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Microsoft provides comprehensive medical coverage for you and your eligible dependents with zero paycheck premiums. The Kaiser Washington HMO Plan is designed to offer personalized and coordinated care, along with cost predictability, to simplify managing your health. This plan is only available to employees and their dependents residing in Washington state.
You’re eligible to participate in the Kaiser Washington HMO Plan if you’re a benefit-eligible employee on the Microsoft US payroll and reside in Washington state. Corporate employees, interns, and visiting researchers are eligible to participate in this plan. Retail employees are not eligible. You can also enroll eligible dependents including your legally married spouse or domestic partner (same or opposite sex), dependent children under age 26, and incapacitated children aged 26 and older. For additional details, review the full definition of an eligible employee, eligible dependents, and the explanation of those who are not eligible for coverage.
Note: You can only enroll in or make changes to your medical insurance election as a new hire, during the annual open enrollment period, or if you have a qualifying status change (like a marriage, divorce, or the birth of a child). To learn more, go to Qualified Status Change. To enroll or update your benefits with an eligible status change, go to Enroll/Change Benefits.
No duplicate coverage
If both you and your spouse or domestic partner are employed by Microsoft and are eligible for benefit coverage, you are only allowed to be covered under one plan. You can either enroll as a dependent under your spouse or eligible domestic partner's plan or enroll in your own separate coverage, but not both. Your eligible children must be enrolled under only one employee's coverage.
Important note: If you have other coverage, learn how Coordination of Benefits (COB) applies to you and your enrolled dependents.
With the Kaiser Washington HMO Plan, there is no annual deductible and most services have a copay. The Plan covers preventive care at 100%. Except in the case of emergencies, coverage is generally limited to care received within the Kaiser network (including prescriptions). Services obtained at the Living Well Health Center are considered in-network. You choose a Kaiser Permanente provider; except in emergencies, all services must be provided at a Kaiser Permanente facility or contracted provider.
Filling prescriptions
Prescriptions can be filled only at Kaiser Washington pharmacies (which does include the on-campus Living Well Health Center Pharmacy in Building 21). If you take medications on an ongoing basis, Kaiser also has a mail-order option that delivers medications to your home.
Your prescription copay depends on the tier your medication falls under: value, generic, preferred brand, or non-preferred brand. Preventive prescription drugs are covered in full. Prescription drugs may be subject to quantity limits and/or prior authorization. Check out the Kaiser WA Prescription Formulary for all the details.
Here’s a quick breakdown:
Kaiser Washington network | |
| Annual deductible | None |
| Copays | $20 primary care visit $40 specialist visit $75 emergency room (waived if admitted) $100 hospital outpatient |
| Annual out-of-pocket maximum | $1,500 per person; $4,500 per family |
| Out-of-network care | Emergency only |
There is no overall annual or lifetime maximum in the Kaiser Washington HMO Plan. However, annual, lifetime, and other benefit maximums apply to certain benefits. Check out the Summary Plan Description for a full list of what’s covered, as well as exclusions and limitations.
Kaiser makes it easy to get the care you need when you need it, and virtual care options don’t require a copay. For urgent needs that aren’t life threatening, you can talk with a clinician anytime, night or day, by calling 1 (800) 297-6877 or have an on-demand online visit. You can also send messages to your doctor directly and schedule appointments online or through the Kaiser Washington app. To check out all your care options, go to Convenient Ways to Get Care.
The Kaiser Washington HMO Plan provides comprehensive medical coverage. Here’s a snapshot of the most commonly used benefits but be sure to reference the Summary Plan Description for full details. Services provided outside of the network may not be covered.
Important Note! Prescription drugs may be subject to quantity limits and/or prior authorization. See the Kaiser Washington HMO Plan formulary for details.
Service | Coverage amount |
Acupuncture services (medically necessary)
| 100% after $20 copay per visit
(8 visit limit per medical diagnosis per calendar year; additional visits when approved) |
Ambulance | 90% |
Autism/ABA therapy | 90% |
Chiropractic/manipulative services (medically necessary) | 100% after $20 copay per visit
(20 visit limit per calendar year) |
Contraception | 100% |
Hearing care and hardware | Exams: 100% after applicable copay for routine hearing examinations (waived if child under 21) |
Home health care | 100% |
Hospice | 100% |
Hospital – inpatient | 90% |
Hospital – outpatient | 100% after $100 copay per visit |
Infertility (fertility and family building) | 90% for services within Progyny provider network, subject to certain limits |
Lab tests and X-rays | 100% |
Maternity care – inpatient | 90% |
Maternity care – outpatient | 100% for routine prenatal and postpartum visits; primary/specialist copays apply for non-routine visits |
Maternity virtual support and supplies | 90% |
Mental health, ADHD, substance abuse, chemical dependency, and alcoholism treatment | Inpatient and outpatient facility: 90%
Outpatient professional: 100% after $20 copay per visit |
Mental health outpatient services through Spring Health (MS CARES employee assistance program) | 100% (up to 24 sessions per calendar year) |
Office visits | Primary care: 100% after $20 copay
Specialist care: 100% after $40 copay per visit |
Prescription drugs (retail: 30-day supply)
See the Kaiser WA Prescription Formulary
| Value-based generic: 100%
Generic: 100% after $10 copay
Preferred brand: 100% after $25 copay
Non-preferred brand: 100% after $50 copay |
Prescription drugs (mail order: 90-day supply)
| Value-based generic: 100%
Generic: 100% after $15 copay
Preferred brand: 100% after $60 copay
Non-preferred brand: 100% after $135 copay |
Preventive care (services and prescription drugs) | 100% |
Rehabilitative services: physical, occupational, massage, and speech (medically necessary) | 100% after $20 primary or $40 specialist copay per visit (60 visit limit per calendar year) |
Urgent care | 100% after $20 copay |
| If you want to: | Go here: |
| Schedule appointments, view medical records, exchange secure email messages with your doctors, order a replacement or additional heath plan ID card(s), or find a list of network physicians and specialists | Kaiser Foundation Health Plan of Washington Group number 172300 |
| Ask questions about benefits coverage; the use of non-Kaiser Foundation Health Plan of Washington providers; or to find network physicians or specialists | (206) 901-4636 or (888) 901-4636 Group number 172300 |
| Learn about the Affordable Care Act (ACA) Form 1095 | Affordable Care Act (ACA) Tax Form 1095 |
| Ask questions or learn about COBRA coverage for you or your eligible dependents | Microsoft COBRA Service Center (833) 253-4929 |