Overview
HMO with HMO Flex is an affordable plan option that allows your employees to access the best of Kaiser Permanente’s integrated HMO with the added flexibility to see non-Kaiser Permanente providers for certain covered outpatient services (service limits apply).
Kaiser Permanente HMO: In-network care from Kaiser Permanente’s highly-rated integrated health care delivery system. The Kaiser Permanente HMO provides the most coordinated care generally with the lowest out-of-pocket costs.
HMO Flex Rider: Kaiser Permanente offers the HMO Flex benefit to eligible members, subject to their employer’s contract. The HMO Flex benefit provides coverage for primary care office visits to non-Kaiser Permanente providers. HMO Flex covers up to 10 routine office visits per year* for the following types of providers: General Practice, Family Medicine, Internal Medicine, Obstetrics and Gynecology, Pediatrics, Behavioral Health (Mental Health and Chemical Dependency providers)
*Only specific services are covered under the Kaiser Permanente HMO Flex rider, and limitations and exclusions apply. Office visits are limited to 10 routine primary care office visits per year, including immunizations and clinically-administered contraceptives covered under health care reform. Basic lab, X-rays, and testing are limited to 10 combined services per year. Prescription drugs are limited to 10 prescriptions per year. Prescriptions are not subject to the Kaiser Permanente formulary, but medications on the Kaiser Permanente formulary are recommended. See kp.org/formulary for the up-to-date list. For details, Kaiser Permanente members should see their Benefit Summary.