Kaiser HMO
Call Kaiser's customer service: 800-464-4000
Call Kaiser's 24/7 Appointment and Advice Line: 866-454-8855
Find doctors’ locations near you
View electronic health records (registration on kp.org required for secure access to My Health Manager)
Plan group number: Group 890
You choose a Primary Care Physician (PCP). Your PCP coordinates all care through Kaiser providers and facilities and refers you to in-network specialists or hospitals when necessary.
Deductible: None
Copayment: $10 per office visit ($100 hospital per-admission copay)
Coinsurance: None, most services covered at 100% with minimal office-visit copayment
Annual Out-of-Pocket Maximum (individual/family): $1,500/$3,000
Preventive Care Copayment: None
Emergency (ER)* Copayment: $35 per visit at a Kaiser facility (waived if admitted)
Urgent Care Copayment: $10 per visit at a Kaiser facility
Service Area: Live/work within a 30-mile radius of a Kaiser hospital
* Reminder, costs at the ER are typically much higher than at an urgent care facility. Non-Kaiser facility services are covered only if medically necessary, and notification must be provided within 24 to 48 hours.
Valley Health Plan HMO
Call VHP's customer service: 888-421-8444
Call VHP's 24/7 Nurse Advice Line: 866-682-9492
Plan group number: Group C, Policy A
You choose a Primary Care Physician (PCP). Your PCP coordinates all care through Valley Health Plan providers and contracted facilities and refers you to in-network specialists or hospitals when necessary.
Deductible: None
Copayment: None (no hospital per-admission copay at Valley Health Plan hospitals)
Coinsurance: None, most services covered at 100%
Annual Out-of-Pocket Maximum (individual/family): $1,000/$2,000
Preventive Care Copayment: None
Emergency (ER)* Copayment: None (at Valley Health Plan hospitals)
Urgent Care Copayment: None
Service Area: Live/work in Santa Clara County
* Reminder, costs at the ER are typically much higher than at an urgent care facility. Services received at hospitals outside the network are covered only if medically necessary, and notification must be provided within 24 to 48 hours.
Health Net POS
Call Health Net's customer service: 800-522-0088
Plan group number: Group 40785A
You can seek care from three “Tiers” of providers: Health Net HMO providers, Health Net PPO network providers, and out-of-network providers.
Deductible (annual):
- HMO Providers – None
- PPO Providers – None
- Out-of-Network Providers - $200 per member/$600 per family
Copayment (varies, depending on the type of service; office visits listed here):
- HMO Providers – $15 per office visit ($0 hospital per-admission copay, if referred by PCP)
- PPO Providers – $20 per office visit
- Out-of-Network Providers – Not applicable
Coinsurance:
- HMO Providers – None, most services covered at 100%
- PPO Providers – Plan pays 90%, you pay 10% (prior authorization required for hospital services)
- Out-of-Network Providers – Plan pays 70% of maximum allowable amount, you pay 30% (in addition to deductible)
Annual Out-of-Pocket Maximum (individual/family):
- HMO Providers – $1,500/$4,500
- PPO Providers – $2,000/$6,000
- Out-of-Network Providers – $3,000/$9,000
A $2,000/$4,000 annual out-of-pocket maximum applies for prescription drug services (combined in and out-of-network maximum, separate from the medical out-of-pocket maximum).
Preventive Care Copayment:
- HMO Providers – None
- PPO Providers – None
- Out-of-Network Providers – None (coverage provided only to age 18)
Emergency (ER) Copayment:
- HMO Providers – $50 per in-network visit
- PPO Providers* – $75 per visit
- Out-of-Network Providers* – Plan pays 70% of maximum allowable amount (after deductible)
- Cost sharing is waived if admitted
Urgent Care Copayment:
- HMO Providers –$35 per in-network visit
- PPO Providers* – $50 per visit
- Out-of-Network Providers* – Plan pays 70% of maximum allowable amount (after deductible)
Service Area:
- HMO Providers – Receive care from Health Net HMO providers within a 30-mile radius of where you live/work
- PPO Providers - Receive care from providers in a selected network of Health Net medical doctors, hospitals, and other health care professionals
- Out-of-network providers – Receive care from any licensed provider
* If deemed an emergency, the Plan pays benefits for covered PPO and out-of-network services at the HMO level.
