Kaiser Permanente Medical (CA Only)
Kaiser plans are only available to those who live in the Kaiser service area in California. You must use Kaiser physicians and facilities if you choose one of these plans.
| Deductible - The amount you must pay for medical services, before the plan pays a benefit. Preventative care is always covered at 100% with no deductible required. Coinsurance - This is the percentage of the cost you pay for certain services after the deductible has been met. You can think of this as “cost sharing”. For example, once your deductible has been met you could pay 20% for the cost of certain services and the plan could pay 80%. Copay - The flat fee paid by the member when a medical service is received, i.e. $20 for a doctor's visit or $20 for a prescription. In Network Provider - An in-network provider is a hospital, doctor, medical group, and/or other healthcare provider contracted to provide services to insurance company customers for a discounted fee. Using these providers will lessen your medical expenses when using your benefits. Out of Network Provider - An out of network provider is a hospital, doctor, medical group, or other healthcare provider who are not contracted to provide services to insurance company customers. Because the fees are not negotiated in advance with the insurance company, the provider can charge the member as much as they wish. Out of Pocket Maximum - The maximum amount a member would have to pay out of their pocket for medical expenses for the year, with the exception of benefit premiums (which come out of your paycheck). Your out-of-pocket maximum includes your deductible, any coinsurance paid and all co-payments (medical and prescription drug). |