Summary of Benefits for Early Retirees (Under Age 62 and not eligible or enrolled in Medicare) |
|
Kaiser Permanente HMO
(In Network Only) |
UnitedHealthcare HMO
(In Network Only) |
Out-of-Area Plan UnitedHealthcare
(In Network Benefits) |
Member Customer Service Number |
(800) 464-4000 |
(800) 624-8822 |
Northern California (800) 624-8822
Out-of-state
(866)633-2446 |
Website |
www.kp.org |
www.myuhc.com |
www.myuhc.com |
General Features |
|
Calendar Year Deductible |
None |
None |
$500 per Individual
$1,000 per Family |
Maximum Benefits |
Unlimited |
Unlimited |
Unlimited |
Annual Co-payment Maximum |
$1,500 per Individual
$3,000 per Family |
$1,000 per Individual
$3,000 per Family |
$4,500 per Individual
$9,000 per Family |
Hospital Benefits |
No charge |
No charge |
80% after deductible has been met |
Emergency Services
Co-payment waived if admitted |
$5 co-payment |
$50 co-payment |
$100 co-payment; deductible does not apply |
Urgently Needed Services
Medically Necessary services required outside geographic area service by Primary Medical Group |
$5 co-payment |
$50 co-payment |
$50 co-payment; deductible does not apply |
Pre-existing Conditions |
All Medically Necessary conditions are covered provided they are a covered benefit |
Inpatient Hospital Benefits |
|
Alcohol, Drug or Other Substance Abuse Detoxification |
No charge |
No charge |
80% after deductible |
Mental Health Services
As required by law, coverage includes treatment for Severe Mental Illness of adults and the treatment of Serious Emotional Disturbance. |
No charge |
No charge |
80% after deductible |
Physician Care |
No charge |
No charge |
No charge |
Reconstructive Surgery |
No charge |
No charge |
80% after deductible |
Rehabilitative Care
Including physical, occupational and speech therapy |
No charge |
No charge |
$20 co-payment |
Skilled Nursing Facility
Up to 100 Consecutive Days from the first treatment per disability |
No charge |
No charge |
80% after deductible |
Outpatient Benefits |
|
Alcohol, Drug or Other Substance Abuse Detoxification |
$5 per visit |
No charge |
$20 co-payment |
Ambulance |
No charge |
No charge |
80% after deductible |
Durable Medical Equipment |
No charge |
No charge |
80% after deductible |
Voluntary Termination of Pregnancy (medical, medication, surgical):
1st Trimester |
$5 co-payment |
$75 co-payment |
The amount you pay is based on where the covered service is provided. |
Laboratory Services
When available through or authorized by PCP |
No charge |
No charge |
No charge |
Maternity Care, Tests Procedures |
No charge |
No charge |
The amount you pay is based on where the covered service is provided. |
Mental Health Services
As required by law, coverage includes treatment for Severe Mental Illness (SMI) of adults and the treatment of Serious Emotional Disturbance (SED) |
$5 co-payment |
$5 co-payment |
$20 co-payment |
Oral Surgery Services
No dental |
No charge |
No charge |
$40 co-payment |
Outpatient Medical Rehabilitation Therapy at a Participating Free-Standing or Outpatient Surgery Facility |
$5 co-payment |
$5 co-payment |
$20 co-payment |
Outpatient Surgery at a Participating Free-Standing or Outpatient Surgery Facility |
$5 co-payment |
No charge |
80% after deductible |
Preventative Care
Physician, laboratory, radiology and related services as recommended by the American Academy of Pediatrics, Advisory Committee on Immunization Practices and U.S. Preventive Services Task Force and authorized through the patient's primary care provider |
$5 co-payment |
No charge |
No charge |
Physician Office Visit |
$5 co-payment |
$5 co-payment |
$20 co-payment for Primary Care Physician;
$40 co-payment for Specialist |
Well-Woman Care
Includes PAP smear by PCP or an OB/GYN in PMG and a referral by the PMG for screening mammography as recommended by the U.S. Preventive Services Task Force |
$5 co-payment |
No charge |
No charge |
