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$3,000 Deductible Plan
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PDF version| Benefits Summary | |
| Annual Medical Deductible - Individual | $3,000 |
| Annual Medical Deductible - Family | n/a |
| Annual Out-of-Pocket Maximum - Individual | $6,000 |
| Annual Out-of-Pocket Maximum - Family | n/a |
| Professional Services | |
| Primary and specialty care visits (includes routine and urgent care appointments) | $40 per visit |
| Well-child visits from 0 to 23 months | $30 per visit |
| Family planning visits | $40 per visit |
| Eye exams | $40 per visit |
| Hearing tests | $40 per visit |
| Outpatient Services | |
| Outpatient surgery | 20% coinsurance after deductible |
| Most X-rays and lab tests | $10 per encounter after deductible |
| Maternity Coverage | |
| Maternity Coverage | Not covered |
| Hospitalization Services | |
| Room and board, surgery, anesthesia, X-rays, lab tests, and medications | 20% coinsurance after deductible |
| Emergency Services | |
| Emergency room visits | $150 per day after deductible (waived if admitted directly to the hospital) |
| Ambulance services | $150 per trip after deductible |
| Prescription Drug Coverage | |
| Generic drugs | $10 up to a 30-day supply |
| Brand-name drugs | $35 up to a 30-day supply |
| Mail-order program | $20 generic/$70 brand for 100-day supply of most maintenance drugs |
| View Plan Details (PDF) |
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| Disclosure Form (PDF) |
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| * | Dental rates are based on family rates. When purchased with a KPIC medical plan where family coverage is not available, actual dental rates may vary from the rates quoted on this page.
The system calculates the estimated rates based on the information you have provided. Actual rates may vary based on which family members are approved for coverage and on your selection of optional benefits. The quote is not a binding contract between you and Kaiser Permanente. Rates are subject to change. KFHP and KPIC deductible plans offer a copay for preventative care and certain other services from the first day of coverage. You will have to pay all other health care expenses out of pocket until you meet your deductible. For more information, please refer to the Disclosure Form. |
- individual family:
