Kaiser Permanente

KP VA Silver 4500 Ded/Vision

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Links

Plan Overview

Medical Deductible	Individual: $4,500 Family: $9,000 Per Person: $4,500
Prescription Drug Deductible	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical
Medical Out-of-Pocket Maximum	Individual: $8,300 Family: $16,600 Per Person: $8,300
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: $60 Copay

Prescription Drug Information

Preferred Brand Drugs	Standard: $60 Copay
Non Preferred Brand Drugs	Standard: 50% Coinsurance after deductible
Generic Drugs	Standard: $30 Copay
Specialty Drugs	Standard: 50% Coinsurance after deductible

Inpatient Coverage

Hospital Services	Standard: 35% Coinsurance after deductible
Inpatient Services	Standard: 35% Coinsurance after deductible

Emergency and Urgent Care

Emergency Room

Standard: 35% Coinsurance after deductible