|
Medical Procedure
|
Kaiser
|
|
|
Not Eligible for Medicare
|
Enrolled in Medicare
"Senior Advantage"
|
| Annual Deductible |
None
|
None
|
| Annual Co-Payment Limit on Allowable Charges |
Plan pays 100% after co-payments reach $1,500 in a year ($3,000 for a family) |
Plan pays 100% after co-payments reach $1,500 in a year ($3,000 for a family) |
| Overall Lifetime Maximum |
None
|
None
|
| Hospital |
|
|
|
|
You pay $500 per admission |
Plan pays 100% |
|
|
You pay $20 per visit |
You pay $10 per visit |
| Extended Care Facility (Skilled Nursing) |
Plan pays 100%; 100 days maximum |
Plan pays 100%; 100 days maximum |
| Physician Services - Routine Physical |
|
|
|
|
You pay $20 per visit |
You pay $10 per visit |
Inpatient Surgery
|
Plan pays 100% |
Plan pays 100% |
Outpatient Surgery
|
Plan pays 100% (You pay $20 for office visit) |
Plan pays 100% (You pay $10 for office visit) |
Hospital Visits
|
Plan pays 100% |
Plan pays 100% |
Office Visits
|
You pay $20 per visit |
You pay $10 per visit |
| Diagnostic X-Ray and Lab |
Plan pays 100% (You pay $20 for office visit) |
Plan pays 100% |
| Durable Medical Equipment |
Plan pays 100%, for limited items |
Plan pays 100% |
| Home Nursing Care |
Plan pays 100% |
Plan pays 100% |
| Physical Therapy |
You pay $20 per visit |
You pay $10 per visit |
| Speech Therapy |
You pay $20 per visit |
You pay $10 per visit |
| Chiropractic Care |
Not covered
|
Not Covered
|
| Hearing Aids |
Not covered
|
Not covered
|
| Substance Abuse - |
|
|
|
|
You pay $500 per admission, up to 60 days per calendar year; not to exceed 120 days in any 5 year period |
Plan pays 100%, up to 60 days per calendar year, not to exceed 120 days in any 5 year period |
|
|
You pay $5 per group session or $20 per individual session |
You pay $5 per group or $10 per individual visit |
| Psychiatric Care - |
|
|
|
|
You pay $500 per admission; 30 days maximum |
Play pays 100%, maximum of 190 days per lifetime |
|
|
You pay $20 per visit; up to 20 visits per year |
You pay $10 per visit up to 20 visits per year |
| Prescription Drugs |
Must be obtained at a participating HMO pharmacy |
|
|
You pay $10 per generic and $25 per brand name prescription, up to a 100-day supply |
You pay $10 per prescription, up to a 100-day supply |
Maintenance (30 day supply or more thru the Mail Order)
|
Mail Order -
You pay $15 per prescription up to a 100-day supply
|
Mail Order -
You pay $10 per prescription up to 100-day supply
|
| Vision Care |
You pay $20 for exam, lenses and frames not included |
You pay $10 for exam, $150 allowance for frames & lenses every 24-months |
| Dental Care |
Not covered
|
Not covered
|
| Ambulance |
Plan pays 100% |
Plan pays 100% |
| Emergency Room Care |
You pay $35 (co-payment waived if admitted to hospital) |
You pay $20 (co-payment waived if admitted to hospital) |
