These are some of the most common questions people have about our plans. Some questions are not applicable in all regions serviced by Kaiser Permanente. If you have questions about a specific type of plan or a particular benefit, call us at 1-800-245-3181. We'll be happy to answer any questions.

What is coinsurance?
This is the percentage of charges you pay when you receive a covered service. Coinsurance amounts vary depending on the plan and the service.
What is a copayment (copay)?
This is the specific dollar amount you pay when you receive certain covered services or prescriptions. Copayments vary depending on the plan and the service.
What is a deductible?
In a deductible plan, the deductible is the fixed amount you must pay in a calendar or contract year before Kaiser Permanente will cover certain services in that calendar or contract year.
What is a health savings account (HSA)?
An HSA is a savings account intended to be used for qualified medical expenses. HSAs have certain federal tax advantages as well as certain restrictions.
What are HSA-qualified deductible plans?
These are deductible plans eligible to be paired with an optional health savings account. They are similar to deductible plans but work differently in certain respects.
What is meant by "Not subject to deductible"?
In deductible plans, some medical services are covered immediately and therefore are not subject to deductible. This means that from your first day of coverage, you can receive these services for a copayment or coinsurance, without having to first satisfy the deductible.
What is an out-of-pocket maximum (OOPM)?
The OOPM is the maximum amount you will have to pay for most covered medical services in a calendar or contract year (whichever is applicable).
What is a premium?
This is the amount you pay every month for health care coverage.
Is a physical exam required to qualify?
No. All you have to do is complete the medical questionnaire included in your application.
Can I enroll only my children?
Yes. You can apply for coverage for just your children, just your spouse, just yourself, or any combination of you and your dependents living in our service area. Child-only accounts are not available in all areas for HSA-qualified deductible plans. HSA-qualified deductible plans are not available in all areas.
Can family members apply for different plans?
Yes. Just complete a separate application for each plan you or your family members apply for.
In areas where available, how do HSA-qualified deductible plans work?
HSA-qualified plans are a type of deductible plan designed to work with a health savings account, or HSA. The advantage of an HSA-qualified plan is that you can deposit tax-deductible dollars into the account that you can later use to pay for qualified medical expenses. Plus, any interest that the HSA might earn is tax free. (Federal income tax only) Any funds you don't use in one year will roll over to the next. There's no “use it or lose it” with HSAs.*
What are qualified medical expenses in an HSA-qualified plan?
You can use an HSA to pay for deductibles, coinsurance, and many supplies and services not covered by your health plan. Generally, these are expenses that would qualify for the medical and dental expense deduction on your income tax.

Here are just a few examples of what may be HSA-qualified expenses:
  • Certain over-the-counter medications
  • Eyeglasses and LASIK surgery
  • Dental and orthodonture care
  • Acupuncture
  • Chiropractic services
  • Hearing aids
For a complete list, see Publication 502, Medical and Dental Expenses at www.irs.gov.
What if I need care when I'm traveling?
You're covered for emergency care anywhere in the world. If you're temporarily outside your service area, you're also covered for urgent care to prevent serious deterioration of your health if the care cannot be delayed until you return to your service area.
Are prescription medications covered? How do I get my prescriptions filled? Can I order my prescriptions by mail?
Most of our plans offer a prescription coverage option. You can order most refills online with My Health Manager† and pick them up at your medical office or receive them by mail at no extra charge.
Are mammograms covered?
Yes. They are available for no- or low-cost from the first day of coverage. You don't have to meet a deductible first for many preventive services.

*Kaiser Permanente does not provide or administer financial products, including HSAs, and does not offer financial, tax, or investment advice. HSA account holders are responsible for their own investment decisions. If an HSA account holder uses his or her HSA debit card to pay for something other than a qualified medical expense, the expenditure is subject to tax and, for individuals who are not disabled or over 65, a 10 percent tax penalty. Please note that when Wells Fargo Health Benefit Services pays disbursements, it does not monitor whether they are for qualified medical expenses. It is the HSA account holder's responsibility to determine whether expenses qualify for tax-free reimbursement from his or her HSA. For information about a Wells Fargo HSA, please contact Wells Fargo at 1-866-890-8308. The tax references in this document relate to federal income tax only. Consult with your financial or tax advisor for information about your state's income tax laws.

†Online services are available through My Health Manager at kp.org. Most My Health Manager features are available only to members receiving care at Kaiser Permanente—owned medical facilities.