Kaiser is an HMO (Health Maintenance Organization) with a closed network of providers.

Plan changes for 2019

There are no changes to out-of-pocket costs for 2019.

Pharmacists must dispense a prescription for Schedule II controlled substances as a partial fill, if requested by the patient or physician, with the copayment prorated accordingly. No additional fees can be assessed for subsequent partial fills if the full copay was collected at the first partial fill.

A Kaiser member who is discharged from a hospital or after an urgent care episode outside of a Kaiser Permanente region will receive medically necessary durable medical equipment if the equipment would have been covered at a Kaiser Permanente facility.

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.
  • Behavioral health benefits are provided by Kaiser and Optum.

Best fit for you if:

  • 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

Monthly plan costs for faculty and staff

Retiree plan costs chart »

Pay Band
(per annum)
Self Self +
Child(ren)
Self +
Adult
Family
$56,000 and under $20.97 $37.75 $45.93 $62.68
$56,001–$111,000 $57.02 $102.64 $128.23 $173.82
$111,001–$167,000 $94.02 $169.24 $201.99 $277.18
$167,001 and above $132.33 $238.20 $278.41 $384.25
Rates for union-represented employees are subject to ongoing collective bargaining as appropriate.


Typical out-of-pocket costs

  • Office visits/Urgent care: $20
  • Emergency room visits: $75
  • Hospital stay: $250
  • Prescription drugs: $5, generic; $25, brand name

ID cards

New members should receive ID cards from Kaiser in early January. You may also order a copy of your ID card on the Kaiser website or call 800-464-4000 to request your ID number.