MEDICAL PLANS FOR SMALL EMPLOYERS

Transcription

1 Kaiser Permanente MEDICAL PLANS FOR SMALL EMPLOYERS O R E G O N 018 For Oregon groups with 1 to 50 employees Coverage effective on or after January 1, _NW-OR_11/17 All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest. 500 NE Multnomah St., Suite 100, Portland, OR 973.

2 A WELL-BALANCED TOTAL SOLUTION FOR SMALL EMPLOYERS WITH 1 TO 50 EMPLOYEES At Kaiser Permanente, we re a little different from other carriers. We offer a fully integrated health care delivery system with providers, hospitals, pharmacies, and labs working together to provide better health care for our members. With access to value-added wellness services, care management programs, a 4-hour advice nurse line, and convenient online tools at kp.org, we help make it easier for members to play an active role in their health care. A healthy workforce can mean higher productivity, less absenteeism, and fewer accidents in the workplace. And that translates into savings, no matter which plan you choose. When you partner with Kaiser Permanente, you re not only teaming up with an industry leader you re investing in top-quality care for your employees without losing sight of your bottom line. Our integrated model produces results you can measure. And industry analysts, third-party quality organizations, and the media consistently recognize us for it. VARIETY OF PLAN OPTIONS We offer a broad range of health care products to meet the needs of your small business: Traditional copay plans Deductible plans Point-of-service plans, including a preferred provider organization (PPO) Plans qualified for health savings accounts (HSAs) Bundled plans you choose the plan options; your employees select the plan best suited to their needs Dental plans if you d like information about our dental plans, contact your Small Business Group representative or visit kp.org/dental/nw

3 TABLE OF CONTENTS Value-added services...4 Convenient care...5 Where to find care Plan overviews....8 Plan highlights for Added Choice point-of-service plans Plan highlights for Senior Advantage plan Plan highlights for prescription drugs, alternative care, vision, and dental The right plan for your business....9 Plan highlights for bundled plan options Plan highlights for traditional copay plans Plan highlights for deductible plans Plan highlights for HSA-qualified high deductible health plans Kaiser Permanente consumer-directed plans IMPORTANT INFORMATION This brochure provides summaries for various plans and is not a contract. These plans are subject to exclusions and limitations. Plan details, including all benefits, exclusions, and limitations, are provided in the Evidence of Coverage (EOC). To obtain an EOC for a particular plan, call Member Services at For TTY, call 711. For language interpretation services, call Contact your sales executive or account manager for written coverage information including: Factors that affect rate setting and rate adjustments Provisions related to renewing coverage Premiums available to small groups Geographic areas covered Underwriting guidelines 3

4 VALUE-ADDED SERVICES FOR EMPLOYERS: From convenient online tools to occupational health and safety support, Kaiser Permanente offers the resources to effectively help manage your group s health. ACCOUNT.KP.ORG YOUR ONE-STOP, SELF-SERVICE RESOURCE Visit account.kp.org to access account services and find: The latest information on health coverage Downloadable forms Tools for total health Medical directories Answers to employee questions OCCUPATIONAL HEALTH AND SAFETY Help improve the health and productivity of your workforce and bottom line with the Kaiser Permanente occupational health program. With Kaiser On-the-Job you and your employees have access to specialized occupational health and safety services, including: Specialized care for treatment of work-related injuries Assistance with workers compensation paperwork Easy referrals to physical therapy, radiology, and specialty care OSHA-mandated medical exams Department of Transportation physicals Drug and alcohol testing Immunizations On-site lab testing and pharmacy Telehealth services Kaiser On-the-Job is available to your entire workforce, even those without coverage under our health plans, so all your employees can benefit from the quality of our care. Because there are 7 Kaiser On-the-Job locations in Oregon and Southwest Washington, employees can conveniently access the services they need. Visit kp.org/occupationalhealth/nw for more information. FOR MEMBERS: At Kaiser Permanente, your employees can enjoy our online tools and discounts that will help keep them happy and healthy. CHP ACTIVE AND HEALTHY chpactiveandhealthy.com Your employees have access to a complementary and alternative medicine benefit. CHP Active and Healthy gives members discounts on: Alternative care (chiropractic, acupuncture, massage, and naturopath services) Health club memberships Sporting events Ski and snowboard tickets Theme park tickets Movie tickets And more ONLINE ACCESS ANYTIME, ANYWHERE Through kp.org, members have access to information and tools to better manage their health. Members can use it 4 hours a day, 7 days a week, to: View their Personal Action Plan their doctor s office with nonurgent questions Schedule, cancel, or review routine appointments View most lab test results Refill prescriptions View recent immunizations, allergies, and more To start using these features, go to kp.org/register. Always on the go? Download the Kaiser Permanente mobile app to stay connected anytime, anywhere. TOTAL HEALTH ASSESSMENT kp.org/tha The Total Health Assessment is an online tool to help members learn more about how their lifestyle behavior interacts with their health. Members take a simple online survey about their stress levels, physical activity, and eating habits to get a customized action plan based on their answers. It connects members to online programs tailored to their lifestyles. 4

