What The Kaiser Permanente HMO Covers
The following is a summary of the types of covered services under the Kaiser Permanente HMO for Hawaii and California. Note that the term "copayment" as used in this section may also be referred to as a "registration fee" by Kaiser Hawaii.
Be aware that there is an annual out-of-pocket maximum. This means that when you or a family member reaches the out-of-pocket limit, benefits for that person are paid at 100% of covered expenses for the balance of the calendar year. In Hawaii the out-of-pocket maximum is $2,500 per individual and $7,500 per family, and in California the maximum is $1,500 per individual and $3,000 per family.
For additional details on these and other covered services, refer to the Kaiser Permanente Member Handbook you received.Back to Top
Routine Office Visits
Well Child Care
At The Hospital
Note that no benefits are paid for non-emergency care obtained in an emergency room of a non-Kaiser facility.Back to Top
Semi-Private Room And Board
Inpatient X-ray And Lab Services
Note that benefits for reconstructive surgery may be limited. However, if you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this program.Back to Top
Important Notice Regarding Newborns' and Mothers' Health Protection Act
Federal law protects the benefit rights of mothers and newborns related to any hospital stay in connection with childbirth. In general, group health programs and health insurance issuers may not:
Mental Health/Substance Abuse Treatment
Note that copayments and limitations may not apply under the California Kaiser HMOs for certain diagnoses in accordance with California State Law (AB88) governing insured plans.
Other Frequently Utilized Services
Vision (Eye Care) Services
Outpatient X-ray & Lab Services
Skilled Nursing Facility
Home Health Care
Hearing Aids/Hearing Exams
Durable Medical Equipment (DME)