Page 22 - Skechers 2022 Benefits Guide

CALIFORNIA KAISER PERMANENTE MEDICAL PLAN
OVERVIEW — CA ONLY
WHO CAN JOIN?
Full-time California employees and their eligible dependents may join the plan on the 31st day from date of hire. Eligible dependents include spouses, domestic partners, and dependent children under the age of 26.
Employee
Employee + Family
Out-of-Pocket Maximum
Employee
Employee + Family
Services
Physician Office Visits
Specialist Office Visits
Preventative
Emergency Services
Hospitalization
Outpatient Services
X-ray and Laboratory Services
Mental health and Substance Abuse – Outpatient Visit
Mental health and Substance Abuse – Inpatient Visit
None
None
$1,500
$3,000
$30 Copay
$45 Copay
No Copay
$100 Copay
$250 Copay
$45 Copay
No Copay
$30 Copay
$250 Copay
KAISER MEDICAL CONTRIBUTIONS*
Contributions**
Employee $47
Employee + Spouse/Domestic Partner $145
Employee + Child(ren) $127
Employee + Family $213
*Contributions include Medical Only.
**Your cost per paycheck (pre-tax). When you become eligible for the Plan, your benefits become effective on the 31st day of employment and you will be responsible for all per paycheck costs in the pay period in which your 31st day falls. If you become ineligible for the plan, your benefits terminate on the last day of the month in which you become ineligible, and you will be responsible for all per paycheck costs for the month. Benefits costs are NOT prorated.
KAISER MEDICAL HIGHLIGHTS
Your Cost Share Shown Below
In the Kaiser Medical Plan, all care must be received from providers within Kaiser’s Network (except in an emergency). Members must select a Primary Care Physician. To find participating providers near you, please visit Kaiser’s website at kp.org or call member services at 800-464-4000.
Member Services: 800-464-4000 Website: kp.org
IF YOU WOULD LIKE TO ENROLL IN THE PLAN, YOU MUST LOG IN TO skechersbenefits.com
Prescription Drugs (30-Day Supply)
Generic $15 Copay
Preferred $30 Copay
Mail Order Prescription Drugs ( 100-Day Supply)
Generic $30 Copay
Preferred $60 Copay
22 SKECHERS