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- Gold 0/25 RX Copay
- Gold 1500/20
- Gold 2000/20
- Silver 2200/25
- Silver 3700/20/HSA
- Silver 4000/25
- Silver 4500/30 RX Copay
- Silver 5500/25
- Bronze 6500/35/HSA
- Bronze 6500/50
- Bronze 7500/60 RX Copay
- Bronze 8500/50
- Catastrophic
- Colorado Option Gold
- Colorado Option Silver
- Colorado Option Bronze
- Select Gold 0/25 RX Copay
- Select Gold 1500/20
- Select Gold 2000/20
- Select Silver 2200/25
- Select Silver 3700/20/HSA
- Select Silver 4000/25
- Select Silver 4500/30 RX Copay
- Select Silver 5500/25
- Select Bronze 6500/50
- Select Bronze 6500/35/HSA
- Select Bronze 7500/60 RX Copay
- Select Bronze 8500/50
- Select Catastrophic
Individual & Family Plan Documents
Review plan listings of previous evidence of coverage (EOC) documents.
- Gold 0/25 RX Copay
- Gold 1500/20
- Gold 2000/20
- Silver 1000/20/87 CSR
- Silver 200/5/94 CSR
- Silver 2200/25
- Silver 2200/25/73 CSR
- Silver 275/25/87 CSR
- Silver 2900/20/73 CSR
- Silver 3000/20/73 CSR
- Silver 3700/20/HSA
- Silver 4000/25
- Silver 4500/30 RX Copay
- Silver 4000/30 RX Copay 73 CSR
- Silver 50/5 RX Copay 94 CSR
- Silver 50/5/94 CSR
- Silver 500/20 RX Copay 87 CSR
- Silver 75/10/94 CSR
- Silver 850/10/87 CSR
- Bronze 6500/50
- Bronze 6500/35/HSA
- Bronze 7500/60 RX Copay
- Bronze 8500/50
- Catastrophic
- Colorado Option Gold
- Colorado Option Silver
- Colorado Option Silver 73
- Colorado Option Silver 87
- Colorado Option Silver 94
- Colorado Option Bronze
- Select Gold 0/25 RX Copay
- Select Gold 1500/20
- Select Gold 2000/20
- Select Silver 1000/20/87 CSR
- Select Silver 200/5/94 CSR
- Select Silver 2200/25
- Select Silver 2200/25/73 CSR
- Select Silver 275/25/87 CSR
- Select Silver 2900/20/73 CSR
- Select Silver 3000/20/73 CSR
- Select Silver 3700/20/HSA
- Select Silver 4000/25
- Select Silver 4000/30 RX Copay 73 CSR
- Select Silver 4500/30 RX Copay
- Select Silver 50/5 RX Copay 94 CSR
- Select Silver 50/5/94 CSR
- Select Silver 500/20 RX Copay 87 CSR
- Select Silver 75/10/94 CSR
- Select Silver 850/10/87 CSR
- Select Bronze 6500/35/HSA
- Select Bronze 6500/50
- Select Bronze 7500/60 RX Copay
- Select Bronze 8500/50
- Select Catastrophic
- Gold 0/25 RX Copay - AI-AN
- Gold 0/25 RX Copay - AI-AN LTD
- Gold 1500/20 - AI-AN
- Gold 1500/20 AI-AN LTD
- Gold 2000/20 - AI-AN
- Gold 2000/20- AI-AN LTD
- Silver 2200/25 - AI-AN
- Silver 2200/25 - AI-AN LTD
- Silver 3700/20 - AI-AN
- Silver 3700/20 - AI-AN LTD
- Silver 4000/25 - AI-AN
- Silver 4500/30 RX Copay - AI-AN
- Silver 4500/30 RX Copay - AI-AN LTD
- Silver 5000/25 - AI-AN LTD
- Bronze 6500/35 - AI-AN
- Bronze 6500/35 - AI-AN LTD
- Bronze 6500/50 - AI-AN
- Bronze 6500/50 - AI-AN LTD
- Bronze 7500/60 RX Copay - AI-AN
- Bronze 7500/60 RX Copay - AI-AN LTD
- Bronze 8500/50 - AI-AN
- Bronze 8500/50 - AI-AN LTD
- American Indian/Alaskan Native
- American Indian/Alaskan Native LTD
- Colorado Option Gold - AI-AN
- Colorado Option Gold - AI-AN LTD
- Colorado Option Silver - AI-AN
- Colorado Option Silver - AI-AN LTD
- Colorado Option Bronze - AI-AN
- Colorado Option Bronze - AI-AN LTD
- Select Gold 0/25 RX Copay - AI-AN
- Select Gold 0/25 RX Copay - AI-AN LTD
- Select Gold 1500/20 - AI-AN
- Select Gold 1500/20 - AI-AN LTD
- Select Gold 2000/20 - AI-AN LTD
- Select Gold 2000/20- AI-AN
- Select Silver 2200/25 - AI-AN
- Select Silver 2200/25 - AI-AN LTD
- Select Silver 3700/20 - AI-AN
- Select Silver 3700/20 - AI-AN LTD
- Select Silver 4000/25 - AI-AN
- Select Silver 4500/30 RX Copay - AI-AN
- Select Silver 4500/30 RX Copay - AI-AN LTD
- Select Silver 5000/25 - AI-AN LTD
- Select Bronze 6500/35 - AI-AN
- Select Bronze 6500/35 - AI-AN LTD
- Select Bronze 6500/50 - AI-AN
- Select Bronze 6500/50 - AI-AN LTD
- Select Bronze 7500/60 RX Copay - AI-AN
- Select Bronze 7500/60 RX Copay- AI-AN LTD
- Select Bronze 8500/50 - AI-AN
- Select Bronze 8500/50 - AI-AN LTD
- Select American Indian/Alaskan Native
- Select American Indian/Alaskan Native LTD
Questions?
Have questions about the sample plan documents? Visit buykp.org or call 1-800-488-3590 (TTY 711).
Kaiser Permanente Member
The sample documents may vary from your actual benefits. To view a copy of your specific plan documents, please log into www.kp.org or contact Member Services.