Hawaii health plan · 2025

KP HI Gold 1000 Ded/250 Rx Ded · 60612HI0110011

Kaiser Foundation Health Plan, Inc - Hawaii offers this marketplace health insurance plan (Plan ID 60612HI0110011) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Gold Plan type: HMO CSR: Limited Cost Sharing Plan Variation Issuer: Kaiser Foundation Health Plan, Inc - Hawaii
Telehealth Data pending HSA eligible No Dental Not listed Vision Adult/Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 79.05%. Expect to pay roughly 20.95% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 78.84% (21.16% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$306 – $1202

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$8,700

$17400 per group

Review MOOP rules

Office visits

Primary care $30.00
Specialist $70.00
HSA Not eligible

Drug tiers

Generic $10.00
Preferred brand 30.00% Coinsurance after deductible

View formulary tiers

$420 / mo before subsidies

≈ $5038 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1331 / mo before subsidies

≈ $15966 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1611 / mo before subsidies

≈ $19337 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1024 / mo before subsidies

≈ $12288 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$350.00 Copay after deductible

Durable Medical Equipment

20.00%

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Hawaii). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Limited Cost Sharing Plan Variation plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$350.00 Copay after deductible

Durable Medical Equipment

20.00%

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 60612HI0110011
Coverage year 2025
State Hawaii
Issuer Kaiser Foundation Health Plan, Inc - Hawaii
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 60612HI0110011-03
Available variants

Standard On Exchange Plan · 60612HI0110011-01

Open to Indians below 300% FPL · 60612HI0110011-02

Open to Indians above 300% FPL · 60612HI0110011-03
Last plan update Tue, 13 Aug 2024 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Hawaii N/A
PCPs in Hawaii N/A
Telehealth support Data pending
Nationwide providers N/A

Provider network(s)

Providers Hawaii All US states
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

2,183 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
GENERIC 1,529
BRAND 357
SPECIALTY-TIER 192
PREFERRED-GENERIC 105
Prior authorization Drugs
Required 0
Not Required 2,183
Step therapy Drugs
Required 0
Not Required 2,183
Quantity limits Drugs
Has Limit 29
No Limit 2,154

Customer highlights

What stands out for members

  • Issuer: Kaiser Foundation Health Plan, Inc - Hawaii · Plan ID 60612HI0110011 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 60612HI0110011-03 (Open to Indians above 300% FPL) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

Coverage details pending

nan

Exclusions: nan

Diabetes Education

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Copay indicated is for Primary Care visit. For visit with a Specialist, the Specialist office visit copay applies. Telehealth visits (if clinically appropriate) $0 copay, refer to EOC.

Exclusions: nan

Home Health Care Services

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Physician visit covered at applicable office visit copay.

Exclusions: nan

Laboratory Outpatient and Professional Services

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Cost share indicated is "per day"

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Telehealth visits (if clinically appropriate) $0 copay, refer to EOC.

Exclusions: nan

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

No charge for primary care office visits for children through age 18. Telehealth visits (if clinically appropriate) $0 copay, refer to EOC.

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Telehealth visits (if clinically appropriate) $0 copay, refer to EOC.

Exclusions: nan

Rehabilitative Speech Therapy

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Telehealth visits (if clinically appropriate) $0 copay, refer to EOC.

Exclusions: nan

Specialist Visit

$70.00
Tier 1 in-network $70.00
Out-of-network 100.00%

Telehealth visits (if clinically appropriate) $0 copay, refer to EOC.

Exclusions: nan

Specialty Laboratory Services

$350.00 Copay after deductible
Tier 1 in-network $350.00 Copay after deductible
Out-of-network 100.00%

Cost share indicated is "per day"

Exclusions: nan

Urgent Care Centers or Facilities

$30.00
Tier 1 in-network $30.00
Out-of-network 20.00%

Copay indicated is for Primary Care visit. For visit with a Specialist, the Specialist office visit copay applies. Cost share indicated as a copay for in-network urgent care services received within the service area and as a coinsurance for urgent care services received outside of the service area

Exclusions: nan

X-rays and Diagnostic Imaging

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Cost share indicated is "per day"

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Drug covered at cost share indicated, additional office visit charge applies.

