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 Please refer to the Evidence of Coverage for more information; most DME is not covered.
8 Kaiser Permanente members who are enrolled in this benefit plan are entitled to a 20 percent discount on eyeglasses and contact lenses purchased at Kaiser Permanente optical centers. These discounts may not be coordinated with any other health plan vision benefit. The discounts will not apply to any sale, promotional, or packaged eyewear program, for any contact lens extended purchase agreement, or to low-vision aids or devices. Visit kp.org/2020 for Kaiser Permanente optical locations.