5 CONVENIENT CARE MEETING MEMBERS WHEN AND WHERE THEY NEED CARE Kaiser Permanente offers members options for how they connect with our exceptional providers. Both on-demand and scheduled care is available, allowing your workforce to thrive with better outcomes, all while saving them and your business time and money. Online and mobile Members can manage their care on kp.org or use the Kaiser Permanente mobile app to schedule routine appointments, refill most prescriptions, and more even on the go. Skip the trip with virtual care , phone, and video visits allow members to save time and get the care they need, from wherever they want it.* Care around the clock wherever you are Nurses are available 4/7 for consultation and appointment scheduling, with direct access to physician consultation when needed. Plus, with Kaiser Permanente s Away from Home Travel Line, members can receive around-the-clock support even when traveling. Convenient locations With 34 medical offices, 0 dental clinics, and access to all The Portland Clinic locations, we re close by. Plus, with new locations in the Pearl District and Beaverton, we re expanding access to meet member demand. At many clinics, members can access their doctor and lab, X-ray, pharmacy, and even dental services often all in one convenient location. Urgent and emergency care Urgent care is available with in-person and online appointments for treatment of minor injuries and illnesses. Emergency care is available for life-threatening medical or psychiatric conditions. Cost estimator Members can access a cost estimator to see how much treatments, procedures, tests, or other medical services could cost. New member onboarding New members receive dedicated support to transfer their health records and prescriptions, make appointments, and register on kp.org. Want to learn more? Visit kp.org/choosebetter. *May be subject to cost share for members on HSA-qualified high deductible health plans (HDHP). 5

6 WHERE TO FIND CARE Washington Polk Columbia 6 Yamhill Salem Lane Please note: Facility locations are approximate. Facility location numbers on this map correspond with our larger location map for Kaiser Permanente Northwest. 5 Longview 30 Portland 5 11 Hillsboro 60 Beaverton Cowlitz Clark Facility information is current as of September 017. For up-to-date information, please visit kp.org/facilities. 05 Vancouver Tigard Tualatin Clackamas Portland 5 Milwaukie N 84 Multnomah Vancouver Oregon City THE PORTLAND CLINIC AVAILABLE THROUGH KAISER PERMANENTE Kaiser Permanente health plans include access to primary care and specialty care at The Portland Clinic. Members who access The Portland Clinic will find the same high-quality care they have come to expect from Kaiser Permanente and will have access to an additional 6 locations. Visit kp.org/theportlandclinic for more information. 55 MEDICAL FACILITIES Portland-area medical centers 1 Kaiser Permanente Sunnyside Medical Center SE Sunnyside Road Clackamas, OR Kaiser Permanente Westside Medical Center 875 NW Stucki Ave. Hillsboro, OR OHSU Doernbecher Children s Hospital 3181 SW Sam Jackson Park Road Portland, OR 9739 (For children 17 and younger) Portland-area medical offices 4 Beaverton Medical Office 4855 SW Western Ave. Beaverton, OR Brookside Center SE Sunnyside Road Clackamas, OR Care Essentials by Kaiser Permanente 1035 NW Northrup St. Portland, OR Cedar Hills Medical Office 1450 SW Walker Rd. Beaverton, OR Center for Health Research 3800 N. Interstate Ave. Portland, OR Clackamas Eye Care 1100 SE Stevens Court, Suite 106 Portland, OR Gateway Medical Office 1700 NE 10nd Ave. Portland, OR Hillsboro Medical Office 5373 E. Main St. Hillsboro, OR Interstate Medical Office Central 3600 N. Interstate Ave. Portland, OR Interstate Medical Office East 3550 N. Interstate Ave. Portland, OR Interstate Medical Office South 3500 N. Interstate Ave. Portland, OR Interstate Medical Office West 335 N. Interstate Ave. Portland, OR Interstate Radiation Oncology Center 360 N. Interstate Ave. Portland, OR Lake Road Nephrology Center 690 SE Lake Road, Suite 100 Milwaukie, OR Mt. Scott Medical Office 9800 SE Sunnyside Road Clackamas, OR 97015

