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- Gold $0 $25
- Gold $500 $20
- Gold $1000 $20
- Gold $1500 $30
- Gold $2000 $20
- Silver $3500 $30
- Silver $4500 $35
- Silver $6000 $50
- Bronze $7500 $50
- Gold $500 $20 Bridge Program
- Gold $3500 $0 HSA
- Silver $4000 $0 HSA
- Bronze $6500 40% HSA
- Silver $5000 $40 Virtual Complete
- Silver $5500 $50 Virtual Complete
- Bronze $5500 $60 Virtual Complete
- Catastrophic $10600 $0
- Signature Gold $0 $25
- Signature Gold $500 $20
- Signature Gold $1000 $20
- Signature Gold $1500 $30
- Signature Gold $2000 $20
- Signature Silver $3500 $30
- Signature Silver $4500 $35
- Signature Silver $6000 $50
- Signature Bronze $7500 $50
- Signature Gold $500 $20 Bridge Program
- Signature Gold $3500 $0 HSA
- Signature Silver $4000 $0 HSA
- Signature Bronze $6500 40% HSA
- Signature Silver $5000 $40 Virtual Complete
- Signature Silver $5500 $50 Virtual Complete
- Signature Bronze $5500 $60 Virtual Complete
- Signature Catastrophic $10600 $0
Individual & Family Plan Documents
Review plan listings of previous evidence of coverage documents.
- Traditional HMO
- Gold $500 $20
- Gold $1000 $20
- Gold $1500 $30
- Gold $2000 $20
- Silver $0 $0
- Silver $0 $5 A
- Silver $150 $5
- Silver $700 $20
- Silver $750 $20
- Silver $850 $15
- Silver $3000 $40
- Silver $3300 $30
- Silver $3500 $30
- Silver $3500 $35
- Silver $4500 $35
- Silver $6000 $50
- Bronze $7500 $50
- Bronze $6500 40% HSA
- Silver $0 $0 Virtual Complete
- Silver $500 $30 Virtual Complete
- Silver $3000 $40 Virtual Complete
- Silver $5000 $40 Virtual Complete
- Bronze $5500 $60 Virtual Complete
- Catastrophic $10600 $0
- Signature HMO
- Signature Gold $500 $20
- Signature Gold $1000 $20
- Signature Gold $1500 $30
- Signature Gold $2000 $20
- Signature Silver $0 $0
- Signature Silver $0 $5 A
- Signature Silver $150 $5
- Signature Silver $700 $20
- Signature Silver $750 $20
- Signature Silver $850 $15
- Signature Silver $3000 $40
- Signature Silver $3300 $30
- Signature Silver $3500 $30
- Signature Silver $3500 $35
- Signature Silver $4000 $35
- Signature Silver $4500 $35
- Signature Silver $6000 $50
- Signature Bronze $7500 $50
- Signature Bronze $6500 40% HSA
- Signature Silver $0 $0 Virtual Complete
- Signature Silver $500 $30 Virtual Complete
- Signature Silver $3000 $40 Virtual Complete
- Signature Silver $5000 $40 Virtual Complete
- Signature Bronze $5500 $60 Virtual Complete
- Signature Catastrophic $10600 $0
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.