Active Health Plan Benefit Tabs™

This is a summary of benefits and not a substitute for the Southern California IBEW-NECA Health Plan Summary Plan Description, and to the extent it differs from the SPD, the terms of the SPD will govern.


Overview
 

Kaiser is a staff model Health Maintenance Organization (HMO). Doctors belong to the Kaiser Permanente Medical Group which is affiliated with the Kaiser Foundation Health Plan of Southern California. You choose a primary care physician (PCP). Your PCP will be responsible for all of your healthcare needs, and will refer you to a specialist when necessary. Note that certain providers allow for annual enrollments only.

Lifetime Maximum
 

No plan maximum

Annual Copayment Maximums
 

$1,500 Individual
$3,000 Family

Inpatient Hospital Charges
 

No charge

Outpatient Office Visits and Most Outpatient Services
 

Your copayment is $5 per visit for almost all covered outpatient services.

Chiropractic
 

Chiropractic benefits are offered through American Specialty Health Plans of California. The co-payment for each visit is $5 for up to 30 visits per year.

Prescriptions
 

Not covered through Kaiser. See the Prescription BenefitTab.

Early retirees please refer to the prescription benefits described under the Retiree Benefit tabs.

Dependent Coverage
 

Kaiser has its own definition of covered dependents.

Important: If you have a baby, the newborn must be enrolled within 30 days. Kaiser does not automatically enroll newborns as dependents, even if they are born at a Kaiser facility.