Health and Welfare Plan BenefitTabs™

  • Kaiser

     

  • Covered Features

    Kaiser Permanente is one of the three medical plans available to eligible participants.

     

  • Choice of Providers

    You must use Kaiser Permanente facilities and providers for all services with an exception for bona fide medical emergencies.

     

  • Plan Maximums

    No plan maximum

     

  • Out-Of-Pocket Maximums

    $1,500 Individual
    $3,000 Family

     

  • Hospital Confinement
    Room and Board, surgery,
    anesthesia and miscellaneous

    No charge

     

  • Doctor Visits - Office

    Your copayment is: $20 per visit

     

  • Doctor Visits - Hospital

    No charge

     

  • Outpatient Lab & X-Rays

    No charge

     

  • Preventive Health Care
    (Routine check-ups,
    well baby care, immunizations,
    preventative screenings, etc.)

    Effective August 1, 2011, 100% preventive care coverage is available in accordance with the Affordable Care Act. Click here for more information.

     

  • Ambulance Services

    No charge if authorized and medically necessary

     

  • Emergency Room Visit

    Your copayment is $100 per visit;
    (Senior Advantage Retirees: $50 per visit)

     

  • Prescription

    Generic Drugs: your copayment is $10 for up to a 30-day supply.
    Brand Name: your copayment is $30 for up to a 30-day supply.

    Senior Advantage Retirees:
    Generic Drugs: your copayment is $10 for up to a 30-day supply.
    Brand Name: your copayment is $25 for up to a 30-day supply.

     

  • Mother's Maternity
    Hospital Expenses

    No charge
    $20 charge for prenatal and first postpartum visit.

     

  • Mother's Maternity
    Expenses - Office
    Newborn Care

    No charge
    No charge in hospital if enrolled within 31 days of birth.

     

  • Evidence of Coverage

    This Evidence of Coverage (EOC) describes the health care coverage of the Kaiser Permanente Traditional Plan. Click here to view the Kaiser EOC.

    In addition, Kaiser has a contract with the Centers for Medicare & Medicaid Services (CMS) as a Medicare Advantage Organization, which is renewed annually. This contract provides Medicare Services (including Medicare Part D prescription drug coverage) through Senior Advantage, except for hospice care for Members with Medicare Part A and qualifying clinical trials, which are covered under Original Medicare. Click here to view the Kaiser Senior Advantage EOC.

     

  • Mental Health and Substance Abuse Treatment Benefits

    Effective 8/1/11, Kaiser members will have both Substance Abuse Treatment and Mental Health benefits available only through Kaiser. They will no longer have access to the "MAP." or out-of-network Substance Abuse Treatment coverage through OPTUM Health.

    Outpatient:
    $20 co-pay for Individual Visits
    $10 co-pay for Group Visits
    Inpatient: No Charge

    Hospital covered in full