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Below is a brief outline of benefits provided under the Kaiser HMO plan. Refer to the official benefits booklet for a comprehensive description of plan benefits. Under all circumstances, the benefits booklet will take precedence over information contained on this website. Contact Kaiser Permanente for questions of coverage.
Deductible | None |
Annual Out of Pocket Max | $2,000 individual/$4,000 family |
Lifetime maximum benefit | Unlimited |
Office Visits | 100% after $25 copay |
Immunizations | 100% |
Adult physicals | 100% |
Well-woman exams/screenings | 100% |
Well-baby exams | 100% |
Emergency Room (copay waived if admitted) |
$100 copay |
Inpatient hospital services | 100% |
Outpatient hospital services | 100% after $25 copay |
Outpatient surgical center | 100% after $25 copay |
30-day supply | |
---|---|
Generic | $10 copay |
Brand formulary | $30 copay |
Nonformulary | N/A |
90-day supply | |
---|---|
Generic | $20 copay |
Brand formulary | $60 copay |
Nonformulary | N/A |