Kaiser Permanente Better lnformed. Better Together. We've made it easy to have the right plan We've matched you to a 2014 plan that meets all of the standards of health care reform. lfyou like this plan, you don't need to do anything. Your renewal into this new plan is automatic -- just keep paying the premium on your bill. Here's a quick comparison of your current plan and your new plan: Your 2013 plan Your 2014 plan Individual plan annual deductible (subscriber only) $4500 Family plan annual deductible (individual/family) No dependent coverage Individual plan annual out--of-pocket $5,600 $6,350 maximum (subscriber only) Family plan annual out-of--pocket maximum (individual/family) $12700/$l Z700 No dependent coverage Benefits Routine physical exam No charge No charge Primary care office visit $40 after deductible 40% after deductible Inpatient hospital care (per admission) 30% after deductible 40% after deductible Emergency Department visit A $150 after deductible 40% after deductible Prescription drugs from a plan All after deductible pharmacy (up to a 30-day supply) after deductible Want more 0Pti0|1S? Be sure to act during open enrollment: October 1, 2013, through March 31, 2014. After that, you can change plans if: - you qualify for a special enrollment period triggered by an event such as a loss of health coverage, marriage, divorce, or the birth or adoption of a child; or I you wait for the next enrollment period, starting in October 2014. If you want to explore other health plans, here's what to do: I Look at the overview of our other health plans and their rates on the next few pages to compare plans. Remember that you can cover your family under the same plan or on separate plans. Or visit to compare plans. You can enroll in the plan that best fits your needs right there. You'll need your Kaiser Permanente medical record number to access your information. - See the previous page to find out whether you may qualify for financial help from the federal government. If you do, you may have more options than you think. If you qualify, the federal government will pay Kaiser Permanente any financial assistance on your behalf. Need help? Call us at 1-855-213-5823. We value your membership, and we're ready to answer any questions and help you find the right plan for you and your family. 083 California Kaiser Permanente Better informed. Better Together. Health plan benefit highlights KP CA KP CA Bronze HSA Bronze Bronze KP CA Silver 1250i'40 HSAoua|ilied Deductible KP CA KP CA "30 Silver Hsdoiralilied Deductibie Individual plan annual deductible [subscriber only} S4500 55.000 $3,500 $1 500 Si .250 Family plan annual deducliblelindividualflamilyl 59.000.59.000 $5,000,810 000 Individual plan annual out-of-pocket maximum tsubsmbemnm 36.350 56.350 Sb,350 So.350 $6.350 55.350.512.700 si2.7ooi'si2.70o ioci tindividuallfalnilyl Preventive care Routine physical exam, mammograms. etc. No charge lilo charge No charge lilo charge No charge Outpatient services {per visit or procedure) First 3 ollice visits 560.' Primary care oflire visit 40% after deductible Additional sbo S30 alter deductibte 20% al'lEl deductible $40 after deductible. Specialty care office visit 40% after deductible S70 alter deductible S30 after deductible 20% after deductible 540 Most X-rays 40"/oalterdeductible 30'l1i after deductible S30 afterdeductible 20"-ii alter deductible S40 alter deductible Most lab tests 40% after deducdble 30% alter deductible S30 alter deductible 20% alter deductible $25 alter deductible MRI, CT, PET 40% after dediictible 30% alter deductible 30% after deductible 20% alter deductible $300 after deductible Outpatient surgery alter deductible 30'lli iilter deductible 30% after deductible 20% alter rleductible 30% after deductible First 3 ollice visits Mental health visit 40% alter deductible Arlrlilional UlSll5 $60 $30 alter deductible alter deductible 540 after Inpatient hospital care (peradmissionl 40% alter deductible 303;. dliei deductible 3o-barter deductible 20:; fillfill deductible 309: after deductible lab tests, medications Matemity Routine prenatal care visit. first postpartum visit No charge No charge No charge no charge Delivery and inpatient well-baby care 40% alter deductible 30'-4. alter deductible after deductible alter deductible aiter deductible Emergency and urgent care Emergency Department visit (waived il admitted) after deductible $300 after deduct-nle 30?: after deductible -'rite-' deductible S250 alter deductible First 3 ollic-3 visits 860' Urgent care visit 40% after deductible Additional visits S03 530 after deductible alts' deductible Se'-0 alter deductible Prescription drugs Generic' 40% Generic: Generic: Generic. 231 Generic 52'; Plan pharmacy (up to a 30-day supply} Brand Brand 850 Brand: 5340 Blaricl. Brfinr. $50 All alter deductible All alter deductible Ali alter deductible -'all alter derlurrhle After 3250 brand deductible Generic S-3E Generic: S30 Ci-:-rier: 20' Cierieric S40 Mail-order (up to a 100-day supply) Brand: 40% Brand S100 Brand: 580 Brand 20'; Brand. S'i=3Cr All after deductible All alter deductible All alterdeductihle Ail alter deductible Alter 5250 brand deductible Detailed information about your plan is 'n the Membership Agreement, which will be mailed to you upon request. To request a copy u' the Merriberslirp itgreenienz for a particular plan please call us at 1 800--to/I-4000. For services siihiect to the deductible. you will have to pay health care expenses out of pocket until you meet your deductible. Most deductibles, copayriients, and coinsurance contribute to the otit-of-pocket maximum. 'The KP CA Bronze 5000i'b0 plan includes three office visits at $60 each before you reach your deductible. Office visits include primary, urgent, postnatal. or outpatient mental health care, 60133213 Californiai