Small Business Plan Documents

These are sample evidence of coverage (EOC) documents for grandfathered plans. Enrolled members will receive the most current version that should be used to determine terms of coverage.

California Plans Closed to New Membership

$0-$3,300 Deductible Plan with HSA Option
$30 Copayment Plan
$30-$1,500 Deductible Plan with HRA
$40-$2000 Deductible Plan
NCAL KFHP Chiropractic-Acupuncture Benefit

For more small business plans, please access these additional EOCs.

$0-$3,200 Deductible Plan with HSA Option 16376
$30 Copayment Plan 4475
$30-$1,500 Deductible Plan with HRA 4224
$40-$2000 Deductible Plan 4243
NCAL KFHP Chiropractic-Acupuncture Benefit 4001

Questions?

Have questions about the sample plan documents? Please visit Small Business Plans or call 1-877-305-7933 (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.

More resources

Evidence of coverage: Individual & Family | Small Business | Large Business

Benefits

Benefits & coverage

Cost estimates

Need help with benefits?

Appointments & Care

Appointments

Care options

Doctors & locations

Care while traveling

Need help getting care?

Records

Frequently used records

Other records

Managing your records

Need help with records & forms?

Pharmacy

Refilling medications

Managing medications

Need help with medications?

Billing

Billing & payments

Claims & costs

Need help with billing?

Health & Wellness

Ways to stay healthy

Resource directories

Topics of special interest

Prevention

Additional resources

Small Business Plan Documents

California Plans Closed to New Membership

Questions?

Kaiser Permanente Member

More resources