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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
These are sample evidence of coverage (EOC) plan documents that may assist you in making an informed decision on which plan to choose. After enrollment, you will receive the most current version that should be used to determine terms of coverage for your plan.
- 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
Archive
Review plan listings of previous evidence of coverage documents.
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.