7 19 Mt. Talbert Medical Office SE Sunnyside Road Clackamas, OR Murrayhill Medical Office 1100 SW Murray Scholls Place, Suite 100 Beaverton, OR One Town Center SE Sunnyside Road, Suite 490 Clackamas, OR Rockwood Medical Office SE Stark St. Portland, OR Sunnybrook Medical Office 9900 SE Sunnyside Road Clackamas, OR Sunnyside Medical Office SE Sunnyside Road Clackamas, OR Sunset Medical Office NW Evergreen Parkway Hillsboro, OR Tualatin Medical Office SW 90th Ave. Tualatin, OR Westside Medical Office 875 NW Stucki Ave. Hillsboro, OR 9714 (located inside Kaiser Permanente Westside Medical Center) The Portland Clinic facilities* 8 The Portland Clinic Beaverton SW Millikan Way Beaverton, OR The Portland Clinic Columbia 5847 NE 1nd Ave. Portland, OR The Portland Clinic Downtown 800 SW 13th Ave. Portland, OR The Portland Clinic East 541 NE 0th Ave., Suite 10 Portland, OR The Portland Clinic South 6640 SW Redwood Lane Portland, OR The Portland Clinic Tigard 950 SW Hall Blvd. Tigard, OR 973 Vancouver-area medical center and offices 34 Legacy Salmon Creek Medical Center 11 NE 139th St. Vancouver, WA (4-hour, emergency, low-risk childbirth, and selected services only) 35 Cascade Park Medical Office 1607 SE Mill Plain Blvd. Vancouver, WA Mill Plain One Medical Office 03 SE Park Plaza Drive, Suite 140 Vancouver, WA Orchards Medical Office 7101 NE 137th Ave. Vancouver, WA Salmon Creek Medical Office NE 0th Ave. Vancouver, WA Salem-area medical center and offices 39 Salem Hospital 890 Oak St. SE Salem, OR Keizer Station Medical Office 5940 Ulali Drive Keizer, OR North Lancaster Medical Office 400 Lancaster Drive NE Salem, OR Skyline Medical Office 515 Skyline Road S. Salem, OR West Salem Medical Office 1160 Wallace Road NW Salem, OR Longview-area medical center and office 44 PeaceHealth St. John Medical Center 1614 E. Kessler Blvd. Longview, WA Longview-Kelso Medical Office 130 Seventh Ave. Longview, WA 9863 Eugene-Springfield-area medical office 46 Downtown Eugene Medical Office 100 W. 13th Ave. Eugene, OR Battle Ground-area medical office 47 Battle Ground Medical Office 70 W. Main St., Suite 15 Battle Ground, WA DENTAL FACILITIES Portland-area dental offices Aloha Dental Office SW Tualatin Valley Hwy. Beaverton, OR Beaverton Dental Office 4855 SW Western Ave. Beaverton, OR Cedar Hills Dental Office 1450 SW Walker Rd. Beaverton, OR Clackamas Dental Office 1009 SE Sunnyside Road Clackamas, OR Eastmoreland Dental Office 505 SE 8th Ave. Portland, OR Glisan Dental Office 1010 NE Glisan St. Portland, OR Grand Avenue Dental Office 1314 NE Grand Ave. Portland, OR Gresham Dental Office 360 NW Burnside St. Gresham, OR Kaiser Permanente Dental at Johnson Creek 9300 SE 91st Ave., Ste. 310 Happy Valley, OR North Interstate Dental Office 701 N. Interstate Ave. Portland, OR Oregon City Dental Office 1900 McLoughlin Blvd., Suite 68 Oregon City, OR Rockwood Dental Office 8 NE 181st Ave. Portland, OR Sunset Dental Office NW Tanasbourne Drive Hillsboro, OR Tigard Dental Office 7105 SW Hampton St. Tigard, OR 973 Vancouver-area dental offices 6 Cascade Park Dental Office 1711 SE Mill Plain Blvd. Vancouver, WA Salmon Creek Dental Office NE 0th Ave. Vancouver, WA Salem-area dental offices 64 North Lancaster Dental Office 300 Lancaster Drive NE Salem, OR Skyline Dental Office 5135 Skyline Road S. Salem, OR Longview-area dental office 66 Longview-Kelso Dental Office 130 Seventh Ave. Longview, WA 9863 Eugene-Springfield-area dental office 67 Valley River Dental Office 1011 Valley River Way Eugene, OR *Available to all Kaiser Permanente members except those on Medicaid, receiving full financial assistance, or visiting from another Kaiser Permanente region.

