California Health Insurance Plans

Individual and family plans $1500 deductible plan

Features:	Member pays out of pocket:
Medical calendar year deductible	$1500-individual/$3000-family
Annual out of pocket expense maximum	$3500 individual/$7000 family
Lifetime benefit maximum	none

Plan provider office visits

Primary and specialty care visits	$30.00 per visit (Includes routine and urgent care appointments)
Well child visits-0-23 months	$30.00 per office visit
Family planning visits	$30.00 per office visit
Eye examinations	$30.00 per office visit
Hearing test	$30.00 per office visit
Physical, speech, occupational	$30.00 per office visit

Outpatient Services

Outpatient surgery	$250.00 per surgical procedure
Injection for allergies	$5.00 per injection per visit after deductible is met
Immunizations	none
X-rays and labs	$10.00 per service after deducible is met

Health education

Individual visits	$30.00
Group visits	none

Hospitalization

Room and board, surgery, anesthesia, X-rays, lab tests, and medications

$500.00 per day for covered facility after deductible is met

Emergency Services

Emergency Room visits	$150.00 per visit-excluded if admitted directly to hospital from ER after deductible is met)
Emergency Ambulance	$150.00 per ambulance request and ride after deductible is met

Prescription Drug Coverage

Generic	$10.00 30 day supply per prescription
Brand name drugs	$35.00
Mail order	$20.00/generic-$70.00 maintenance drugs 100 day supply

Durable medical equipment

DME in home	30% co-insurance
Prosthetic and orthotic devices	none

Mental health services

Inpatient psychiatry	$500.00 per day up to 30 days
Outpatient visits individual	$30.00 per visits up to 10 per calendar year
Group therapy	$15.00 per visit up to 10 per calendar year
Inpatient chemical dependency detoxification	$500.00 per day after deductible is met
Outpatient individual therapy	$30.00 per visit after deductible is met
Outpatient group therapy visits	$5.00 per visit after deductible is met
Transitional residential recovery services	$100.00 per admission after deductible is met (Up to 60 days per calendar year, not to exceed 120 days in any five-year period)

Home health services

Home health	no charge for member
Nursing facility	$50.00 per day after deductible is met (up to 60 days per benefit period)
Hospice care	no charge

Other Kaiser Permanente California Articles

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