HSA Benefit Summaries
Chris, Holly or Bob at 770-396-9517 or toll-free at 1-877-711-8376
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HSA Benefit Summaries |
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Chris, Holly or Bob at 770-396-9517 or toll-free at 1-877-711-8376 |
| Kaiser Permanente HSA Plan Benefits | |||||||||
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| Description of Benefits |
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| Maximum Benefit While Covered |
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| Annual Deductible |
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| Annual Out-of-Pocket Maximum |
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Coinsurance (the amount that Kaiser pays after the deductible has been met) |
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| Preventive Visits | $15 copay |
$15 copay |
$15 copay | $15 copay | $15 copay | $15 copay | $15 copay | ||
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Preventive Services (not subject to deductible and coinsurance) |
Plan pays 100% |
Plan pays 100% |
Plan pays 100% |
Plan pays 100% |
Plan pays 100% |
Plan pays 100% |
Plan pays 100% |
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| All Other Covered Services |
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*The deductible and out of pocket maximum apply to self-only plans: not applicable for individuals covered under the family plans. Personal Advantage applicants are subject to medical review. Please Note: This is a summary description and is not intended to replace the Individual Agreement or Personal Advantage Evidence of Coverage, which contain the complete provisions of this coverage. Some services require precerification. |
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Click here
for monthly rates Click here
to download a Kaiser Permanente Application and check list
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| Fax your completed application to our fax: 770-396-4318 (original must be received prior to underwriting approval) | |||||||||