Kaiser Permanente

KP DC Silver 3200 Ded/1200 RxDed/Vision

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Links

Plan Overview

Medical Deductible	Individual: $3,200 Family: $6,400 Per Person: $3,200
Prescription Drug Deductible	Individual: $1,200 Family: $1,200 Per Person: $1,200
Medical Out-of-Pocket Maximum	Individual: $8,350 Family: $16,700 Per Person: $8,350
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Office Visit

Primary Doctor	Standard: $30 Copay
Specialist	Standard: $60 Copay

Prescription Drug Information

Preferred Brand Drugs	Standard: $60 Copay after deductible
Non Preferred Brand Drugs	Standard: 30% Coinsurance after deductible
Generic Drugs	Standard: $20 Copay
Specialty Drugs	Standard: 30% Coinsurance after deductible

Inpatient Coverage

Hospital Services	Standard: 30% Coinsurance after deductible
Inpatient Services	Standard: 30% Coinsurance after deductible

Emergency and Urgent Care

Emergency Room

Standard: 30% Coinsurance after deductible