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Medical Plan

Kaiser Permanente HMO Plan*

Enjoy a $0 deductible and low annual out-of-pocket maximum. Benefit Tip: This plan does not provide out-of-network coverage, and you must designate a Primary Care Physician before visiting the doctor.

*Available to employees in select zip codes in the following states only: California, Colorado, District of Columbia, Georgia, Maryland, Oregon, Virginia and Washington.

Kaiser Permanente
In-Network
Calendar Year Deductible
Individual
$0
Family
$0
Calendar Year Out-of-Pocket Maximum (Includes Deductible)
Individual
$1,500
Family
$3,000
Coinsurance
You Pay
Preventive Care
$0
Primary Care Physician
$25
Specialist
$40
Urgent Care
$25
Emergency Room
$100
Inpatient Hospital
$25
Mental Health & Substance Abuse
You Pay
Inpatient
$12
Outpatient
$5
Pharmacy Retail RX (up to 30-day supply)
You Pay
Preventive
N/A
Generic
$10
Preferred Brand
$35
Non-Preferred Brand
N/A
Specialty
N/A
CVS Mail Order RX (up to 90-day supply)
You Pay
Preventive
N/A
Generic
$20
Preferred Brand
$70
Non-Preferred Brand
N/A
Specialty (30-day supply only)
N/A

*After deductible
**If the actual cost of the drug is less than the minimum, you pay the cost of the drug.
†Available to employees in the following states only: California, Colorado, District of Columbia, Georgia, Maryland, Oregon, Virginia and Washington.

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Medical Plan

Kaiser Permanente HMO Plan*

Enjoy a $0 deductible and low annual out-of-pocket maximum. Benefit Tip: This plan does not provide out-of-network coverage, and you must designate a Primary Care Physician before visiting the doctor.

*Available to employees in select zip codes in the following states only: California, Colorado, District of Columbia, Georgia, Maryland, Oregon, Virginia and Washington.

Kaiser Permanente
In-Network
Calendar Year Deductible
Individual
$0
Family
$0
Calendar Year Out-of-Pocket Maximum (Includes Deductible)
Individual
$1,500
Family
$3,000
Coinsurance
You Pay
Preventive Care
$0
Primary Care Physician
$25
Specialist
$40
Urgent Care
$25
Emergency Room
$100
Inpatient Hospital
$25
Mental Health & Substance Abuse
You Pay
Inpatient
$12
Outpatient
$5
Pharmacy Retail RX (up to 30-day supply)
You Pay
Preventive
N/A
Generic
$10
Preferred Brand
$35
Non-Preferred Brand
N/A
Specialty
N/A
CVS Mail Order RX (up to 90-day supply)
You Pay
Preventive
N/A
Generic
$20
Preferred Brand
$70
Non-Preferred Brand
N/A
Specialty (30-day supply only)
N/A

*After deductible
**If the actual cost of the drug is less than the minimum, you pay the cost of the drug.
†Available to employees in the following states only: California, Colorado, District of Columbia, Georgia, Maryland, Oregon, Virginia and Washington.

Part-time and Temporary employees are eligible for a limited subset of benefits.  Union employees: refer to your collective bargaining agreement for your benefits eligibility.