HSA-Qualified Deductible HMO Plan

Glossary

Your Kaiser Permanente HSA-Qualified Deductible HMO Plan is not just health coverage — it's a partnership in health.

You receive preventive care services at little or no cost to you, and online features let you manage most of your care around the clock.

Your benefits include:

  • a personal doctor for routine medical care
  • copays or coinsurance for most covered services after you meet your deductible
  • no referrals needed for certain specialties, like optometry and obstetrics/gynecology
  • an out-of-pocket maximum that limits how much you'll spend on most services each year
  • no additional coinsurance needed after the annual out-of-pocket maximum is met
  • a pre-tax health savings account* to help pay for certain medical expenses†

* To be eligible for an HSA, you must be enrolled in an HSA-qualified deductible health plan and meet other HSA eligibility rules. For more information, see IRS Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans. The tax references in this document relate to federal income tax only. Consult with your financial or tax adviser for information about state income tax laws.

† To view the list of qualified medical expenses defined under Internal Revenue Code Section 213(d), see IRS Publication 502, Medical and Dental Expenses.

Your Evidence of Coverage or Summary Plan Description contains a complete explanation of benefits, exclusions, and limitations. The information provided here is not intended nor designed to serve as your Evidence of Coverage.

For details about your plan, see your employer's Summary Plan Description or other Plan documents.

Your health benefits are self-insured by your employer, union, or Plan sponsor. Kaiser Permanente Insurance Company provides certain administrative services for the Plan and is not an insurer of the Plan or financially liable for health care benefits under the Plan.

Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, 404-364-7000