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

nan

Exclusions: nan

Dialysis

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

nan

Exclusions: nan

Durable Medical Equipment

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

nan

Exclusions: nan

Emergency Room Services

$350.00 Copay after deductible
Tier 1 in-network $350.00 Copay after deductible
Out-of-network $350.00 Copay after deductible

Must notify KP within 48 hours if admitted to a non-plan provider; limited to initial emergency only

Exclusions: nan

Emergency Transportation/Ambulance

20.00%
Tier 1 in-network 20.00%
Out-of-network 20.00%

nan

Exclusions: nan

Hospice Services

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Physician visit covered at applicable office visit copay.

Exclusions: nan

Inpatient Hospital Services (e.g., Hospital Stay)

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

nan

Exclusions: nan

Inpatient Physician and Surgical Services

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

No charge for primary care office visits for children through age 18. Telehealth visits (if clinically appropriate) $0 copay, refer to EOC.

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

nan

Exclusions: nan

Outpatient Rehabilitation Services

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Telehealth visits (if clinically appropriate) $0 copay, refer to EOC.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

nan

Exclusions: nan

Radiation

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

nan

Exclusions: nan

Skilled Nursing Facility

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 120.0 Days per Year

Cost share indicated is for skilled nursing care.

Exclusions: nan

Substance Abuse Disorder Inpatient Services

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

nan

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

No charge for primary care office visits for children through age 18. Telehealth visits (if clinically appropriate) $0 copay, refer to EOC.

Exclusions: nan

Transplant

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Cost share indicated is for services performed on an inpatient basis.

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Hearing Aids

60.00%
Tier 1 in-network 60.00%
Out-of-network 100.00%

Limit: 1.0 Item(s) per 3 Years

Hearing aid(s) provided once every 36 months per ear.

Exclusions: nan

Major Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Prenatal and Postnatal Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Telehealth visits (if clinically appropriate) $0 copay, refer to EOC.

Exclusions: nan

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Telehealth visits (if clinically appropriate) $0 copay, refer to EOC.

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Copay refers to generic drugs used to treat certain chronic conditions. Subject to formulary guidelines.

Exclusions: nan

Generic Drugs Maintenance

$3.00
Tier 1 in-network $3.00
Out-of-network 100.00%

Copay refers to all other generic drugs not used to treat certain chronic conditions. Subject to formulary guidelines.

Exclusions: nan

Non-Preferred Brand Drugs

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Subject to formulary guidelines

Exclusions: nan

Preferred Brand Drugs

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Subject to formulary guidelines

Exclusions: nan

Specialty Drugs

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Subject to formulary guidelines

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

$350.00 Copay after deductible
Tier 1 in-network $350.00 Copay after deductible
Out-of-network $350.00 Copay after deductible

Services of dentists are covered, but only when the dentist performs emergency or surgical services that could also be performed by a physician

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

Coverage details pending

nan

Exclusions: nan

Infusion Therapy

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Drug covered at cost share indicated, additional office visit charge applies.

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Telehealth visits (if clinically appropriate) $0 copay, refer to EOC.

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Prosthetic Devices

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Cost share indicated is for services performed on an inpatient basis.

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

When performed during an outpatient surgery in an ambulatory surgery center

Exclusions: nan

Active & Fit

$200.00
Tier 1 in-network $200.00
Out-of-network 100.00%

Copay indicated is for basic fitness club and exercise center membership program.

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Drug covered at cost share indicated, additional office visit charge applies.

Exclusions: nan

Bariatric Surgery

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Cost share indicated is for services performed on an inpatient basis.

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

nan

Exclusions: nan

Gender Affirming Care

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

nan

Exclusions: nan

Habilitation Services

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Coverage limited to state-defined habilitative services. Telehealth visits (if clinically appropriate) $0 copay, refer to EOC.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

$350.00 Copay after deductible
Tier 1 in-network $350.00 Copay after deductible
Out-of-network 100.00%

Cost share indicated is "per day"

Exclusions: nan

Infertility Treatment

$30.00, 20.00%
Tier 1 in-network $30.00, 20.00%
Out-of-network 100.00%

Limit: 1.0 Procedure(s) per Lifetime

Copay indicated is for Primary Care visit. For visit with a Specialist, the Specialist office visit copay applies. Limited to initial consult only. In Vitro Fertilization provided at coinsurance indicated once per lifetime.

