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Kaiser Permanente Senior Advantage

Human Resources Benefits Unit 750

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  • Doctor and specialist visits are available for a $10 copay.
  • Most preventative services, such as well baby/child visits (up to 23 months), immunizations, routine physicals, mammograms, and routine preventative screenings are covered at no cost.
  • Hospitalization, radiology, and lab tests are also covered at no cost.
  • Prescription medication is covered at a copay range of $5 - $10.

However, you must use Kaiser Permanente’s physicians, hospitals and other approved health care providers. Otherwise, you will not be eligible to receive benefits, except in a life-threatening situation such as an out-of-area urgent or emergency situation.

Medical Plan Summary

Plan Information Kaiser Permanente Senior Advantage
Calendar Year Deductible


Calendar Year Out of Pocket Maximum
(Including Deductibles, Co-pays, and Coinsurance)

$1,500 individual
$3,000 family

Lifetime MaximumNone
Dependent Children Eligibility

Any Dependent child under age 26 provided he/she is not eligible for own group coverage.
Disabled: No age limit, details in EOC


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Office Visits and Professional Services

ServiceKaiser Permanente Senior Advantage
Physician & Specialist Office Visits$10 co-pay
Preventive Care Adult Routine CareNo Charge, no deductible
Preventive Care Adult Routine Care OB/GYNNo Charge, no deductible
Diagnostic Lab and X-Ray$0
Physical Therapy (Medically necessary treatment only)$10 co-pay, no deductible
ChiropracticDiscounted rates through Kaiser Choose Healthy
Mental Health & Substance Abuse
Individual Therapy: $10 co-pay, no deductible
Group Therapy: $5 co-pay, no deductible


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Surgical and Hospital Services

Service  Kaiser Permanente Senior Advantage
Inpatient Hospital and Physician Services$0
Outpatient Surgery$10 per procedure
Emergency Room$50 after deductible
Ambulance$50 per trip, no deductible
Mental Health & Substance Abuse (Inpatient)$0
Skilled Nursing Facility$0, no deductible
Up to 100 days per benefit
Home Health$0 (part-time, intermittent)
Hearing AidsNot Covered


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Prescription Drugs

Service Kaiser Permanente Senior Advantage
Generic or Tier 1$5 co-pay 100 day supply, no deductible
Non-Preferred Generic or Tier 2$10 co-pay 100 day supply, no deductible
Preferred Brand or Tier 3$10 co-pay 100 day supply, no deductible
Non-Preferred Brand or Tier 4N/A
Specialty or Tier 5N/A
Mail Order BenefitSame as retail
Mandatory Mail OrderN/A
Mandatory Generic Program N/A


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