HSA-Qualified Deductible HMO Plan
With this plan, most preventive care services are covered at little or no out-of-pocket cost to you — all year round. This gives you convenient access to routine care that helps you stay healthy and get the most out of life.
Learn about the difference between preventive and non-preventive services.
For all other services — including prescription drugs — you'll pay the full charges until you reach your deductible. Then you’ll start paying copays or coinsurance for most services covered by your plan for the rest of the year.
You also have an out-of-pocket maximum, which can help protect you financially if you have a serious illness or injury. After you reach this maximum, we’ll provide all covered services at no cost to you for the rest of the year.
The benefits outlined above are only a summary. To learn more about your specific plan benefits, check your Evidence of Coverage or call the number on your Kaiser Permanente ID card.
How family deductibles and out-of-pocket maximums work
on an HSA-Qualified Deductible HMO Plan
All plans have a family deductible and a family out-of-pocket maximum. If your family is covered under your plan, there are a couple of different ways your deductible and out-of-pocket maximum may work:
- Some plans only have a family deductible and a family out-of-pocket maximum. Once you, a family member, or combination of family members reaches the family deductible, everyone will start paying less than the full charges for covered services - just a copay or coinsurance for the rest of the year. If you, a family member, or a combination of family members reaches the family out-of-pocket maximum, no one in your family will have to pay for any covered services for the rest of the year.
- Other plans also have an individual deductible and out-of-pocket maximum. If a family member reaches his or her individual deductible, he or she will start paying copays or coinsurance before the rest of the family. And if any family members reach their individual out-of-pocket maximum before the rest of the family, they won't need to pay for any covered services.
If you’re not sure how your deductible or out-of-pocket maximum works for you and your family, check your Evidence of Coverage or call the number on your Kaiser Permanente ID card.
Setting up an HSA
If you enroll in an HSA-Qualified Deductible HMO Plan, you have the option of opening a health savings account (HSA). An HSA is a trust that you can contribute money to through your employer's pre-tax payroll deduction plan or through tax-deductible deposits that you, your employer, or your family members make directly to your account. You can use your HSA to pay for qualified medical expenses†, usually with a convenient debit card provided by your HSA administrator. For more information, including where to open your HSA and how to pay for services using it, see Managing your HSA.
For additional information:
*The tax references on this website relate to federal income tax only. Consult with your financial or tax adviser for information about state income tax laws. Federal and state tax laws and regulations are subject to change. If tax, investment, or legal advice is required, seek the services of a qualified professional.
†A qualified medical expense is defined under Internal Revenue Code Section 213(d). For a list of qualified medical expenses, download IRS Publication 502, Medical and Dental Expenses, at irs.gov/publications. As an HSA account holder, you’re ultimately responsible for determining whether an expense is a qualified medical expense.
‡Services not covered by your plan will not contribute towards your deductible and out-of-pocket maximum.
**If your family deductible is the same amount as your family out-of-pocket maximum, this won’t be true. In that situation, after your family reaches this amount, all family members covered under your plan will receive covered services at no cost for the rest of the calendar year.
♦You will need the free Adobe Acrobat Reader to read this file.