AREF 2017 Benefit Guide

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Type of Plan HMO
Deductible
Individual Not Applicable
Family Not Applicable
Out of Pocket Maximum
Individual $6,350
Family $12,700
Lifetime Maximum
Unlimited
(Some benefits may have limitations)
Coinsurance Not Applicable
Physician's Office Visits
Primary Care $25 Copay
Specialty Care $50 Copay
Preventive Plan pays 100%
Maternity
(Obstetrician / Midwife)
Plan pays 100%
Inpatient Facility Charge $500 Copay
Outpatient Facility Charge $100 Copay
After- Hours Urgent Care $45 Copay, per visit
Emergency Room
$200 Copay, per visit
(waived if admitted)
Generic Drugs $15 Copay
Brand Preferred Drugs $30 Copay
Generic Drugs $25 Copay
Brand Preferred Drugs $40 Copay
Eligibility Date Date of Hire
Contact Information 404-261-2590
888-865-5813 toll free
Medical Coverage - Kaiser HMO
Prescription Drugs - Mail Order Available. Contact Kaiser Permanente Customer Service for more detail.
Kaiser Permanente Pharmacies
Network Pharmacies - Walgreens and Rite Aid