Human Resources Benefits Unit

Kaiser Permanente Deductible First HDHP

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Kaiser Permanente's microsite for County of Sonoma employees


The Deductible First HDHP plan provides a 21% savings compared to the current Kaiser Permanente $10 Copay Plan. This plan requires a member to meet the calendar year deductible FIRST before ANY plan benefits will be paid, except covered preventive services.

  • Members will pay 100% of the doctor office visits, radiology services, lab tests, prescriptions, hospitalizations, etc., until the calendar year deductible is met. Once the deductible is met, covered medical, hospital, and prescription benefits will be provided for a copayment or coinsurance amount.
  • While this plan does require a member to meet the deductible first, members who anticipate a hospital stay (such as a surgery or the birth of a child), may find this plan offers a lower total out-of-pocket cost than the new Hospital Services HDHP plan.
  • The calendar year out-of-pocket maximum includes; calendar year deductibles, copayments, and coinsurance.

Note: If you (the employee) elect to enroll in this plan, which qualifies as a HSA-qualified high deductible health plan, and you have a Flexible Spending Account and/or a Health Reimbursement Arrangement (HRA), be advised that under IRS rules you are NOT allowed to contribute to a Health Savings Account (HSA). Because the County’s FSA and HRA accounts can be used to reimburse your out-of-pocket medical expenses, the IRS does not allow you to also contribute to a Health Savings Account at the same time as it is considered prohibited health coverage.

Plan InformationKaiser Permanente Deductible First HDHP
Calendar Year DeductibleSelf-Only Enrollment: $1,300
Any One Member in a Family of Two or More: $2,600
Family of Two or More: $2,600
CoinsuranceVaries - See Kaiser’s Evidence of Coverage
Calendar Year Out of Pocket Maximum
(Including Deductibles, Co-pays, and Coinsurance)
Self-Only Enrollment: $3,000
Any One Member in a Family of Two or More: $6,000
Family of Two or More: $6,000
Lifetime MaximumNone

Dependent Children Eligibility

Any Dependent Child under age 26. No age limit if disabled.

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Service Kaiser Permanente Deductible First HDHP
Physician & Specialist Office Visits$20 co-pay after deductible
Preventive Care Birth to Age 18No Charge, no deductible
Preventive Care Adult Routine CareNo Charge, no deductible
Preventive Care Adult Routine OB/GYNNo Charge, no deductible
Diagnostic Lab and X-Ray$10 per encounter, no deductible
Physical Therapy
(Medically necessary treatment only)
$20 co-pay after deductible
ChiropracticDiscounted rates through Kaiser Choose Healthy
Mental Health & Substance Abuse
(Out-patient)
$20 co-pay after deductible

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Service Kaiser Permanente Deductible First HDHP
Inpatient Hospital and Physician Services$250 co-pay per admission after deductible
Outpatient Surgery$150 co-pay per procedure after deductible
Maternity$250 co-pay per admission after deductible
Emergency Room$100 co-pay after deductible
Ambulance$100 co-pay per admission after deductible
Mental Health & Substance Abuse (Inpatient)$250 co-pay per admission after deductible
Skilled Nursing Facility$250 co-pay per admission after deductible
Home HealthNo charge after deductible
100 days per year

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ServiceKaiser Permanente Deductible First HDHP
Generic or Tier 1$10 co-pay 30 day supply after deductible
Formulary Brand or Tier 2$30 co-pay 30 day supply after deductible
Mail Order Benefit Generic or Tier 1$20 co-pay 100 day supply after deductible
Mail Order Benefit Formulary Brand or Tier 2$60 co-pay 100 day supply after deductible
Mandatory Mail OrderNo
Mandatory Generic ProgramNot available

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Contact Information

Benefits Unit

Human Resources Department

Business Hours
Monday – Friday
8:00 AM – 5:00 PM
Contact us by Phone
Address
575 Administration Drive
Room 116 B
Santa Rosa, CA 95403
38.465237, -122.725363

Helpful Documents Kaiser Deductible First

Kaiser Permanente Plan Options