Overview
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Kaiser is a staff model Health Maintenance Organization (HMO). Doctors belong to the Kaiser Permanente Medical Group which is affiliated with the Kaiser Foundation Health Plan of Southern California. You choose a primary care physician (PCP). Your PCP will be responsible for all of your healthcare needs, and will refer you to a specialist when necessary. Note that certain providers allow for annual enrollments only.
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Lifetime Maximum
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No plan maximum
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Annual Copayment Maximums
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$1,500 Individual
$3,000 Family
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Inpatient Hospital Charges
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No charge
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Outpatient Office Visits and Most Outpatient Services
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Your copayment is $5 per visit for almost all covered outpatient services.
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Chiropractic
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Chiropractic benefits are offered through American Specialty Health Plans of California. The co-payment for each visit is $5 for up to 30 visits per year.
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Prescriptions
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Not covered through Kaiser. See the Prescription BenefitTab.
Early retirees please refer to the prescription benefits described under the Retiree Benefit tabs.
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Dependent Coverage
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Kaiser has its own definition of covered dependents.
Important: If you have a baby, the newborn must be enrolled within 30 days. Kaiser does not automatically enroll newborns as dependents, even if they are born at a Kaiser facility, and will not accept enrollment after 30 days.
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Additional Info
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Phone: 1-800-464-4000
Web Site: www.members.kp.org
Summary Schedule of Benefits
Kaiser Group #:
Active - 1155-00
Retiree - 1155-01
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