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Kaiser Permanente of
Oregon
Index | Exclusions
& Limitations | Locate
Physicians | Locate
Facility | Brochure & Application
Plan Benefits
Platinum | Gold | Silver | Bronze | HDHP
Plan Premiums
Platinum | Gold | Silver | Bronze | HDHP 1500 | HDHP
2600
| |
Silver 1500
with Prescription |
Silver 2500
with Prescription |
Silver 3500
with Prescription |
| Annual Deductible |
| Individual |
$1,500 |
$2,500 |
$3,500 |
| Family |
$4,500 |
$7,500 |
$10,500 |
| Annual Out-of-Pocket Maximum |
| Individual |
$5,000 |
$7,000 |
$9,000 |
| Family |
$15,000 |
$21,000 |
$27,000 |
| Benefits |
You Pay |
| Preventive Care |
| Immunizations |
$0 |
| Adult and well-child physicals |
$25 NSD |
| Well-babyy visits |
$25 NSD |
| Annual gynecholgical exams |
$25 NSD |
| Mammograms |
30% NSD |
| Physician/provider services |
| Primary care office visit |
$25 NSD |
| Specialty care office visit |
30% |
| Inpatient & maternity |
| Prenatal office visits 3 |
$25 NSD |
| Hospital care |
30% |
| Emergency & urgent care |
| Emergency care |
30% |
| Urgent care |
$25 NSD |
| Ambulance Service |
30% |
| Prescription drugs |
| Annual deductible per
individual |
$500 |
| After-deductible copayment |
50% up to $150 max for
30-day supply |
| Other services |
| Lab |
30% |
| X-ray |
30% |
“NSD”: Not subject to deductible
- Waved if admitted to the hospital.
- Copayments apply to prescriptions costing more than $15. The full charge applies to prescriptions that cost $15 or less.
Mail-order prescription delivery is limited to a 30-day supply.
- This benefit also covers one post-natal visit.
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Plan Updates 