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Kaiser Permanente Traditional HMO

Human Resources Benefits Unit 750

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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.

Medical Plan Summary

Plan Information Kaiser Permanente HMO
Calendar Year DeductibleNone
Calendar Year Out of Pocket Maximum
(Including Deductibles, Co-pays, and Coinsurance)

Maximum per Member: $1,500
Maximum per Family of 2 or more:

Lifetime Maximum None
Dependent Children Eligibility Any Dependent Child under age 26. No age limit if disabled.


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Office Visit and Professional Services

ServiceKaiser Permanente HMO
Physician & Specialist$10 co-pay
Preventive Care Birth to Age 18No Charge
Preventive Care Adult routine CareNo Charge
Preventive Care Adult Routine OB/GYNNo Charge
Diagnostic Lab and X-rayNo Charge
Physical Therapy (Medically necessary treatment only) $10 co-pay medically necessary treatment only
ChiropracticDiscounted rates through Kaiser Choose Healthy
Mental Health & Substance Abuse (Out-patient)

Individual Therapy: $10 co-pay
Group Therapy: $5 co-pay


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Surgical and Hospital Services

ServiceKaiser Permanente HMO
Inpatient Hospital and Physician ServicesNo 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


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Prescription Drugs

ServiceKaiser 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 1Same as retail
Mail Order Benefit Formulary Brand or Tier 2Same as retail
Mandatory Mail OrderNo
Mandatory Generic ProgramNot available


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