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Kaiser Silver 70 HMO 1750/40

Kaiser Silver 70 HMO 1750/40

Kaiser Silver 70 HMO 1750/40

In-Network

Cost Share Information 
Individual Deductible  $1,750
Family Deductible  $3,500
Out of Pocket Limit-Individual  $6,800 (including deductible)
Out of Pocket Limit-Family  $13,600 (including deductible)
Co-Insurance  30%
Lifetime Maximum  Unlimited
Office Visits 
Primary Care  $40 deductible waived
Specialist  $40 deductible waived
Adult Preventive Care  No Charge
Child Preventive Care  No Charge
Maternity Prenatal/Postnatal Care  No Charge
Rehabilitation Services  $40 deductible waived
Chiropractic Care  Not Covered 
Inpatient Services 
Inpatient Hospital 30% after deductible 
Maternity Delivery/Inpatient  30% after deductible 
Outpatient Services 
Outpatient Facility  30% after deductible 
Mental Health Outpatient  $40 deductible waived
Lab/X-Ray  $40/$60 deductible waived 
Emergency Care 

Emergency Room 

$350 after deductible

Urgent Care  $40 deductible waived  
Ambulance  $250 after deductible 
Prescription Drugs 
Rx Deductible  $250 individual/ $500 family 
Rx Generic  $20 deductible waived
Rx Preferred  $55 after deductible 
Rx Non-Preferred  $55 after deductible 
Recovery/ Special Needs 

Home Health Care 

Refer to carrier 

Durable Medical Equipment  30% deductible waived
 
Optional Benefits  None 

Complete Benefit Summary


If you you have questions about the Kaiser Silver 70 HMO 1750/40 plan or any other plans from Kaiser Permanente of California please call The Lynn Company at (800)-326-5966 for more information on California Health Insurance Plans
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