Kaiser Permanente
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Child Health Plan
Headline: Summary of benefits

April 1, 2012 through March 31, 2013

Kaiser Permanente helps your child stay healthy and active. You can choose a personal physician who will get to know your child. If your child qualifies, coverage includes, but is not limited to the following benefits:



Doctor office visits



$5 generic (100-day supply)

Urgent care


Emergency visits


Hospital care

No charge

Hearing and vision tests

No charge

Laboratory/X-ray services

No charge

Mental health care

Outpatient: $5 per individual therapy visit; up to 20 visits per calendar year
Inpatient: no charge; up to 30 days per calendar year


$125 allowance for pair of eyeglasses every 24 months

Copayment maximum
per calendar year

$250 per child/$500 for two or more children

Dental coverage for Kaiser Permanente Child Health Plan is offered to all our Child Health Plan members at no additional premium. The DeltaCare program is administered by PMI, the HMO affiliate of Delta Dental.

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