Kaiser Permanente
Plans
Most of Kaiser Permanente's benefits are similar from
plan to plan. The main difference is how you prefer to
pay for coverage. People who see the doctor frequently
may prefer to pay a higher monthly premium in exchange
for being able to pay a set copayment for doctor’s
office visits before meeting the deductible. Those who
want health care coverage just for major illnesses may
choose a plan with a higher deductible and lower monthly
premiums. Your choice will depend on your own lifestyle
and financial situation.
You must pay full charges for most covered services
until you meet your plan’s deductible. Then you are
eligible to pay a copayment or coinsurance for these
covered services for the rest of the year. If your
coinsurance costs after you meet your deductible meet
your out-of-pocket maximum (OOPM), then you will pay
nothing for these covered services for the remainder of
the year. Not subject to the deductible Some covered
services are available for a copayment before you meet
your deductible. You can pay a copay or coinsurance from
the first day of coverage for:
- Well-baby visits (through age 2)
- Immunizations (no charge)Certain preventive
tests and procedures
- Prescription drugs
With some of our plans (500 Deductible with Rx Plan,
1000 Deductible with Rx Plan, 1500 Deductible with Rx
Plan, 2000 Deductible with Rx Plan, and 3000 Deductible
with Rx Plan), office visits are also not subject to the
deductible. With these plans, you can pay a copay or
coinsurance for doctor visits from the first day of
coverage. Meeting deductibles and OOPMs Enrolled family
members can meet their deductibles or OOPMs in two ways
in a family plan.
- They can each separately meet the individual
deductible or OOPM.
- Or, the family’s combined expenses can meet the
family deductible or OOPM.
If a service is not subject to the deductible under
your plan, then you must continue to pay copayments or
coinsurance for that service even after you reach your
OOPM.
Service Area
Selected zip codes in Benton, Clackamas, Columbia, Hood
River, Linn, Marion, Multnomah, Polk, Washington, and
Yamhill counties