CALIFORNIA. Kaiser Permanente Student Health Plan. Comparison charts

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1 CALIFORNIA Kaiser Permanente Student Health Plan Comparison charts

2 1 Protect your students with award-winning integrated care Offer your students and their dependents a health plan with broad coverage from a national leader in prevention, wellness, and total health. It s easy for you and your students get the benefits they need to stay healthy, active, and focused on their education. Get more value from every plan With the Kaiser Permanente Student Health Plan, your students will benefit from the value of an integrated care delivery system where doctors, hospitals, and health plan are all connected working together to ensure high-quality care for your students. Our physicians practice evidence-based medicine that results in a higher standard of care, and more efficient and cost-effective services. Each of our 11 standard plan types offers your students flexible and convenient options for year-round coverage. You also have the option to add vision, chiropractic, dental, and acupuncture riders. Each of our plans has rich prescription drug coverage with no deductibles for generic or brand-name drugs, and easy refills online. HMO plans with no deductibles, lifetime maximums, or annual limits. They offer broad coverage and preventive care with low, predictable copayments for all services at our facilities. And there are no claim forms or bills for students to manage. HMO plans with added coverage all the features of our HMO plan. Plus, during school-designated breaks, students can access doctors in the PHCS Network or any licensed nonparticipating provider.* And there are no claim forms or bills for students to manage for services performed at Kaiser Permanente facilities. Deductible HMO plans offer preventive care at little or no cost. Students pay full charges for other designated services until they reach their deductible, and then we pay for most covered services (not including copayments or coinsurance) for the rest of the calendar year. Please contact your Kaiser Permanente broker or representative to learn more, or visit businessnet.kp.org. * Eligible students must meet their application deductible amount and pay coinsurance for covered services. Some covered services may need to be pre-certified. Kaiser Permanente Insurance Company (KPIC) is a California corporation that is licensed as a disability company that issues and services policies of insurance covering the non-hmo components of group health plans and other types of complementary insurance products. KPIC is a subsidiary of Kaiser Foundation Health Plan, Inc. Information may have changed since publication.

3 2 HMO $20 plan $40 plan Annual deductible (individual/family) None Annual out-of-pocket limit (individual/family) $3,000/$6,000 Allergy injection $5 Chemical dependency outpatient services $20/$5 $40/$5 Covered health education programs No charge No charge Diagnostic test (X-ray, blood work) $10 Durable medical equipment 20% Emergency department services $150 Emergency medical transportation $150 Home health care (up to hour visits per calendar year) No charge Hospice services No charge Hospital stay or inpatient services (per admission) $500 Imaging (CT/PET scans, MRIs) $50 Immunizations (most are covered) No charge inpatient services (per admission) $500 outpatient services $20/$10 $40/$20 Out-of-network services Not covered except for emergencies Outpatient surgery $250 Physical, occupational, and speech therapy $20 $40 Prenatal care $15 Prescription drug coverage (generic/brand for 30-day supply) $10/$30 Preventive care/screening $20 $40 Prosthetics and orthotics $20 $40 Provider office visits $20 $40 Skilled nursing care No charge $100 per admission Well-child visits (through age 23 months) $15

4 3 HMO with added coverage $20 plan $40 plan Kaiser Permanente Participating Nonparticipating Kaiser Permanente Participating Nonparticipating Annual deductible (individual/family) None $500/$1,000 None $500/$1,000 Annual out-of-pocket limit (individual/family) $3,000/$6,000 $4,500/$9,000 $9,000/$18,000 $3,000/$6,000 $4,500/$9,000 $9,000/$18,000 Allergy injection (per visit after deductible) No charge 30% 50% No charge 30% 50% Chemical dependency outpatient services $20/$5 Not covered $40/$5 Not covered Covered health education programs $20/No charge Not covered $40/No charge Not covered Diagnostic test (X-ray, blood work) (per procedure except preventive screenings $10 30% 50% $10 30% 50% after deductible) Durable medical equipment 50% 50% Emergency department services $150 $150 Emergency medical transportation $150 $150 Home health care (up to hour visits per calendar year) No charge 20% No charge 20% Hospice services No charge 30% 50% No charge 30% 50% Hospital stay or inpatient services $500/day $ % $ % $500/day $ % $ % Imaging (CT/PET scans, MRIs) (per procedure after deductible) $50 30% 50% $50 30% 50% Immunizations (most are covered) No charge Not covered No charge Not covered inpatient services $500/day $ % $ % $500/day $ % $ % outpatient services $20/$10 30% 50% $40/$20 30% 50% Outpatient surgery $250 30% 50% $250 30% 50% Physical, occupational, and speech therapy (after deductible) $20 30% 50% $40 30% 50% Prenatal care $10 30% 50% $10 30% 50% Prescription drug coverage (generic/brand for 30-day supply) $10/$30 $15/$35 Not covered $10/$30 $15/$35 Not covered Preventive care/screening $20 30% 50% $40 30% 50% Prosthetics and orthotics No charge Not covered No charge Not covered Provider office visits $20 30% 50% $40 30% 50% Skilled nursing care (up to 100 days per calendar year after deductible) No charge 30% 50% No charge 30% 50% $100 Not covered $100 Not covered Well-child visits (through age 23 months) $10 30% 50% $10 30% 50%

5 4 Deductible HMO $150/$20 $150/$40 $500/$20 $500/$40 $1,000/$40 $1,500/$40 $1,500/$40 XP Annual deductible (individual/family) $150/$300 $500/$1,000 $1,000/$2,000 $1,500/$3,000 Annual out-of-pocket limit (individual/family) $3,000/$6,000 $3,000/$6,000 $4,000/$8,000 $4,000/$8,000 Allergy injection (per visit after deductible) $5 Chemical dependency outpatient services $20/$5 $40/$5 $20/$5 $40/$5 $40/$5 $40/$5 $40/$5* Covered health education programs $20/No charge $40/No charge $20/No charge $40/No charge $40/No charge $40/No charge Diagnostic test (X-ray, blood work) (per procedure except preventive $10 screenings after deductible) Durable medical equipment 20% Emergency department services (per visit after deductible) Emergency medical transportation (per trip after deductible) $150 Home health care (up to hour visits per calendar year) No charge Hospice services No charge Hospital stay or inpatient services Imaging (CT/PET scans, MRIs) (per procedure after deductible) $50 Immunizations (most are covered) No charge inpatient services outpatient services $20/$10 $40/$20 $20/$10 $40/$20 $40/$20 $40/$20 $40/$20* Out-of-network services No coverage except for emergencies Outpatient surgery Physical, occupational, and speech therapy (after deductible) $20 $40 $20 $40 $40 $40 Prenatal care $15 Prescription drug coverage (generic/brand for 30-day supply) $10/$30 $15/$30 Preventive care/screening $20 $40 $20 $40 $40 $40 $40 Prosthetics and orthotics No charge Provider office visits $20 $40 $20 $40 $40 $40 $40* Skilled nursing care (up to 100 days per calendar year after deductible) $100 $100 $100 $100 Well-child visits (through age 23 months) $15 * For this plan, the additional service is subject to the deductible. kp.org Business Marketing Communications June 2014