KP Bronze I $50 - PedDent - Fit

Individual Health Insurance (Obamacare)

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KP Bronze I $50 - PedDent - Fit

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Monthly Cost

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Benefits & Coverage

Plan Name
KP Bronze I $50 - PedDent - Fit
Plan Year
2018
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Expanded Bronze
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
$50 Copay
Specialist Visit
$100 Copay
Laboratory Outpatient and Professional Services
$60 Copay
X-rays and Diagnostic Imaging
$60 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans
40.00% Coinsurance after deductible
Deductible - Family
$13000 per group
Out-of-Pocket Maximum - Family
$14700 per group

Prescription drug coverage

Generic Drugs
$3 Copay
Preferred Brand Drugs
50.00% Coinsurance after deductible
Non-Preferred Brand Drugs
50.00% Coinsurance after deductible
Specialty Drugs
50.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URL
https://healthy.kaiserpermanente.org/care/doctors-locations/#/search
Does this plan have access to a national provider network?
No
Is a referral required to see a Specialist?
Yes - Referral required for certain specialists
Does this plan cover services outside plan service area?
Yes - Emergency Services, Urgent Care and Authorized Referrals
Does this plan cover services outside the country?
Yes - Emergency Services

Hospital services

Emergency Room Services
40.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
40.00% Coinsurance after deductible
Inpatient Physician and Surgical Services
40.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service
20.00% Coinsurance

Maternity

Prenatal and Postnatal Care
Not Applicable
Delivery and all inpatient services for maternity care
40.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services
$50 Copay
Mental/Behavioral Health Inpatient Services
40.00% Coinsurance after deductible
Substance use disorder outpatient services
$50 Copay
Substance use disorder inpatient services
40.00% 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 Children
Included
Eye Glasses for Children
Included
Routine Eye Exam for Adults
Included

Child Dental Coverage

Child Dental Coverage - Routine Dental Care
Not Covered
Child Dental Coverage - Basic Dental Care
Not Covered
Child Dental Coverage - Orthodontia
Not Covered
Child Dental Coverage - Major Dental Care
Not Covered

Adult Dental Coverage

Adult Dental Coverage - Routine Dental Care
Not Covered
Adult Dental Coverage - Basic Dental Care
Not Covered
Adult Dental Coverage - Orthodontia
Not Covered
Adult Dental Coverage - Major Dental Care
Not Covered

Exclusions and Limitations

More Included Benefits
Other 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
Diabetes Care Management
Inherited Metabolic Disorder - PKU
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Prescription Drugs Other
Active & Fit
House Calls
Specialty Laboratory Services
Testing Services
Active&Fit
Generic Drugs Other
More Limited Benefits
Skilled Nursing Facility
Hearing Aids
Infertility Treatment
Abortion for Which Public Funding is Prohibited
More Excluded Benefits
Acupuncture
Cosmetic Surgery
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Dental Check-Up for Children
Chiropractic Care
Routine Foot Care
Non-Emergency Care When Traveling Outside the U.S.

What To Know

  • This is an ACA (Obamacare) compliant health plan.

Physician Directory

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