KP VA Bronze 5500/50/Dental Plan Details for 2020- HealthPocket

KP VA Bronze 5500/50/Dental

$472.82/mo

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Zip Code23464
Applicant4/2/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameKP VA Bronze 5500/50/Dental
Plan IDhhs-95185VA0540006
Plan Year2020
Insurance ProviderKaiser Permanente
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$5,500
Out-of-Pocket Maximum$8,150
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$50 Copay after deductible
Specialist Visit$70 Copay after deductible
Laboratory Outpatient and Professional Services$50 Copay
X-rays and Diagnostic Imaging$110 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans$625 Copay after deductible
Deductible - Family$11000 per group
Out-of-Pocket Maximum - Family$16300 per group

Prescription drug coverage

Generic Drugs$30 Copay
Preferred Brand Drugs$100 Copay after deductible
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Specialty Drugs50.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttp://www.geoaccess.com/Kaiser/po/KaiserIntro.asp
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.
Does this plan cover services outside plan service area?Yes - Emergency Care Only
Does this plan cover services outside the country?Yes - Emergency Care Only

Hospital services

Emergency Room Services35.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)35.00% Coinsurance after deductible
Inpatient Physician and Surgical Services35.00% Coinsurance after deductible
Emergency Transportation or Ambulance ServiceNot Applicable

Maternity

Prenatal and Postnatal CareNot Applicable
Delivery and all inpatient services for maternity care35.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$50 Copay
Mental/Behavioral Health Inpatient Services35.00% Coinsurance after deductible
Substance use disorder outpatient services$50 Copay
Substance use disorder inpatient services35.00% Coinsurance after deductible

Medical Management Programs

Does this plan offer disease managment programs?Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
Does this plan offer a wellness program?Included

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsIncluded

Child Dental Coverage

Child Dental Coverage - Routine Dental CareIncluded
Child Dental Coverage - Basic Dental CareIncluded
Child Dental Coverage - OrthodontiaIncluded
Child Dental Coverage - Major Dental CareIncluded

Adult Dental Coverage

Adult Dental Coverage - Routine Dental CareIncluded
Adult Dental Coverage - Basic Dental CareIncluded
Adult Dental Coverage - OrthodontiaIncluded
Adult Dental Coverage - Major Dental CareIncluded

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Preventive Care/Screening/Immunization
Bariatric Surgery
Imaging (CT/PET Scans, MRIs)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Durable Medical Equipment
Hospice Services
Dental Anesthesia
Diabetes Care Management
Mental Health Other
Abortion for Which Public Funding is Prohibited
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Blood and Blood Services
Bones/Joints
Clinical Trials
Early Intervention Services
Rape and Incest Coverage
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited BenefitsSkilled Nursing Facility
Private-Duty Nursing
Dental Check-Up for Children
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded BenefitsAcupuncture
Cosmetic Surgery
Hearing Aids
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Weight Loss Programs
Routine Foot Care
Non-Emergency Care When Traveling Outside the U.S.
PremiumPlan NameDeductible
from $322
Anthem HealthKeepers Bronze X 5700 Online Plus
$5,700.00Select
from $386
KP VA Bronze 5500/50/Dental
$5,500.00Select
from $393
Anthem HealthKeepers Bronze 5700 Online Plus
$5,700.00Select
from $472
KP VA Bronze 5500/50/Dental
$5,500.00Select
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Charles, Fayton
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Reynaldo, Francisco
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Ravinder, Mohan
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Maxine, Beatty
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Eric, Jones
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Amy, Petersen
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Dana, Taylor-oliveira
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Laura, Dobbs
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Emily, Stokke
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Jose, Paredes
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Leanna, Smith
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Rachel, Buechler
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Tamara, Tugung
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Taylor, Braegelman
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Atlantic Surgical Assistants, Inc
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Brenna, Fencil
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Allison, Taliaferro
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Amber, Scanlon
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Talya, Singleton
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Robyn, Toran
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Brittany, Wulfsberg
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Michael, Mascolo
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Charles Fayton, M.D.
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  • Phone Number
    (757) 420-6218
  • Office Locations
    6477 College Park Sq
    Virginia Beach, VA 23464
6477 College Park Sq Virginia Beach VA, 23464

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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 Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).