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Oregon Medical Insurance > Kaiser Permanente of Oregon > Gold Benefits

HealthNet Health Plans

Kaiser Permanente
for Individuals and Families
Gold $500 & $1,000 Deductible Plans
Annual Individual deductible
$500, $1,000
Annual Family deductible
$1,500, $3,000
Lifetime benefit maximum
$2,000,000

Annual out-of-pocket maximum
Not all copayments count toward your limit; not all copayments are waived after limit is met.
$3,750 member
$11,250 per family
BENEFITS
All benefits must be provided or authorized by a Kaiser Permanente physician.
Members pay
*Hospital care (including maternity care)
All inpatient care is covered after payment of applicable copayments. There are no limits on prescribed hospital days.
$750 per day, up to
$3,750 per admission
(after deductible)
*Office Visits
For diagnosis and treatment by primary care providers, consultation and treatment by specialists, routine physical and hearing exams, well baby visits through age 2, prenatal care, eye exam and urgent care. Plus any copayments or coinsurance for lab or X-ray
$25 per primary care office visit
$35 per specialty office visit
(After Deductible.  Deductible waived for wellbaby visits, prenatal care, and certain preventive procedures.)
Optional:  Outpatient Rx drugs
This is an optional benefit that must be added to the plan during enrollment with Rx rider.
Rx deductible: $500
Retail: 50% (after deductible) up to $150 max per 30-day Rx
Laboratory
Inpatient
Included under hospital care benefit
Outpatient
$15 per visit
(after deductible) No deductible for preventive tests
X-rays and other special procedures
Inpatient
Included under hospital care benefit
Outpatient
$25 per visit
(after deductible) No deductible for preventive tests or preventive procedures.
Immunizations
No charge
Allergy shots and other injections
$5 per visit
(after deductible)
Outpatient surgery
$100 per visit
(after deductible)
Infertility services
Diagnosis and treatment of infertility, subject to exclusions
Not covered
*MATERNITY CARE
Inpatient
All necessary physician and hospital services, including care for the newborn.
$500 per day,
up to $2,500 per admission
(after deductible)
Outpatient
Prenatal and postnatal maternity care.
Note: Applicants who are pregnant are not eligible to enroll in Kaiser Permanente for Individuals and Families.
$25 per prenatal care visit
(no deductible)
EMERGENCY CARE
*Emergency care
† Within and outside Kaiser Permanente Service Area
$100 copay
(after deductible)**
Ambulance
For medically necessary transportation
$75 per transport
(after deductible)
* Plus any copayments or coinsurance for lab or X-ray.
* * The Emergency care copay will be waived and the hospital copay will apply if admitted directly to hospital from an Emergency Department. Additional copayments or coinsurance may apply for lab, X-ray, etc.
†Emergency Services for an Emergency Medical Condition at a Non-Network Facility inside the Service Area are covered; however, care after your condition is stabilized must be preauthorized by Health Plan to be covered. Health Plan may require you to be transferred to a Hospital or Medical Office following stabilization. Outside Kaiser Permanente service area—Reimbursement of usual and customary charges for unforeseen illness or injuries. Continuing or follow-up care must be received at Kaiser Permanente facilities in order to be covered.>

This benefit summary lists the copayments you pay for services. This summary is not a contract but a general listing of major benefits, exclusions, and limitations.  Your particular benefits are those contained in the Kaiser Permanente Personal Advantage membership agreement, which you will receive if accepted.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
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