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Kaiser HMO
Kaiser HMO
A Kaiser Permanente – California plan
Kaiser is an HMO (Health Maintenance Organization) with a closed network of providers. Washington Center employees can choose the new Kaiser Mid-Atlantic HMO plan at the same monthly premium cost as Kaiser CA HMO.
The information below is a summary. See plan documents for details.
- Full Full eligibility available
- Mid Mid eligibility available
- Core Core eligibility available
- Retirees Retirees eligibility available
How the plan works
- You choose a primary care physician (PCP) from Kaiser’s network.
- The PCP coordinates your care and refers you to specialists.
- The plan covers the cost of services only when your primary care physician authorizes it.
- Kaiser provides coverage for services outside of the network only in cases of emergency and urgently needed services.
- Behavioral health benefits are provided by Kaiser and Optum.
- See updated information about coverage for COVID tests.
- You’re covered for emergency and urgent care anywhere in the world if you get hurt or sick while traveling. Visit Care While Traveling on the Kaiser Permanente website or call the Away from Home Travel Line at 951-268-3900.
Best fit for you if:
- You and the family members you cover live in California
- You want low monthly premiums
- You want low, predictable out-of-pocket costs
- You like having one doctor manage your care
- You are happy with the selection of providers within the Kaiser system
Understanding your costs
When choosing a plan, make sure to consider all your costs — including your monthly premiums and what you can expect to pay out-of-pocket for care. ALEX will ask you a few questions to help you estimate how much you may need to spend.
In the past, UC covered a larger share of the total cost for Kaiser HMO compared to other plans with similar benefits. In 2026, UC is balancing employee premiums across similar health plans. UC will pay roughly the same percentage of total premium costs for Kaiser HMO as they do for UC Blue & Gold HMO. Premiums for some members of Kaiser HMO will increase.
Premiums for represented employees will be implemented consistent with applicable collective bargaining agreements and the law.
| Pay Band (full-time salary rate) | Self | Self + Child(ren) | Self + Adult | Family |
|---|---|---|---|---|
| $73,000 and under | $75.57 | $136.02 | $257.78 | $318.23 |
| $73,001–$145,000 | $120.61 | $217.09 | $352.35 | $448.83 |
| $145,001–$217,000 | $165.64 | $298.15 | $446.92 | $579.43 |
| $217,001 and above | $210.68 | $379.22 | $541.50 | $710.04 |
Kaiser HMO offers coverage within the Kaiser network only, with no deductible. The annual out-of-pocket maximum is $1,500 for individual coverage and $3,000 for coverage of a family of two or more.
- Office visits/Urgent care: $30
- Emergency room visits: $125
- Hospital stay: $250
- Prescription drugs:
- Generic: $10
- Brand name: $30
- Non-formulary: $50
- Specialty: 30% up to $150 maximum per prescription
Enrolling in Medicare
Kaiser Permanente Senior Advantage is considered the “partner plan” of Kaiser HMO. That means that if you are a retiree enrolled in Kaiser HMO, you’ll be transferred into Kaiser Permanente Senior Advantage when you turn 65, once Medicare has approved your enrollment form.
If you will be Medicare-eligible in 2026 and would like to learn more about Kaiser Senior Advantage, register for a virtual information session.
Plan documents
Find the 2025 and 2026 plan documents for Kaiser CA HMO and Kaiser Mid-Atlantic HMO on the Kaiser website.
Contact information: Kaiser CA HMO members
- English: 800-464-4000
- Español: 800-788-0616
- Chinese dialects: 800-757-7585
- Prospective members: 800-324-9208
- Optum (behavioral health): 888-440-8225
Contact information: UCOP Washington Center
- Kaiser Mid-Atlantic: 800-777-7902