Insurance Rates 2009-2010
| Age |
EE only |
EE+S |
EE+C |
EE+S+C |
| up to 29 |
$222 |
$25.82 |
$619 |
$117.69 |
$609 |
$11.38 |
$861 |
$173.54 |
| 30-39 |
$245 |
$28.50 |
$665 |
$125.65 |
$626 |
$116.65 |
$952 |
$191.88 |
| 40-49 |
$316 |
$36.69 |
$727 |
$131.77 |
$600 |
$102.46 |
$959 |
$185.31 |
| 50-54 |
$411 |
$47.65 |
$854 |
$150.12 |
$678 |
$109.50 |
$1,092 |
$205.04 |
| 55-59 |
$520 |
$60.23 |
$1,091 |
$192.23 |
$777 |
$119.77 |
$1,255 |
$230.08 |
| 60-64 |
$641 |
$74.19 |
$1,217 |
$207.35 |
$857 |
$124.27 |
$1,421 |
$254.42 |
| 65+ |
$727 |
$84.12 |
$1,571 |
$279.12 |
$1,093 |
$168.81 |
$1,727 |
$315.12 |
247 Delivers pays 50% of the eligible employee only.
Total Monthly Rate
Employee wkly portion |
EE only = eligible employee only
EE+S = eligible employee plus spouse
EE+C = eligible employee plus children without spouse
EE+S+C = eligible employee plus spouse and children |
Current employees can only enroll or make changes in the month of
September. Changes will take affect October 1st. Please do not let this
opportunity pass by. We do try to keep this page up to date, but please
check with Kaiser for your Features, Co-Pays, Deductibles, ect.
| FEATURES |
| MEDICAL CALENDAR-YEAR
DEDUCTIBLE |
$0 |
| PHARMACY CALENDAR-YEAR
DEDUCTIBLE |
$250 for brand prescriptions |
ANNUAL OUT-OF-POCKET MAXIMUM1
Individual/Family |
$3,500/$7,000 |
| IN THE MEDICAL OFFICE |
| Office visits |
$30 |
| Preventive exams |
$30 |
| Maternity/prenatal care2 |
$0 |
| Well-child preventive
care visits3 |
$0 |
| Vaccines
(immunizations) |
$0 |
| Allergy injections |
$5 |
| Infertility services |
Not covered |
| Occupational, physical,
and speech therapy |
$30 |
| Most labs and imaging |
$10 |
| MRI/CT/PET |
$50 |
| Outpatient surgery |
$200 |
| Chiropractic care |
$15 20-visits per year |
| EMERGENCY SERVICES |
| Emergency Department
visits (waived if admitted directly to hospital) |
$100 |
| Ambulance |
$75 |
| PRESCRIPTIONS4 |
(up to a 100-day supply) |
| Generic |
$105 |
| Brand |
$35 (after pharmacy deductible) |
| HOSPITAL CARE |
| Physicians services,
room and board, test, medications, supplies, therapies |
$400 per day |
| Skilled nursing
facility care (up to 100 days per benefit period) |
$0 |
| MENTAL
HEALTH SERVICES6 |
| In the medical office
(up to 20 visits per calendar year) |
$30 individual
$15 group |
| In the hospital (up to
30 days per calendar year) |
$400 |
| CHEMICAL DEPENDENCY SERVICES |
| In the medical office |
$30 individual |
| In the hospital
(detoxification only) |
$400 per day |
| OTHER |
| Certain durable medical
equipment (DME) DME used in the home in accord with our DME
formulary |
Not covered7 |
| Optical (eyewear) |
Not covered |
| Vision exam |
$30 |
| Home health care (up to
100 two-hour visits per calendar year) |
$0 |
| Hospice care |
$0 |
| 1The
annual out-of-pocket maximum is the limit to the total amount
that an individual or family must pay for certain services in a
calendar year (as discussed int the Evidence of Coverage). |
| 2Scheduled
prenatal visits and the first postpartum visit. |
| 323
months or younger. |
| 4Prescription
drugs are covered in accord with our formulary when prescribed
by a plan physician and obtained at Plan pharmacies. A few drugs
have different copayments; please refer to the Evidence of
Coverage for detailed information about prescription drug
copayments. |
| 5This
service is not subject to a deductible. |
| 6Visit
or day limits do not apply to serious emotional disturbances of
children and severe mental illnesses as described in the
Evidence of Coverage. |
| 7Please
refer to the Evidence of Coverage for more information; most DME
is not covered. |
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