KPF
Kaiser Permanente - Fresno California — Prosper
PSHB New for 2027|Kaiser Permanente - Fresno California|Traditional|HMO
Premium
biweekly · employee paysSelf Only
$74.45biweekly · employee pays
vs 2026—
Lowest$74.45 (2027)
Highest$74.45 (2027)
Since 2027—
Self Plus One
$172.07biweekly · employee pays
vs 2026—
Lowest$172.07 (2027)
Highest$172.07 (2027)
Since 2027—
Self & Family
$172.07biweekly · employee pays
vs 2026—
Lowest$172.07 (2027)
Highest$172.07 (2027)
Since 2027—
Premium history
SharePeriodRate type
Year by year
follows the chart's share, period and rate-type selection| Year | Self Only | Δ | Self Plus One | Δ | Self & Family | Δ | Listed as |
|---|
Changelog
- 2027First appears in OPM rate tablesNew plan option for 2027.
Full rate schedule
Plan yearIn-network
2027 plan benefits file| Self Only | Self Plus One | Self & Family | |
|---|---|---|---|
| Annual deductible | $250 | $500 | $500 |
| Medical account contribution | Not applicable | Not applicable | Not applicable |
| Net deductible | $250 | $500 | $500 |
| Annual out-of-pocket maximum | $7,500 | $15,000 | $15,000 |
- Type of accountNot Applicable
- Total Annual Part B Premium Reimbursement Amount per enrollee (PDP)$3,000
- Medicare Part D EGWP Prescription Drug Out-of-Pocket Maximum per enrollee$2,400
- Total Annual Part B Premium Reimbursement Amount Per Enrollee (MAPD)$3,000
- Tier 0$0 Copayment
- Tier 1$15 Copayment
- Tier 2$100 Copayment
- Tier 3$100 Copayment
- Tier 4$300 Copayment
- Mail Order PharmacyNo
- Deductible waiver (with Medicare Part A as Primary)$250
- Deductible waiver (with Medicare Part B as Primary)$250
- Deductible Waiver with Parts A & B$250
- Out-of-Pocket Maximum with Parts A & B$7,500
- Primary Care Physician Office Visit with Medicare A & B Primary$30 Copayment
- Specialty Physician Office Visit with Parts A & B$40 Copayment
- Inpatient Hospital Services with Parts A & B$900 Copayment
- Outpatient Hospital Services with Part A$300 Copayment
- Outpatient physician services (with Medicare Part B as Primary)$300 Copayment
- Part B Premium Reimbursement with Parts A & BNot applicable
- Requirement for Part B ReimbursementNot applicable
- Deductible Waiver with Part CNot applicable
- Out-of-Pocket Maximum with Part C$2,500
- Primary Care Physician Office Visit with Medicare Advantage (Part C) Primary$25 Copayment
- Specialty Physician Office Visit with Part C$30 Copayment
- Inpatient Hospital Services with Part C$500 Copayment
- Outpatient Hospital Services with Part C$100 Copayment
- Outpatient physician services (with Medicare Advantage Part C as Primary)$100 Copayment
- Part B Premium Reimbursement with Part CNot applicable
- Preventive CareMember Pays Nothing
- Primary Care Office Visit$30 Copayment
- Specialist Office Visit$40 Copayment
- Emergency Care$375 Copayment
- Urgent Care$30 Copayment
- Doctor Costs for Inpatient SurgeryMember Pays Nothing
- Hospital Inpatient Cost Per Admission$900 Copayment
- Hospital Room CostsMember Pays Nothing
- Other Inpatient Hospital CostsMember Pays Nothing
- Doctor Costs for Outpatient SurgeryMember Pays Nothing
- Other Outpatient Surgery Costs$300 Copayment
- Diagnostic Tests or Procedures (e.g., Blood Tests, X-rays, Urinalysis, Ultrasounds)$25 Copayment
- Diagnostic Tests or Procedures (e.g., CT scans, MRIs, PET Scans)$75 Copayment
- Enhanced Lab NetworkNot applicable
