Medical
Pathways offers two different medical HMO plan options through Kaiser.
Health Maintenance Organization (HMO)
- Kaiser Deductible HMO
- Kaiser HMO LOW
Here’s an overview of how an HMO plan works:
An HMO provides for predictable costs to the member. You pay a copay for most services, but all care must be received within the HMO network. Out-of-network care is not covered except in an emergency. You may need to meet a deductible (Deductible HMO) before the plan starts to pay. You must also choose a primary care provider. Kaiser plans only allow you to use facilities and providers within the Kaiser network, with the exception of emergency care services.
Kaiser Deductible HMO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$1,000/$2,000
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$20 copay
Urgent Care
$20 copay
Emergency Room
20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Specialty
$30 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Specialty
Not covered
Plan Cost
Full Time Employees
Employee Only: $0
Employee + 1 Dependent: $455.81
Employee + 2 or more Dependents: $834.12
Part Time Employees
Employee Only: $304.28
Employee + 1 Dependent: $760.08
Employee + 2 or more Dependents: $1,138.40
Kaiser HMO LOW
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0
Out-of-Pocket Max (Individual/Family)
$3,500/$7,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$40 copay
Urgent Care
$20 copay
Emergency Room
$350 copay
Retail Rx (Up to 30-Day Supply)
Generic
$15 copay
Preferred Brand
$35 copay
Specialty
20% coinsurance (not to exceed $250)
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30 copay
Preferred Brand
$70 copay
Plan Cost
Full Time Employee
Employee Only: $0
Employee + 1 Dependent: $502.16
Employee + 2 or more Dependents: $918.95
Part Time Employee
Employee Only: $322.31
Employee + 1 Dependent: $824.47
Employee + 2 or more Dependents: $1,241.25