HSA-Qualified Deductible EPO Plan

Your HSA-Qualified Deductible EPO Plan is not just health coverage — it's a partnership in health.

You receive preventive care services at little or no cost to you, and online features let you manage your care around the clock.

Your benefits include:

your choice of a personal doctor for each family member for routine medical care
copays or coinsurance for most covered services after you meet your deductible
no referrals needed for certain specialties, like optometry and routine obstetrics/gynecology
an out-of-pocket maximum that limits how much you'll spend on most covered services each year
a pre-tax health savings account* to help pay for certain medical expenses^†

* To be eligible for an HSA, you must be enrolled in an HSA-qualified deductible health plan and meet other HSA eligibility rules. For more information, see IRS Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans. The tax references in this document relate to federal income tax only. Consult with your financial or tax adviser for information about state income tax laws.

† To view the list of qualified medical expenses defined under Internal Revenue Code Section 213(d), see IRS Publication 502, Medical and Dental Expenses.

Your Evidence of Coverage or Summary Plan Description contains a complete explanation of benefits, exclusions, and limitations. The information provided here is not intended nor designed to serve as your Evidence of Coverage.

Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. in Maryland, Virginia, and Washington, D.C., 2101 E. Jefferson St., Rockville, MD 20852