- Applied Behavioral Analysis (ABA)$30 Copayment
- ChiropracticMember Pays All Charges
- Occupational Therapy$30 Copayment
- Physical Therapy$30 Copayment
- Speech Therapy$30 Copayment
- Professional Services (Mental Health and Substance Use Disorder)$30 Copayment
- Inpatient Hospital (Mental Health and Substance Use Disorder Services)$900 Copayment
- Outpatient Hospital (Mental Health and Substance Use Disorder Services)Member Pays Nothing
- Diagnosis and Treatment (Infertility Services)$40 Copayment
- Fertility Preservation Procedures (e.g., iatrogenic infertility) (Infertility Services)$40 Copayment
- Artificial Insemination Services (e.g. ICI, IVI, IUI)$300 Copayment
- Assisted Reproductive Technology (ART) (e.g., IVF, GIFT, ZIFT) (Infertility Services)$300 Copayment
- Surgical ProceduresMember Pays Nothing
- Reconstructive SurgeryMember Pays Nothing
- Hearing Services$30 Copayment
- Hearing Aids (external)Covered
- Prenatal Care, Screening for Gestational Diabetes, Delivery, and Postpartum Care (Maternity Care)Member Pays Nothing
- Hospital Stay--Vaginal Birth, Cesarean Birth (Maternity Care)$900 Copayment
- Hospice CareMember Pays Nothing
- Home Health Services (Skilled Nursing Care)Member Pays Nothing
- Durable Medical Equipment50% Coinsurance
- Outpatient Rehabilitation (Skilled Nursing Care Facility)$30 Copayment
- Diabetes EducationMember Pays Nothing
- Nutritional CounselingMember Pays Nothing
- Routine Dental Exams and Cleaning for AdultsNot Covered
- Routine Dental Exams and Cleaning for ChildrenNot Covered
- Routine Eye ExamsCovered
- Eye Exams for Medical Condition or Non-Surgical TreatmentCovered
- EyeglassesNot Covered
- Contact LensesNot Covered
- Acupuncture$30 Copayment
- Chronic Disease Management: Heart DiseaseCovered
- Chronic Disease Management: ObesityCovered
- Chronic Disease Management: HypertensionCovered
- Chronic Disease Management: AsthmaNot Covered
Out-of-network
2027 plan benefits file| Self Only | Self Plus One | Self & Family | |
|---|---|---|---|
| Annual deductible | Not applicable | Not applicable | Not applicable |
| Medical account contribution | Not applicable | Not applicable | Not applicable |
| Net deductible | Not applicable | Not applicable | Not applicable |
| Annual out-of-pocket maximum | Not applicable | Not applicable | Not applicable |
- Type of accountNot Applicable
- Tier 0100% Coinsurance
- Tier 1100% Coinsurance
- Tier 2100% Coinsurance
- Tier 3100% Coinsurance
- Tier 4100% Coinsurance
- Mail Order PharmacyNo
- Deductible waiver (with Medicare Part A as Primary)Not applicable
- Deductible waiver (with Medicare Part B as Primary)Not applicable
- Deductible Waiver with Parts A & BNot applicable
- Out-of-Pocket Maximum with Parts A & BNot applicable
- Primary Care Physician Office Visit with Medicare A & B PrimaryNot applicable
- Specialty Physician Office Visit with Parts A & BNot applicable
- Inpatient Hospital Services with Parts A & BNot applicable
- Outpatient Hospital Services with Part ANot applicable
- Outpatient physician services (with Medicare Part B as Primary)Not applicable
- Part B Premium Reimbursement with Parts A & BNot applicable
- Requirement for Part B ReimbursementNot applicable
- Deductible Waiver with Part CNot applicable
- Out-of-Pocket Maximum with Part CNot applicable
- Primary Care Physician Office Visit with Medicare Advantage (Part C) PrimaryNot applicable
