$5,000 Deductible Plan

Printer-friendly versionPrinter-friendly versionSend to friendSend to friendPDF versionPDF version
Benefits Summary
Annual Medical Deductible - Individual $5,000
Annual Medical Deductible - Family n/a
Annual Out-of-Pocket Maximum - Individual $7,500
Annual Out-of-Pocket Maximum - Family n/a
Professional Services
Primary and specialty care visits (includes routine and urgent care appointments) $50 per visit after deductible
Well-child visits from 0 to 23 months $30 per visit
Family planning visits $50 per visit
Eye exams $50 per visit
Hearing tests $50 per visit
Outpatient Services
Outpatient surgery 30% 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 30% coinsurance after deductible
Emergency Services
Emergency room visits $150 per visit after deductible (waived if admitted directly to the hospital)
Ambulance services $150 per trip after deductible
Prescription Drug Coverage
Generic drugs Not covered
Brand-name drugs Not covered
Mail-order program Not covered
 
  View Plan Details
(PDF)
  Disclosure Form
(PDF)
*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.