A quick look at your plan

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 or no cost to you.

Your new plan for 2021: HMO Plus with Signature NetworkSM

You’ll still have the same high-quality care,* with access to more than 1,600 physicians. But now you’ll enjoy even more flexibility and convenience—because HMO Plus with Signature NetworkSM covers up to 10 out-of-network medical visits for certain physician, laboratory, and radiology services—plus 5 pharmacy refills a year with any out-of-network provider, anywhere in the United States.

So if you have a favorite doctor who’s not in the Kaiser Permanente network, you can continue that relationship. And if you have to travel outside our service area, you’ll be covered for care and pharmacy services. It’s a plus that makes your life—and your health care—more convenient than ever.

A quick look at out-of-pocket costs

  In Network Out of Network1
Primary care visit $10 $30
Specialist visit $20 $40
Preventive care/screening/immunization $0 $0
Most lab tests and X-rays $0 $20
Generic (in-network/community pharmacy)2 $5 / $15 $25
Preferred brand (in-network/community pharmacy)2 $15 / $25 $45
Non-preferred brand (in-network/community pharmacy)2 $15/$25 $70
Emergency room services $150
Urgent care3 $20 
Routine prenatal care, first postpartum visit $20 Not covered
In-patient delivery $0 Not covered
Outpatient surgery $20 Not covered
Inpatient hospital care (per admission) $0 Not covered 

For illustrative purposes only.

1This plan covers up to 10 out-of-network medical visits for certain physician, laboratory and radiology services, and 5 pharmacy refills a year with any licensed provider outside of the Kaiser Permanente care delivery system, anywhere in the United States.

2For more information about prescription drugs and other common medical events, including exclusions and limitations, read Summary of Benefits and Coverage below.

3Out-of-network urgent care available when out of service area.

Your active employee and early retiree plan details.

We recommend you view on your laptop or desktop computer.

Medicare retirees enrolled in Kaiser Permanente Medicare Advantage (HMO)

Primary care visit copay (waived for children through age 5) $10
Specialist visit $10
Medicare-covered preventive care/screening/immunization $0
Diagnostic test (xray, blood work) $0
Imaging (CT/PETscans, MRI) $0
Per prescription1
Mail Order (up to a 90-day supply)–$3
Plan Pharmacies (up to a 60-day supply)–$5
Participating retail pharmacies (up to a 60-day supply)–$10
 
Emergency room services, per visit (waived if admitted) $50
Urgent care, per visit $10
Hospitalization, facility or surgeon $0
Video appointments with the doctor $0

All copays and costs with preferred providers.

1For more information about prescription drugs and other common medical events, including exclusions and limitations, read Summary of Benefits below.

Your retiree plan details

We recommend you view on your laptop or desktop computer.

Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll.

Other Important Documents

*In the National Committee for Quality Assurance (NCQA) 2019–2020 Health Insurance Plan Ratings, Kaiser Permanente of the Mid-Atlantic States’ private health plan is rated 5 out of 5, among the top 1% in the nation, and our Medicare health plan is rated 4.5 out of 5, the highest rating in DC, MD, and VA. The 2019 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 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 (2020), Washingtonian magazine (2019), Baltimore magazine (2019), and Washington Consumers’ CHECKBOOK magazine (2018). According to NCQA’s Quality Compass® 2019, we lead DC, MD, and VA in the following categories: colorectal screening, breast cancer screening, childhood immunizations combo 9, cervical cancer screening, and timeliness of prenatal and postpartum care for women. Quality Compass is a registered trademark of the NCQA.