Kaiser Permanente of Oregon

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Plan Benefits
Platinum | Gold | Silver | Bronze | HDHP
Plan Premiums
Platinum | Gold | Silver | Bronze | HDHP 1500 | HDHP 2600

Kaiser Permanente for Individuals and Families	$2,600 deductible with HSA Option without Rx plan	$2,600 deductible with HSA Option with Rx plan
Annual Individual deductible	$2,600 member $5,200 per family	$2,600 member $5,200 per family
Lifetime benefit maximum	$2 million	$2 million
Annual out-of-pocket maximum Not all copayments count toward your limit; not all copayments are waived after limit is met.	$5,000 member $10,000 per family	$5,000 member $10,000 per family
Hospital care (including maternity care)*	Members pay	Members pay
All inpatient care is covered after payment of applicable copayments. There are no limits on prescribed hospital days.	20% coinsurance†	20% coinsurance†
Office visits*	Members pay	Members pay
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†	20% per primary care visit† 20% per specialty care visit†
Outpatient Rx drugs	Members pay	Members pay
When prescribed by a Kaiser Permanente physician or a licensed dentist in accordance with our formulary process.	Not covered	$15 generic Rx $30 brand-name Rx (30-day supply)
Other Benefits	Members pay	Members pay
Laboratory Inpatient and outpatient.	20%‡	20%‡
X-rays and other special procedures Inpatient and outpatient.	20%‡	20%‡
*Emergency care Within and outside Kaiser Permanente Service Area	20% coinsurance (after deductible)**	20% coinsurance (after deductible)**
* 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. 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.