Kaiser California Plans
$25.00 copayment plan
| Features: |
Member pays out of pocket: |
| Medical calendar year deductible |
none |
| Annual out of pocket expense maximum |
$2500 individual/$5000 family |
| Lifetime benefit maximum |
none |
Plan Provider Office Visits
| Primary and specialty care visits |
$25.00 per visit (Includes routine and urgent care appointments) |
| Well child visits-0-23 months |
none |
| Family planning visits |
$25.00 per office visit |
| Prenatal care and first postpartum |
none |
| Eye examinations |
$25.00 per office visit |
| Hearing test |
$25.00 per office visit |
| Physical, speech, occupational |
$25.00 per office visit |
Outpatient Services
| Outpatient surgery |
$100.00 per surgical procedure |
| Injection for allergies |
$5.00 per injection per visit |
| Immunizations |
none |
| X-rays and labs |
$10.00 per service |
Health education
| Individual visits |
$25.00 |
| Group visits |
none |
Hospitalization
| Room and board, surgery, anesthesia, X-rays, lab tests, and medications |
$200.00 per day for covered facility |
Emergency Services
| Emergency Room visits |
$100.00 per visit-excluded if admitted directly to hospital from ER |
| Emergency Ambulance |
$100.00 per ambulance request and ride |
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 |
not covered by this plan |
| Prosthetic and orthotic devices |
none |
Mental health services
| Inpatient psychiatry |
$200.00 per day up to 30 days |
| Outpatient visits individual |
$25.00 per visits up to 20 per calendar year |
| Group therapy |
$12.00 per visit up to 20 per calendar year. Up to 20 additional group therapy visits that meet Medical Group criteria in the same calendar year |
| Inpatient chemical dependency detoxification |
$200.00 per day |
| Outpatient individual therapy |
$25.00 per visit |
| Outpatient group therapy visits |
$5.00 per visit |
| Transitional residential recovery services |
$100.00 per admission (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 |
no charge for member |
| Hospice care |
no charge |
Other Kaiser Permanente California Articles
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