Kaiser HMO Plan
California only! Higher paycheck costs in exchange for lower out-of-pocket costs.
Available only in California, the Kaiser HMO is a managed care medical plan that provides medical and prescription drug benefits only when you receive care within the HMO network and when the care is coordinated by your primary care physician.
Kaiser HMO Plan Details
In-Network | |
|---|---|
Annual Deductible | $0 all coverage levels |
Annual Out-of-Pocket Maximum | $1,500 single $3,300 all other coverage levels |
Lifetime Maximum Benefit | Unlimited |
General Medical Expenses | |
Primary & Specialist Doctor Office Visit | $25 copay |
Inpatient Hospital Care3 (requires preauthorization) | |
Hospitalization | $500 per admission |
Inpatient Physician and Surgeon Services | 100% covered |
Inpatient Lab and X-ray | 100% covered |
Maternity and Delivery Services & Newborn Nursery Services2 | 100% covered |
Outpatient Care | |
Outpatient Surgery | $100 per procedure |
Outpatient Lab and X-ray | $10 copay |
Preventative Care | |
Annual Physical Exam & Immunizations | 100% covered |
Well-Baby & Well-Child Exams and Immunizations | 100% covered |
Well-Woman Exam | 100% covered |
Other Preventive Care | 100% covered |
Emergency Services | |
Emergency Room | $100 copay if not admitted to hospital $0 if admitted directly to hospital |
Urgent Care Clinic | $20 copay |
Ambulance Services | $50 per trip |
Mental Health, Substance Abuse Care | |
Mental Health: Outpatient Coverage | $10 copay for group visit $20 copay for single visit |
Mental Health: Inpatient Coverage | 100% covered |
Detox Rehab: Outpatient Coverage | $5 copay for group visit $20 copay for single visit |
Detox Rehab: Inpatient Coverage | 100% covered |
Other Benefits | |
Durable Medical Equipment | 20% coinsurance |
Home Health Care | 100% covered (up to 100 visits per calendar year) |
Skilled Nursing Facility | 100% covered (up to 100 days per benefit period) |
Chiropractic Services | $10 copay (up to 30 office visits per calendar year) $50 allowance per calendar year for chiropractic appliances |
Covered Infertility Treatment | 50% coinsurance |
Prescription Drugs | Prescription drug coverage is provided through Kaiser. |
(1) Review your medical plan details on the MyBMC Rewards website and select the Plan Documents tile. (2) Your newborn is automatically covered under the plan for the first 31 days after the date of birth. If you wish to continue coverage for the newborn beyond that date, you must add the child to your medical coverage through the MyBMC Rewards website (select change your coverage) within 31 days after the newborn’s date of birth. (3) Care outside of a Kaiser facility is limited to emergency care only. | |