KP GA Signature Bronze 5000/50 Plan Details for 2021- HealthPocket

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Zip Code30044
Applicant11/27/1985 Male

Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameKP GA Signature Bronze 5000/50
Plan IDqhp-89942GA0050019
Plan Year2020
Insurance ProviderKaiser Permanente
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$5,000
Out-of-Pocket Maximum$7,350
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness35% Coinsurance after deductible
Specialist Visit35% Coinsurance after deductible
Laboratory Outpatient and Professional Services35.00% Coinsurance after deductible
X-rays and Diagnostic Imaging35.00% Coinsurance after deductible
Deductible - Family$10000
Out-of-Pocket Maximum - Family$14700

Prescription drug coverage

Generic Drugs$35 Copay
Preferred Brand Drugs50% Coinsurance after deductible
Non-Preferred Brand Drugs50% Coinsurance after deductible
Specialty Drugs50% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://kp.org/gaprovider

Hospital services

Emergency Room Services35% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)35% Coinsurance after deductible
Inpatient Physician and Surgical Services35% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care35.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services35.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services35.00% Coinsurance after deductible

Vision Coverage

Routine Eye Exam for ChildrenNot Applicable
Eye Glasses for ChildrenNot Applicable

Exclusions and Limitations

More Included BenefitsOutpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Hospice Services
Urgent Care Centers or Facilities
Other Practitioner Office Visit (Nurse, Physician Assistant)
Home Health Care Services
Inpatient Physician and Surgical Services
Skilled Nursing Facility
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Durable Medical Equipment
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Rehabilitative Speech Therapy
Rehabilitative Occupational and Rehabilitative Physical Therapy
Well Baby Visits and Care
Transplant
Accidental Dental
Dialysis
Allergy Testing
Chemotherapy
Radiation
Diabetes Education
Prosthetic Devices
Infusion Therapy
Treatment for Temporomandibular Joint Disorders
Nutritional Counseling
Reconstructive Surgery
More Excluded BenefitsInfertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Bariatric Surgery
Cosmetic Surgery
Hearing Aids
Routine Foot Care
Acupuncture
Weight Loss Programs
Dental Check-Up for Children
Abortion for Which Public Funding is Prohibited
PremiumPlan NameDeductible
from $330
KP GA Signature Bronze 5000/50
$5,000.00Select
from $345
Ambetter Balanced Care 204 HSA (2021)
$4,800.00Select
from $359
Ambetter Balanced Care 204 HSA (2021) + Vision + Adult Dental
$4,800.00Select
from $362
KP GA Bronze 5000/50
$5,000.00Select
from $364
SoloCare Silver PPO 40007 Area 12
$5,000.00Select
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  • Phone Number
    (678) 344-8700
  • Office Locations
    2878 Five Forks Trickum Rd
    Lawrenceville, GA 30044
2878 Five Forks Trickum Rd Lawrenceville GA, 30044

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.