Quick look at your plans
Your health care plan with Kaiser Permanente is more than just health coverage — it’s a partnership in health. It connects you to a group of physicians, services, and tools that help you live your healthy best. Plus, you get most preventive care services at little to no cost.
Integrated Health Model (IHM)
With our IHM plan, all your care is connected — plan, doctors, medical facilities, and more. Your primary care physician manages all your care to make it more convenient and personalized for you. You’ll choose your primary care physician from among 1,700+ Permanente physicians and specialists working within the region’s leading health system.* They practice at our innovative, state-of-the-art medical centers, where you can access many services under one roof, saving you time and hassle. You can also save yourself trips with $0 telehealth care from the comfort of home.**
You can get many types of specialty care without a referral, including obstetrics-gynecology (ob-gyn), pediatrics, and mental health services. You also have access to urgent care and emergency care nationwide, so you’re always covered.
A quick look at out-of-pocket costs
|Active employees||In Network||Out of Network1|
|Primary care visit||$15||Not covered|
|Specialist visit||$15||Not covered|
|Preventive care||$0||Not covered|
|Most lab tests and X-rays||$0||Not covered|
|Most generic (in-network/community pharmacy)2||Not covered||Not covered|
|Preferred brand (in-network/community pharmacy)2||Not covered||Not covered|
|Non-preferred brand (in-network/community pharmacy)2||Not covered||Not covered|
|Routine prenatal care, first postpartum visit||$0||Not covered|
|Inpatient delivery (per admission)||$0||Not covered|
|Outpatient surgery (per visit)5||$0||Not covered|
|Inpatient hospital care (per admission)5||$0||Not covered|
This is a summary of the features of the Kaiser Permanente health plan. For more information, read your Summary of Benefits and Coverage (SBC). All benefits are subject to the definitions, limitations, and exclusions set forth in the Evidence of Coverage (EOC).
1 This plan covers up to 10 out-of-network medical visits for certain physician, laboratory, and radiology services, and 5 pharmacy refills per year with any licensed provider outside of the Kaiser Permanente care delivery system, anywhere in the United States.
2 Certain medications are eligible for Mail Order Pharmacy. Mail Order Pharmacy can deliver to addresses in MD, VA, DC, and certain locations outside the service area. Plan providers determine the drug that is medically necessary. If you request another drug, you pay prices charged to members for non-covered drugs. For more information about prescription drugs and other common medical events, including exclusions and limitations, read your Summary of Benefits and Coverage (SBC).
3 Per visit or trip as an outpatient at a hospital.
4 Per visit or trip as an outpatient at a hospital, when you receive care at a Kaiser Permanente facility. Out-of-network urgent care available when out of service area.
5 There is no charge after the office visit, outpatient, or inpatient hospital copayment is made.
Active employees plan details
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Effective 01/01/2023 – 12/31/2023
- Summary of Benefits and Coverage (SBC)
- Evidence of Coverage (EOC)
Other important documents
* In the survey Best Health Insurance Companies for 2021 by Insure.com, Kaiser Permanente as a national enterprise is rated #1 overall among 15 companies. In the NCQA Commercial Health Plan Ratings 2022, our commercial plan is rated 5 out of 5, the highest rating in MD, VA, and DC. The 2022 Commission on Cancer, a program of the American College of Surgeons, granted Three-Year Accreditation with Commendation to the Kaiser Permanente cancer care program. The Mid-Atlantic Permanente Medical Group is the largest multispecialty medical group in the Washington, DC, and Baltimore areas and exclusively treats Kaiser Permanente members. Permanente doctors are recognized as Top Doctors in Northern Virginia Magazine (2023), Washingtonian magazine (2022), and Baltimore magazine (2022). According to NCQA’s Quality Compass® 2022, we’re rated 5 out of 5 in 29 measures, including: controlling blood pressure (heart disease), blood pressure control (140/90) (diabetes), glucose control, colorectal cancer screening, breast cancer screening, cervical cancer screening, childhood immunizations, prenatal check-ups, and postpartum care. Quality Compass is a registered trademark of the NCQA.
** If you travel out of state, phone appointments and video visits may not be available due to state laws that may prevent doctors and health care providers from providing care across state lines. Laws differ by state. If you have an HSA-qualified deductible plan, you may need to pay the full charges for scheduled phone appointments and video visits until you reach your deductible. Once you reach your deductible, you won’t pay anything for scheduled phone appointments and video visits. If you have an HMO Plus or DHMO Plus plan, you can access care from non-network providers within Kaiser Permanente service areas. You will be charged an out-of-network copay.
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Connect with a Kaiser Permanente advisor to learn more: 855-839-5763 (TTY 711), Open 7 days a week from 7 a.m. to 11 p.m.