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 most 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 calendar 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 most covered services at no cost to you for the rest of the calendar year.
For the following individuals and families and small business plans, Bronze 3500/30, Bronze 4500/40%, Bronze HSA 3500/30, Bronze HSA 4500/40%, Silver 1500/20%, and Silver HSA 1500/20%, 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.
You can also set up a health savings account (HSA), which allows you to contribute pretax or tax-deductible dollars* to pay for medical care and services. Your employer may also contribute funds to your HSA. Since you can use your HSA funds to help pay for expenses such as your deductible, your HSA may help reduce your out-of-pocket costs as well.
Paying for services
You can use your HSA to pay for qualified medical expenses,† usually with a convenient debit card connected to your account. Qualified medical expenses include copays, coinsurance, and deductible payments for a wide range of services — for example:
- prescription drugs
- office visits with your personal physician or specialty physicians
- outpatient surgery
- X-rays, MRIs, CT scans, PET scans, and laboratory tests
- physical, occupational, and speech therapy visits
- allergy injection visits
- hospitalization (including X-rays, lab tests, and drugs received during your stay)
- inpatient surgery and anesthesia
- emergency services
- ambulance services
Qualified medical expenses may also include services not covered by your health plan.‡
You choose how to spend it
Your HSA belongs to you, and you’re in charge of managing it. That means you can use the money in your tax-free HSA to pay for qualified medical expenses, now or in the future. Or you can grow the account and use the money after you turn 65.
No matter when you choose to use it, the money in your HSA is yours. Whatever you don’t spend rolls over to the next year, and you can take it with you if you retire or change jobs or health plans.
Calculate your savings
Our calculators can give you an idea of how an HSA can reduce your taxes — and grow over time.
If your family is covered under your plan, there are a couple of different ways your deductible and out-of-pocket maximum may work:
- All plans have a family deductible and a family out-of-pocket maximum. Certain plans only have these combined deductible and out-of-pocket maximum amounts. (They’re sometimes called “aggregate” plans.)
- Some plans also have individual deductibles and individual out-of-pocket maximums, which work together with the family deductible and family out-of-pocket maximum. (They’re sometimes called “embedded” plans.)
Family deductibles — common to all plans
All plans have a family deductible. As soon as the combined medical expenses of everyone in your family equal this amount, you’ll reach your family deductible. Then all family members covered under your plan will start paying copays or coinsurance for most covered services for the rest of the year.**
Individual deductibles — common to some plans
Some plans also have individual deductibles that work together with the family deductible. Any covered family member who reaches his or her individual deductible will start paying copays or coinsurance for most covered services for the rest of the year. All other family members will keep paying the full charges for most services until they reach their individual deductible or until the combined medical expenses of everyone in the family reach the family deductible amount.
If you’re not sure which type of deductible and out-of-pocket maximum you have, check your Evidence of Coverage or call the number on your Kaiser Permanente ID card.
Where to open an HSA
If your employer offers an HSA administered through Kaiser Permanente, you can set up an account directly through your employer. You also have the option of opening an HSA administered by any eligible financial institution of your choice.
If you choose an HSA administered through Kaiser Permanente, after you enroll you'll receive a Health Payment Card and a welcome letter that explains how to get started. Once you've signed on to your account at kp.org/healthpayment and accepted the terms and conditions, you'll be able to start contributing funds to your HSA and using them to pay for qualified medical expenses. You can make these payments with your Health Payment Card, which works just like a debit card.
Managing your HSA administered through Kaiser Permanente is easy. You can do it online at kp.org/healthpayment or with our free KP HRA/HSA/FSA Balance Tracker app, which you can download for your smartphone or mobile device. A monthly account administration fee of $3.25 per member may be paid by you or your employer. The fee is waived once your average daily account balance reaches $2,000.
Learn about 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.