Sacramento Area Electrical Workers
Trust Funds
| Initial Eligibility Effective Date | 1st of the 2nd month following reserve dollar bank accumulation of $2,000 |
| Continuing Eligibility | $1,000 in reserves for one month coverage |
| Pre-Existing Conditions New Members and Dependents |
None |
| Resident Requirement | Must reside or work within Kaiser service area |
| Dependent Coverage | Up to age 19 or 24, if full-time student |
| Office Visit Copayment | $20/visit |
| Deductible | not applicable |
| Annual Out-of-Pocket Limit | $1,500 Single / $3,000 Family |
| Lifetime Maximum | not applicable |
| Death benefit - $7,500 Active Employee Only | All benefits the same |
| Choice of Doctor/Hospital | Service provided at Kaiser Permanente facilities by their staff, unless referred by a Kaiser Permanente Physician. |
| Inpatient Hospital | $100 Copayment |
| Outpatient Surgery | $20 per procedure |
| Emergency Care | $75 copayment waived if admitted as an inpatient |
| Ambulance | no charge |
| Maternity | $20 copayment per visit |
| Well Baby Care | $20 copayment per visit |
| Immunizations | no charge |
| Mental Health* | Inpatient: Up to 45 days per calendar year at no charge. * Outpatient: Therapy provided at $20 co-payment. *No limit for serious emotional disturbances of children and severe mental illnesses as described in the Evidence of Coverage. |
| Chemical Dependency/Substance Abuse* | Inpatient: Detoxification provided at no charge. Outpatient: Therapy provided at $20 co-payment per visit. Additional Coverage: Provided by HealthNet Managed Health Network (MHN), pre-authorization is required. Same as HealthNet HMO Chemical Dependency/Substance Abuse benefit |
| Prescription Drugs | |
| Generic | $10 copayment |
| Brand | $30 copayment |
This comparison chart is merely an overview of the benefits, which are effective January 1, 2009, and does not anemptto cover all the benefit features, limitations, and exclusions In these programs. For details you should consult the materials prepared by Kaiser Permanente or contact Kaiser Permanente Member Services at 1-800-464-4000, group #1799.