Kaiser Permanente Traditional HMO Plan

HMO Platinum Plan ($10 copay)

HMO Gold Plan ($40 copay)

With this Kaiser Permanente health plan, you get a wide range of care and support to help you stay healthy and get the most out of life. Preventive care services — like routine physical exams, mammograms, and cholesterol screenings — are covered at no cost or at a copay,* and you pay just a copay for other services covered by your plan. For some specialty care, you don't even need a referral.

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How Your HMO Plans Work

Limits on how much you pay for care

For covered services, you'll pay one set amount — your copay. Copays keep things simple and make it easy to know what to expect. For some supplemental services, like infertility treatments, you'll pay a percentage of the charges — what's called a coinsurance. You also have an out-of-pocket maximum. It helps limit how much you’ll pay for care. If you reach your maximum, you won't pay for covered services for the rest of the year. This helps protect you financially if you ever get seriously sick or injured. For a small number of services, you may keep paying copays or coinsurance after reaching your out-of-pocket maximum.

No deductibles

For many types of routine care, including doctor's office visits and inpatient hospitalization, you'll pay just a copay. Your copays may be higher for inpatient hospitalization and emergency care, but emergency care copays are waived if you're admitted to the hospital.

Prescription drug coverage

Your generic, brand-name, and specialty prescription drugs are covered at a copay or coinsurance when you fill your prescriptions at our pharmacies. See the Disclosure Form Part One at the front of this book for details on your prescription coverage. To fill your prescription, simply visit one of our pharmacies, which are conveniently located at most Kaiser Permanente facilities. For refills, you can order: