Sign out
- Platinum 0 Deductible-Vision-PPO-High-Ortho-Dental-Rider
- Platinum 0 Deductible-Vision-PPO-Basic-Ortho-Dental-Rider
- Platinum 0-Ded-Vision-EPO-Ortho-Dental-Rider
- Platinum 0 Deductible-Vision-EPO-Dental-Rider
- Platinum 0 Ded-Vision
- Gold 0 Deductible/150-Rx Deductible-Vision-PPO-High-Ortho-Dental-Rider
- Gold 0 Deductible/150-Rx Deductible-Vision-PPO-Basic-Ortho-Dental-Rider
- Gold 0-Deductible/150-Rx Deductible-Vision-EPO-Ortho-Dental-Rider
- Gold 0 Deductible/150-Rx Deductible-Vision-EPO-Dental-Rider
- Gold 0 Deductible 150/Rx Deductible-Vision
- Gold 1100 Deductible/200-Rx Deductible-Vision-PPO-High-Ortho-Dental-Rider
- Gold 1100 Deductible/200-Rx Deductible-Vision-PPO-Basic-Ortho-Dental-Rider
- Gold 1100-Deductible/200-Rx Deductible-Vision-EPO-Ortho-Dental-Rider
- Gold 1100 Deductible/200-Rx Deductible-Vision-EPO-Dental-Rider
- Gold 1100 Deductible/200-Rx Deductible-Vision
- Gold Plus 1700 Deductible-Vision-PPO-High-Ortho-Dental-Rider
- Gold Plus 1700-Deductible-Vision-PPO-Basic-Ortho-Dental-Rider
- Gold Plus-1700-Deductible-Vision-EPO-Ortho-Dental-Rider
- Gold Plus 1700 Deductible-Vision-EPO-Dental-Rider
- Gold Plus 1700 Deductible-Vision
- Gold 1750 Deductible/250-Rx Deductible-Vision-PPO-High-Ortho-Dental-Rider
- Gold 1750 Deductible/250-Rx Deductible-Vision-PPO-Basic-Ortho-Dental-Rider
- Gold 1750-Deductible/250-Rx Deductible-Vision-EPO-Ortho-Dental-Rider
- Gold 1750 Deductible/250-Rx Deductible-Vision-EPO-Dental-Rider
- Gold 1750 Deductible/250-Rx Deductible-Vision
- Silver 3000 Deductible/700-Rx Deductible-Vision-PPO-High-Ortho-Dental-Rider
- Silver 3000 Deductible/700-Rx Deductible-Vision-PPO-Basic-Ortho-Dental-Rider
- Silver 3000 Deductible/700-Rx Deductible-Vision-EPO-Ortho-Dental-Rider
- Silver 3000 Deductible/700-Rx Deductible-Vision-EPO-Dental-Rider
- Silver 3000 Deductible/700-Rx /Deductible-Vision
- Silver 6000-Deductible-Vision-PPO-High-Ortho-Dental-Rider
- Silver 6000 Deductible-Vision-PPO-Basic-Ortho-Dental-Rider
- Silver 6000 Deductible-Vision-EPO-Ortho-Dental-Rider
- Silver 6000 Deductible-Vision-EPO-Dental-Rider
- Silver 6000 Deductible-Vision
- Bronze 6700 Deductible-Vision-PPO-High-Ortho-Dental-Rider
- Bronze 6700 Deductible-Vision PPO-Basic-Ortho-Dental-Rider
- Bronze 6700 Deductible-Vision-EPO-Ortho-Dental-Rider
- Bronze 6700 Deductible-Vision-EPO-Dental-Rider
- Bronze 6700 Deductible-Vision
- Bronze 7500 Deductible-HSA-Vision-PPO-High-Ortho-Dental-Rider
- Bronze 7500 Deductible-HSA-Vision-PPO-Basic-Ortho-Dental-Rider
- Bronze 7500 Deductible-HSA-Vision-EPO-Ortho-Dental-Rider
- Bronze 7500 Deductible-HSA-Vision-EPO-Dental-Rider
- Bronze 7500 Deductible-HSA-Vision
- Catastrophic 9200 Deductible-Vision-PPO-High-Ortho-Dental-Rider
- Catastrophic 9200-Deductible-Vision-PPO-Basic-Ortho-Dental-Rider
- Catastrophic 9200 Deductible-Vision-EPO-Ortho-Dental-Rider
- Catastrophic 9200 Deductible-Vision-EPO-Dental-Rider
- Catastrophic 9200 Deductible-Vision
- Silver Virtual Forward 3200 Deductible-PPO-High-Ortho-Dental-Rider
- Silver Virtual Forward 3200-Deductible-PPO-Basic-Ortho-Dental-Rider
- Silver Virtual Forward 3200-Deductible-EPO-Ortho-Dental-Rider
- Silver Virtual Forward-3200 Deductible-EPO-Dental-Rider
- Silver Virtual Forward 3200 Deductible
- Silver Virtual Forward 4200 Deductible-PPO-High-Ortho-Dental-Rider
