If you elect to participate in the Kaiser Permanente HMO plan, you are limited to using physicians and facilities that are part of Kaiser Permanente’s network of providers. All health care services (except for emergencies) must be coordinated and approved by your primary care physician (PCP).
Here are some of the features of the Kaiser Permanente HMO Plan. For more information, refer to the 2023 Faculty & Staff Medical Plan Coverage Comparison Chart or 2023 LIUNA BU Medical Plan Coverage Comparison Chart and the Summary Plan Description (SPD).
|Plan Benefits||You Pay…|
|Physician Services (office visits)||$20 copay; $35 specialist copay|
|Physician Services (inpatient)||$0|
|Preventive care (physical exams and well baby)||$0|
|Emergency care||$100 copay (waived if admitted)|
|Hospital copay per inpatient admission||$250|
|Hospital service benefits||$0 after $250 hospital copay|
|Outpatient surgery||$100 copay|
|Vision Care||$10 optometrist copay; $20 ophthalmologist copay
Discounted lenses, frames, and contacts
|Plan Year Maximums|
|Annual Maximum Benefit||None|
|Annual Out-of-Pocket Maximum||$3,500 per person
$9,400 per 3 or more persons