Kaiser Plans
$0/$1,500 Deductible Plan with HSA
| Features: |
Member pays out of pocket: |
| Medical calendar year deductible |
$1500 individual/$3000 family |
| Annual out of pocket expense maximum |
$1500 individual/$3000 family |
| Lifetime benefit maximum |
none |
Plan provider office visits
| Primary and specialty care visits |
no charge per visit after deductible is met (Includes routine and urgent care appointments) |
| Well child visits-0-23 months |
no charge per office visit after deductible is met |
| Family planning visits |
no charge per visit after deductible is met |
| Scheduled prenatal care |
no charge for member |
| First postpartum visit |
no charge after deductible is met |
| Eye examinations |
no charge after deductible is met |
| Hearing test |
no charge after deductible is met |
| Chiropractic |
not covered |
| Physical, speech, occupational |
no charge after deductible is met |
Outpatient Services
| Outpatient surgery |
no charge after deductible is met |
| Injection for allergies |
no charge after deductible is met |
| Immunizations |
none |
| X-rays and labs |
no charge after deductible is met |
Health education
| Individual visits |
no charge after deductible is met |
| Group visits |
no charge after deductible is met |
Hospitalization
| Room and board, surgery, anesthesia, X-rays, lab tests, and medications |
no charge after deductible is met |
Emergency Services
| Emergency Room visits |
no charge after deductible is met |
| Emergency Ambulance |
no charge per ambulance request after deductible is met |
Prescription Drug Coverage
| Generic |
no charge up to 100 day supply per prescription after deductible |
| Brand name drugs |
no charge up to 100 day supply after deductible is met |
Durable medical equipment
| DME in home |
not covered |
| Prosthetic and orthotic devices |
none |
Mental health services
| Inpatient psychiatry |
no charge after deductible is met up to 30 days per calendar yr |
| Outpatient visits individual |
no charge after deductible is met up to 20 per calendar year |
| Group therapy |
no charge up to 20 per calendar year after deductible is met |
| Inpatient chemical dependency detoxification |
no charge after deductible |
| Outpatient individual therapy |
no charge after deductible is met |
| Outpatient group therapy visits |
no charge after deductible is met |
| Transitional residential recovery service |
no charge 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 after deductible is met (100 two hr visits per calendar year) |
| Nursing facility |
no charge after deductible (up to 100 days per benefit period) |
| Hospice care |
no charge after deductible |
Other Kaiser Permanente California Articles
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