- Silver Virtual Forward 4200-Deductible-PPO-Basic-Ortho-Dental-Rider
- Silver Virtual Forward 4200-Deductible-EPO-Ortho-Dental-Rider
- Silver Virtual Forward 4200 Deductible-EPO-Dental-Rider
- Silver Virtual Forward 4200 Deductible
- Gold Value 1000 Deductible/150-Rx Deductible-Vision-PPO-High-Ortho-Dental-Rider
- Gold Value 1000 Deductible/150-Rx Deductible-Vision-PPO-Basic-Ortho-Dental-Rider
- Gold Value 1000 Deductible/150-Rx Deductible-Vision-EPO-Ortho-Dental-Rider
- Gold Value 1000 Deductible/150-Rx Deductible-Vision-EPO-Dental-Rider
- Gold Value 1000 Deductible/50-Rx Deductible-Vision
- Silver Value 4500 Deductible/750-Rx Deductible-Vision-PPO-High-Ortho-Dental-Rider
- Silver Value 4500 Deductible/750-Rx Deductible-Vision-PPO-Basic-Ortho-Dental-Rider
- Silver Value 4500 Deductible/750-Rx Deductible-Vision-EPO-Ortho-Dental-Rider
- Silver Value 4500 Deductible/750-Rx Deductible-Vision-EPO-Dental-Rider
- Silver Value 4500 Deductible/750-Rx Deductible-Vision
- Bronze Value 9200 Deductible-Vision-PPO-High-Ortho-Dental-Rider
- Bronze Value 9200 Deductible-Vision-PPO-Basic-Ortho-Dental-Rider
- Bronze Value 9200 Deductible-Vision-EPO-Ortho-Dental-Rider
- Bronze Value 9200 Deductible-Vision-EPO-Dental-Rider
- Bronze Value 9200 Deductible-Vision
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.
- Platinum 0 Deductible-Vision
- Gold 0 Deductible/150 Rx Deductible-Vision
- Gold 1750 Deductible/250 Rx Deductible-Vision
- Silver 6000 Deductible-Vision
- Silver 2000 Deductible-CSR-Vision
- Silver 0 Deductible-CSR-A-Vision
- Silver 0 Deductible-CSR-B-Vision
- Bronze 6700 Deductible-Vision
- Bronze 7500 Deductible-HSA-Vision
- Catastrophic 9200 Deductible-Vision
- Gold Value 1000 Deductible/150 Rx Deductible-Vision
- Silver Value 1000 Deductible/150 Rx Deductible-CSR-Vision
- Silver Value 4500 Deductible/750 Rx Deductible-Vision
- Silver Value 4500 Deductible/750 Rx Deductible-CSR-Vision
- Silver Value 0 Deductible-CSR-Vision
- Bronze Value 9200 Deductible-Vision
- Silver Virtual Forward 3200 Deductible
- Silver Virtual Forward 2000 Deductible-CSR
- Silver Virtual Forward 500 Deductible-CSR
- Silver Virtual Forward 0 Deductible-CSR
- American Indian/Alaskan Native - HMO - Vision
- American Indian/Alaskan Native - Vision
- Gold 0 Deductible-Vision-C-POS-High-Ortho-Dental
- Gold 0 Deductible-Vision-C-POS-High-Dental
- Gold 0 Deductible-Vision-C-POS-Basic-Ortho-Dental
- Gold 0 Deductible-Vision-C-POS-Basic-Dental
- Gold 0 Deductible-Vision-Copay-Ortho-Dental
- Gold 0 Deductible-Vision-Copay-Dental
- Gold 0 Deductible-Vision
- Gold 1250 Deductible/200-Rx Deductible-Vision-C-POS-High-Ortho-Dental
- Gold 1250 Deductible/200-Rx Deductible-Vision-C-POS-High-Dental
- Gold 1250 Deductible/200-Rx Deductible-Vision-C-POS-Basic-Ortho-Dental
- Gold 1250 Deductible/200 Rx Deductible-Vision-C-POS-Basic-Dental
- Gold 1250 Deductible/200-Rx Deductible-Vision-Copay-Ortho-Dental
- Gold 1250 Deductible/200-Rx Deductible-Vision-Copay-Dental
- Gold 1250 Deductible/200-Rx Deductible-Vision
- Gold 2000 Deductible-Vision-C-POS-High-Ortho-Dental
- Gold 2000 Deductible-Vision-C-POS-High-Dental
- Gold 2000 Deductible-Vision-C-POS-Basic-Ortho-Dental
- Gold 2000 Deductible-Vision-C-POS-Basic-Dental
- Gold 2000 Deductible-Vision-Copay-Ortho-Dental
- Gold 2000 Deductible-Vision-Copay-Dental
