Kaiser 15 HMO
Original Implementation Date: 05/01/2018 | Plan Effective Date: 01/01/2024Providers
Under the VEBA Kaiser 15 HMO plans, members must choose a Kaiser doctor after enrolling in the plan by logging into www.kp.org or calling Kaiser Customer Service. The members' doctor, nurses, and specialists work together as a team, connected through the electronic health record to deliver personalized care.
Members can change their PCP at any time by contacting Kaiser, but the plan can only be changed during the annual Open Enrollment or within 30 days of a qualifying life event.
Network Diagram - KHMO15.pdf
How to Find a Doctor
Go to www.kp.org or contact Kaiser Customer Service
Search for facilities or doctors in your area
AFTER your coverage begins, you can call Kaiser or log onto www.kp.org to assign your Primary Care Physician
Out-of-Pocket Costs
The amounts that a member pays when utilizing services.
Deductible
MedicalNone
Out-of-Pocket Max
Medical$1,500 / $3,000
Annually
Out-of-Pocket Max
PrescriptionNone
PCP Office Visit
$15 copay
Specialist Office Visit
Referral Required$15 copay
Preventive Care
Annually$0 copay
Urgent Care
$15 copay
Emergency Care
Waived if admitted$100 copay
Outpatient Surgery
$0 copay
Hospitalization
In-Patient$0 copay
Radiology
Standard Services:
$0 copay
Complex (MRI / PET):
$0 copay
Eye Health
No Referral RequiredAnnual Eye Exam:
$0 copay
Additional Benefits
Chiropractic & Acupuncture
Chiropractic and acupuncture benefits are provided by OptumHealth. Services must be medically necessary and may be subject to prior authorization from OptumHealth.
Subscribers will receive a separate ID card to access the chiropractic benefit.
Copay: $20 per visit
Network of Providers: California Schools VEBA
Kindbody - Fertility and Family-Building Services
California Schools VEBA partners with Kindbody to provide you with fertility and family-building services. Discounts and resources are available to VEBA members that are enrolled in Kaiser plans.
Out-of-Area Services
Subscribers
In or Out-of-State
Urgent Care*
Emergency Care
Out-of-Country
Urgent Care*
Emergency Care
Dependent(s)
In or Out-of-State
Urgent Care*
Emergency Care
Out-of-Country
Urgent Care*
Emergency Care
ID Cards
Plan Documents
Summary Plan Description
Summary of Benefits & Coverage