Page 7 - 2021 Master's University Benefit Brochure_Final3

Kaiser Medical HMO Benefits

In-Network Only

You Pay Difference Card Pays Kaiser Benefits
$0 $1,500 Individual $1,500 Individual
Annual Deductible $0
$3,000 Family $3,000 Family
$2,500 Individual $2,500 Individual
Annual Coinsurance Max $0
$5,000 Family $5,000 Family
Office Visit

Primary Provider $15 copay $25 copay $40 copay
Specialist $15 copay $25 copay $40 copay

Preventive Services No charge N/A No charge

$0 $15 copay $15 copay
Chiropractic Care
(30 visits per calendar
year)
Lab and X-ray

Diagnostic $10 copay $0 $10 copay
$100 copay $50 copay 30% up to $150
Complex Imaging

Inpatient Hospitalization $0 Deductible & 30% coinsurance
coinsurance after deductible

Outpatient Surgery $0 Deductible & 30% coinsurance
coinsurance after deductible
Urgent Care $10 copay $30 copay $40 copay

Durable Medical $0 Coinsurance 20% coinsurance
Equipment (Ded. Waived)
Deductible + 30% coinsurance
Emergency Room $100 after deductible
coinsurance

Pharmacy $10/$30/20% up to $0 $10/$30/20% up to $200
$200

The Master’s University & Seminary Page 6
2021 Employee Benefits Brochure