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2017 Stantec
Benefits Guide
Benefit Highlights
Kaiser HMO Plan
Plan year deductible
$250 per person
$500 per family
Plan year out-of-pocket maximum
(Includes deductible)
$3000 per person
$6000 per family
Lifetime maximum
Unlimited
Routine office visits
$10 copay
Specialist visits
$10 copay
Preventive care
$0 copay
$0 copay for well child (age 0 to 23 months)
Urgent care
(physician and medical services)
$10 copay (CA)
$35 copay (CO)
Emergency room
90% after deductible
Hospital inpatient and outpatient
90% after deductible
Prescription drugs
Retail (up to 30 days)
$10 generic
$30 brand name
Mail order
2x the retail copay
Mail order (up to 100 days)
Mental health
Inpatient: 90% after deductible
Outpatient: $10 copay
Substance abuse
Inpatient detoxification: 90% after
deductible
Outpatient therapy visits: $10 copay
Outpatient lab and x-ray
$10 copay (CA)
90% after deductible (CO)
Chiropractic care
$15 copay up to 20 visits per year (CA)
Not covered (CO)
Vision exam
$10 copay
Prescription eyewear
Not Covered