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Benefits Unit
Kaiser Permanente Deductible First HDHP
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.
Benefit Charts
Employees and Retirees
Medical Plan Summary
Office Visits and Professional Services
Surgical and Hospital Services
Prescription Drugs
Premium Rates
For Employees
Employee Semi Monthly Medical Plan Premiums
Extra-Help Semi Monthly Medical Plan Premiums
For Retirees
Medicare Monthly Medical Plan Premiums
Non-Medicare Monthly Medical Plan Premiums
Medical Plan Summary
| Plan Information | Kaiser Permanente Deductible First HDHP |
|---|---|
| Calendar Year Deductible | Self-Only Enrollment: $1,300
Any One Member in a Family of Two or More: $2,600 Family of Two or More: $2,600 |
| Coinsurance | Varies - 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 Maximum | None |
Dependent Children Eligibility | Any Dependent Child under age 26. No age limit if disabled. |
Office Visits and Professional Services
| Service | Kaiser Permanente Deductible First HDHP |
|---|---|
| Physician & Specialist Office Visits | $20 co-pay after deductible |
| Preventive Care Birth to Age 18 | No Charge, no deductible |
| Preventive Care Adult Routine Care | No Charge, no deductible |
| Preventive Care Adult Routine OB/GYN | No Charge, no deductible |
| Diagnostic Lab and X-Ray | $10 per encounter, no deductible |
| Physical Therapy
(Medically necessary treatment only) | $20 co-pay after deductible |
| Chiropractic | Discounted rates through Kaiser Choose Healthy |
| Mental Health & Substance Abuse
(Out-patient) | $20 co-pay after deductible |
Surgical and Hospital Services
| 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 Health | No charge after deductible
100 days per year |
Prescription Drugs
| Service | Kaiser 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 Order | No |
| Mandatory Generic Program | Not available |