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- Platinum 0/5
- Gold 0/40
- Bronze 6000/65
- Platinum 0/5 PedDent
- Gold 0/40 PedDent
- Bronze 6000/65 PedDent
- Platinum 0/5 Plus CAM
- Gold 0/40 Plus CAM
- Bronze 6000/65 Plus CAM
- Platinum 0/5 Plus CAM PedDent
- Gold 0/40 Plus CAM PedDent
- Bronze 6000/65 Plus CAM PedDent
- Gold 1000 Ded/250 Rx Ded
- Silver 3000 Ded/600 Rx Ded
- Silver 4000 Ded/600 Rx Ded
- Gold 1000 Ded/250 Rx Ded PedDent
- Silver 3000 Ded/600 Rx Ded PedDent
- Silver 4000 Ded/600 Rx Ded PedDent
- Silver 3000 Ded/600 Rx Ded Plus CAM
- Silver 3000 Ded/600 Rx Ded Plus CAM PedDent
- Standard Platinum 0/10
- Standard Gold 2000/30
- Standard Silver 6000/40
- Standard Bronze 7500/50
- Standard Platinum 0/10 PedDent
- Standard Gold 2000/30 PedDent
- Standard Silver 6000/40 PedDent
- Standard Bronze 7500/50 PedDent
Individual & Family Plan Documents
Review plan listings of previous evidence of coverage documents.
- Platinum 0/5 Plus CAM
- Gold 0/40 Plus CAM
- Bronze 6000/65 Plus CAM
- Platinum 0/5 Plus CAM AI/0
- Gold 0/40 Plus CAM AI/0
- Silver - Plus CAM AI/0
- Bronze 6000/65 Plus CAM AI/0
- Platinum 0/5 Plus CAM AI/LTD
- Gold 0/40 Plus CAM AI/LTD
- Bronze 6000/65 Plus CAM AI/AN LTD
- Gold 1000 Ded/250 Rx Ded
- Silver 4000 Ded/600 Rx Ded
- Gold 1000 Ded/250 Rx Ded AI/LTD
- Silver 4000 Ded/600 Rx Ded AI/LTD
- Silver 25/5 CSR94
- Silver 750/20 CSR87
- Silver 0/5 CSR94 Plus CAM
- Silver 2000 Ded/300 Rx Ded CSR73
- Silver 200 Ded/100 Rx Ded CSR87 Plus CAM
- Silver 2850 Ded/600 Rx Ded CSR73 Plus CAM
- Silver 3000 Ded/600 Rx Ded Plus CAM
- Silver 3000 Ded/600 Rx Ded Plus CAM AI/LTD
- Gold - AI/0
- Silver - AI/0
- Standard Platinum 0/10
- Standard Gold 2000/30
- Standard Silver 6000/40
- Standard Bronze 7500/50
- Standard Platinum 0/10 AI/0
- Standard Gold 2000/30 AI/0
- Standard Silver 6000/40 AI/0
- Standard Bronze 7500/50 AI/0
- Standard Platinum 0/10 AI/LTD
- Standard Gold 2000/30 AI/LTD
- Standard Silver 6000/40 AI/LTD
- Standard Bronze 7500/50 AI/LTD
- Standard Silver 0/0 CSR94
- Standard Silver 700/20 CSR87
- Standard Silver 3000/40 CSR73
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.