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Home > Kaiser > 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. 
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