KP WA Bronze 6000/30% H.S.A with Pediatric Dental Plan Details for 2020- HealthPocket

KP WA Bronze 6000/30% H.S.A with Pediatric Dental

$328.52/mo

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Zip Code98115
Applicant10/26/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameKP WA Bronze 6000/30% H.S.A with Pediatric Dental
Plan IDhhs-23371WA1790005
Plan Year2020
Insurance ProviderKaiser Permanente
Metal LevelExpanded Bronze
Plan TypeEPO
Deductible$6,000
Out-of-Pocket Maximum$6,900
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness30.00% Coinsurance after deductible
Specialist Visit30.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services30.00% Coinsurance after deductible
X-rays and Diagnostic Imaging30.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans30.00% Coinsurance after deductible
Deductible - Family$12000 per group
Out-of-Pocket Maximum - Family$13800 per group

Prescription drug coverage

Generic Drugs$20 Copay after deductible
Preferred Brand Drugs$50 Copay after deductible
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Specialty Drugs50.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://healthy.kaiserpermanente.org/health/care/consumer/locate-our-services/doctors-and-locations
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.
Does this plan cover services outside plan service area?Yes - Out of Area Dependent; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions
Does this plan cover services outside the country?Yes - Emergency medical conditions, including prescription drugs

Hospital services

Emergency Room Services30.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)30.00% Coinsurance after deductible
Inpatient Physician and Surgical Services30.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service30.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care$0 Copay
Delivery and all inpatient services for maternity care30.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services30.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services30.00% Coinsurance after deductible
Substance use disorder outpatient services30.00% Coinsurance after deductible
Substance use disorder inpatient services30.00% 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
Does this plan offer a wellness program?Included

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsNot Covered

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 CareNot Covered
Adult Dental Coverage - Basic Dental CareNot Covered
Adult Dental Coverage - OrthodontiaNot Covered
Adult Dental Coverage - Major Dental CareNot Covered

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Preventive Care/Screening/Immunization
Hearing Aids
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
Durable Medical Equipment
Routine Foot Care
Dental Anesthesia
Diabetes Care Management
Inherited Metabolic Disorder - PKU
Abortion for Which Public Funding is Prohibited
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
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited BenefitsSkilled Nursing Facility
Acupuncture
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Hospice Services
Dental Check-Up for Children
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded BenefitsBariatric Surgery
Cosmetic Surgery
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Non-Emergency Care When Traveling Outside the U.S.
Accidental Dental
PremiumPlan NameDeductible
from $310
Bronze HDHP 6000 EPO RealValue
$6,000.00Select
from $325
KP WA Bronze 6000/30% H.S.A.
$6,000.00Select
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Jonathan, Moceri
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Sheryl, Morelli
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David, Viscardi
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Bethanie, Bayha
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Ashley, Jerath Tatum
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Hollowbone Medicine, Inc
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Amber, Clark Girtch
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Lindsey, Tennant-moore
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Mary, Barrett
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Alicia, Myers
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Helpprn Pllc
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Erika, Clute
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Ryan, Wilson
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Laura, Sargent
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Samantha, Vanderputten
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Sametra, Green
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Rachel, Smith
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Sierra, Owsley
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Margaret, Flack
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Maegan, Bell
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Courtney, Rogers
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Jonathan Moceri, MD
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  • Phone Number
    (206) 954-5525
  • Office Locations
    1037 Ne 65th St
    Seattle, WA 98115
1037 Ne 65th St Seattle WA, 98115

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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.