HMOs
What you need to know
Individuals in the Maryland, Virginia, Washington, D.C., or California metropolitan areas can choose an HMO medical plan instead of a Cigna plan. In the HMO plans, you pay low copays and typically don’t need to pay coinsurance or deductibles. The plans also include prescription drug coverage. Learn if you’re eligible for coverage.
HMO Basics
With an HMO, you receive all care (except in emergencies) within the HMO’s network. A primary care physician (PCP) coordinates your care and authorizes referrals if you need to see a specialist.
If you choose HMO coverage, you will receive detailed information from the HMO about what your plan covers, its cost-sharing requirements, limits and exclusions, rules and procedures to follow, a list of its providers, and contact information.
You can review information about all of the HMO options that are available. You are eligible to enroll in an HMO option as long as it is available in the area where you live. Please note that if you are electing an HMO Plan, the Tiers will also apply, depending on the HMO plan you choose. There are no buy-up/elect-down options with HMO plan elections:
- For Kaiser Northern CA., Southern CA., and Mid-Atlantic HMO coverage, you will be eligible to elect any of these HMO Plans regardless of the Tier of coverage you earn, in which only 11 weeks will get used.
Extended tour out of town?
HMO coverage is local. If you think you’ll be away from your residence and working in a location where an HMO is not available, consider a Cigna plan instead.
Kaiser Permanente—Mid-Atlantic
Most services are only covered by Kaiser plan providers and facilities; however, for emergency care, you will pay the same copay if you see a non-plan provider. This plan includes dental checkups, basic vision care, and eyeglasses for your covered child(ren).
Get resources to manage your care and get the most from your plan by logging in to your Kaiser member portal.
Learn more about Kaiser Permanente—Mid-Atlantic.
To see what you pay for coverage, view the premium rates.
Plan at a glance
Plan features
$9,400 family
Prescription drug coverage1,2
Kaiser prescription drug benefits are covered through Kaiser Pharmacy. This plan offers network coverage only. You can fill prescriptions via mail order, at a Kaiser retail pharmacy, or at other participating pharmacies.
For detailed information about prescription drug coverage, visit Kaiser’s drug formulary page.
1 You pay nothing for preventive drugs, contraceptives, or oral chemotherapy drugs.
2 Up to 60-day supply. For a 90-day supply, your copay will be 1.5 times the 60-day copay.
For specialty drugs, the applicable generic, preferred, and non-preferred brand copays apply.
Kaiser Permanente—Northern California
Most services are only covered by Kaiser plan providers and facilities; however, you will pay the same copay if you see a non-plan provider for urgent and emergency services. The plan includes an eye exam for your covered child(ren).
Get resources to manage your care and get the most from your plan by logging in to your Kaiser member portal.
Learn more about Kaiser—Northern California.
To see what you pay for coverage, view the premium rates.
Plan at a glance
Plan features
$3,000 family
1Kaiser will refer you to an acupuncturist if you need these services.
Prescription drug coverage
Kaiser prescription drug benefits are covered through Kaiser Pharmacy. This plan offers network coverage only. You can fill prescriptions via mail order or at a Kaiser retail pharmacy.
For detailed information about prescription drug coverage, visit Kaiser’s drug formulary page.
(90-day fill)
1 Up to a 100-day supply pharmacy and mail order; no charge for contraceptives.
2 You pay the same as for a preferred brand drug when approved through exception process.
3 Up to a 30-day supply through Kaiser retail pharmacy. Subject to formulary guidelines.
Kaiser Permanente—Southern California
Most services are only covered by Kaiser plan providers and facilities; however, you will pay the same copay if you see a non-plan provider for urgent and emergency services. The plan includes an eye exam for your covered child(ren).
Get resources to manage your care and get the most from your plan by logging in to your Kaiser member portal.
Learn more about Kaiser—Southern California.
To see what you pay for coverage, view the premium rates.
Plan at a glance
Plan features
$3,000 family
1Kaiser will refer you to an acupuncturist if you need these services.
Prescription drug coverage
Kaiser prescription drug benefits are covered through Kaiser Pharmacy. This plan offers network coverage only. You can fill prescriptions via mail order or at a Kaiser retail pharmacy.
For detailed information about prescription drug coverage, visit Kaiser’s drug formulary page.
(100-day fill)
1 Up to a 100-day supply pharmacy and mail order; no charge for contraceptives.
2 You pay the same as for a preferred brand drug when approved through exception process.
3 Up to a 30-day supply through Kaiser retail pharmacy. Subject to formulary guidelines.