Preventive Care Services and Doctor’s Office Visits Deductible HMO Plan
You also have an out-of-pocket maximum, which helps limit how much you'll pay for care. If you reach your out-of-pocket maximum, you won't pay for covered services for the rest of the year. This helps protect you financially if you ever get seriously sick or injured. For a small number of services, like durable medical equipment, you may keep paying copays or coinsurance after reaching your out-of-pocket maximum.
The benefits outlined above are only a summary. Check your Evidence of Coverage or call the number on your Kaiser Permanente ID card to learn more about your specific plan benefits.
When does the deductible apply?
|Examples of services you’ll pay full charges for until you reach your deductible||Examples of services you’ll pay a copay or coinsurance for — all year round|
How deductible works for a family
If you have a family plan, you have a deductible and out-of-pocket maximum for your whole family, as well as one for each family member. If a family member reaches his or her individual deductible first, he or she will start paying copays or coinsurance (instead of the full charges) before the rest of the family. After you reach your family deductible, everyone in your family will start paying a copay or coinsurance for covered services, even if they haven’t reached their individual deductible.
If you reach your family out-of-pocket maximum, no one in your family will pay for covered services for the rest of the year. And if anyone in the family reaches their individual out-of-pocket maximum before the rest of the family, they won’t have to pay for covered services for the rest of the year.
For additional information
*Some plans have a brand-name pharmacy deductible, in which case you pay full charges for brand-name prescriptions until you reach that deductible each year.
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