Kaiser Permanente Multi Choice Group Plans in Georgia

Kaiser Permanente's
Multi Choice Group Plan Benefit Summaries
Page 2
click here for more Multi Choice plan options

Description of Benefits
2006 Small Group Multi Choice Plan Options - Page 1 of 2

Plan E
Plan F
Plan G
Plan H Plan I

Lifetime Maximum
While Covered
(some benefits may have limitations) Tier 1 (Kaiser Permanente providers)
Unlimited
Unlimited
Unlimited
Unlimited Unlimited

Tier 2 (PHCS PPO providers)
$2,000,000
combined
maximum
(tiers 2&3)
$2,000,000
combined
maximum
(tiers 2&3)
$2,000,000
combined
maximum
(tiers 2&3)
$2,000,000
combined
maximum
(tiers 2&3)
$2,000,000
combined
maximum
(tiers 2&3)

Tier 3 (Non- participating providers)

Calendar year Deductible
(per member-max 3 members) Tier 1 (Kaiser Permanente providers)
$500
$750
$1,000
$2,000 $3,000

Tier 2 (PHCS PPO providers)
$2,000
$2,500
$3,000
$4,000 $5,000

Tier 3 (Non- participating providers)
$4,000
$5,000
$5,000
$6,000 $7,500

Coinsurance Tier 1 (Kaiser Permanente providers)
90%
90%
80%
80% 80%

Tier 2 (PHCS PPO providers)
70%
70%
70%
70% 70%

Tier 3 (Non- participating providers)
60%
60%
60%
60% 60%

Out-of-Pocket Maximum for Calendar Year - Includes Deductible
Excludes copayments
(per member-max 3 members) Tier 1 (Kaiser Permanente providers)
$1,500
$1,750
$3,000
$4,000 $5,000

Tier 2 (PHCS PPO providers)
$4,000
$5,500
$5,000
$6,000 $7,000

Tier 3 (Non- participating providers)
$8,000
$9,000
$9,000
$10,000 $11,500

Physicians Office Visit PCP/Specialist
(includes x-ray and lab work done and billed by Drs. office) Tier 1 (Kaiser Permanente providers)
$25/$35
$30/$40
$30/$40
$30/$40 $30/$40

Tier 2 (PHCS PPO providers)
$35/$45
$40/$60
$40/$60
$40/$60 $40/$60

Tier 3 (Non- participating providers)
60%
60%
60%
60% 60%

Outpatient Diagnostic Testing includes x-ray, lab and preventive testing
(Plan pays after deductible) Tier 1 (Kaiser Permanente providers)
90%
90%
80%
80% 80%

Tier 2 (PHCS PPO providers)
70%
70%
70%
70% 70%

Tier 3 (Non- participating providers)
60%
60%
60%
60% 60%

Outpatient Diagnostic High Tech Radiology Services includes MRi, CT Scan, Pet Scan, others)
plan pays after deductible Tier 1 (Kaiser Permanente providers)
90%
90%
80%
80% 80%

Tier 2 (PHCS PPO providers)
70%
70%
70%
70% 70%

Tier 3 (Non- participating providers)
60%
60%
60%
60% 60%

Outpatient Surgery Facility
(Plan pays after deductible) Tier 1 (Kaiser Permanente providers) 90% 90% 80% 80% 80%

Tier 2 (PHCS PPO providers) 70% 70% 70% 70% 70%

Tier 3 (Non- participating providers) 60% 60% 60% 60% 60%

Physical and Occupational Therapy
(20 visits per calendar year) Tier 1 (Kaiser Permanente providers)
90%
90%
80%
80% 80%

Tier 2 (PHCS PPO providers)
70%
70%
70%
70% 70%

Tier 3 (Non- participating providers)
60%
60%
60%
60% 60%

Physician Outpatient Surgery Services (surgeon, radiologist, anesthesiologist, etc)
(Plan pays after deductible) Tier 1 (Kaiser Permanente providers)
90%
90%
80%
80% 80%

Tier 2 (PHCS PPO providers)
70%
70%
70%
70% 70%

Tier 3 (Non- participating providers)
60%
60%
60%
60% 60%

Inpatient Hospital
(Includes Maternity)
(Plan pays after deductible) Tier 1 (Kaiser Permanente providers)
90%
90%
80%
80% 80%

