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Kaiser Silver 70 HMO 1750/40

Kaiser Silver 70 HMO 1750/40	In-Network
Cost Share Information
Individual Deductible	$1,750
Family Deductible	$3,500
Out of Pocket Limit-Individual	$6,800 (including deductible)
Out of Pocket Limit-Family	$13,600 (including deductible)
Co-Insurance	30%
Lifetime Maximum	Unlimited
Office Visits
Primary Care	$40 deductible waived
Specialist	$40 deductible waived
Adult Preventive Care	No Charge
Child Preventive Care	No Charge
Maternity Prenatal/Postnatal Care	No Charge
Rehabilitation Services	$40 deductible waived
Chiropractic Care	Not Covered
Inpatient Services
Inpatient Hospital	30% after deductible
Maternity Delivery/Inpatient	30% after deductible
Outpatient Services
Outpatient Facility	30% after deductible
Mental Health Outpatient	$40 deductible waived
Lab/X-Ray	$40/$60 deductible waived
Emergency Care
Emergency Room	$350 after deductible
Urgent Care	$40 deductible waived
Ambulance	$250 after deductible
Prescription Drugs
Rx Deductible	$250 individual/ $500 family
Rx Generic	$20 deductible waived
Rx Preferred	$55 after deductible
Rx Non-Preferred	$55 after deductible
Recovery/ Special Needs
Home Health Care	Refer to carrier
Durable Medical Equipment	30% deductible waived

Optional Benefits	None

Complete Benefit Summary

If you you have questions about the Kaiser Silver 70 HMO 1750/40 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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Please note that we cannot bind insurance via email, fax, or voicemail. Any quotes given are subject to underwriting guidelines by the respective insurance carriers. Any reference of coverage used are not intended to express legal opinion as to the nature of coverage, but rather just a brief generalization of coverages. Please read your policy for coverage details.

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3761 Bernard Street | Bakersfield, CA 93306
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