Covered Features |
Kaiser Permanente is one of the three medical plans available to eligible participants. |
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Choice of Providers |
You must use Kaiser Permanente facilities and providers for all services with an exception for bona fide medical emergencies. |
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Plan Maximums |
No plan maximum |
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Out-Of-Pocket Maximums |
$1,500 Individual
$3,000 Family
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Hospital Confinement
Room and Board, surgery,
anesthesia and miscellaneous |
No charge |
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Doctor Visits
Office
Hospital |
Your copayment is:
$15 per visit
No charge |
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Outpatient Lab & X-Rays |
No charge |
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Preventive Health Care
(Routine check-ups,
well baby care, immunizations,
pap smears, etc.)
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Your copayment is:
$15 per visit |
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Ambulance Services |
No charge if authorized and medically necessary |
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Prescription |
Generic Drugs: your copayment is $10 for up to a 100-day supply.
Brand Name: your copayment is $20 for up to a 100-day supply. |
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Mother's Maternity
Hospital Expenses |
No charge |
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Mother's Maternity
Expenses - Office
Newborn Care |
No charge
No charge in hospital if enrolled within 31 days of birth. |
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