This webpage provides information on Kaiser Permanente's supplemental health plan for Medicare eligible retirees and employees.
All other employees should visit the Kaiser Permanente Medical Insurance webpage to learn about health insurance benefits with Kaiser Permanente.
Medicare eligible Prince William County Public Schools (PWCS) retirees and employees have a new health insurance option in 2022 from Kaiser Permanente.
The 2022 monthly premium for this plan is $251.35 per person, per month.
When you choose a Kaiser Permanente Medicare health plan through Prince William County Public Schools, Kaiser Permanente will bill you directly and you will receive a bill in the mail for your monthly premium.
For more information or to enroll, please call 1-800-747-2189 or visit Kaiser Permanente's website:
You pay a $30 copayment for each preventive care office visit, which includes up to two oral exams, two cleanings, and two bitewing X-rays every year. Other covered dental services are provided at a reduced fee.
You pay $0 for one hearing aid for each ear, every 36 months. You are also covered for medically necessary hearing aid evaluations and diagnostic procedures to determine the hearing aid model which will best compensate for loss of hearing.
Benefits include coverage for routine eye exams, glaucoma and cataract screenings, and an allowance on glasses and contact lenses. Visit kp2020.org for more information and to view optical locations, conveniently located in many Kaiser Permanente medical centers.
Fitness center membership with a local participating Silver&Fit fitness center and digital fitness choices with home fitness tools to help you thrive in the comfort of your home. Visit SilverAndFit.com for more information.
The plan includes 24 one-way rides per contract year for nonemergency medical appointments at Kaiser Permanente medical centers and contracted facilities at no extra cost. Call 1-855-932-5412, 24 hours a day, 7 days a week, to schedule a ride.
The plan offers flexible virtual care options to visit with your Kaiser Permanente doctor by phone or video from the comfort of home. You can also call our 24/7 advice line and email your Kaiser Permanente doctor for nonurgent questions. Visit kp.org/GetCare for more information.
The annual deductible for this plan is $0.
| Benefits and Services | Coverage and Copayment |
|---|---|
| Preventative care | Covered in full |
| Office visit - primary and specialty | $15 copay |
| Physical therapy | $15 copay |
| Labs, X-rays, and other outpatient diagnostic tests | Covered in full |
| Other imaging procedures, such as MRI, CT, and PET | Covered in full |
| Inpatient hospital | $100 per benefit period |
| Outpatient services/surgery | Covered in full |
| Emergency room1 | $50 copay |
| Urgent care | $15 copay |
| Ambulance | Covered in full |
| Durable medical equipment | Covered in full |
| Routine eye exam2 | $15 copay |
| Preventive dental exam and cleaning3 | $30 copay |
| Hearing aids | $0 for one hearing aid for each ear (every 36 months) |
1
Copay
waived
if
admitted
to
inpatient
hospital
2
At
Vision
Essentials
by
Kaiser
Permanente
locations
3
With
the
Preventive
Dental
plan
underwritten
by
Kaiser
Permanente
and
administered
by
Dominion
National.
Part D prescription drug coverage is included in Kaiser Permanente Medicare Advantage plans.
When you order prescription refills from a Kaiser Permanente pharmacy or online, you can use the preferred prescription home delivery option for many drugs and have them sent to your home at no extra charge.
You pay the copays and coinsurance shown in the chart below until your total yearly drug costs reach $7,050. (Total yearly drug costs are the amounts paid by both you and any Part D plan during a calendar year.) If you reach the $7,050 limit, you move on to the catastrophic stage and your coverage changes. There is not a coverage gap with the Kaiser Permanente Medicare Advantage plan.
| Tier |
Preferred
pharmacy (up to a 60-day supply) |
Standard
pharmacy (up to a 60-day supply) |
OON
pharmacy (up to a 30-day supply) and LTC pharmacy (up to a 31-day supply) |
Prescription
home
delivery
1 (up to a 90-day supply) |
|---|---|---|---|---|
|
Tier
1 (preferred generic) |
$15 | $25 | $12.50 | $10 |
|
Tier
2 (generic) |
$15 | $25 | $12.50 | $10 |
|
Tier
3 (preferred brand) |
$15 | $25 | $12.50 | $10 |
|
Tier
4 (non-preferred brand) |
$15 | $25 | $12.50 | $10 |
|
Tier
5 (specialty) |
$15 | $25 | $12.50 | $10 |
|
Tier
6 (vaccines) |
$0 | $0 | $0 | Not available |
1 For certain drugs, you can get prescription refills mailed to you through Kaiser Permanente prescription home delivery. You should receive them within 3-5 days.
After
your
yearly
out-of-pocket
drug
costs
(including
drugs
purchased
through
your
retail
pharmacy
and
through
mail
order)
reach
$7,050,
you
pay:
