2013 benefits open enrollment guide - Jones Lang LaSalle

Plan Summary Chart for California and Oregon employees participating in the Kaiser Permanente plan
The comparison chart below provides you with an overview of our medical programs. Please review the information carefully as you cannot change
your medical option until the next open enrollment period, unless you have a qualified family status change.
Important note:
The Kaiser Permanente plan is only available to employees based in California and Oregon.
Who Provides Care
Preventative Care:
KP STANDARD OPTION KP PLUS OPTION KP BASIC OPTION
There are no out-of-network benefits available. Only services provided by a Kaiser Permanente provider are considered covered
benefits.
100% 100% 100%
• Routine physical exam
• Well-child care
• Well-woman exam
• Immunizations
• Screenings
Annual Deductible
• Employee
• Employee+1
• Family
$500
$1,250
$1,250
$1,250
$3,100
$3,100
Coinsurance 80% N/A 70%
Annual Out-of-Pocket Maximum
(includes deductible)
• Employee
• Employee+1
• Family
HSA Company Contribution
• Employee
• Employee+1
• Family
$2,000
$5,000
$5,000
N/A
$3,000
$7,500
$7,500
Contributions are prorated
$600
$1,200
$1,200
$2,700
$6,150
$6,150
$5,000
$12,000
$12,000
Office Visit $20 copay $20 copay $30 copay
Surgery or Hospital Care
• Inpatient
• Outpatient
Infertility Treatment
Mental Health Treatment
• Outpatient
• Inpatient hospital charges
80% after deductible $250 per admission after deductible for
outpatient
50% Coinsurance after deductible (for
diagnosis and treatment)
$20 per individual visit for outpatient
80% after deductible for inpatient
$150 per procedure after deductible for
Inpatient
50% Coinsurance after deductible (for
diagnosis and treatment)
$20 per individual visit for outpatient
$250 per admission after deductible for
inpatient
Contributions are prorated
$600
$1,200
$1,200
70% after deductible
50% Coinsurance after deductible (for
diagnosis and treatment)
$30 per individual visit for outpatient
70% after deductible for inpatient
Vision Exam 100% $20 Copay after deductible $30 Copay after deductible
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