HMO Plans

Health Plan Name	Office Visit Copay	Hospital Copay	Outpatient Copay
Basic HMO	$30	$400/day, max $1600	$150
Standard HMO	$20	$150/day, max $600	$50
Classic 15	$15	$500	$150
Classic 20	$20	$750	$150
Classic 30	$30	$1000	$150
Classic 35	$30	20% to $4k max	$200

Deductible Plans

Plan Name	Office Visit Copay	Deductible	Coinsurance
Plan 621	$30	$750	20% to $2,500 max
Plan 631	$30	$2000	30% to $5,500 max

HSA Plans

Plan Name	Deductible	Coinsurance	Max Out-of-Pocket
HDS1	$2,000/$4,000	100/0	$2000/$4000
HDS2	$2,500/$5,000	80/20	$5000/$10,000

The following plans allow employees to use Kaiser facilities, use the Mountain Medical Affiliates network doctors, or go completely out-of-network for care.  Benefits vary according to which option is chosen.  Employees can choose to go to a Kaiser doctor for routine visits and pay the appropriate copay for the visit, and still continue to use a specialist outside of Kaiser with a separate deductible applying.

                 Triple Option Plan 330

                 Triple Option Plan 333

                 Triple Option Plan 334

                 Kaiser Dental Brochure

                 Supplemental Option Rates 2005