care 20% after deductible 20% after deductible

Urgent Care

$20 copay $30 copay

Prescription Drugs – Kaiser Permanente Pharmacy

(up to a 30-day supply) • Generic • Brand • Non-Preferred • Specialty

Prescription Drugs – Mail Order

(up to a 100-day supply) • Generic • Brand • Non-Preferred • Specialty $15 $30 N/A 20% up to $150

$30 $60 N/A 20% up to $150 $15 $30 $60 20% up to $150

$30 $60 $120 20% up to $150

Kaiser Permanente Maternity Support Program

You’re at the beginning of an incredible journey — and you’ll get an amazing reward at the end. As you prepare to welcome your new baby, we’re here to give you the care and support you need for a happy, healthy pregnancy. You’re bound to have lots of questions, and we have answers, articles, videos, checklists, and resources to guide you through every stage — from a positive pregnancy test, to delivery day, to life with your little one. Get ready for an action-packed 9 months!

My Health Manager

My Health Manager is a secure, one-stop resource that helps you stay connected to your health care team from the convenience of your computer, 24 hours a day. You can use My Health Manager mobile to email your doctor’s office, view most test results, schedule or cancel routine appointments, refill most prescriptions, and view your past visits. You can also download a free app to use My Health Manager on your Apple or Android device.

Your Care, Your Way, Connect to Care

Get the care you need the way you want it. No matter which option you choose, your providers can see your health history, update your medical record, and give you personalized care that fits your life.

CHOOSE WHERE, WHEN, AND HOW YOU GET CARE

24/7 CARE ADVICE: Get medical advice and care guidance in the moment from a Kaiser Permanente provider. IN-PERSON VISIT: Same-day appointments are often available. Sign in to kp.org anytime or call us to schedule a visit. EMAIL: Message your doctor’s office with nonurgent questions anytime. Sign in to kp.org or use our mobile app. PHONE APPOINTMENT: Save yourself a trip to the doctor’s office for minor conditions by scheduling a call with a clinician. VIDEO VISIT: Meet face-to-face online with a clinician on your computer, smartphone, or tablet for minor conditions or follow-up care. E-VISIT: Get quick online care for minor health problems. Fill out a short questionnaire about your symptoms, and a clinician will get back to you with a care plan — usually within 2 hours.