Plan-B Californa Kaiser Medical Options

Plan B California Kaiser HMO Medical Options

Medical Procedure	Kaiser *HMO Plan*
Medical Procedure	Kaiser *HMO Plan*
Annual Deductible	None
Annual Co-Payment Limit on Allowable Charges	Plan pays 100% after co-payments reach $1,500 in a year ($3,000 for a family)
Overall Lifetime Maximum	None
Hospital
Inpatient	You pay $500 per admission
Outpatient	You pay $20 per visit
*Extended Care Facility (Skilled Nursing)*	Plan pays 100%; 100 days maximum
Physician Services
Office Visits	You pay $20 per visit ($5 for well-baby care, up to 24 months)
Routine Physical Adults	You pay $20 per visit
Children (up to age 6)	You pay $20 per visit ($5 for well-baby care, up to 24 months)
Children (age 6 to 18)	You pay $20 per visit
Inpatient Surgery	Plan pays 100%
Outpatient Surgery	Plan pays 100% (You pay $25 for office visit)
Hospital Visits	Plan pays 100%
Diagnostic X-Ray and Lab	Plan pays 100% (You pay $25 for office visit, $5 for well-baby care)
CAT Scans & MRI's	Plan pays 100% when medically necessary
Durable Medical Equipment	Plan pays 100% for limited items
Casts, Splints, Trusses, Braces & Crutches	Limited Coverage
Home Nursing Care	Plan pays 100%
Chiropractic Care	Not covered
Physical Therapy	You pay $20 per visit
Speech Therapy	You pay $20 per visit
Maternity Care	Same as any other illness except you pay $5 per pre-natal visit
Psychiatric Care -
Inpatient	You pay $500 per admission
Outpatient	You pay $20 per visit
Substance Abuse -	You may choose between coverage under the Beat It! Program or your HMO, or a combination of both, as follows (See California Fee-for-Service Plan B for Beat It! details)::
Inpatient	You pay $500 per admission
Outpatient	You pay $5 per group session or $25 per individual session
Prescription Drugs	Must be obtained at a participating HMO pharmacy
Short-term (outpatient)	You pay $10 per generic and $25 per brand name prescription
Maintenance (30 day supply or more thru the Mail Order)	You pay $10 per generic and $25 per brand name prescription up to a 100-day supply
Hearing Aids	Not covered
Emergency Room Care	You pay $35 (co-payment waived if admitted to hospital)

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The information contained on this website is intended to provide only highlights of the benefits available under the Sheet Metal Workers Trust Funds' plans and plans of benefits. Complete details about the plans are contained in the governing plan documents. In the event of any inconsistency between the information on this website and the official plan documents, the terms of the plan documents, as interpreted by the plan's Board of Trustees in its sole and absolute discretion, will control. The respective Boards of Trustees of the plans reserve the right to amend, modify, or terminate all or part of the plans at any time, subject to applicable law.