Page 11 - Covered 6 Employee Benefits 2021-2022
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Kaiser Medical Plans
Zero Deductible HMO*
Deductible:
Individual none
Family none
Annual Out of Pocket
Maximum:
Individual $3,000
Family $6,000
Hospital Services:
Inpatient $500 per day up to a maximum of $1,500 per admission
Outpatient Surgery $250 per procedure
Emergency Room $150 per visit
Physician Services:
Office Visit
(PCP/Specialist) $20 / $20
Urgent Care $20
Preventive Care: No charge
Prescription Drugs:
Generic $15 for a 30-day supply
Brand Name $35 for a 30-day supply
Specialty 30% coinsurance not to exceed $200
*Please refer to carrier benefit summaries for more detailed information. Should there be a
discrepancy between this booklet and the provisions of the insurance contracts or plan documents,
the provisions of the insurance contracts or plan documents will govern
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