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- Gold 500 Deductible/500 RX Deductible
- Gold 1000 Deductible/500 RX Deductible
- Gold 2000 Deductible/500 RX Deductible
- Silver 3400 Deductible/500 RX Deductible
- Silver 4500/35
- Bronze 6500/40/HSA
- Catastrophic 9200
- Signature Gold 500 Deductible/500 RX Deductible
- Signature Gold 1000 Deductible/500 RX Deductible
- Signature Gold 2000 Deductible/500 RX Deductible
- Signature Silver 3400 Deductible/500 RX Deductible
- Signature Silver 4500/35
- Signature Bronze 6500/40/HSA
- Signature Catastrophic 9450
- Signature Standard Gold 1500/30
- Signature Standard Silver 5000/40
- Signature Standard Bronze 7500/50
- Signature Silver Virtual Complete 5000
- Signature Silver Virtual Complete 5500
- Signature Bronze Virtual Complete 5500 Deductible/1500 RX Deductible
- Standard Gold 1500/30
- Standard Silver 5000/40
- Standard Bronze 7500/50
- Silver Virtual Complete 5000
- Silver Virtual Complete 5500
- Bronze Virtual Complete 5500 Deductible/1500 RX Deductible
Individual & Family Plan Documents
Review plan listings of previous evidence of coverage documents.
- Gold 500 Deductible/500 RX Deductible
- Gold 1000 Deductible/500 RX Deductible
- Gold 2000 Deductible/500 RX Deductible
- Silver 0/94 CSR
- Silver 150/5/94 CSR
- Silver 3300 Deductible/500 RX Deductible/73 CSR
- Silver 3400 Deductible/500 RX Deductible
- Silver 3500/35 73 CSR
- Silver 4500/35
- Silver 750/87 CSR
- Silver 850/15/87 CSR
- Bronze 6500/40/HSA
- Catastrophic 9200
- Signature Gold 500 Deductible/500 RX Deductible
- Signature Gold 1000 Deductible/500 RX Deductible
- Signature Gold 2000 Deductible/500 RX Deductible
- Signature Silver 0/94 CSR
- Signature Silver 150/5/94 CSR
- Signature Silver 3300 Deductible/500 RX Deductible/73 CSR
- Signature Silver 3400 Deductible/500 RX Deductible
- Signature Silver 3500/35 73 CSR
- Signature Silver 750/87 CSR
- Signature Silver 850/15/87 CSR
- Signature Silver 4500/35
- Signature Bronze 6500/40/HSA
- Signature Catastrophic 9200
- Signature American Indian/Alaskan Native
- Signature Standard Gold 1500/30
- Signature Standard Silver 0/0/94 CSR
- Signature Standard Silver 5000/40
- Signature Standard Silver 3000/40/73 CSR
- Signature Standard Silver 500/20/87 CSR
- Signature Standard Bronze 7500/50
- Signature Silver Virtual Complete 0/94 CSR
- Signature Silver Virtual Complete 3000/73 CSR
- Signature Silver Virtual Complete 500/87 CSR
- Signature Silver Virtual Complete 5000
- Signature Bronze Virtual Complete 5500 Deductible/1500 RX Deductible
- Silver Virtual Complete 0/94 CSR
- Silver Virtual Complete 3000/73 CSR
- Silver Virtual Complete 500/87 CSR
- Silver Virtual Complete 5000
- Bronze Virtual Complete 5500 Deductible/1500 RX Deductible
- Standard Gold 1500/30
- Standard Silver 5000/40
- Standard Silver 3000/40/73 CSR
- Standard Silver 500/20/87 CSR
- Standard Silver 0/0/94 CSR
- Standard Bronze 7500/50
- American Indian/Alaskan Native
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.