KP VA Standard Bronze 7500 Ded/Vision – HMO

Network type: HMO
Coverage tier: Expanded Bronze
Primary care visit: $50 copay
Specialist visit: $100 copay
Urgent care visit: $75 copay

Description

Health Care Plan Details

Network type HMO
Deductible $7,500 per person $7,500 per person
Out-of-pocket max $9,400 per person $18,800 per family
Metal tier Expanded Bronze

Visit Copay

Primary care visit $50 copay
Specialist visit $100 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $75 copay
Emergency room 50% after deductible
Ambulance No charge after deductible
Hospital stay (facility) 50% after deductible
Hospital stay (physician) 50% after deductible
Outpatient procedure (facility) 50% after deductible
Outpatient procedure (physician) 50% after deductible
Physical rehabilitation $50 copay

Maternitowny and Pregnancy

Labor, delivery, hospital stay 50% after deductible

Pharmacy, Drugs, and Medication

Generic $25 copay
Brand $50 copay after deductible
Non-preferred Brand $100 copay after deductible
Specialty $500 copay after deductible

Lab Tests and Diagnostic Procedures

X-rays 50% after deductible
Imaging (CT/PET/MRI) 50% after deductible
Blood work 50% after deductible

Mental and Psychiatric Health Care

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

Health Plan Provider Information

Health Plan Benefits https://d2ed110nmrd591.cloudfront.net/blobs/TAxqYFJv9CboftvgRQJcrgvf.pdf