Kaiser Permanente of Oregon

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Plan Benefits
Platinum | Gold Rx | Silver Rx | Bronze | HSA Compatible | Child-only
Plan Premiums
Platinum | Gold Rx | Silver Rx | Bronze | HSA Compatible | Child-only

SILVER DEDUCTIBLE PLANS w/Rx	$1,500	$2,500	$3,500	$5,000	$7,500
Features
Deductible (individual/family)	$1,500/$4,500	$2,500/$7,500	$3,500/$10,500	$5,000/$15,000	$7,500/$22,500
Out-of-pocket maximum (individual/family)	$7,000/$21,000
Lifetime maximum	$2 million
Benefits	Services not subject to deductible unless otherwise indicated
Preventive Care
Immunizations	No charge
Routine physicals	$30 copay
Well-baby visits
Gynecholgical exams/Mammograms
Outpatient services (per visit or procedure)
Primary care office visit	$30 copay
Specialty care office visit	30% coinsurance (after deductible)
Nurse treatment visit (includes allergy injections)1
Outpatient surgery2
Lab tests2
X-rays2
Inpatient hospital care
Inpatient care (including maternity)	30% coinsurance (after deductible)
Maximum per admittance	None
Maternity coverage
Prenatal care (applies to prenatal office visits, one postnatal visit, and lactation consultants)	$30 copay
Emergency & urgent care
Emergency Department visit	30% coinsurance (after deductible)
Urgent care visit
Ambulance Service
Prescription drugs
(up to a 30-day supply)	30% coinsurance (after deductible)
Other services
Vision exams	30% coinsurance (after deductible)
Vision hardware allowance (applies to lenses, frames, and/or contacts every 24 months)	Not covered