Kaiser Permenente - Child-only Plan

Oregon Health Insurance
Call 800.884.2343 or
541.434.9613
FAX - 541.284.2994

CHILD ONLY DEDUCTIBLE PLANS	KP 2500/25/Rx	KP 5000/25/Rx
Features
Deductible	$2.500	$5.000
Out-of-pocket maximum	$3,750
Benefits	Services not subject to deductible unless otherwise indicated
Preventive Care
Immunizations	No charge
Yearly routine physicals
Well-baby visits
Mammograms
Outpatient services (per visit or procedure)
Primary care office visit	$25 copay
Specialty office visit	$35 copay
Nurse treatment visit (includes allergy injections)¹	$10 copay
Outpatient surgery²	$150 copay (after deductible)
Lab tests and X-rays²	$10 copay
Inpatient hospital care
Inpatient care (including maternity)	$750 copay per day (after deductible)
Maximum per admittance	$3,750 (after deductible)
Maternity coverage
Prenatal care (applies to prenatal office visits, one postnatal visit, and lactation consultants)	No charge
Emergency & urgent care
Emergency Department visit	20% coinsurance (after deductible)
Urgent care visit	$45 copay
Ambulance Service	20% coinsurance (after deductible)
Prescription drugs
(up to a 30-day supply)	$15 or 50% (whichever is greater)
Other services
Vision exams	$25 copay
Vision hardware allowance (applies to lenses, frames, and/or contacts every 24 months)	$100 allowance
Dental plans	Optional coverage available