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

Coverage details pending

nan

Exclusions: nan

Reconstructive Surgery

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Cost share indicated is for services performed on an inpatient basis.

Exclusions: nan

Routine Eye Exam (Adult)

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

nan

Exclusions: nan

Routine Foot Care

Coverage details pending

nan

Exclusions: nan

Testing Services

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

Cost share indicated is "per test"

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

30.00%
Tier 1 in-network 30.00%
Out-of-network 100.00%

Cost share indicated is for services performed on an inpatient basis.

Exclusions: nan

Variant attributes

KP HI Gold 1000 Ded/250 Rx Ded · Variant 60612HI0110011-03

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Limited Cost Sharing Plan Variation

HIOS Product ID

60612HI011

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

60612HI0110011-03

Plan Marketing Name

KP HI Gold 1000 Ded/250 Rx Ded

Plan Variant Marketing Name

KP HI Gold 1000 Ded/250 Rx Ded AI/LTD

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

79.05%

Issuer ID

60612

Issuer Marketplace Marketing Name

Kaiser Permanente

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

HIN001

Out of Country Coverage

Yes

Out of Country Coverage Description

Emergency Services

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Emergency Services, Urgent Care and Authorized Referrals

Service Area ID

HIS001

State Code

HI

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.788432533834101

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

50.00%

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

Medical EHB Deductible, In Network (Tier 1), Default Coinsurance

30.00%

SBC Scenario, Having a Baby, Coinsurance

$2,300

SBC Scenario, Having a Baby, Copayment

$20

SBC Scenario, Having a Baby, Deductible

$1,000

SBC Scenario, Having Diabetes, Coinsurance

$1,300

SBC Scenario, Having Diabetes, Copayment

$500

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$200

SBC Scenario, Treatment of a Simple Fracture, Copayment

$500

SBC Scenario, Treatment of a Simple Fracture, Deductible

$1,000

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$17400 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$8700 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$8,700

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

HIF005

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$0

SBC Scenario, Having Diabetes, Limit

$0

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Drug EHB Deductible, In Network (Tier 1), Family Per Group

$500 per group

Drug EHB Deductible, In Network (Tier 1), Family Per Person

$250 per person

Drug EHB Deductible, In Network (Tier 1), Individual

$250

Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Out of Network, Individual

Not Applicable

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs

EHB Percent of Total Premium

0.9976

First Tier Utilization

100%

Import Date

2024-08-13 20:01:38

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

Yes

Medical EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Medical EHB Deductible, In Network (Tier 1), Family Per Group

$2000 per group

Medical EHB Deductible, In Network (Tier 1), Family Per Person

$1000 per person

Medical EHB Deductible, In Network (Tier 1), Individual

$1,000

Medical EHB Deductible, Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Out of Network, Individual

Not Applicable

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

HMO

QHP/Non QHP

On the Exchange

Source Name

SERFF

Specialist Requiring a Referral

Referral required for certain specialists

Plan ID

60612HI0110011

Unique Plan Design

Yes

Wellness Program Offered

Yes

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Hawaii?

KP HI Gold 1000 Ded/250 Rx Ded (60612HI0110011) is a Gold HMO from Kaiser Foundation Health Plan, Inc - Hawaii in Hawaii for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does KP HI Gold 1000 Ded/250 Rx Ded support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is KP HI Gold 1000 Ded/250 Rx Ded HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Adult, Child.

Does KP HI Gold 1000 Ded/250 Rx Ded support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with KP HI Gold 1000 Ded/250 Rx Ded?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.

Is there out-of-country coverage for KP HI Gold 1000 Ded/250 Rx Ded?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Emergency Services

Does KP HI Gold 1000 Ded/250 Rx Ded cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Emergency Services, Urgent Care and Authorized Referrals

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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