Tier 2 (PHCS PPO providers)
70%
70%
70%
70% 70%

Tier 3 (Non- participating providers)
60%
60%
60%
60% 60%

Physician Inpatient Services
(Includes Maternity) (surgeon, radiologist, anesthesiologist, etc)
(Plan pays after deductible) Tier 1 (Kaiser Permanente providers)
90%
90%
180%
80% 80%

Tier 2 (PHCS PPO providers)
70%
70%
70%
70% 70%

Tier 3 (Non- participating providers)
60%
60%
60%
60% 60%

Durable Medical Equipment
(Plan pays after deductible) Tier 1 (Kaiser Permanente providers)
90%
90%
80%
80% 80%

Tier 2 (PHCS PPO providers)
70% ($250 annual max)
70% ($250 annual max)
70% ($250 annual max)
70% ($250 annual max) 70% ($250 annual max)

Tier 3 (Non- participating providers)
60% ($250 annual max)
60% ($250 annual max)
60% ($250 annual max)
60% ($250 annual max) 60% ($250 annual max)

Inpatient Behavioral Health/Substance Abuse
30 Day calendar year max
(Plan pays after deductible) Tier 1 (Kaiser Permanente providers)
90%
90%
80%
80% 80%

Tier 2 (PHCS PPO providers) 70% 70% 70% 70% 70%

Tier 3 (Non- participating providers) 60% 60% 60% 60% 60%

Outpatient Mental Health 20 Visit calendar year max Tier 1 (Kaiser Permanente providers)
$35
$40
$40
$40 $40

Tier 2 (PHCS PPO providers) $45 $60 $60 $60 $60

Tier 3 (Non- participating providers) 60% 60% 60% 60% 60%

Inpatient Mental Health Professional Tier 1 (Kaiser Permanente providers) 90% 90% 80% 80% 80%

Tier 2 (PHCS PPO providers) 70% 70% 70% 70% 70%

Tier 3 (Non-participating providers) 60% 60% 60% 60% 60%

Emergency Services
Hospital ER/After Hours Urgent Care
(per visit - waived if admitted) Tier 1 (Kaiser Permanente providers)
$100/$50
$150/$60
$150/$60
$150/$60 $150/$60

Tier 2 (PHCS PPO providers)
$100/$70
$150/$80
$150/$80
$150/$80 $150/$80

Tier 3 (Non- participating providers)
$100/60%
$150/60%
$150/60%
$150/60% $150/60%

Prescription Drug Deductible Tier 1 (Kaiser Permanente pharmacy) $0 $0 $100 $100 $100

Tier 2 and 3 (all other pharmacies) $150 combined   $150 combined   $200 combined   $200 combined   $200 combined

Prescription Drug Copays*
Generic/Brand Preferred/Brand Non-Preferred

*$5,000 maximum/yr combined benefit for Tier 2 and Tier 3 Tier 1 (Kaiser Permanente providers) $10/$20
/N/A $10/$20
/N/A $15/$30
/N/A $15/$30
/N/A $15/$30
/N/A

Tier 2 (PHCS PPO providers) $15/$30
/$45 $15/$30
/$45 $20/$45
/$60 $20/$45
/$60 $20/$45
/$60

Tier 3 (Non- participating providers) $15/$30
/$45 $15/$30
/$45 $20/$45
/$60 $20/$45
/$60 $20/$45
/$60

Vision Exam Tier 1 (Kaiser Permanente providers) $35 $40 $40 $40 $40

Tier 2 (PHCS PPO providers) $45 $60 $60 $60 $60

Tier 3 (Non- participating providers) 60% 60% 60% 60% 60%

Note: Plan benefits listed above are intended as a summary only and do not replace benefits listed in certificate of coverage. Some specific benefits may have limitations and/or exclusions. Refer to your policy for more detail.

Click here to view the Tier 1 network providers
Click here to view the Tier 2 providers
(select "group health PPO" to view)

Click here for more Multi Choice plans and benefits
Click here for Kaiser Group HMO plans and benefits Click here for Individual Plan Options

Call today or click here to download a census form for a quick quote!!

