Kaiser Platinum 90 HMO

Kaiser Platinum 90 HMO Kaiser Platinum 90 HMO In-Network Cost Share Information  Individual Deductible  $0 Family Deductible  $0 Out of Pocket Limit-Individual  $4,000 Out of Pocket Limit-Family  $8,000 Co-Insurance  10% Lifetime Maximum  Unlimited Office Visits  Primary Care  $15 Specialist  $40 Adult Preventive Care  No Charge Child Preventive Care  No Charge Maternity Prenatal/Postnatal Care  No Charge Rehabilitation Services  $15 Chiropractic Care  Not Covered  Inpatient Services  Inpatient Hospital $250 per day; 5 days/admit Maternity Delivery/Inpatient  $250 per day, 5 days/admit Outpatient Services  Outpatient Facility  $250 Mental Health Outpatient  $15 Lab/X-Ray  $20/$40 Emergency Care  Emergency Room  $150 Urgent Care  $15 Ambulance  $150  Prescription Drugs  Rx Deductible  N/A Rx Generic  $5 Rx Preferred  $15 Rx Non-Preferred  $15 Recovery/ Special Needs  Home Health Care $20; 100 visits per year Durable Medical Equipment  10%   Optional Benefits  None  Complete Benefit Summary If you you have questions about the Kaiser Platinum 90 HMO plan or any other plans from Kaiser Permanente of California please call The Lynn Company at (800)-326-5966 for more information on California Health Insurance Plans.