Kaiser Medical insurance is available to employees with a CA Zip Code. HALO offers two HMO options through Kaiser.
- An HMO is a medical plan where care is directed from a Primary Care Physician (PCP) and require referrals for specialist visits. Additionally, there is no coverage for services received that are out-of-network.
- The Kaiser network of health providers and hospitals are completely independent from BCBS IL. No providers or settings are shared between Kaiser and BCBS IL.
Coverage Details
| Kaiser | Traditional HMO | Deductible HMO |
| Plan Provisions | In-Network |
| Calendar Year Deductible |
| Individual | $0 | $1,000 |
| Family | $0 | $2,000 |
| Calendar Year Out-of-Pocket Maximum (Includes Deductible) |
| Individual | $3,000 | $6,250 |
| Family | $6,000 | $12,500 |
| Copays/Coinsurance |
| Preventive Care | No charge | No charge |
| Office Visit | $40 Copay | $40 Copay |
| Specialist Visit | $40 Copay | $40 Copay |
| Diagnostic test (x-ray, blood work) | $10 Copay | X-Ray: $40
Lab Tests: $30 |
| Imaging ((CT/PET scans, MRIs) | $50 Copay | 30% coinsurance |
| Urgent Care | $40 Copay | $40 Copay |
| Inpatient Hospital Stay (Facility Fee/ Physician Fee) | $500 / Day
No Physician Fee | 30% coinsurance |
| Outpatient Surgery | $250 Copay | 30% coinsurance |
| Emergency Room Care | $150 Copay | 30% coinsurance |
| Emergency Medical Transportation | $150 Copay | 30% coinsurance |
Prescription Drugs - Retail Supply (30 days)
|
| Generic | $10 Copay | $25 Copay |
| Preferred | $30 Copay | $50 Copay |
| Non-Preferred | $30 Copay | $50 Copay |
| Specialty | $30 Copay | 20% coinsurance up to $150 |
| Prescription Drugs - Mail Order (90 days) |
| Generic | $20 Copay | $50 Copay |
| Preferred | $60 Copay | $100 Copay |
| Non-Preferred | $60 Copay | $100 Copay |
| Specialty | Not Applicable | Not Applicable |
The table above is a high-level summary of coverage provisions. For detailed information, please review the plan documents below.
How much does Kaiser cost?
| Bi-Weekly Contributions | Employee Only | Employee + Spouse | Employee + Child(ren) | Employee + Family |
| Traditional HMO |
| Wellness | $204.81 | $524.29 | $471.04 | $737.27 |
| Non-Wellness | $225.29 | $576.72 | $518.14 | $811.00 |
| Deductible HMO |
| Wellness | $118.76 | $335.60 | $263.43 | $478.04 |
| Non-Wellness | $130.64 | $369.16 | $289.78 | $525.84 |
| Tobacco Surcharge | $17.31 added per pay period, per tobacco user |
Contact Information & Kaiser Resources
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