KAISER PERMANENTE
Available to Hawaii-based team members only
We offer two Kaiser plans for team members in Hawaii. The first is an HMO Plan and the second is a Point-of-Service Plan — Buy-Up Option. An HMO is a system of managed healthcare providing medical services within a specific geographic area. Kaiser Permanente has its own doctors, physician assistants, nurse practitioners, and operates its own hospitals and outpatient facilities.
There are copays for services, such as office visits, specialist visits, and hospitalization, but no deductible. Generally, services are covered in full after the specified copays.
HMO Plan Highlights
- You are required to select a Primary Care Physician (PCP).
- Services must be authorized or provided by your PCP or Primary Medical Group (PMG).
- You do not have the option to seek treatment outside of Kaiser Permanente-contracted facilities, except in emergencies.
| Kaiser Permanente | |
|---|---|
| Annual Deductible | |
| Individual | $0 (none) |
| Family | $0 (none) |
| Out-of-Pocket Maximum (includes deductible) | |
| Individual | $2,500 |
| Family | $7,500 |
| Coinsurance | 20% |
| Physician Office Visits | |
| Preventive Care | Covered at 100% |
| Primary Care Visit | Visit $15 copay (age 18+); $0 copay (through age 17) |
| Specialist Visit | $15 copay per visit |
| Chiropractic Services (max 12 visits) | $20 copay per visit |
| Hospital Services | |
| Inpatient | 20% after deductible |
| Emergency Room | 20% after deductible |
| Urgent Care | $15 copay per visit |
| Outpatient Services | |
| X-Ray and Lab Tests | $15 copay/day; specialty 20% |
| Prescription Drugs | |
| Generic | $10 copay ($3 OTC) |
| Formulary/Brand | $45 copay |
| Specialty | $200 copay |
Point-of-Service Plan – Buy-Up Option
For 2026, we’re pleased to introduce the Kaiser Permanente Point-of-Service Plan as a new buy-up option. This plan offers greater flexibility and provider choice while maintaining access to Kaiser Permanente’s high-quality care and services. It also offers a “best of both worlds” solution—the coordinated care of Kaiser Permanente with the flexibility to see outside providers when needed.
Why Choose the Buy-Up Plan?
This plan is ideal for members who want the freedom to choose providers both inside and outside the Kaiser Permanente network, with tiered coverage options that balance flexibility and cost.
Three Tiers of Provider Access:
- Tier 1: Kaiser Permanente Providers
- Tier 2: Participating Network Providers
- Tier 3: Nonparticipating Providers
| Buy-Up | ||
|---|---|---|
| In-Network — Tier 1 | Contracted Network — Tier 2 and Out-of Network — Tier 3 | |
| Deductible | ||
| Single | $0 (none) | $100 |
| Family | $0 (none) | $300 |
| Out-of-Pocket Maximum | ||
| Single | $2,000 | $2,000 |
| Family | $6,000 | $6,000 |
| Coinsurance | ||
| 20% | ||
| Physician Office Visits | ||
| Preventative Care | Covered at 100% | |
| Primary Care Visit | $20 | Coinsurance/deductible |
| Specialist Visit | $20 | Coinsurance/deductible |
| Urgent Care | $15 | |
| Hospital Services | ||
| Inpatient | 10% | 20% |
| Outpatient | 10% | 20% |
| Emergency Room | $100 | |
| Pharmacy—Retail | ||
| Generic Maintenance | $3 | 20% |
| Other Generic | $10 | 20% |
| Brand | $45 | 20% |
| Specialty | $200 | 20% |
| Medical Plan Premiums | |||
|---|---|---|---|
| Weekly | Bi-Weekly | Monthly | |
| Employee (EE) | $79.09 | $158.17 | $342.70 |
| EE + Spouse | $196.61 | $393.22 | $851.98 |
| EE + Child(ren) | $180.55 | $361.11 | $782.40 |
| Family | $333.36 | $666.72 | $1,444.55 |