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Oregon Medical Insurance > Kaiser Permanente of Oregon > Silver $3500 Benefits

HealthNet Health Plans

Kaiser Permanente
for Individuals and Families
$3,500 Deductible Plan
Annual individual deductible
(per calendar year)
$3,500

Annual out-of-pocket maximum
(per calendar year)
Not all copayments count toward your limit; not all copayments are waived after limit is met.
$9,000 member
$27,000 per family
Lifetime benefit maximum
$2,000,000
BENEFITS
All benefits must be provided or authorized by a Kaiser Permanente physician.
Members pay
*Hospital care (including maternity care)
All inpatient care is covered after payment of applicable copayments. There are no limits on prescribed hospital days.
30% coinsurance
(after deductible)
*Office Visits
For diagnosis and treatment by primary care providers, consultation and treatment by specialists, routine physical and hearing exams, well baby visits through age 2, prenatal care, eye exam and urgent care.
$25 copayment per primary care visit1*
30% coinsurance per specialty care visit
(after deductible)
(Deductible waived for wellbaby visits and prenatal care, and certain preventive procedures.)
Optional:  Outpatient Rx drugs
This is an optional benefit that must be added to the plan during enrollment with Rx rider.
Rx deductible: $500
Retail: 50% (after deductible) up to $150 max per 30-day Rx
Laboratory
Inpatient
Included under hospital care benefit
Outpatient
30% coinsurance
(after deductible) No deductible for preventive tests
X-rays and other special procedures
Inpatient
Included under hospital care benefit
Outpatient
30% coinsurance
(after deductible) No deductible for preventive tests or preventive procedures.
EMERGENCY CARE
*Emergency care
† Within and outside Kaiser Permanente Service Area
30% coinsurance
(after deductible)
Ambulance
For medically necessary transportation
30% per transport
(after deductible)
* Plus any copayments or coinsurance for lab or X-ray.

†Emergency Services for an Emergency Medical Condition at a Non-Network Facility inside the Service Area are covered; however, care after your condition is stabilized must be preauthorized by Health Plan to be covered. Health Plan may require you to be transferred to a Hospital or Medical Office following stabilization. Outside Kaiser Permanente service area—Reimbursement of usual and customary charges for unforeseen illness or injuries. Continuing or follow-up care must be received at Kaiser Permanente facilities in order to be covered.

This benefit summary lists the copayments you pay for services. This summary is not a contract but a general listing of major benefits, exclusions, and limitations.  Your particular benefits are those contained in the Kaiser Permanente Personal Advantage membership agreement, which you will receive if accepted.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
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