Kaiser Permanente

KP DC Essential Gold 500 Ded/Vision

Plan Overview

Medical Deductible
  • Individual: $500
  • Family: $1,000
  • Per Person: $500
Medical Out-of-Pocket Maximum
  • Individual: $6,050
  • Family: $12,100
  • Per Person: $6,050
Drug Out-of-Pocket Maximum
  • Individual: Included in Medical
  • Family: Included in Medical
  • Per Person: Included in Medical

Office Visit

Primary Doctor
  • Standard: $25 Copay
Specialist
  • Standard: $50 Copay

Prescription Drug Information

Preferred Brand Drugs
  • Standard: $50 Copay
Non Preferred Brand Drugs
  • Standard: $70 Copay
Generic Drugs
  • Standard: $15 Copay
Specialty Drugs
  • Standard: $150 Copay

Inpatient Coverage

Hospital Services
  • Standard: $600 Copay per Day after deductible
Inpatient Services
  • Standard: No Charge after deductible

Emergency and Urgent Care

Emergency Room
  • Standard: $300 Copay