Self-only enrollment/Family enrollment
admitted directly to the hospital)
medications, supplies, therapies
per benefit period)
calendar year)
per calendar year)
Kaiser Permanente plans do not include a pre-existing condition clause.
1 The annual out-of-pocket maximum is the limit to the total amount that an individual or family must pay for certain services in a calendar year (as discussed in the Evidence of Coverage).
2 Scheduled prenatal visits and the first postpartum visit.
4 Prescription drugs are covered in accord with our formulary when prescribed by a Plan physician and obtained at Plan pharmacies. A few drugs have different copayments; please refer to the Evidence of Coverage for detailed information about prescription drug copayments.
5 This service is not subject to a deductible.
6 Visit or day limits do not apply to serious emotional disturbances of children and severe mental illnesses as described in the Evidence of Coverage.
7 Allowance toward the cost of eyeglass lenses, frames, and contact lenses fitting and dispensing every 24 months.
