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Oregon Medical Insurance > Kaiser Permanente of Oregon > Platinum Benefits

PLATINUM COPAYMENT PLAN
KP 0/20/Rx
Features  
Deductible
None
Out-of-pocket maximum
$2,000
Lifetime maximum
None
Benefits
You Pay
Preventive Care
Immunizations
No charge
Yearly routine physicals
Well-baby visits
Mammograms
Outpatient services (per visit or procedure)
Primary care office visit
$20 copay
Specialty office visit
$30 copay
Nurse treatment visit (includes allergy injections)1
$10 copay
Outpatient surgery2
$50 copay
Lab tests and X-ray2
$20 copay
Inpatient hospital care
Inpatient care (including maternity)
$300 copay per day
Maximum per admittance
$1,500
Maternity coverage (outpatient)
Prenatal care (applies to prenatal office visits, one postnatal visit, and lactation consultants)
No charge
Emergency & urgent care
Emergency department visit
$100 copay 3
Urgent care visit
$40 copay
Ambulance Service
$50 per trip
Prescription drugs
(up to a 30-day supply)
$15 or 50%
(whichever is greater)
Other services
Vision exams
$20 copay
Vision hardware allowance (applies to lenses, frames, and/or contacts every 24 months)
$150 allowance
Dental plans
Optional coverage available
  1. Waived if in conjunction with an office visit
  2. Preventive procedures and tests not subject to deductible
  3. Waived if admitted

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
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