HMOs offer healthcare for participants and their families through an exclusive network of healthcare providers.
How the Kaiser HMO Plans Work
The Kaiser HMO Plan requires that participants receive all medical care exclusively from the HMO's network of providers in order for them to receive benefits. When a participant enrolls in an HMO, he or she, as well as his or her covered dependents should see their primary care physician (PCP) for all routine medical care and will need a referral to a network specialist whenever he or she needs specialty care.
For a Kaiser Permanente member, coverage includes exclusive access to top-notch doctors and hospitals. A physician-led team works together to make sure the care a member receives is tailored to his or her needs. The care team is connected to the member’s electronic health record, which makes it easy to share information, see the member’s health history, and deliver high-quality, personalized.
The Kaiser Permanente HMO plan makes it simple and convenient to get the care you need. Kaiser combines care and coverage – which makes them different than other health care options. Doctors, hospitals, and health plans work together to help make exceptional health care easy to get. That means member’s will have peace of mind knowing care for their total health is there whenever they need it.
When you go in for care, you pay just a copay or coinsurance for most services covered by your plan. Many preventive care services are covered at little or no charge. After you reach your out-of-pocket maximum, you won’t have to pay copays or coinsurance for most covered services for the rest of the calendar year. This can help protect you financially if you have a serious illness or injury. The Kaiser Permanente plan includes a prescription drug benefit.
What the Kaiser Permanente HMO Plans Cover
Generally, Kaiser covers preventive, wellness, emergency, surgical, and hospital services.
For a complete list of what is covered by Kaiser, participants should refer to the Evidence of Coverage.
Care Options While You Are Away From Home
If something unexpected happens while a member is away from home, it’s easier than ever to get care. Members can get urgent care anywhere in the world. At many locations outside Kaiser Permanente states, the member will only pay a copay or coinsurance for care or prescriptions related to their urgent care visit. For emergency care, a member can simply go to the nearest hospital emergency room. If it’s a Kaiser Permanente location or Cigna PPO provider, the member will only pay your normal copay or coinsurance.
Kaiser Foundation Health Plan Arbitration Agreement
The Kaiser Hawaii and California plans are required to use binding arbitration to settle disputes related to or arising out of care delivery. The California Health and Safety code 1363.1, and Hawaii Case Law requires Kaiser Permanente to notify the employee of the use of arbitration at the point of enrollment.
Note: If you do not agree to the arbitration language you should choose a different medical plan option.
By Enrolling in a Kaiser Permanente California Plan, you understand that this action will serve as your agreement to the conditions provided in the Kaiser Foundation Health Plan Arbitration Agreement and that by law this will have the same effect as a signature on a paper form.