SimpliveraCoverage Companion

Gold A

Kaiser Foundation Health Plan of Washington · 2027 plan year

Gold
Ind. deductible
$2,100
Family deductible
$4,200
Ind. OOP max
$7,000
Family OOP max
$14,000

Other cost-sharing reduction variants for this plan:

Standard Gold Off Exchange PlanStandard Gold On Exchange PlanZero Cost Sharing Plan Variation

More Kaiser Foundation Health Plan of Washington plans in WA

Basics Plus Catastrophic HSAVisitsPlus GoldKaiser Permanente Cascade Complete GoldKaiser Permanente Cascade Silver

Live premium estimate

$

Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$20.00 Copay after deductible

Specialist

BenefitIn-network
Specialist Visit$40.00 Copay after deductible

Hospital

BenefitIn-network
Emergency Room Services20.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)20.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services20.00% Coinsurance after deductible
Urgent Care Centers or Facilities$45.00 Copay after deductible

Pharmacy

BenefitIn-network
Generic Drugs$20.00 Copay after deductible
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Preferred Brand Drugs20.00% Coinsurance after deductible
Specialty Drugs50.00% Coinsurance after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services20.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services$20.00 Copay after deductible

Other

BenefitIn-network
Habilitation Services20.00% Coinsurance after deductible
Abortion for Which Public Funding is ProhibitedNo Charge after deductible
Acupuncture$20.00 Copay after deductible
Chemotherapy$40.00 Copay after deductible
Chiropractic Care$20.00 Copay after deductible
Cosmetic Surgery20.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care20.00% Coinsurance after deductible
Dental Anesthesia20.00% Coinsurance after deductible
Diabetes Care Management$20.00 Copay after deductible
Diabetes Education$20.00 Copay after deductible
Dialysis$20.00 Copay after deductible
Durable Medical Equipment20.00% Coinsurance after deductible
Emergency Transportation/Ambulance20.00% Coinsurance after deductible
Eye Glasses for ChildrenNo charge
Gender Affirming Care20.00% Coinsurance after deductible
Hearing Aids20.00% Coinsurance after deductible
Hearing Exams$20.00 Copay after deductible
Home Health Care Services20.00% Coinsurance after deductible
Hospice ServicesNo Charge after deductible
Imaging (CT/PET Scans, MRIs)20.00% Coinsurance after deductible
Infertility Treatment20.00% Coinsurance after deductible
Infusion Therapy$20.00 Copay after deductible
Inherited Metabolic Disorder - PKU20.00% Coinsurance after deductible
Inpatient Physician and Surgical Services20.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services20.00% Coinsurance after deductible
Nutritional Counseling$20.00 Copay after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)$20.00 Copay after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)20.00% Coinsurance after deductible
Outpatient Rehabilitation Services20.00% Coinsurance after deductible
Prenatal and Postnatal CareNo charge
Prosthetic Devices20.00% Coinsurance after deductible
Radiation$40.00 Copay after deductible
Reconstructive Surgery20.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy20.00% Coinsurance after deductible
Rehabilitative Speech Therapy20.00% Coinsurance after deductible
Routine Eye Exam (Adult)$20.00 Copay after deductible
Routine Eye Exam for ChildrenNo charge
Routine Foot Care$40.00 Copay after deductible
Skilled Nursing Facility20.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services20.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services$20.00 Copay after deductible
Transplant20.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders$20.00 Copay after deductible
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging20.00% Coinsurance after deductible

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