Understand your healthcare coverage.
About Your HMO Medical Benefits
As a member of the Kaiser Permanente® Health Maintenance Organization (HMO) under Kaiser HMO Plan C or the Kaiser Permanente Senior Advantage plan, you will receive your medical care from an integrated network of physicians and specialists at a medical office, medical center, or affiliated hospital near you.
- You may choose a primary care physician for you or your family members at this link or receive assistance in selecting a doctor or scheduling your first appointment by calling 800.278.3296.
- Initial referrals for most specialty care services will be coordinated by a Kaiser Permanente® physician. However, many departments such as OB/GYN, Optometry, Psychiatry and Addiction Medicine are self-referred.
- There is a deductible with HMO Plan C; however, there are no claim forms to submit unless you receive emergency services outside of a plan facility. There is no deductible for the Kaiser Permanente Senior Advantage plan.
- Preventive care services are covered at 100%.
Kaiser HMO Coverage
Annual Calendar Year Deductible
Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible. Once the deductible has been fufilled, the plan will pay for all (100%) of the cost of your in-network care that is eligible for coinsurance. You are then only financially responsible for any copays.
Maximum Calendar Year Out-of-pocket
The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they must meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.
Professional Services
Your Kaiser HMO plan gives you ease of access to receiving basic health services, including primary care, diagnostics, specialists, and preventive care.
- Primary Care Visit
- Specialist
- Preventive Care/Screening/Immunization
- Diagnostic X-ray and Lab
- Complex Diagnostics (X-ray, Blood Work)
- Therapy (Physical, Occupational, Speech)
- Acupuncture
Hospital & Emergency Services
With your Kaiser HMO plan, benefits for outpatient surgery are only covered through care by the provider, but emergency care services are available with all providers.
- Inpatient
- Outpatient Surgery
- Emergency Room
- Urgent Care
Maternity Care
Your Kaiser HMO plan gives you access to affordable pregnancy services and maternity support for in-network care only.
- Physician Services
(Prenatal or Postnatal) - Hospital Services
Mental Health & Substance Abuse
If you are enrolled in any HMO plan, your mental health and substance abuse coverage is provided through Kaiser, which gives you access to inpatient and outpatient services at varying rates. Out-of-network care is not covered.
- Inpatient
- Outpatient
Chiropractic with Simple MSK
When you’re seeking relief from pain caused by an accident, injury, or muscle strain, or just looking for a natural healthcare approach, our Chiropractic Benefits may be able to assist you. These benefits offered by Simple MSK provide you access to licensed professionals at a discounted rate.
- Simple MSK provider with deductible waived
- Non-Simple MSK provider allowed with conditions
- Diagnostic X-Ray benefits available after deductible
- Up to 28 visits per calendar year
Telehealth Services with Kaiser
As an HMO plan participant, Kaiser Permanente® provides you with a myriad of ways to manage your health. If you are pressed for time and/or prefer to meet with your physician via video, you can schedule an appointment in minutes by phone or using your mobile phone or computer . You can also email your physician, view lab results, and refill prescriptions.
- Schedule appointments, including video visits*
- Check your appointment reminders and details
- Get your health reminders for what’s due
- Email your doctor
- View lab results
- Read quick tips on pressing health topics
- Call our 24/7 Appointment and Advice Center
Appointment scheduling is available for Adult and Family Medicine, Women’s Health, Pediatrics, and Optometry. Video visit not available for Optometry.
KP My Doctor Online Mobile App
Telehealth care can be accessed online via your Kaiser Permanente® health portal at any time, but there are also Kaiser Permanente mobile apps that can make your experience even easier. For personalized care, Kaiser recommends downloading the KP My Doctor Online (NCAL Only) mobile app, which can help you take wellness to the next level. It’s available for free on Apple and Android devices. As a KP member, you can get personalized alerts about the care you and your family need to stay healthy, receive health screenings and immunization notices, get seasonal health tips from our physician experts, and check appointment information and reminders to get good health on the go.
The KP My Doctor Online mobile app gives you a suite of tools to use while you are on the go! Learn more about the app here, or search for My Doctor Online (NCAL Only) in the App Store or Google Play to get started. Use the application with your Kaiser Permanente user ID and password to:
- See your health history at your fingertips
- Refill prescriptions for yourself or another member
- Check the status of your prescription order
- Schedule, view, and cancel appointments
- Access your message center to email your doctor or another KP department
- Find KP locations and facilities near you
Frequently Asked Questions
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