Kaiser Permanente

KP DC Essential Silver 4850 Ded/350 RxDed

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

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Plan Overview

Medical Deductible	Individual: $4,850 Family: $9,700 Per Person: $4,850
Prescription Drug Deductible	Individual: $350 Family: $350 Per Person: $350
Medical Out-of-Pocket Maximum	Individual: $8,850 Family: $17,700 Per Person: $8,850
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Office Visit

Primary Doctor	Standard: $40 Copay
Specialist	Standard: $80 Copay

Prescription Drug Information

Preferred Brand Drugs	Standard: $50 Copay after deductible
Non Preferred Brand Drugs	Standard: $70 Copay after deductible
Generic Drugs	Standard: $20 Copay
Specialty Drugs	Standard: $150 Copay after deductible

Inpatient Coverage

Hospital Services	Standard: 20% Coinsurance after deductible
Inpatient Services	Standard: 20% Coinsurance after deductible

Emergency and Urgent Care

Emergency Room

Standard: $400 Copay after deductible