STANDARD GROUP PLAN KAISER FOUNDATION HEALTH PLAN (Formerly the Permanente Health Plan) A nonprofit organization For you and your family-Medical care in the home, hospital, doctor's office Group Membership The family dependents are entitled to the same benefits as the subscriber with the following differences Hospital care.-60 days of hospital care each calendar year is provided without charge for each illness or injury plus an additional 51 days immediately following at half private rates. All drugs and medicines are provided without charge during the 60-day period. Private rates are charged for drugs and medicines during the 51-day period. Doctors' care at your home.-$2 is charged for each home call by a doctor. X-rays, laboratory work and physical therapy.-All necessary X-rays, X-ray therapy, laboratory tests, and physical therapy are provided at half private rates. Maternity care.-Full maternity care is provided for $95 if confinement occurs after 10 months' membership, $140 if before 10 months' membership. Removal of tonsils and adenoids.-All services provided at a total charge of $35. Preexisting conditions Any illness, injury, or condition present at the time of joining the plan will receive the same services of physicians and surgeons as are provided for illnesses arising while a member of the plan. All other services such as hospitalization, X-ray, laboratory, etc., will be provided at half private rates, except that inpatient drugs and ambulance service will be provided at full private rates. Congenital conditions are considered preexisting. Exclusions Mental illness or disorder; attempts at suicide or other intentionally selfinflicted injuries or illnesses; tuberculosis; alcoholism; conditions covered by workmen's compensation; service-connected conditions; dental care; corrective appliances; conditions resulting from a major disaster or epidemic; contagious diseases and diseases requiring isolation, including poliomyelitis and its complications. Conversion privilege If membership through a group is terminated a member may apply within 30 days for conversion membership under an individual account. Any person who has had continuous membership in the plan for 2 years is entitled to such conver sion without medical review or physical examination. Full details may be secured at any of the health plan offices. Termination of membership If membership is terminated because of nonpayment of membership fees, all rights to service cease as of the date of termination. If a member is terminated by the health plan, the member will be entitled to continuation of service, in accordance with the provisions of the plan, for any condition under treatment at the time of termination for a period not to exceed 365 consecutive days from date of termination, provided membership fees are paid during the period of treatment. Who is eligible to be a member of the health plan The subscriber to the health plan may subscribe for himself alone, or for himself, his spouse and unmarried children under 19 years of age. If the spouse of subscriber is over 60 years of age, he or she must pass a physical examination before being accepted as a member. Children upon reaching age 19 or upon becoming married must apply for separate membership, if they wish to enjoy further benefits. Newborn children become eligible for membership at birth, provided application for membership is made. Monthly membership fees Subscriber onlv-- Subscriber and 1 family dependent__ Subscriber and 2 or more family dependents-- $4.30 7.60 9.50 Registration fee.-An initial registration fee of $2 is added to the first month's membership fee. Hospital care A MEDICAL SERVICE AT A COST WITHIN YOUR MEANS The Subscriber Is Entitled To Room and board (private room and special diet as required) Use of operating room Anesthetics and services of anesthetist Blood transfusions (no charge if blood is replaced) Necessary ambulance service within 30 miles of hospitals 111 days of hospital care each calendar year without charge for each illness or injury, its recurrences, and complications, arising while a member of the plan. Doctors' care while hospitalized Operations Consultation and treatment by specialists All services of physicians and surgeons without charge while hospitalized. Doctors' care in the office Consultation and treatment by specialists Eye examinations for glasses 24-hour emergency service All office visits at a registration fee of $1 per visit. Doctors' care at your home Necessary home calls by doctors Necessary calls by nurses under doctors' orders 24-hour emergency service All necessary home calls by doctors and calls by nurses. A charge of $2 is made for the first home call by a doctor for each illness or injury. No charge for succeeding doctor's calls or for nurse's visits. Drugs and medicines Prescriptions Drugs and medicines All drugs and medicines without charge while hospitalized for the 111 days covered by the plan. A reasonable charge is made for drugs and medicines furnished to patients receiving treatment at their homes or at the doctor's office. X-Rays and laboratory work All prescribed X-rays, X-ray therapy, and laboratory tests without charge for each illness or injury, arising while a member of the plan. Physical therapy Diathermy Heat treatments Whirlpool baths, etc. full year's care for each illness or All prescribed physical therapy up to a injury arising while a member of the plan. is made while the member is hospitalized. pitalized will be provided at $1 per treatment. service will be provided at half private rates. Full care of mother before, during, and after confinement Full care of child during the mother's confinement Blood transfusions (no charge if blood is replaced) Full maternity care at a charge of $60 if confinement occurs after 10 months' continuous membership; $140 if before 10 months' membership. In the event pregnancy is interrupted or terminated, a charge will be made for services rendered. Such charge shall in no event exceed two-thirds the charges above specified for obstetrical care. Removal of tonsils and adenoids Physicians and surgeons Laboratory Drugs and medicines while hospitalized. All services provided at a total charge of $15. Emergency care for accidental injury outside service area X-ray and laboratory work Doctors' care Necessary ambulance service when authorized When a member is accidentally