Kaiser Platinum 90 HMO

Kaiser Platinum 90 HMO is ACA compliant.

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Kaiser Permanente's Platinum 90 HMO - Available 01/01/20

Kaiser PermanenteThe Kaiser Permanente Platinum 90 HMO plan in California has no deductibles. All covered services contribute to the out-of-pocket maximum. Preventive care services, such as routine physical exams and mammogram screenings, are at no charge. This is the most benefit rich Kaiser plan in California and will satisfy your mandated individual health insurance requirement also known as "minimum essential health coverage ".

Plan Name Platinum 90 HMO
Medical Deductible $0
Drug Benefits Deductible $0
Annual Out-of-Pocket Platinum 90 HMO
Out of Pocket Max for Med and Drug EHB Benefits (Total) Individual:$3,350 Family:$6,700
Emergency Health Platinum 90 HMO
Urgent Care Centers or Facilities $15
Emergency Room Services $150
Emergency Transportation/Ambulance $150
Home Health Care Platinum 90 HMO
Home Health Care Services $20 / visit
Hospitalization Services Platinum 90 HMO
Inpatient Physician and Surgical Services No Charge
Re/habilitation Services Inpatient $250 / day; Outpatient $15 / visit
Inpatient Hospital Services (e.g., Hospital Stay) $250 / day
Skilled Nursing Facility $150 / day
Substance Abuse Disorder Outpatient Services $15 / individualvisit; $15 / day for other outpatient services
Substance Abuse Disorder Inpatient Services $250
Maternity Care Platinum 90 HMO
Delivery and All Inpatient Services for Maternity Care $250 / day
Prenatal and Postnatal Care No Charge
Other Services Platinum 90 HMO
Mental/Behavioral Health Inpatient Services $250
Durable Medical Equipment 10% Coinsurance
Hospice Services No Charge
Mental/Behavioral Health Outpatient Services $15 Copay per visit; $15 Copay for other outpatient services
Outpatient Services Platinum 90 HMO
Outpatient Surgery Physician/Surgical Services Not Applicable
Outpatient Facility Fee (e.g., Ambulatory Surgery Center) $125 / procedure
Outpatient Rehabilitaion Svcs $15
Prescription Drug Coverage Platinum 90 HMO
Generic Drugs $5
Non-Preferred Brand Drugs $15
Preferred Brand Drugs $15
Specialty Drugs tier 4 10% coinsurance
Preventative Care Platinum 90 HMO
Well Baby Visits and Care No Charge
Preventive Care/Screening/Immunization No Charge
Professional Services Platinum 90 HMO
X-rays and Diagnostic Test X-ray $30 / Lab $15
Specialist Visit $30
Laboratory Outpatient $15
Primary Care Visit to Treat an Injury or Illness $15

When receiving medical attention, you must only use a Kaiser Permanente medical facility unless it is a medical emergency. Click here for Kaiser Permanente physician and location information.

Information contained in this website is limited in scope, subject to change without notice, and does not contain all the terms, conditions, limitations, or exclusions of the referenced benefit plans. Only the insurance company Plan Documents and Policy's contain the exact terms and conditions of coverage.

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