Summary of Benefits for Early Retirees (Under Age 62 and not eligible or enrolled in Medicare) |
|
Kaiser Permanente HMO
(In Network Only) |
UnitedHealthcare HMO
(In Network Only) |
Out-of-Area Plan UnitedHealthcare (In Network Benefits) |
Member Customer Service Number |
(800) 464-4000 |
(800) 624-8822 |
Northern California (800) 624-8822
Out-of-state
(866)633-2446 |
Website |
www.members.kp.org |
www.myuhc.com |
www.myuhc.com |
General Features |
Calendar Year Deductible |
None |
None |
$500 per Individual
$1,000 per Family |
Maximum Benefits |
Unlimited |
Unlimited |
Unlimited |
Annual Co-payment Maximum |
$1,500 per Individual
$3,000 per Family |
$2,500 per Individual
$5,000 per Family |
$4,500 per Individual
$9,000 per Family |
Hospital Benefits |
$250 Co-Payment per admission |
$250 Co-Payment per admission |
80% after deductible has been met |
Emergency Services
Co-payment waived if admitted |
$100 co-payment |
$250 co-payment |
$100 co-payment: deductible does not apply |
Urgently Needed Services
Medically Necessary services required outside geographic area service by Primary Medical Group |
$20 co-payment |
$20 co-payment |
$50 co-payment: deductible does not apply |
Pre-existing Conditions |
All Medically Necessary conditions are covered provided they are a covered benefit |
Benefits Available While Hospitalized as an Inpatient |
Alcohol, Drug or Other Substance Abuse Detoxification |
$250 co-payment per admission |
$250 co-payment per admission |
80% after deductible |
Mental Health Services
As required by law, coverage includes treatment for Severe Mental Illness of adults and the treatment of Serious Emotional Disturbance. (SED) |
$250 co-payment per admission |
$250 co-payment per admission |
80% after deductible |
Physician Care |
$250 co-payment |
No charge |
80% after deductible |
Reconstructive Surgery |
$250 co-payment |
$250 co-payment |
80% after deductible |
Rehabilitative Care
Including physical, occupational and speech therapy |
$250 co-payment |
$250 co-payment |
$20 co-payment |
Skilled Nursing Facility
Up to 100 Consecutive Days from the first treatment per disability |
No charge |
$250 co-payment |
80% after deductible |
Benefits Available on an Outpatient Basis |
Ambulance |
$100 per trip |
No charge |
80% after deductible |
Alcohol, Drug or Other Substance Abuse Detoxification |
$20 per visit per individual visit: $5 co-payment per group visit |
$20 per visit |
$20 co-payment |
Durable Medical Equipment |
No charge |
No charge |
80% after deductible |
Laboratory Services
When available through or authorized by PCP |
No charge |
No charge |
No charge |
Maternity Care, Tests Procedures |
No charge |
No charge |
The amount you pay is based on where the covered service is provided. |
Mental Health Services (As required by law, coverage includes treatment for Severe Mental Illness (SMI) of adults and the treatment of Serious Emotional Disturbance (SED)) |
$20 per visit |
$25 per visit |
80% after deductable |
Outpatient Medical Rehabilitation Therapy at Participating Free Standing or Outpatient Surgery Facility |
$20 co-payment |
$20 co-payment |
80% after deductable |
Outpatient Surgery at Participating Free Standing or Outpatient Surgery Facility |
$250 co-payment per procedure |
No Charge |
80% after deductable |
Preventive Care Physician Office Visits (Physician, laboratory, radiology and related services as recommended by the American Academy of Pediatrics (AAP). Advisory Committee on Immunization Practices (ACIP) and U.S. Preventive Services Task Force and authorized through PCP for children). |
No Charge |
No Charge |
No Charge |
Well-Woman Care (includes PAP smear (By PCP or an OB/GYN in PMG and a referral by the PMG for screening mammography as recommended by the U.S. Preventive Services Task Force)). |
No Charge |
No Charge |
No Charge |