How The Kaiser Permanente HMO Works

The Kaiser Permanente HMO, like most HMOs, emphasizes preventive care. Most covered services are provided at no cost to you, or with only a small copayment. Covered services include regular checkups, treatment of illness or injury, hospitalization, mental health/substance abuse treatment, prescription drugs, hearing aids, and vision care. Important: If you enroll in Kaiser, you are not eligible for the benefits provided through Vision Service Plan (VSP); instead, you are eligible to receive vision benefits through Kaiser as outlined in the section below.

However, these services are only covered when you use Kaiser providers and facilities. No benefits are paid for services obtained outside the Kaiser organization. There is one exception: If you are away from home and you require emergency care or urgent medical attention, your treatment at a non-Kaiser facility will be covered at 80% of reasonable and customary charges if you could not safely get to a Kaiser Permanente hospital. However, you must notify Kaiser as soon as possible after the accident. You must pay for the covered expenses at the time of service; keep all the receipts and file a claim with Kaiser upon returning home.

Note for Hawaii residents: If you move outside the Hawaii service area, the plan may terminate your coverage. Likewise, if you live outside the Hawaii service area, you may not enroll in Hawaii Kaiser Permanente. The only exception is for eligible dependent children attending college outside of Kaiser's Hawaii service area.