Kaiser Permanente California
$20/$500 Deductible Health Insurance Plan
A plan summary of the Kaiser Permanente California $20/$500 Deductible Plan is detailed out below for both In Network and Out of Network coverage.
| In Network |
Out of Network |
Copay |
$500 Deductible |
Not Applicable |
Office Visits |
$20 |
Not Applicable |
Annual Deductible |
Individual: $500 |
Not Applicable |
Annual Out-Of-Pocket Limit |
Individual: $2,500 |
Not Applicable |
Lifetime Maximum |
Unlimited |
Not Applicable |
Prescription Drugs |
Generic: $10
Brand Formulary: $35
|
Not Applicable |
Laboratory & X-Ray |
$10 after Deductible |
Not Applicable |
Annual Physical Exam |
No Charge |
Not Applicable |
Annual OB-GYN Exam |
No Charge |
Not Applicable |
Well Baby Care |
No Charge |
Not Applicable |
Outpatient Surgery |
$50 / procedure after Deductible |
Not Applicable |
Emergency Room |
$100 after Deductible (Waived if admitted) |
$100 after Deductible (Waived if admitted) |
Inpatient Hospital |
$100 after Deductible / day |
Not Applicable |
Ambulance |
$150 after Deductible |
$150 after Deductible |
Home Health Care |
See Brochure |
Not Applicable |
Mental Health - Outpatient |
See Brochure |
Not Applicable |
Chiropractic Care |
See Brochure |
Not Applicable |
Acupuncture |
See Brochure |
Not Applicable |
Mental Health - Inpatient |
See Brochure |
Not Applicable |
Chemical Dependency |
See Brochure |
Not Applicable |
Maternity Care |
Covered, See Brochure for complete details |
Not Applicable |
To learn more about your individual and family California health insurance options, the price of each plan and/or a detailed benefit summary of the plans, visit us here.
NOTICE! Final rates and benefits are based on actual plan selection (including plan riders you may request) and the assignment of any rate adjustment factors due to the health plan's underwriting guidelines.
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