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$0/$2,700 HSA DeductibleKaiser Permanente

Kaiser Permanente $0/$2,700 HSA Deductible Plan Information

The $0/$2,700 HSA Deductible plan from Kaiser Permanente features the following:

Plan Type: HSA
Deductible: $2,700
IDr. Co-Pay [0%]
Hospitalization $400
Rx Card Yes
Maternity Covered


$0/$2,700 HSA Deductible Summary:

In Network Out of Network
Annual Deductible Individual: $2,700 Family: $5,450 Not Applicable
Annual Out-Of-Pocket Limit Individual: $5,000 Family: $10,000 Not Applicable
Lifetime Maximum None Not Applicable
Office Visits No Charge after Deductible Not Applicable
Prescription Drugs $10 Generic $35 Brand Formulary (after Deductible) Not Applicable
Laboratory and Radiology $10 after Deductible Not Applicable
Annual Physical Exam No Charge Not Applicable
Annual OB-GYN Exam No Charge Not Applicable
Well Baby Care No Charge Not Applicable
Outpatient Surgery $200/procedure after Deductible Not Applicable
Emergency Room $100 after Deductible (waived if admitted) $100 after Deductible (waived if admitted)
Ambulance $100 after Deductible $100 after Deductible
Home Health Care See Brochure Not Applicable
Mental Health Services - Outpatient See Brochure Not Applicable
Chiropractic Care See Brochure Not Applicable
Acupuncture / Acupressure See Brochure Not Applicable
Inpatient Hospital $400 after Deductible/day Not Applicable
Maternity Care Covered, See brochure for complete details Not Applicable
Mental Health - Inpatient See Brochure Not Applicable
Chemical Dependency See Brochure Not Applicable

IMPORTANT NOTICE: Coinsurance amounts represented with a "%" are payable after the plan deductibles are reached; Co-pay amounts represented with a "$" are not subject to plan deductibles (except where noted). Refer to contract for a detailed explanation of plan benefits, features, exclusions and limitations. Benefits subject to change without notice. Out of pocket maximum shown includes the plan deductible unless otherwise noted. Co-pays, Deductibles, and Coinsurance amounts listed above are your share of the costs for covered benefits.

Do Not Cancel your current coverage until a new policy is approved and you have received written confirmation of the policy's rates and benefits from the insurance company. Rate and Benefit Disclaimer Notification!

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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