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:
$20 per visit, effective 8/1/09
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:
$20 per visit or
$5 per visit for Well Baby Care (through 23 months) |
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Ambulance Services |
No charge if authorized and medically necessary |
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Emergency Room Visit |
Effective 8/1/09: Your copayment is $50 per visit |
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Prescription |
Effective 8/1/09
Generic Drugs: your copayment is $10 for up to a 30-day supply.
Brand Name: your copayment is $30 for up to a 30-day supply.
Senior Advantage Retirees:
Generic Drugs: your copayment is $10 for up to a 30-day supply.
Brand Name: your copayment is $25 for up to a 30-day supply. |
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Mother's Maternity
Hospital Expenses |
No charge
$20 charge for prenatal and first postpartum visit. |
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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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Evidence of Coverage |
This Evidence of Coverage (EOC) describes the health
care coverage of the Kaiser Permanente Traditional Plan. Click here to view the Kaiser EOC.
In addition, Kaiser has a
contract with the Centers for Medicare & Medicaid
Services (CMS) as a Medicare Advantage Organization,
which is renewed annually. This contract provides
Medicare Services (including Medicare Part D
prescription drug coverage) through Senior Advantage,
except for hospice care for Members with Medicare
Part A and qualifying clinical trials, which are covered
under Original Medicare. Click here to view the Kaiser Senior Advantage EOC. |
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