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Benefits Unit
Kaiser Permanente Traditional HMO
Kaiser Permanente's microsite for County of Sonoma employees
The Traditional $10 Copay Plan provides access to comprehensive full-service medical care.
- Doctor and specialist visits are available for a $10 copay.
- 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.
- Hospitalization, radiology, and lab tests are also covered at no cost.
- Prescription medication is covered at a copay range of $5 - $10.
However, you must use Kaiser Permanente’s physicians, hospitals and other approved health care providers. Otherwise, you will not be eligible to receive benefits, except in a life-threatening situation such as an out-of-area urgent or emergency situation.
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 HMO |
|---|---|
| Calendar Year Deductible | None |
| Coinsurance | None |
| Calendar Year Out of Pocket Maximum
(Including Deductibles, Co-pays, and Coinsurance) | Maximum per Member: $1,500 |
| Lifetime Maximum | None |
| Dependent Children Eligibility | Any Dependent Child under age 26. No age limit if disabled. |
Office Visit and Professional Services
| Service | Kaiser Permanente HMO |
|---|---|
| Physician & Specialist | $10 co-pay |
| Preventive Care Birth to Age 18 | No Charge |
| Preventive Care Adult routine Care | No Charge |
| Preventive Care Adult Routine OB/GYN | No Charge |
| Diagnostic Lab and X-ray | No Charge |
| Physical Therapy (Medically necessary treatment only) | $10 co-pay medically necessary treatment only |
| Chiropractic | Discounted rates through Kaiser Choose Healthy |
| Mental Health & Substance Abuse (Out-patient) | Individual Therapy: $10 co-pay
|
Surgical and Hospital Services
| Service | Kaiser Permanente HMO |
|---|---|
| Inpatient Hospital and Physician Services | No Charge |
| Outpatient Surgery | $10 co-pay |
| Maternity | No Charge |
| Emergency Room | $50 co-pay |
| Ambulance | $50 per trip |
| Mental Health & Substance Abuse (Inpatient) | No Charge |
| Skilled Nursing Facility | No Charge.
Up to 100 days per benefit period |
| Home Health | No Charge.
100 days per year |
Prescription Drugs
| Service | Kaiser Permanente HMO |
|---|---|
| Generic or Tier 1 | $5 co-pay 100 days supply |
| Formulary Brand or Tier 2 | $10 co-pay 100 days supply |
| Mail Order Benefit Generic or Tier 1 | Same as retail |
| Mail Order Benefit Formulary Brand or Tier 2 | Same as retail |
| Mandatory Mail Order | No |
| Mandatory Generic Program | Not available |