5 Dunwoody Park South,
Suite 110
Atlanta, GA 30338
Call Bob, Holly or Rosa at
(770) 396-9517
Outside of the Atlanta area,
call toll-free:
1-877-711-8376.
Email: insurancenow@mindspring.com

Description of Benefits		2006 Small Group Multi Choice Plan Options - Page 1 of 2
Description of Benefits		Plan E	Plan F	Plan G	Plan H	Plan I

Lifetime Maximum While Covered (some benefits may have limitations)	Tier 1 (Kaiser Permanente providers)	Unlimited	Unlimited	Unlimited	Unlimited	Unlimited
	Tier 2 (PHCS PPO providers)	$2,000,000 combined maximum (tiers 2&3)	$2,000,000 combined maximum (tiers 2&3)	$2,000,000 combined maximum (tiers 2&3)	$2,000,000 combined maximum (tiers 2&3)	$2,000,000 combined maximum (tiers 2&3)
	Tier 3 (Non- participating providers)	$2,000,000 combined maximum (tiers 2&3)	$2,000,000 combined maximum (tiers 2&3)	$2,000,000 combined maximum (tiers 2&3)	$2,000,000 combined maximum (tiers 2&3)	$2,000,000 combined maximum (tiers 2&3)

Calendar year Deductible (per member-max 3 members)	Tier 1 (Kaiser Permanente providers)	$500	$750	$1,000	$2,000	$3,000
	Tier 2 (PHCS PPO providers)	$2,000	$2,500	$3,000	$4,000	$5,000
	Tier 3 (Non- participating providers)	$4,000	$5,000	$5,000	$6,000	$7,500

Coinsurance	Tier 1 (Kaiser Permanente providers)	90%	90%	80%	80%	80%
	Tier 2 (PHCS PPO providers)	70%	70%	70%	70%	70%
	Tier 3 (Non- participating providers)	60%	60%	60%	60%	60%

Out-of-Pocket Maximum for Calendar Year - Includes Deductible Excludes copayments (per member-max 3 members)	Tier 1 (Kaiser Permanente providers)	$1,500	$1,750	$3,000	$4,000	$5,000
	Tier 2 (PHCS PPO providers)	$4,000	$5,500	$5,000	$6,000	$7,000
	Tier 3 (Non- participating providers)	$8,000	$9,000	$9,000	$10,000	$11,500

Physicians Office Visit PCP/Specialist (includes x-ray and lab work done and billed by Drs. office)	Tier 1 (Kaiser Permanente providers)	$25/$35	$30/$40	$30/$40	$30/$40	$30/$40
	Tier 2 (PHCS PPO providers)	$35/$45	$40/$60	$40/$60	$40/$60	$40/$60
	Tier 3 (Non- participating providers)	60%	60%	60%	60%	60%

Outpatient Diagnostic Testing includes x-ray, lab and preventive testing (Plan pays after deductible)	Tier 1 (Kaiser Permanente providers)	90%	90%	80%	80%	80%
	Tier 2 (PHCS PPO providers)	70%	70%	70%	70%	70%
	Tier 3 (Non- participating providers)	60%	60%	60%	60%	60%

Outpatient Diagnostic High Tech Radiology Services includes MRi, CT Scan, Pet Scan, others) plan pays after deductible	Tier 1 (Kaiser Permanente providers)	90%	90%	80%	80%	80%
	Tier 2 (PHCS PPO providers)	70%	70%	70%	70%	70%
	Tier 3 (Non- participating providers)	60%	60%	60%	60%	60%

Outpatient Surgery Facility (Plan pays after deductible)	Tier 1 (Kaiser Permanente providers)	90%	90%	80%	80%	80%
	Tier 2 (PHCS PPO providers)	70%	70%	70%	70%	70%
	Tier 3 (Non- participating providers)	60%	60%	60%	60%	60%

Physical and Occupational Therapy (20 visits per calendar year)	Tier 1 (Kaiser Permanente providers)	90%	90%	80%	80%	80%
	Tier 2 (PHCS PPO providers)	70%	70%	70%	70%	70%
	Tier 3 (Non- participating providers)	60%	60%	60%	60%	60%

Physician Outpatient Surgery Services (surgeon, radiologist, anesthesiologist, etc) (Plan pays after deductible)	Tier 1 (Kaiser Permanente providers)	90%	90%	80%	80%	80%
	Tier 2 (PHCS PPO providers)	70%	70%	70%	70%	70%
	Tier 3 (Non- participating providers)	60%	60%	60%	60%	60%

Inpatient Hospital (Includes Maternity) (Plan pays after deductible)	Tier 1 (Kaiser Permanente providers)	90%	90%	80%	80%	80%
	Tier 2 (PHCS PPO providers)	70%	70%	70%	70%	70%
	Tier 3 (Non- participating providers)	60%	60%	60%	60%	60%

