Kaiser Foundation Health Plan of Georgia

KP GA Signature Catastrophic 9200

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Major Dental Care

Links

Plan Overview

Combined Medical and Drug Deductible	Individual: $9,200.00 Family: $18400.0 Per Person: $9200.0
Combined Medical and Drug Out of Pocket Maximum	Individual: $9,200.00 Family: $18400.0 Per Person: $9200.0

Office Visit

Primary Doctor	CoPay: No Charge CoInsurance: No Charge after deductible Covered: Covered Benefit Explanation: First 3 visits deductible waived. Virtual visits (if clinically appropriate) $0 copay, refer to EOC.
Specialist	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered Benefit Explanation: Virtual visits (if clinically appropriate) $0 copay, refer to EOC.

Prescription Drug Information

Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered Benefit Explanation: Mail order 90 day supply.
Non Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered Benefit Explanation: Mail order 90 day supply.
Generic Drugs	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered Benefit Explanation: Mail order 90 day supply.
Specialty Drugs	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered Benefit Explanation: Mail order 90 day supply.

Inpatient Coverage

Hospital Services	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered
Inpatient Services	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered

Emergency and Urgent Care

Emergency Room

CoPay: Not Applicable
CoInsurance: No Charge after deductible
Covered: Covered

Maternity

Labor and Delivery Hospital Stay	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered
Pre and Postnatal Office Visit	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered Benefit Explanation: Virtual visits (if clinically appropriate) $0 copay, refer to EOC.

Vision

Routine Eye Exams for Children

CoPay: Not Applicable
CoInsurance: No Charge after deductible
Covered: Covered
Limit Quantity: 1
Limit Unit : Exam(s) per Year

Major Dental Care

Routine Dental Checkups for Children	Covered: Not Covered
Routine Dental Checkups for Adults	Covered: Not Covered