Summary of Benefits for Medicare Eligible Retirees (Enrolled in Medicare Parts A & B) |
|
Kaiser Permanente
Senior Advantage
HMO |
UnitedHealthcare® Group Medicare Advantage HMO |
Out-of-Area Plan UnitedHealthcare® Group Medicare Advantage |
Member Customer Service Number |
(800) 464-4000 |
(800) 457-8506 |
(800) 457-8506 |
Website |
www.kp.org |
www.uhcretiree.com |
www.uhcretiree.com |
General Features |
|
Calendar Year Deductible |
None |
None |
None |
Maximum Benefits |
Unlimited |
Unlimited |
Unlimited |
Annual Co-Payment Maximum |
$1,500 per Individual
$3,000 per Family |
$6,700 |
$6,700 |
Hospital Benefits |
No charge |
No charge |
No charge |
Emergency Services
Co-payment waived if admitted |
$5 co-payment |
$20 co-payment |
$20 co-payment |
Urgently Needed Services
Medically Necessary services required outside geographic area service by Primary Medical Group |
$5 co-payment |
$15 co-payment |
$15 co-payment |
Pre-existing Conditions |
All Medically Necessary conditions are covered provided they are a covered benefit. |
Inpatient Hospital Benefits |
|
Alcohol, Drug or Other Substance Abuse Detoxification |
No charge |
No charge |
No charge |
Mental Health Services
As required by law, coverage includes treatment for Severe Mental Illness (SMI) of adults and the treatment of Serious Emotional Disturbance (SED) |
No charge |
No charge |
No charge |
Physician Care |
No charge |
No charge |
No charge |
Reconstructive Surgery |
No charge |
No charge |
No charge |
Rehabilitative Care
Including physical, occupational and speech therapy |
No charge |
No charge |
No charge |
Skilled Nursing Facility
Up to 100 Consecutive Days from the first treatment per disability |
No charge |
No charge up to 100 days |
No charge up to 100 days |
Outpatient Benefits |
|
Alcohol, Drug or Other Substance Abuse Detoxification |
$5 per individual visit
co-payment
$2 per group visit
co-payment |
$5 co-payment |
$5 co-payment |
Ambulance |
No charge |
No charge |
No charge |
Durable Medical Equipment |
No charge |
No charge |
No charge |
Mental Health Services
As required by law, coverage includes treatment for Severe Mental Illness of adults and the treatment of Serious Emotional Disturbance |
$5 per individual visit
co-payment
$2 per group visit
co-payment |
$5 co-payment |
$5 co-payment |
Oral Surgery Services
No dental |
No charge |
No charge |
No charge |
Outpatient Medical Rehabilitation Therapy at a Participating Free-Standing or Outpatient Surgery Facility |
$5 co-payment |
No charge |
No charge |
Outpatient Surgery at a Participating Free-Standing or Outpatient Surgery Facility |
$5 co-payment |
No charge |
No charge |
Periodic Health Evaluations
Physician, laboratory, radiology and related services as recommended by the American Academy of Pediatrics, Advisory Committee on Immunization Practices and U.S. Preventive Services Task Force and authorized through the patient's primary care physician |
$5 co-payment |
No charge |
No charge |
Physician Office Visit |
$5 co-payment |
$5 co-payment |
$5 co-payment |
Well-Woman Care Office Visit
Includes PAP smear by PCP or an OB/GYN in Primary Medical Group and a referral by the Primary Medical Group for screening mammography as recommended by the U.S. Preventive Services Task Force |
$5 co-payment |
No charge |
No charge |
Prescription Drugs |
|
Retail Pharmacy: Generic Drugs |
$5 co-payment
Up to a 100-day supply |
$5 co-payment
Up to a 30-day supply |
$10 co-payment
Up to a 30-day supply |
Retail Pharmacy: Brand Retail Drugs |
$15 co-payment
Up to a 100-day supply |
$15 co-payment
Up to a 30-day supply |
$20 co-payment
Up to a 30-day supply |
Mail Order: Generic Drugs |
$5 co-payment
Up to a 100-day supply |
$10 co-payment
Up to a 30-day supply |
$20 co-payment
Up to a 90-day supply |
Mail Order: Brand Name Drugs |
$15 co-payment
Up to a 100-day supply |
$30 co-payment
Up to a 30-day supply |
$40 co-payment
Up to a 90-day supply |