Oregon Medical Insurance > Kaiser Permanente of Oregon > Bronze Benefits

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Bronze 5000 |
Bronze 7500 |
| Annual Deductible |
| Individual |
$5,000 |
$7,500 |
| Family |
$15,000 |
$22,500 |
| Annual Out-of-Pocket Maximum |
| Individual |
$10,000 |
$10,000 |
| Family |
$30,000 |
$30,000 |
| Benefits |
You Pay |
| Preventive Care |
| Immunizations |
$0 |
| Adult and well-child physicals |
$25 NSD |
| Well-babyy visits |
$25 NSD |
| Annual gynecholgical exams |
$25 NSD |
| Mammograms |
50% |
| Physician/provider services |
| Primary care office visit |
$25 NSD |
| Specialty care office visit |
50% |
| Inpatient & maternity |
| Prenatal office visits 3 |
$25 NSD |
| Hospital care |
50% |
| Emergency & urgent care |
| Emergency care |
$0 |
| Urgent care |
$25 NSD |
| Ambulance Service |
$0 |
| Prescription drugs |
| Annual deductible per
individual |
Not covered |
| After-deductible copayment |
Not Covered |
| Other services |
| Lab |
50% NSD |
| X-ray |
50% NSD |
“NSD”: Not subject to deductible
- Waved if admitted to the hospital.
- Copayments apply to prescriptions costing more than $15. The full charge applies to prescriptions that cost $15 or less.
Mail-order prescription delivery is limited to a 30-day supply.
- This benefit also covers one post-natal visit.
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