Kaiser Permanente HMO Plan

This managed health care plan provides your health care services through a system of healthcare facilities known as an HMO. Through the Kaiser Permanente HMO, you select a primary care physician who becomes familiar with your health status and medical needs. You are then treated or referred to specialists in the HMO when necessary.

Depending on the provider you see and the services you receive, the Kaiser Permanente HMO Plan generally has lower out-of-pocket costs than the CareFirst PPO plan. If you select this plan, you can only see the physicians associated with the HMO to receive benefits.

Preferred Provider Organization (PPO)

Effective April 13, 2020, all employees are eligible for the PPO Plan. This plan utilizes the CareFirst POS network of healthcare providers-doctors, specialists, hospitals, laboratory facilities, etc.-who have agreed to provide health care services at a contracted rate for employees. When you visit a provider in the PPO network, there is no deductible to meet, and many services are covered at 100% of the negotiated price minus any co-payment.

Under this plan, you do not need to see a primary care physician. You have the flexibility to see any doctor or specialist in the network without a referral. If you see an out-of-network provider, you will still receive benefits for covered services. However, your out-of-pocket costs are generally higher, and you must meet an annual deductible before benefits are paid. Suppose the out-of-network provider charges more than the PPO negotiated price. In that case, you are responsible for paying the difference between the out-of-network provider cost and the PPO’s contracted price.

You can find an in-network provider near you by visiting CareFirst.

CareFirst also offers online Explanations of Benefits (EOBs) and other helpful tools and resources on its website. Read more about online EOBs.

CareFirst Blue Choice HMO Plan

This managed health care plan provides your health care services through a system of healthcare facilities known as an HMO. You select a primary care physician who becomes familiar with your health status and medical needs through the HMO. You are then treated or referred to specialists in the HMO when necessary.

Depending on the provider you see and the services you receive, the CareFirst Blue Choice HMO Plan generally has lower out-of-pocket costs than the CareFirst POS plan. If you select this plan, you can only see the physicians associated with the HMO to receive benefits.

CareFirst offers online Explanations of Benefits (EOBs) and other helpful tools and resources on its website. Read more about online EOBs.

Medical Benefit Comparison

Your Medical Benefits

*Benefits for Kaiser enrollees who are retired and Medicare-eligible differ in some respects from the benefits for active employees and pre-Medicare retirees.
** Remember, when you see an out-of-network provider for care, the provider may charge more than the POS Allowance. If this is the case, you are responsible for paying the balance in addition to your coinsurance.
***Surgical benefits are available only at Centers of Blue Distinction.

Limitation and Exclusions

Covered medical services must be medically necessary as determined under the plan’s rules. Cosmetic procedures and experimental procedures are generally not covered. In addition, some medical services may be excluded, limited, or require prior authorization for medical necessity. Refer to the benefits booklet from your carrier or contact your carrier for more details.

No Surprises Act

You may have heard stories from friends or news about balance bills or surprise bills from health care providers. Starting in 2022, a new law went into effect – the federal No Surprises Act – that protects you from many types of surprise bills. Click here to find out the basics about the new protections and some examples of how they can protect consumers.

Learn more