Health Insurance Questions? Call Holly, Chris or Bob at (770) 396-9517 Outside of the Atlanta area, call toll-free: 1-877-711-8376. Email: holly@insurance-now.com

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NEW Kaiser Permanente HMO Plan In-Network Benefit Summary
Description of Benefits	Kaiser Premier Plans (Best Benefits)	Signature Plans (Lower Cost, still has office vis. copays)	HSA Plans (high deductible, plan pays after deductible)
Lifetime Maximum Per Member*	Unlimited	Unlimited	Unlimited
Annual Deductible Per Member (2 person maximum per family)	Choose From $1,500, $2,500 $3,500 or $5,000 Deductibles	Choose From $1,750, $2,750 $3,750 or $5,750 Deductibles	Choose from $2,500 or $3,500 Deductible
Annual Out-of-Pocket Maximum (2 person family maximum)	The out-of-pocket maximum per member is the same amount as your deductible (in addition to paying your deductible)	$4,000 plus deductible per member	Deductible Only then 100% Coverage
Coinsurance (the amount that Kaiser pays after the deductible has been met)	70%	70%	100%
Office Services - Primary Care - Specialty Care - Special Procedures (Cardiac Stress Tests, EMG, others) -Preventive Services - Maternity Services***	$30 Copay - Unlimited # of Visits $50 Copay - Unlimited # of Visits Plan Pays 70% After Deductible Plan pays100%-Deductible waived Not Covered	$35 Copay - 1st 4 Visits/Year 5+ visits - Plan Pays 70% After Deductible $50 Copay - 1st 4 Visits/Year 5+ visits - Plan Pays 70% After Deductible Plan Pays 70% After Deductible Plan pays100%-Deductible waived Not Covered	Plan Pays 100% After Deductible Plan Pays 100% After Deductible Plan Pays 100% After Deductible Plan pays100%-Deductible waived Not Covered
Outpatient Services - Diagnostic Lab and/or Radiology Services	Plan pays 100%	Plan pays 100%	Plan pays 100% after deductible
- High Tech Radiology Svcs (MRI, CT, PET, others)	Plan pays 70% after deductible	Plan pays 70% after deductible	Plan pays 100% after deductible
- Rehabilitation Therapies 20 visits (Physical, Occupational, and Speech Therapy)	Plan pays 70% after deductible	Plan pays 70% after deductible	Plan pays 100% after deductible
-Outpatient Surgery and/or -Outpatient Hospital Facility	Plan pays 70% after deductible	Plan pays 70% after deductible	Plan pays 100% after deductible
-Physician and Other Outpatient Professional Charges	Plan pays 70% after deductible	Plan pays 70% after deductible	Plan pays 100% after deductible
Emergency Services - Emergency Room Visit (per visit; copay waived if admitted) - After Hours Urgent Care (per visit) - Ambulance (per trip)	$250 copay $75 copay Plan pays 70% after deductible	$500 copay $75 copay Plan pays 70% after deductible	Plan pays 100% after deductible Plan pays 100% after deductible Plan pays 100% after deductible
Inpatient Services - Hospital (facility charge) - Maternity (hospital delivery)*** - Physician and Other Professional Charges	Plan pays 70% after deductible Not Covered Plan pays 70% after deductible	Plan pays 70% after deductible Not Covered Plan pays 70% after deductible	Plan pays 100% after deductible Not Covered Plan pays 100% after deductible
Mental Health Svcs. - Outpatient (48 visits) - Outpatient Group Therapy - Inpatient Mental Health Facility - 30 days - Inpatient Mental Health Professional	$50 copay $30 copay Plan pays 70% after deductible Plan pays 70% after deductible	$50 copay $30 copay Plan pays 70% after deductible Plan pays 70% after deductible	Plan pays 100% after deductible Plan pays 100% after deductible Plan pays 100% after deductible Plan pays 100% after deductible
Durable Medical Equipment/Prosthetics and Orthotics	Plan pays 70% after deductible	Plan pays 70% after deductible	Plan pays 100% after deductible
Vision Exam (Routine-well-visit)	No Charge	No Charge	No Charge
Pharmacy Services - (up to a 30-day supply) Kaiser Permanente Pharmacies Only
- Generic (Kaiser Permanente Pharmacies Only)	$15 copay - no deductible	$15 copay - no deductible	Plan pays 100% after deductible
- Brand Formulary (after Brand Deductible)	$35 copay after $500 Deductible	$35 copay after $1.000 Deductible	Plan pays 100% after deductible
- Non-Brand Formulary (after Brand Deductible)	Not Applicable	Not Applicable	Not Applicable
- Prescription Deductible - applies to brand name drugs only	$500 Deductible	$1,000 Deductible	Included in the Medical Deductible
* Some benefits may have limitations Please Note: This is a summary description and is not intended to replace the Individual Agreement or Personal Advantage Evidence of Coverage, which contain the complete provisions of this coverage. Some services require precerification.
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Fax your completed application to our fax: 770-396-4318 (original must be received prior to underwriting approval)

9 Dunwoody Park, Suite 136 Atlanta, GA 30338	Call Holly, Chris or Bob at (770) 396-9517 Outside of the Atlanta area, call toll-free: 1-877-711-8376. Email: holly@insurance-now.com