Medical Plans and Prescription Coverage

Kaiser Medical Coverage

HMO HMO
Selected Coverage Network Out-of-Network
Plan type Health maintenance organization (HMO) available only to California employees in the Kaiser network. Network coverage only, except in emergencies. Health maintenance organization (HMO) available only to California employees in the Kaiser network. Network coverage only, except in emergencies.
Network name Kaiser Permanente Traditional Plan Kaiser Permanente Traditional Plan
Deductible $0 Employee-only/$0 Family No coverage
Coinsurance You pay $0 No coverage
Out-of-pocket maximum $1,500 Employee-only/$3,000 Family No coverage
Preventive care Covered 100% No coverage
HSA available No. Health Care FSA available No. Health Care FSA available
Virtual Visits Not available Not available
Primary care physician visit You pay $35 No coverage
Specialist Visit You pay $35 No coverage
Maternity (hospitalization) 100% covered after $500 hospital copay No coverage
Hospital admission You pay $500 copay No coverage
Inpatient surgery You pay $0 after $500 hospital copay No coverage
Outpatient surgery $150 copay per procedure No coverage
Emergency room visit $150 copay, then $0; copay waived if admitted $150 copay, then $0; copay waived if admitted

Optum Behavioral Health Virtual Visits

Behavioral Health Virtual Visits provide quick and easy access to behavioral health professionals from your mobile device, tablet or computer.

The value of Behavioral Health Virtual Visits:

  • You can connect with a provider from the comfort of home.
  • Convenient appointment times accommodates busy schedules.
  • They’re part of your behavioral health benefit through UnitedHealthcare. Costs and coverage may vary – please check your plan’s SBCs and the FAQs below for details.

Use a Behavioral Health Virtual Visit for needs such as:

  • Depression
  • Anxiety
  • ADD/ADHD
  • Addiction
  • Mental Health Disorders and Counseling

To schedule a Behavioral Health Virtual Visit:

  1. Visit UnitedHealthcare  and sign in or register for an account.
  2. Find a doctor. Click Find a Doctor > Mental Health Directory > People > Provider Type > Mental Health Providers.
  3. Refine your search. Refine search as needed, and choose a provider with the “Mental health provider” designation.
  4. Call the provider to set up a time.

Optum Behavioral Health Virtual Visits FAQs

Are Optum Behavioral Health Virtual Visits the same as UnitedHealthcare Virtual Visits?

No. UnitedHealthcare’s Virtual Visits model lets members seek medical care virtually for acute conditions. Benefit plans include a specific UHC Virtual Visit benefit. Teladoc, AmWell, and Doctor on Demand are the three national virtual-only provider groups contracted for UHC Virtual Visit. UHC Virtual Visits drives affordability, providing members with a convenient alternative to emergency room or urgent care facilities for treatment of acute medical conditions. Optum Behavioral Health positions virtual capabilities as a modality, allowing all network providers to offer virtual visits as an option. There is no separate benefit. Optum’s model drives access to care.

Do Optum Behavioral Health Virtual Visits have a lower co-pay or co-insurance than in-person visits?

No. For behavioral health, virtual visits are subject to the same out-of-pocket as an in-office visit (behavioral health outpatient office visit). This benefit model ensures that the member has the same out-of-pocket costs whether they see their therapist and/or psychiatrist in-office, virtually or both throughout the course of care.

For NXP Copay Plans 2 and 3, the Behavioral Health Virtual Visit copay is $20. For Medical Plan 1, the allowed amount could vary depending on the provider’s contracted rate and will be applied to the member’s deductible.