injured, at a point more than 30 miles from the nearest authorized medical office or hospital, up to $250 will be allowed for services necessary before his medical condition permits travel to nearest medical office or hospital where health plan service is available. Such allowance will be on the basis of rates recommended by the California Medical Association for use by the Industrial Accident Commission of the State of California. Polio care Treatment and rehabilitation of polio cases following the contagious and acute stage will be provided up to a maximum period of 1 year or a maxinrum value of $2,500 at the California Rehabilitation Center at Vallejo or Santa Monica, Calif. Main office: Kaiser Foundation Health Plan, 280 West MacArthur Boulevard, Oakland, Calif. EQUAL COVERAGE GROUP PLAN KAISER FOUNDATION HEALTH PLAN (Formerly the Permanente Health Plan) A nonprofit organization For you and your family-medical care in the home, hospital, doctor's office Group membership Pre-existing conditions.—Any illness, injury, or condition present at the time of joining the plan will receive the same services of physicians and surgeons as are provided for illnesses arising while a member of the plan. All other services such as hospitalization, X-ray, laboratory, etc., will be provided at half private rates, except that inpatient drugs and ambulance service will be provided at full private rates. Congenital conditions are considered preexisting. Exclusions.-Mental illness or disorder; attempts at suicide or other intentionally self-inflicted injuries or illnesses; tuberculosis; alcoholism; conditions covered by workmen's compensation; service-connected conditions; dental care; corrective appliances; conditions resulting from a major disaster or epidemic; contagious diseases and diseases requiring isolation, including poliomyelitis and its complications. Conversion privilege.—If membership through a group is terminated, a member may apply within 30 days for conversion membership under an individual account. Any person who has had continuous membership in the plan for 2 years is entitled to such conversion without medical review or physical examination. Full details may be secured at any of the health-plan offices. Termination of membership.-If membership is terminated because of nonpayment of membership fees, all rights to service cease as of the date of termination. If a member is terminated by the health plan, the member will be entitled to continuation of service, in accordance with the provisions of the plan, for any condition under treatment at the time of termination for a period not to exceed 365 consecutive days from date of termination, provided membership fees are paid during the period of treatment. Who is eligible to be a member of the health plan.-The subscriber to the health plan may subscribe for himself alone, or for himself, his spouse, and unmarried children under 19 years of age. If the spouse of subscriber is over 60 years of age, he or she must pass a physical examination before being accepted as a member. Children upon reaching age 19 or upon becoming married must apply for separate membership if they wish to enjoy further benefits. Newborn children become eligible for membership at birth, provided application for membership is made. REGISTRATION FEE.-An initial registration fee of $2 is added to the first month's membership fee. A. MEDICAL SERVICE AT A COST WITHIN YOUR MEANS The Subscriber and Family Dependents Are Entitled To Hospital care Room and board (private room and special diet as required) Use of operating room Anesthetics and services of anesthetist Blood transfusions (no charge if blood is replaced) Necessary ambulance service within 30 miles of hospitals One hundred and eleven days of hospital care each calendar year without charge for each illness or injury, its recurrences and complications, arising while a member of the plan. Doctors' care while hospitalized Operations Consultation and treatment by specialists All services of physicians and surgeons without charge while hospitalized. Doctors' care in the office Consultation and treatment by specialists Eye examinations for glasses 24-hour emergency service All office visits at a registration fee of $1 per visit. Doctors' care at your home Necessary home calls by doctors Necessary calls by nurses under doctors' orders 24-hour emergency service All necessary home calls by doctors and calls by nurses. A charge of $2 is made for the first home call by a doctor for each illness or injury. No charge for succeeding doctor's calls or for nurse's visits. Drugs and medicines Prescriptions Drugs and medicines All drugs and medicines without charge while hospitalized for the 111 days covered by the plan. A reasonable charge is made for drugs and medicines furnished to patients receiving treatment at their homes or at the doctor's office. X-rays and laboratory work X-rays X-ray therapy Dental X-rays if required by a dentist Electrocardiograms Basal metabolism tests All laboratory tests All prescribed X-rays, X-ray therapy, and laboratory tests without charge for each illness or injury, arising while a member of the plan. Physical therapy Diathermy Heat treatments Massage Whirlpool baths, etc. All prescribed physical therapy up to a full year's care for each illness or injury arising while a member of the plan. During the year's period, no charge is made while the member is hospitalized. Treatment received while not hospitalized will be provided at $1 per treatment. After a full year's care, this service will be provided at half private rates. Maternity care Hospital care Physicians and surgeons Drugs and medicines while hospitalized X-rays and laboratory work Caesarian sections Full care of mother before, during, and after confinement Full care of child during the mother's confinement Blood transfusions (no charge if blood is replaced) Full maternity care at a charge of $60 if confinement occurs after 10 months' continuous membership; $140 if before 10 months' membership. In the event pregnancy is interrupted or terminated, a charge will be made for services rendered. Such charge shall in no event exceed two-thirds the charges above specified for obstetrical care. Removal of tonsils and adenoids Physicians and surgeons Hospital care Laboratory Drugs and medicines while hospitalized All services provided at a total charge of $15. |