Kaiser Silver 70 HMO Off Exchange

Kaiser Permanente Silver 70 HMO is ACA compliant.

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Kaiser Permanente's CA Silver 70 HMO Off Exchange - Available 01/01/19

The Kaiser Permanente CA Silver 70 HMO off exchange plan has a $2500 individual and a $5000 family medical deductible and pharmacy deductible of $200 per person and $400 for family in network. 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 popular Kaiser plan in California and will satisfy your mandated individual health insurance requirement also known as minimum essential health coverage.


Plan Name KP Silver 70 HMO Off Exchange
Medical Deductible Individual:$2,500 Family:$5,000
Drug Benefits Deductible $200 Indiviual / $400 Family
Annual Out-of-Pocket KP Silver 70 HMO Off Exchange
Out of Pocket Max for Med and Drug Benefits (Total) Individual:$7,550 Family:$15,100
Emergency Health KP Silver 70 HMO Off Exchange
Urgent Care Centers or Facilities $40 Copay
Emergency Room Services $350 Copay
Emergency Transportation/Ambulance $255 / trip
Home Health Care KP Silver 70 HMO Off Exchange
Home Health Care Services $45 Copay no deductible
Hospitalization Services KP Silver 70 HMO Off Exchange
Inpatient Physician and Surgical Services Not applicable
Habilitation Services Inpatient: 20% Coinsurance after deductible; Outpatient: $40 Copay
Inpatient Hospital Services (e.g., Hospital Stay) 20% Coinsurance after deductible
Skilled Nursing Care 20% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services $40 / Visit
Substance Abuse Disorder Inpatient Services 20% Coinsurance after deductible
Maternity Care KP Silver 70 HMO Off Exchange
Delivery and All Inpatient Services for Maternity Care 20% Coinsurance after deductible
Prenatal and Postnatal Care No Charge deductible waived
Other Services KP Silver 70 HMO Off Exchange
Mental/Behavioral Health Inpatient Services 20% Coinsurance after deductible
Durable Medical Equipment 20% Coinsurance no deductible
Hospice Services No Charge deductible waived
Mental/Behavioral Health Outpatient Services $40 / visit no deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy Inpatient: 20% Coinsurance after deductible; Outpatient: $40 / vist no deductible
Outpatient Services KP Silver 70 HMO Off Exchange
Outpatient Surgery Physician/Surgical fees Not Applicable
Outpatient Facility Fee (e.g., Ambulatory Surgery Center) 20% Coinsurance no deductible
Prescription Drug Coverage KP Silver 70 HMO Off Exchange
Generic Drugs $15 after drug deductible
Non-Preferred Brand Drugs $55 after drug deductible
Preferred Brand Drugs $55 after drug deductible
Specialty Drugs 20% after drug deductible
Preventative Care KP Silver 70 HMO Off Exchange
Well Baby Visits and Care No Charge deductible waived
Preventive Care/Screening/Immunization No Charge deductible waived
Professional Services KP Silver 70 HMO Off Exchange
Imaging (CT/PET scans, MRI's) $300 Copay no deductible
Specialist Visit $80 Copay no deductible
Diagnostic Test (X-Ray and Lab Work) $75 X-ray / $35 Lab no deductble
Primary Care Visit to Treat an Injury or Illness $40 Copay no deductible

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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