- Gold 2000 Deductible-Vision
- Silver 2500 Deductible-Vision-C-POS-High-Ortho-Dental
- Silver 2500 Deductible-Vision-C-POS-High-Dental
- Silver 2500 Deductible-Vision-C-POS-Basic-Ortho-Dental
- Silver 2500 Deductible-Vision-C-POS-Basic-Dental
- Silver 2500 Deductible-Vision-Copay-Ortho-Dental
- Silver 2500 Deductible-Vision-Copay-Dental
- Silver 2500 Deductible-Vision
- Silver 4500 Ded Vision C POS High Ortho Dental
- Silver 4500 Ded Vision C POS High Dental
- Silver 4500 Ded Vision C POS Basic Ortho Dental
- Silver 4500 Ded Vision C POS Basic Dental
- Silver 4500 Ded Vision Copay Ortho Dental
- Silver 4500 Ded Vision Copay Dental
- Silver 4500 Ded-Vision
- Bronze 6500 Deductible-Vision-C-POS-High-Ortho-Dental
- Bronze 6500 Deductible-Vision-C-POS-High-Dental
- Bronze 6500 Deductible-Vision-C-POS-Basic-Ortho-Dental
- Bronze 6500 Deductible-Vision-C-POS-Basic-Dental
- Bronze 6500 Deductible-Vision-Copay-Ortho-Dental
- Bronze 6500 Deductible-Vision-Copay-Dental
- Bronze 6500 Deductible-Vision
- Bronze 7000 Deductible-HSA-Vision-C-POS-High-Ortho-Dental
- Bronze 7000 Deductible-HSA-Vision-C-POS-High-Dental
- Bronze 7000 Deductible-HSA-Vision-C-POS-Basic-Ortho-Dental
- Bronze 7000 Deductible-HSA-Vision-C-POS-Basic-Dental
- Bronze 7000 Deductible-HSA-Vision-Copay-Ortho-Dental
- Bronze 7000 Deductible-HSA-Vision-Copay-Dental
- Bronze 7000 Deductible-HSA-Vision
- Bronze 7500 Deductible-C-POS-High-Ortho-Dental
- Bronze 7500 Deductible-C-POS-High-Dental
- Bronze 7500 Deductible-C-POS-Basic-Ortho-Dental
- Bronze 7500 Deductible-C-POS-Basic-Dental
- Bronze 7500 Deductible-Copay-Ortho-Dental
- Bronze 7500 Deductible-Copay-Dental
- Bronze 7500 Deductible
- Catastrophic 9200 Vision C POS High Ortho Dental
- Catastrophic 9200 Ded Vision C POS High Dental
- Catastrophic 9200 Vision C POS Basic Ortho Dental
- Catastrophic 9200 Ded Vision C POS Basic Dental
- Catastrophic 9200 Vision Copay Ortho Dental
- Catastrophic 9200 Vision Copay Dental
- Catastrophic 9200 Ded-Vision
- Standard Platinum 0 Deductible-Vision-C-POS-High-Ortho-Dental
- Standard Platinum 0 Deductible-Vision-C-POS-High-Dental
- Standard Platinum 0 Deductible-Vision-C-POS-Basic-Ortho-Dental
- Standard Platinum 0 Deductible-Vision-C-POS-Basic-Dental
- Standard Platinum 0 Deductible-Vision-Copay-Ortho-Dental
- Standard Platinum 0 Deductible-Vision-Copay-Dental
- Standard Platinum 0 Deductible-Vision
- Standard Gold-1500 Deductible-Vision-C-POS-High-Dental
- Standard Gold 1500 Deductible-Vision-C-POS-High-Ortho-Dental
- Standard Gold 1500 Deductible-Vision-C-POS-Basic-Ortho-Dental
- Standard Gold 1500 Deductible-Vision-C-POS-Basic-Dental
- Standard Gold 1500 Deductible-Vision-Copay-Ortho-Dental
- Standard Gold 1500 Deductible-Vision-Copay-Dental
- Standard Gold 1500 Deductible-Vision
- Standard Bronze 7500 Deductible-Vision-C-POS-High-Ortho-Dental
- Standard Bronze 7500 Deductible-Vision-C-POS-High-Dental
- Standard Bronze 7500 Deductible-Vision-C-POS-Basic-Ortho-Dental
- Standard Bronze 7500 Deductible-Vision-C-POS-Basic-Dental
- Standard Bronze 7500 Deductible-Vision-Copay-Ortho-Dental
- Standard Bronze 7500 Deductible-Vision-Copay-Dental
- Standard Bronze 7500 Deductible-Vision
- Gold Virtual Forward 2350 Ded C POS High Ortho Dental
- Gold Virtual Forward 2350 Ded Vision C POS High Dental
