Kaiser HMO
Employees in select zip codes in California, Colorado, Mid-Atlantic States (MD, D.C. and VA), and Hawaii have the option to enroll in a Kaiser Permanente HMO medical plan.
HMOs provide healthcare for participants and their enrolled dependents through a designated 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 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. Kaiser Permanente members can make appointments directly with some specialists without a referral from their primary care provider (ex., Dermatology, Gynecology). Other specialty services may require referral from a PCP.
For a Kaiser Permanente member, coverage includes exclusive access to top-notch doctors and hospitals. A physician-led team works together to ensure 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, review the member’s health history, and deliver high-quality, personalized.
The Kaiser Permanente HMO plan integrates care and coverage to provide efficient access to high‑quality health services. Through a coordinated network of physicians, hospitals and health plans, members receive comprehensive care designed to support their overall health with confidence and ease.
For most covered services, members pay a copay or coinsurance. Many preventive services are covered at little or no cost. Once the out‑of‑pocket maximum is met, copays and coinsurance for most covered services are waived for the remainder of the calendar year, providing important financial protection in the event of a serious illness or injury. The Kaiser Permanente plan also includes prescription drug coverage.
To learn more about Kaiser Permanente, visit https://select.kp.org/leidos.
What the Kaiser Permanente HMO Plans Cover
Kaiser generally covers preventive, wellness, emergency, surgical, and hospital services. For a complete description of covered services, participants should refer to the Kaiser Evidence of Coverage for their region.
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 a member needs care while away from home, access is straightforward. Urgent care services are available worldwide, and at many locations outside Kaiser Permanente service areas, members typically pay only the applicable copay or coinsurance for urgent care services or related prescriptions. For emergency situations, members may visit the nearest hospital emergency room. When care is received at a Kaiser Permanente facility or a Cigna PPO provider, standard copays or coinsurance apply. Additional details are available in the Evidence of Coverage booklet.
Refer to the flyer for additional information.
Managing Your Health
Kaiser members have access to a wide variety of programs and resources to assist in managing their health and well-being.
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.