Covered Features |
Kaiser Permanente is one of the three medical plans available to eligible participants. |
|
|
| |
|
|
|
Choice of Providers |
You must use Kaiser Permanente facilities and providers for all services with an exception for bona fide medical emergencies. |
|
|
| |
|
|
|
Plan Maximums |
No plan maximum |
|
|
| |
|
|
|
Out-Of-Pocket Maximums |
$1,500 Individual
$3,000 Family
|
|
|
| |
|
|
|
Hospital Confinement
Room and Board, surgery,
anesthesia and miscellaneous |
No charge |
|
|
| |
|
|
|
Doctor Visits
Office
Hospital |
Your copayment is:
$20 per visit
No charge |
|
|
| |
|
|
|
Outpatient Lab & X-Rays |
No charge |
|
|
| |
|
|
|
Preventive Health Care
(Routine check-ups,
well baby care, immunizations,
preventative screenings, etc.)
|
Effective August 1, 2011, 100% preventive care coverage is available in accordance with the Affordable Care Act. Link to http://www.healthcare.gov/law/about/provisions/services/lists.html for more information. |
|
|
| |
|
|
|
Ambulance Services |
No charge if authorized and medically necessary |
|
|
| |
|
|
|
Emergency Room Visit |
Your copayment is $50 per visit |
|
|
| |
|
|
|
Prescription |
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. |
|
|
| |
|
|
|
Mother's Maternity
Hospital Expenses |
No charge
$20 charge for prenatal and first postpartum visit. |
|
|
| |
|
|
|
Mother's Maternity
Expenses - Office
Newborn Care |
No charge
No charge in hospital if enrolled within 31 days of birth. |
|
|
| |
|
|
|
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. |
|
|
| |
|
|
|
Mental Health and Substance Abuse Treatment Benefits |
Effective 8/1/11, Kaiser members will have both Substance Abuse Treatment and Mental Health benefits available only through Kaiser. They will no longer have access to the "MAP." or out-of-network Substance Abuse Treatment coverage through OPTUM Health.
Outpatient:
$20 co-pay for Individual Visits
$10 co-pay for Group Visits
Inpatient: No Charge
Hospital covered in full |
|
|
| |
|
|
|