- Gold Virtual Forward 2350 Ded C POS Basic Ortho Dental
- Gold Virtual Forward 2350 Ded Vision C POS Basic Dental
- Gold Virtual Forward 2350 Ded Copay Ortho Dental
- Gold Virtual Forward 2350 Ded Copay Dental
- Gold Virtual Forward 2350 Ded
- Silver Virtual Forward 3500 Ded C POS High Ortho Dental
- Silver Virtual Forward 3500 Ded C POS High Dental
- Silver Virtual Forward 3500 Ded C POS Basic Ortho Dental
- Silver Virtual Forward 3500 Ded C POS Basic Dental
- Silver Virtual Forward 3500 Ded Copay Ortho Dental
- Silver Virtual Forward 3500 Ded Copay Dental
- Silver Virtual Forward 3500 Ded
- Silver Virtual Forward 4000 Deductible-C-POS-High-Ortho-Dental
- Silver Virtual Forward 4000 Deductible-C-POS-High-Dental
- Silver Virtual Forward 4000 Deductible-C-POS-Basic-Ortho-Dental
- Silver Virtual Forward 4000 Deductible-C-POS-Basic-Dental
- Silver Virtual Forward 4000 Deductible-Copay-Ortho-Dental
- Silver Virtual Forward 4000 Deductible-Copay-Dental
- Silver Virtual Forward 4000 Deductible
- Gold 0 Deductible-Vision
- Gold 2000 Deductible-Vision
- Silver 4500 Deductible-Vision
- Silver 3000 Deductible-CSR-Vision
- Silver 0 Deductible-CSR-B-Vision
- Silver 0 Deductible-CSR-A-Vision
- Bronze 6500 Deductible-Vision
- Bronze 7000 Deductible-HSA-Vision
- Bronze 7500 Deductible
- Catastrophic 9200 Deductible-Vision
- Standard Platinum 0 Deductible-Vision
- Standard Gold 1500 Deductible-Vision
- Standard Silver 5000 Deductible-Vision
- Standard Silver 3000 Deductible-CSR-Vision
- Standard Silver 500 Deductible-CSR-Vision
- Standard Silver 0 Deductible-CSR-Vision
- Standard Bronze 7500 Deductible-Vision
- Gold Virtual Forward 2350 Deductible
- Silver Virtual Forward 3500 Deductible
- Silver Virtual Forward 2500 Deductible-CSR
- Silver Virtual Forward 500 Deductible CSR
- Silver Virtual Forward 0 Deductible-CSR
- Gold-A Vision - AI-AN
- Gold-B Vision - AI-AN
- Silver Vision - AI-AN
- Bronze-A Vision- AI-AN
- Bronze-B Vision - AI-AN
- Bronze - AI-AN
- Standard Platinum Vision - AI-AN
- Standard Gold Vision - AI-AN
- Standard Silver Vision - AI-AN
- Standard Bronze Vision - AI-AN
- Gold Virtual Forward- AI-AN
- Silver Virtual Forward- AI-AN
- Gold 0 Deductible-100-Rx Deductible-Vision
- Gold 1000 Deductible/200-Rx-Deductible-Vision
- Gold 1700 Deductible-HSA-Vision
- Gold Plus 0 Deductible/100 Rx Deductible-Vision
- Silver 0 Deductible-CSR-Vision
- Silver 0 Deductible/30 Rx Deductible-CSR-Vision
- Silver 3100 Deductible/1100 Rx Deductible-CSR-Vision
- Silver 3200 Deductible/1200 Rx Deductible-Vision
- Bronze 6500 Deductible-Vision
- Bronze 6350 Deductible-HSA-Vision
- Catastrophic 9200 Deductible-Vision
- Essential Platinum 0 Deductible-Vision
- Essential Gold 500 Deductible-Vision
- Essential Silver 0 Deductible-CSR
- Essential Silver 150 Deductible-CSR
- Essential Silver 4000 Deductible/350 Rx Deductible-CSR
- Essential-Silver 4850 Deductible/350 Rx Deductible
- Essential Bronze 7500 Deductible/850 Rx Deductible
- Gold Virtual Forward 2000 Deductible
- Silver Virtual Forward 0 Deductible-CSR
- Silver Virtual Forward 500 Deductible-CSR
- Silver Virtual Forward 2500 Deductible-CSR
- Silver Virtual Forward 3500 Deductible
- American Indian/Alaskan Native - HMO Plus - Vision
- American Indian/Alaskan Native - HMO - Vision
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.