KAISER HDHP Benefits

HSA-COMPATIBLE PLANS	$1,500 w/Rx	$1,500	$2,600 w/Rx	$2,600
Features
Deductible	$1,500/$3,000		$2,600/$5,200
Out-of-pocket maximum	$5,000/$10,000
Lifetime maximum	$2 million
Benefits	Services not subject to deductible unless otherwise indicated
Preventive Care
Immunizations	No charge
Routine physicals	20% coinsurance
Well-baby visits
Gynecholgical exams/Mammograms
Outpatient services (per visit or procedure)
Primary care office visit	20% coinsurance (after deductible)
Specialty care office visit
Nurse treatment visit (includes allergy injections)1
Outpatient surgery2
Lab tests2
X-rays2
Inpatient hospital care
Inpatient care (including maternity)	20% coinsurance (after deductible)
Maximum per admittance	None
Maternity coverage
Prenatal care (applies to prenatal office visits, one postnatal visit, and lactation consultants)	20% coinsurance
Emergency & urgent care
Emergency Department visit	20% coinsurance (after deductible)
Urgent care visit
Ambulance Service
Prescription drugs
(up to a 30-day supply)	$15 generic / $30 brand after medical deductible	Not covered	$15 generic / $30 brand after medical deductible	Not covered
Other services
Vision exams	20% coinsurance (after deductible)
Vision hardware allowance (applies to lenses, frames, and/or contacts every 24 months)	Not covered

1. Waived if in conjunction with an office visit
2. Preventive procedures and tests not subject to deductible

Group Product

LifeWise HSA-qualified plans are an affordable way to offer your employees in-network and out-of-network coverage for major illness, as well as the opportunity to grow their health-care dollars. These high-deductible plans keep premiums low and are designed to work in combination with tax-deductible HSAs.