HMO medical plans

What you need to know

In a health maintenance organization (HMO), you and each covered dependent must choose a primary care physician (PCP) within the HMO network. The PCP coordinates all your care with providers within the HMO network.

How an HMO plan works

Pay nothing for preventive care in the HMO network. That includes services like screenings, immunizations, and exams.

You pay only copays when you get care. And there’s no coinsurance to pay, either.

Care outside the HMO network isn’t covered. Unless it’s an emergency situation.

Copays count toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum, the plan pays 100% of covered services for the rest of the year.

Pharmacy benefits are provided by the HMO. You pay a copay for generic, brand, and non-brand prescriptions at in-network pharmacies. But prescriptions filled at an out-of-network pharmacy aren’t covered by the plan.

Certain medications cost nothing for Kaiser HMO members. Prescriptions for medications to treat diabetes, high blood pressure, and high cholesterol are provided at no cost to Kaiser HMO members when they are filled by in-network pharmacies.

HMO plans at a glance

You can enroll in an HMO if you live in one of these states:

California: Kaiser HMO
Utah: SelectHealth HMO

Find out more about what these plans have to offer.

Kaiser HMO (CA)

SelectHealth HMO (UT)

Provider contact information

If you have any questions, please contact paypalincbenefits@paypal.com.