California – Northern

These rates do not apply to all enrollees. If you are in a special enrollment category, please refer to the FEHBP Program website or contact the agency or Tribal Employer which maintains your health benefits enrollment.

2024 Summary of Benefits

2024 FEHB Benefits Rates NCAL View

High Option	Standard Option	Prosper
Deductible	None	$100	$500
2024 Benefits and Services
Outpatient services
Preventive care	$0	$0	$0
Telehealth	$0	$0	$0
Primary care office visit	$15	$30	$25
Specialty care office visit	$25	$40	$35
Laboratory tests	$0	$10 1	20% 1
X-rays	$0	$10 1	20% 1
Chiropractic services – 20 visits per year	$15	$15	$15
Maternity
Routine prenatal care and postpartum visit	$0	$0	$0
Delivery	$250	$500 1	20% 1
Hospital services
Outpatient surgery	$50	$200 1	20% 1
Inpatient hospital	$250	$500 1	20% 1
Emergency and urgent care
Urgent care	$15	$30	$25
Emergency care	$100	$150 1	20% 1
Ambulance	$50	$150 1	20% 1
Prescription drugs
Generic	$10	$15	$15
Brand	$40	$50	$60
Specialty	$100	$150	$200
Out-of-pocket maximum	$2,000	$3,000	$5,500

1 Deductible applies.

Deductible and out-of-pocket maximum amounts are per person, but no more than 2 times per family.
Coinsurance (%) is based on our allowance.
Telehealth options include video, phone, email and more.
Prescription drug copayments are for a 30-day supply at Kaiser Permanente pharmacies. You pay only 2 copays for up to a 100-day supply for most drugs through Kaiser Permanente’s mail-order program.

This is a summary of the features of the Kaiser Permanente – Northern California FEHB plan. Before making a final decision, please read the Plan’s Federal brochure (RI 73-003). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.

Ready to enroll?

To sign up, write down the enrollment code above. You will be asked to provide it during the sign-up process. Then click below to visit OPM.gov or contact your employing agency or retirement office for next steps and other information.

These are highlights of the FEHB enrollment process. Please refer directly to opm.gov and your employing agency or retirement office for FEHB coverage effective dates, enrollment procedures and deadlines, and other information.

Care for growing families

There’s no better place to plan, start, and raise your family because you’re all at the center of everything we do. Check out what you get with your health plan and discover how your dollars go further with Kaiser Permanente.

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Need help? Talk to a Federal Employee Health Benefits Specialist at 1-877-904-0016

Kaiser Permanente health plans around the country: Kaiser Foundation Health Plan, Inc., in Northern and Southern California and Hawaii • Kaiser Foundation Health Plan of Colorado • Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, 404-364-7000 • Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., in Maryland, Virginia, and Washington, D.C., 2101 E. Jefferson St., Rockville, MD 20852 • Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232 • Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc,, 601 Union St., Suite 3100, Seattle, WA 98101