Page 4 - 2019 Point Loma Credit Union Benefits Guide (002)

Medical Insurance

Point Loma Credit Union offers you the choice of 2 medical HMO plan options through Kaiser Permanente. Kaiser utilizes an integrated managed care
approach where most services such as office visits, diagnostic x-ray, lab and pharmacy services can be found at each facility. Under either of these
plans, all of your care must be directed through a Kaiser provider. You will receive benefits only if you use the Kaiser doctors, clinics and hospitals. For a
complete listing of covered services, please refer to the enclosed carrier Summary of Benefit Coverage documents (SBCs) and/or benefit summaries for
more detailed benefit information.

Kaiser HMO Kaiser Deductible HMO

In-Network Only In-Network Only

Calendar Year Deductible (Individual /Family) None $1,500 / $3,000
Calendar Year Out-of-Pocket Maximum (Individual / $3,000 / $6,000 $4,000 / $8,000
Family)
Office Visits (PCP & Specialist) $25 copay $20 copay; deductible waived

Preventive Care No charge No charge

Urgent Care $25 copay $20 copay; deductible waived
Diagnostic X-Ray & Lab $10 copay $10 copay; deductible waived

Complex Imaging (MRI,PET, CT Scans) $50 copay $50 copay; deductible waived

Inpatient Hospital $500 copay 20%; after deductible
Outpatient Surgery $250 copay 20%; after deductible

Emergency Room $100 copay 20%; after deductible

Retail Prescription Drugs up to 30 day supply up to 30 day supply
Generic Generic: $15 copay Generic: $10; deductible waived
Brand Brand: $35 copay Brand: $30; deductible waived

Mail Order Drugs up to 100 day supply up to 100 day supply
Generic Generic: $30 copay Generic: $20 copay; deductible waived
Brand Brand: $70 copay Brand: $60 copay; deductible waived

The Kaiser Permanente Advantage Calling an Advice Nurse 24/7

With some health plans: When your child has a late-night fever,
Kaiser is uniquely designed to give you some of the things you need to there’s often no medical advice available.
live well - all together in one easy to use package. This is health care With Kaiser Permanente: You can call our advice nurses, who have
that fits your life. access to your detailed health information, 24/7, and get answers to
your questions without waiting for an appointment. To reach an advice
Choosing Your Doctor
nurse after-hours, from 7pm to 7am call (888) KP-ONCALL.
With some health plans: All you know is that your doctor accepts Visiting a Specialist
your insurance.

With Kaiser Permanente: Get to know your doctor ahead of time. With some health plans: Hope that your primary care doctor has sent
Browse our doctor bios on kp.org and choose one based on what’s your records.
important to you. You can switch doctors at any time.
With Kaiser Permanente: Your specialist has already reviewed your
During Your Visit information via your electronic health record and can start caring for
you right away.
With some health plans: Your doctor flips through your files, Choosing How You Manage Your Health
searching for answers you’ve already provided.

With Kaiser Permanente: Your doctor can easily review your medical With some health plans: Your doctor flips through your files,
history through your electronic health record, so there’s more time to searching for answers you’ve already provided.
focus on you.
With Kaiser Permanente: It’s up to you how you manage your health
- in person, by phone, or online. And you have the option to email your
doctor’s office with routine questions and get a reply within 48 hours.

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