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MEDICAL – KAISER

MEDICAL – KAISER

Coverage to Build a Foundation of Good Health

At Tyto Athene, we understand the importance of good health as the foundation for a productive life at home and at work. That is why we offer medical and prescription coverage, administered through Kaiser, to fit your needs and budget.

Kaiser HMO- California

HOW THE PLAN WORKS

Preventive Care: The plan pays 100% for in-network preventive care.

Out-of-Pocket Maximum: This is the most that you will have to pay for covered services in a plan year. All medical and prescription drug deductibles, copayments and coinsurance apply toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum, then the plan pays 100% of your eligible expenses, including the cost of all office visits and prescription drugs for the remainder of the year.

Annual Deductible: For non-preventive care there is an annual deductible that must be met. The annual deductible is $500 for Individual coverage and $1,000 for Family Coverage when you use in-network providers.

Kaiser HMO- California Network Providers Non-Network Providers
Calendar Year Deductible: Single/Family $500 / $1,000 N/A
Coinsurance 20% N/A
Maximum Out of Pocket Limit: Single / Family
(Includes the deductible)
$3,000/$6,000 N/A
Office Visit $20 copay N/A
Specialist Office Visit $20 copay N/A
Surgical Services 20% after Deductible N/A
Complex X-Ray and Lab – CT, PET, MRI, MRA 20% after Deductible to a Maximum of $150 N/A
Urgent Care Centers $20 copay Only covered if you are out of the service area
Emergency Medical Care 20% after Deductible Covered if true emergency
In-Patient Hospital Services 20% after Deductible N/A
Out-Patient Hospital Services 20% after Deductible N/A
Prescription Drugs:
Retail (30 day supply) Tier 1 – $10 |Tier 2 – $30 |Tier 3 – $30 |  Specialty 20% up to $150 N/A
Mail Order (90 day supply) Tier 1 – $20 | Tier 2 – $60 | Tier 3- $60 N/A