Human Resources Benefits Unit

Kaiser Permanente Hospital Services DHMO

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Kaiser Permanente's microsite for County of Sonoma employees


The Hospital Services DHMO plan provides a 17% savings compared to the current Kaiser Permanente $10 Copay Plan. 

  • Most doctor office visits, radiology services, lab tests, and prescriptions are available for a copay or coinsurance amount, even before you have reached the calendar year deductible. 
  • Most preventative services, such as well baby/child visits (up to 23 months), immunizations, routine physicals, mammograms, and routine preventative screenings are covered at no cost and are not subject to the calendar year deductible.
  • However, if you have services that are subject to the deductible, such as hospitalizations and in- and out-patient surgeries, you will be required to meet the calendar year deductible before plan benefits will be paid. 
  • This plan has a calendar year out-of-pocket maximum, capping the cost paid by the member. 
  • The out-of-pocket maximum includes the calendar year deductible, copayments, and coinsurance. 

Employees who have an HRA (Health Reimbursement Arrangement) or FSA (Flexible Spending Account) may submit Kaiser out-of-pocket expenses for reimbursement.

Plan Information Kaiser Permanente Hospital Services DHMO
Calendar Year Deductible

$1,000 Self-Only Enrollment
$1,000 Any one member in a family of two or more
$2,000 Family of two or more

Coinsurance

Varies - See Kaiser’s Evidence of Coverage

Calendar Year Out of Pocket Maximum
(Including Deductibles, Co-pays, and Coinsurance)

$3,000 Self-Only Enrollment
$3,000 Any one member in a family of two or more
$6,000 Family of two or more

Lifetime MaximumNone
Dependent Children Eligibility

Any Dependent child under age 26

Disabled: No age limit

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ServiceKaiser Permanente Hospital DHMO
Physician and Specialist Office Visits$20 co-pay, no deductible
Preventive Care Adult Routine CareNo Charge, no deductible
Preventive Care Adult Routine Care OB/GYNNo Charge, no deductible
Diagnostic Lab and X-Ray$10 per encounter, no deductible
Physical Therapy (Medically necessary treatment only)$20 co-pay, no deductible
ChiropracticDiscounted rates through Kaiser Choose Healthy
Mental Health & Substance Abuse
(Outpatient)
Individual Therapy: $20 co-pay, no deductible
Group Therapy: $10 co-pay, no deductible

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Service Kaiser Permanente Hospital Services DHMO
Inpatient Hospital and Physician Services20% Coinsurance after deductible
Outpatient Surgery20% Coinsurance after deductible
Maternity20% Coinsurance after deductible
Emergency Room20% Coinsurance after deductible
Ambulance$150 per trip, no deductible
Mental Health & Substance Abuse (Inpatient)20% Coinsurance after deductible
Skilled Nursing Facility20% Coinsurance, no deductible
Up to 100 days per benefit
Home HealthNo Charge (deductible doesn't apply)
100 days per year

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ServiceKaiser Permanente Hospital Services DHMO
Generic or Tier 1$10 co-pay 30 day supply, no deductible
Formulary Brand or Tier 2$30 co-pay 30 day supply, no deductible
Mail Order Benefit Generic or Tier 1$20 co-pay 100 day supply, no deductible
Mail Order Benefit Formulary Brand or Tier 2$60 co-pay 100 day supply, no 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 Hospital Services

Kaiser Permanente Plan Options