KP HI Gold 0/30

60612HI0110002
Gold
HMO

KP HI Gold 0/30 is a Gold HMO plan by Kaiser Permanente.

IMPORTANT: You are viewing the 2023 version of KP HI Gold 0/30 60612HI0110002. You can enroll in this plan if you qualify for special enrollment until the end of 2023.

Locations

KP HI Gold 0/30 is offered in the following counties.

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Plan Overview

This is a plan overview for 2023 version of KP HI Gold 0/30 60612HI0110002.
Insurer: Kaiser Permanente
Network Type: HMO
Metal Type: Gold
HSA Eligible?: No
Plan ID: 60612HI0110002

Cost-Sharing Overview

KP HI Gold 0/30 offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for KP HI Gold 0/30?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

KP HI Gold 0/30 offers the following features and referral requirements.

Wellness Program: Yes
Disease Program: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
Notice Pregnancy: No
Referral Specialist: Yes
Specialist Requiring Referral: Referral required for certain specialists
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what KP HI Gold 0/30 covers when you are out of the service area or out of the country.

Out of Country Coverage: Yes
Out of Country Coverage Description: Emergency Services
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: Emergency Services, Urgent Care and Authorized Referrals
National Network: No

Additional Benefits and Cost-Sharing

KP HI Gold 0/30 includes the following benefits at the cost sharing rates listed below.

Free Preventive Services

There is no copayment or coinsurance for any of the following KP HI Gold 0/30 preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Additional Resources

Below are additional resources for KP HI Gold 0/30 including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.

Summary of Benefits: Summary of Benefits Link
Plan Brochure: Plan Brochure Link
Formulary: Formulary Link
Premium Payment Website: Premium Payment Link
Ready to sign up for KP HI Gold 0/30?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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