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2021 COSTS & BENEFITS
Kaiser Permanente, a TRICARE® Prime Option
|
*Group A = For enlistment or appointment prior to January 1, 2018
**Group B = For enlistment or appointment after January 1, 2018 |
Kaiser Permanente,
a TRICARE Prime Option Retired,
Groups A* & B** |
Kaiser Permanente,
a TRICARE Prime Option Active Duty Family Members,
Groups A* & B** |
| Enrollment Fees | Groups A* & B**: $0 for first year of enrollment, after which annual enrollment fees match TRICARE Prime. |
$0 |
| Deductibles | $0 | $0 |
| Catastrophic Cap | Group A*: $3000 Group B**: $3,703 |
Group A*: $1000 Group B**: $1,058 |
| Health Plan Costs | ||
| Outpatient Visit – Primary | $21 | $0 |
| Outpatient Visit – Specialty | $31 | $0 |
| Urgent Care | $31 | $0 |
| Emergency Services | $63 | $0 |
| Laboratory and X-Ray | $0 | $0 |
| Ambulance Services | $42 | $0 |
| Ambulatory Surgery (Same Day) | $63 | $0 |
| Mental Health (Inpatient) | $158/admission | $0 |
| Mental Health (Outpatient/Partial Hospitalization) – Primary Care |
$21 | $0 |
| Mental Health (Outpatient/Partial Hospitalization) – Specialty Care |
$31 | $0 |
| Mental Health (Residential Treatment Facility) |
$31/day | $0 |
| Clinical Preventive Services | $0 | $0 |
| Durable Medical Equipment, Prosthetics, and Medical Supplies | 20% | $0 |
| Home Health Care | $0 | $0 |
| Hospice (Medical equipment and pharmacy are billed separately) | $0 | $0 |
| Hospitalization (Inpatient Care) | $158/admission | $0 |
| Immunizations | $0 | $0 |
| Maternity (Delivery/Inpatient) | $158 | $0 |
| Maternity (Delivery/Birthing Center) | $63 | $0 |
| Maternity (Home) Primary | $21 | $0 |
| Maternity (Home) Specialty | $31 | $0 |
| Newborn Care | $0 | $0 |
| Skilled Nursing | $31/day | $0 |
| Pharmacy | ||
| Generic (Category 1) – Military Pharmacy |
$0 | $0 |
| Generic (Category 1) – Home Delivery |
$10 | $10 |
| Generic (Category 1) – Retail | $13 | $13 |
| Brand-name (Category 2) – Military Pharmacy |
$0 | $0 |
| Brand-name (Category 2) – Home Delivery |
$29 | $29 |
| Brand-name (Category 2) – Retail |
$33 | $33 |
| Non-Formulary (Category 3) – Military Pharmacy |
Generally, not available without medical necessity for non-formulary drugs. |
Generally, not available without medical necessity for non-formulary drugs. |
| Non-Formulary (Category 3) – Home Delivery | $60 | $60 |
| Non-Formulary (Category 3) – Retail | $60 | $60 |
| Kaiser Permanente, a TRICARE Prime Option |
|
| Benefit Differences | |
| Telemedicine | Video appointments used on kp.org will not have a cost share |
| Pharmacy | Uses Kaiser Permanente formulary
|
| Vaccines | $13 |
| Medical Supplies | Covered by Kaiser Permanente pharmacy benefit |
| Smoking Cessation |
|
| Breast Pumps |
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