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Kaiser Permanente of
Oregon
Index | Exclusions
& Limitations | Locate
Physicians | Locate
Facility | Brochure & Application
Plan Benefits
Gold | Silver
$1,500 | Silver $2,500
| Silver
$3,500 | HSA $1,500 | HSA
$2,600
Plan Premiums
Gold $500 | Gold
$1,000 | Silver $1,500 | Silver
$2,500 | Silver
$3500 | HSA $1,500 | HSA
$2,600
Kaiser Permanente
for Individuals and Families |
$1,500 deductible with HSA Option
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$1,500 deductible/Rx with HSA Option
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Annual individual deductible
(per calendar year) |
$1,500 member
$3,000 per family
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$1,500 member
$3,000 per family
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Annual out-of-pocket maximum
(per calendar year)
Not all copayments count toward your limit; not all copayments
are waived after limit is met.
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$5,000 member
$10,000 per family
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$5,000 member
$10,000 per family
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| Lifetime benefit maximum |
$2 million
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$2 million
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| Hospital care (including maternity
care)* |
Members pay
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Members pay
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| All inpatient care is covered after payment
of applicable copayments. There are no limits on prescribed hospital days. |
20% coinsurance†
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20% coinsurance†
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| Office visits* |
Members pay
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Members pay
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| 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 exams,
and urgent care. |
20% per primary care visit†
20% per specialty care visit†
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20% per primary care visit†
20% per specialty care visit†
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| Outpatient Rx drugs |
Members pay
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Members pay
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| When prescribed by a Kaiser Permanente
physician or a licensed dentist in accordance with our formulary process. |
Not covered
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$15 generic Rx
$30 brand-name Rx
(after deductible)
(30-day supply)
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| Other Benefits |
Members pay
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Members pay
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Laboratory
Inpatient and outpatient. |
20%‡
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20%‡
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X-rays and other special procedures
Inpatient and outpatient. |
20%‡
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20%‡
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*Emergency care
Within and outside Kaiser Permanente Service Area |
20% coinsurance (after deductible)**
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20% coinsurance (after deductible)**
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* Plus any copayments or coinsurance for lab or X-ray
** The emergency care copay will be waived and the hospital copay will
apply if admitted directly to hospital from an emergency room. Additional
copayments or coinsurance may apply for lab, X-ray, etc.
† (After deductible) Deductible waived for well-baby visits, prenatal
care, and certain preventive procedures.
‡ (After deductible) No deductible for preventive tests or preventive
procedures.
The tax references in this brochure relate to federal income tax only.
Consult with your financial or tax adviser for more information about
your state’s income tax laws.
Kaiser Permanente does not provide or administer financial products,
including HSAs, and does not offer financial, tax, or investment advice.
Members are responsible for their own investment decisions.
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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Plan Updates 