Kaiser Permanente
800-464-4000
Group Number: 979
Kaiser Permanente Health Maintenance Organization (HMO) Plan exists to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. This plan is ideal if you prefer a lower payroll deduction and are comfortable with a PCP directing your care. This is the only health care plan that included vision coverage. Kaiser HMO provides coverage only in Northern California.
|
KAISER MEDICAL PLAN |
Kaiser |
|---|---|
| Annual Deductible | |
| Individual | None |
| Individual within Family | None |
| Family | None |
| Annual Out of Pocket Maximum | |
| Individual | $1,500 |
| Family | $3,000 |
| Lifetime Maximum | |
| Individual | Unlimited |
|
Medical Services |
|
| Primary Care Visit | $20 copay |
| Specialist Office Visit | $20 copay |
| Routine Physical Exam / Preventative Care | No Copay |
| Diagnostic X-ray / Laboratory | Covered at 100% |
| Inpatient Hospital | $250 Copay per Admission |
| Outpatient Hospital | $20 Copay per Visit |
| Emergency Room | $50 copay |
| Urgent Care | $20 copay |
|
Chiropractic/ Acupuncture |
$15 copay; Limited to 30 calendar visits per year |
| Hearing Aid | $2,500 allowance per device; 1 device per year; 2 devices every 3 years |
| Optical Dispensing | $175 Eyewear Allowance Every 2 Years |
| Prescription Drugs | |
| Contraceptive Drugs & Devices | No Charge |
| Generic / Tier 1 (30-day supply) | $10 copay |
| Formulary / Tier 2 (30-day supply) | $25 copay |
| Non-Preferred / Tier 3 (30-day supply) | $25 copay |
| Specialty / Tier 4 (30-day supply) | 20% up to $200 Copay |
| Mail Order (90-day supply) | 2x Copay |