Infosys Logo
People on laptops

New! Kaiser Medical Plans

Available to employees in California and Hawaii

Employees in California have a choice of four Kaiser Permanente medical plans, including two HMOs and two High Deductible Health Plans. Employees in Hawaii are offered a separate Kaiser Hawaii plan. All five Kaiser plans offer in-network coverage only. You must select a primary care physician to initiate and coordinate care. To be eligible for these plans, you must reside within the Kaiser service area. You can check your eligibility in the bswift enrollment system. To find in-network providers, visit choose.kaiserpermanente.org/infosys/plans.

PLAN FEATURES KAISER
BASIC		 KAISER
HMO		 KAISER
BASIC HSA		 KAISER
STANDARD HSA		 KAISER
HAWAII 220
California Only California Only California Only California Only Hawaii Only
In-Network In-Network In-Network In-Network In-Network
Plan Year Deductible Embedded
$3,000 Indiv.
$6,900 Fam.		 Embedded
$5,000 Indiv.
$11,500 Fam.		 Embedded
$3,000 Self only
$3,400 Indiv.
$6,900 Fam.		 Embedded
$1,700 Self only
$3,400 Indiv.
$3,795 Fam.		 $0
Medical Out-of-Pocket Maximum – Includes deductibles and/or copays $7,350 Indiv.
$16,600 Fam.		 $8,500 Indiv.
$17,000 Fam.		 $7,350 Self only
$7,350 Indiv.
$16,600 Fam.		 $3,400 Self only
$3,400 Indiv.
$7,590 Fam.		 $2,500 Indiv.
$7,500 Fam.
Rx Out-of-Pocket Maximum – Includes deductibles and/or copays Included in the medical out-of-pocket max. Included in the medical out-of-pocket max. Included in the medical out-of-pocket max. Included in the medical out-of-pocket max. N/A
Member Coinsurance 30% after ded. 30% after ded. 30% after ded. 20% after ded. 20%
Preventive Care – 1 exam every Plan Year Covered at 100% Covered at 100% Covered at 100% Covered at 100% Covered at 100%
Primary Care Physician $40 copay 30% after ded. After ded. is met, then $40 copay After ded. is met, then $25 copay $15 copay
Specialist $70 copay 30% after ded. After ded. is met, then $70 copay After ded. is met, then $40 copay $15 copay
Lab and X-ray Services 30% after ded. 30% after ded. 30% after ded. 20% after ded. $15 copay
Physical/Occupational/Speech Therapy $40 copay 30% after ded. 30% after ded. 20% after ded. $15 copay
Urgent Care $40 copay 30% after ded. After ded. is met, then $40 copay After ded. is met, then $25 copay $15 copay
Emergency Room:
  - Emergency Care
  - Non-Emergency Care		 $200 copay 30% after ded. 30% after ded. 20% after ded. 20% coinsurance
(waived if admitted)
Hospital Services 30% after ded. 30% after ded. 30% after ded. 20% after ded. 20% coinsurance
PRESCRIPTION DRUGS
Retail (Up to 30-day supply) After ded. is met, then: After ded. is met, then: After ded. is met, then: After ded. is met, then: No ded.
Generic $10 copay $10 copay $10 copay $10 copay $10 copay
Preferred Brand 30% coinsurance;
$40 max.		 30% coinsurance;
$40 max.		 30% coinsurance;
$40 max.		 30% coinsurance;
$40 max.		 $45 copay
Non-Preferred Brand 30% coinsurance;
$40 max.*		 30% coinsurance;
$40 max.*		 30% coinsurance;
$40 max.*		 30% coinsurance;
$40 max.*		 $45 copay
Mail Order (Up to 100-day supply CA / 90-day supply HI) After ded. is met, then: After ded. is met, then: After ded. is met, then: After ded. is met, then: No ded.
Generic $20 copay $20 copay $20 copay $20 copay $20 copay
Preferred Brand 30% coinsurance;
$40 max.		 30% coinsurance;
$40 max.		 30% coinsurance;
$40 max.		 30% coinsurance;
$40 max.		 $90 copay
Non-Preferred Brand 30% coinsurance;
$40 max.*		 30% coinsurance;
$40 max.*		 30% coinsurance;
$40 max.*		 30% coinsurance;
$40 max.*		 $90 copay
*Approval required