KP OR Bronze 5500/50 – EPO

Description

Health Care Plan Details

Network type	EPO
Deductible	$5,500 per person $5,500 per person
Out-of-pocket max	$8,900 per person $17,800 per family
Metal tier	Expanded Bronze

Visit Copay

Primary care visit	$50 copay
Specialist visit	$85 copay after deductible
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	35% coinsurance after deductible
Emergency room	35% coinsurance after deductible
Ambulance	35% coinsurance after deductible
Hospital stay (facility)	35% coinsurance after deductible
Hospital stay (physician)	35% coinsurance after deductible
Outpatient procedure (facility)	35% coinsurance after deductible
Outpatient procedure (physician)	35% coinsurance after deductible
Physical rehabilitation	35% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	35% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$30 copay after deductible
Brand	50% coinsurance after deductible
Non-preferred Brand	50% coinsurance after deductible
Specialty	50% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	$70 copay after deductible
Imaging (CT/PET/MRI)	35% coinsurance after deductible
Blood work	$70 copay after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	$50 copay
Psychiatric hospital stay	35% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/health-plan-documents/summary-of-benefits/nw/individual-family/2024/71287OR0420014-01-en-2024.pdf
Drug and medication plan formulary	http://www.kp.org/orformulary
Search doctor list	https://healthy.kaiserpermanente.org/oregon-washington/doctors-locations#/simple-form