Bronze Benefits from Kaiser Permanente Individual and Family Health Plans

Oregon Health Insurance
Call 800.884.2343 or
541.434.9613
FAX - 541.284.2994

	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.