Page 10 - GBS OE Brochure - Generic Hospitality

MEDICAL BENEFITS
Kaiser Medical Plan Summary
Medical Plan Bene ts
In-Network
Deductible (Annual)
$250 Individual / $500 Family
Coinsurance (You Pay)
20% after Deductible
Out-of-Pocket Maximum
(Inc. Deductibles, Co-ins., and Copays)
$3,000 Individual / $6,000 Family
Preventive Care Services
Covered 100%
Most Primary Care Of ce Visits
$20 Copay
Most Specialist Of ce Visits
$20 Copay
Hospital -Inpatient
20% after Deductible
Outpatient Surgery
20% after Deductible
Emergency Room (per visit, waived if admitted)
20% after Deductible
Urgent Care
$20 Copay
Prescription Drugs
Pharmacy Deductible
None
Retail (30 day supply)
$10 / $30
Mail Order (100 day supply)
$20 / $60
Lifetime Maximum
Unlimited
10 ABC COMPANY | HOSPITALITY 2017 OPEN ENROLLMENT