- Specialty Physician Office Visit with Part CNot applicable
- Inpatient Hospital Services with Part CNot applicable
- Outpatient Hospital Services with Part CNot applicable
- Outpatient physician services (with Medicare Advantage Part C as Primary)Not applicable
- Part B Premium Reimbursement with Part CNot applicable
- Preventive CareMember Pays All Charges
- Primary Care Office VisitMember Pays All Charges
- Specialist Office VisitMember Pays All Charges
- Emergency Care$375 Copayment
- Urgent Care$30 Copayment
- Doctor Costs for Inpatient SurgeryMember Pays All Charges
- Hospital Inpatient Cost Per AdmissionMember Pays All Charges
- Hospital Room CostsMember Pays All Charges
- Other Inpatient Hospital CostsMember Pays All Charges
- Doctor Costs for Outpatient SurgeryMember Pays All Charges
- Other Outpatient Surgery CostsMember Pays All Charges
- Diagnostic Tests or Procedures (e.g., Blood Tests, X-rays, Urinalysis, Ultrasounds)Member Pays All Charges
- Diagnostic Tests or Procedures (e.g., CT scans, MRIs, PET Scans)Member Pays All Charges
- Enhanced Lab NetworkMember Pays All Charges
- Applied Behavioral Analysis (ABA)Member Pays All Charges
- ChiropracticMember Pays All Charges
- Occupational TherapyMember Pays All Charges
- Physical TherapyMember Pays All Charges
- Speech TherapyMember Pays All Charges
- Professional Services (Mental Health and Substance Use Disorder)Member Pays All Charges
- Inpatient Hospital (Mental Health and Substance Use Disorder Services)Member Pays All Charges
- Outpatient Hospital (Mental Health and Substance Use Disorder Services)Member Pays All Charges
- Diagnosis and Treatment (Infertility Services)Member Pays All Charges
- Fertility Preservation Procedures (e.g., iatrogenic infertility) (Infertility Services)Member Pays All Charges
- Artificial Insemination Services (e.g. ICI, IVI, IUI)Member Pays All Charges
- Assisted Reproductive Technology (ART) (e.g., IVF, GIFT, ZIFT) (Infertility Services)Member Pays All Charges
- Surgical ProceduresMember Pays All Charges
- Reconstructive SurgeryMember Pays All Charges
- Hearing ServicesMember Pays All Charges
- Hearing Aids (external)Not Covered
- Prenatal Care, Screening for Gestational Diabetes, Delivery, and Postpartum Care (Maternity Care)Member Pays All Charges
- Hospital Stay--Vaginal Birth, Cesarean Birth (Maternity Care)Member Pays All Charges
- Hospice CareMember Pays All Charges
- Home Health Services (Skilled Nursing Care)Member Pays All Charges
- Durable Medical EquipmentMember Pays All Charges
- Outpatient Rehabilitation (Skilled Nursing Care Facility)Member Pays All Charges
- Diabetes EducationMember Pays All Charges
- Nutritional CounselingMember Pays All Charges
- Routine Dental Exams and Cleaning for AdultsNot Covered
- Routine Dental Exams and Cleaning for ChildrenNot Covered
- Routine Eye ExamsNot Covered
- Eye Exams for Medical Condition or Non-Surgical TreatmentNot Covered
- EyeglassesNot Covered
- Contact LensesNot Covered
- AcupunctureMember Pays All Charges
- Chronic Disease Management: Heart DiseaseNot Covered
- Chronic Disease Management: ObesityNot Covered
- Chronic Disease Management: HypertensionNot Covered
- Chronic Disease Management: AsthmaNot Covered
States
1California
Counties covered
| State | Area |
|---|---|
| California | Fresno, Kings, Madera, Mariposa, Tulare |