Physician Inpatient Services (Includes Maternity) (surgeon, radiologist, anesthesiologist, etc) (Plan pays after deductible)	Tier 1 (Kaiser Permanente providers)	90%	90%	180%	80%	80%
	Tier 2 (PHCS PPO providers)	70%	70%	70%	70%	70%
	Tier 3 (Non- participating providers)	60%	60%	60%	60%	60%

Durable Medical Equipment (Plan pays after deductible)	Tier 1 (Kaiser Permanente providers)	90%	90%	80%	80%	80%
	Tier 2 (PHCS PPO providers)	70% ($250 annual max)	70% ($250 annual max)	70% ($250 annual max)	70% ($250 annual max)	70% ($250 annual max)
	Tier 3 (Non- participating providers)	60% ($250 annual max)	60% ($250 annual max)	60% ($250 annual max)	60% ($250 annual max)	60% ($250 annual max)

Inpatient Behavioral Health/Substance Abuse 30 Day calendar year max (Plan pays after deductible)	Tier 1 (Kaiser Permanente providers)	90%	90%	80%	80%	80%
	Tier 2 (PHCS PPO providers)	70%	70%	70%	70%	70%
	Tier 3 (Non- participating providers)	60%	60%	60%	60%	60%

Outpatient Mental Health 20 Visit calendar year max	Tier 1 (Kaiser Permanente providers)	$35	$40	$40	$40	$40
	Tier 2 (PHCS PPO providers)	$45	$60	$60	$60	$60
	Tier 3 (Non- participating providers)	60%	60%	60%	60%	60%

Inpatient Mental Health Professional	Tier 1 (Kaiser Permanente providers)	90%	90%	80%	80%	80%
	Tier 2 (PHCS PPO providers)	70%	70%	70%	70%	70%
	Tier 3 (Non-participating providers)	60%	60%	60%	60%	60%

Emergency Services Hospital ER/After Hours Urgent Care (per visit - waived if admitted)	Tier 1 (Kaiser Permanente providers)	$100/$50	$150/$60	$150/$60	$150/$60	$150/$60
	Tier 2 (PHCS PPO providers)	$100/$70	$150/$80	$150/$80	$150/$80	$150/$80
	Tier 3 (Non- participating providers)	$100/60%	$150/60%	$150/60%	$150/60%	$150/60%

Prescription Drug Deductible	Tier 1 (Kaiser Permanente pharmacy)	$0	$0	$100	$100	$100
Prescription Drug Deductible	Tier 2 and 3 (all other pharmacies)	$150 combined	$150 combined	$200 combined	$200 combined	$200 combined

Prescription Drug Copays* Generic/Brand Preferred/Brand Non-Preferred *$5,000 maximum/yr combined benefit for Tier 2 and Tier 3	Tier 1 (Kaiser Permanente providers)	$10/$20 /N/A	$10/$20 /N/A	$15/$30 /N/A	$15/$30 /N/A	$15/$30 /N/A
	Tier 2 (PHCS PPO providers)	$15/$30 /$45	$15/$30 /$45	$20/$45 /$60	$20/$45 /$60	$20/$45 /$60
	Tier 3 (Non- participating providers)	$15/$30 /$45	$15/$30 /$45	$20/$45 /$60	$20/$45 /$60	$20/$45 /$60

Vision Exam	Tier 1 (Kaiser Permanente providers)	$35	$40	$40	$40	$40
	Tier 2 (PHCS PPO providers)	$45	$60	$60	$60	$60
	Tier 3 (Non- participating providers)	60%	60%	60%	60%	60%

Note: Plan benefits listed above are intended as a summary only and do not replace benefits listed in certificate of coverage. Some specific benefits may have limitations and/or exclusions. Refer to your policy for more detail.

Click here to view the Tier 1 network providers		Click here to view the Tier 2 providers (select "group health PPO" to view)

Click here for more Multi Choice plans and benefits Click here for Kaiser Group HMO plans and benefits		Click here for Individual Plan Options
Call today or click here to download a census form for a quick quote!!

5 Dunwoody Park South, Suite 110 Atlanta, GA 30338	Call Bob, Holly or Rosa at (770) 396-9517 Outside of the Atlanta area, call toll-free: 1-877-711-8376. Email: insurancenow@mindspring.com