8 PLAN OVERVIEWS All our plans give your employees what they need to help them be healthier and more productive every day prevention, health promotion, and care for ongoing health conditions. You have lots of choices, from traditional copay plans to consumer-directed options, from out-of-area coverage to dental coverage. Here s a quick overview of what we offer. For plan specifics, contact your Kaiser Permanente representative. TRADITIONAL COPAY PLAN Predictable copays and out-of-pocket maximums make it easier for employees to manage their health care spending and give them financial peace of mind. You ll appreciate the variety of copay options. DEDUCTIBLE PLANS You ll get more options at an affordable cost. With the addition of an employee deductible and out-of-pocket cost, monthly payments are lower than for traditional copay plans. You ll be able to reduce premiums while still maintaining quality care and access to our doctors for your employees. HSA-QUALIFIED HIGH DEDUCTIBLE PLANS Offer lower premiums than other plan types, plus tax savings. 1 With our HSAqualified high deductible plans and deductible plans with health reimbursement arrangement (HRA), your employees will have more control over their health care dollars, helpful online decision-support tools, and the same high-value access to services as members of our traditional plans. ADDED CHOICE POS PLANS An Added Choice plan gives your employees the opportunity to keep their current doctor or have the flexibility to choose providers and services from an external provider network. With an Added Choice plan, members benefit from being able to access care from any licensed provider for covered services. KAISER PERMANENTE SENIOR ADVANTAGE PLAN Provides your retirees over 65 with the benefits of Medicare Advantage and Kaiser Permanente s award-winning care. DENTAL PLANS Choose from our cost-effective Traditional HMO dental plans or flexible Dental Choice PPO plans. We have a range of options with comprehensive coverage to meet the unique needs of your employees. Our Dental Choice PPO is designed for flexibility and choice allowing members to see any dentist. 1 The tax references relate to federal income tax only. Consult with your financial or tax advisor for information about state income tax laws. Kaiser Foundation Health Plan of the Northwest s Medicare and commercial health plans are the highest rated plans among health plans in Oregon and Washington, according to NCQA s Medicare Health Insurance Plan Ratings for and NCQA s Private Health Insurance Plan Ratings for Please contact your Kaiser Permanente representative for help building your health care strategy. 8

9 THE RIGHT PLAN FOR YOUR BUSINESS You have the ability to customize a medical plan with vision and/or alternative care benefit options, based on your company s needs and budget. Follow the 3 easy steps to choose a health plan that s right for your business. STEP 1: CHOOSE YOUR MEDICAL PLAN OR PLANS Traditional plans KP OR Platinum 0/0 KP OR Gold 0/30 Deductible plans KP OR Platinum 50/0 KP OR Gold 500/0 KP OR Gold 1000/0 KP OR Gold 1500/35 KP OR Silver 000/40 KP Oregon Standard Gold Plan KP Oregon Standard Silver Plan KP OR Silver 3500/40 KP OR Bronze 5000/50 KP OR Bronze 6600/40 HSA-qualified high deductible health plans KP OR Silver 700/5% HSA KP OR Bronze 500/0 HSA KP Oregon Standard Bronze HSA Plan Added Choice deductible plans 1 KP OR Platinum 50/10 3T POS KP OR Platinum 50/10 3T POS OOA KP OR Gold 600/35 3T POS KP OR Gold 600/35 3T POS OOA KP OR Gold 1000/35 3T POS KP OR Gold 1000/35 3T POS OOA KP OR Silver 500/40 3T POS KP OR Silver 500/40 3T POS OOA STEP : CHOOSE YOUR OPTIONAL BUY-UP COVERAGE All our medical plans, with the exception of the Oregon Standard plans, can be paired with any of the following buy-up options when purchased directly through Kaiser Permanente: A. Vision: Adult vision hardware ($00 benefit/-year period) with adult vision exam (primary care office visit cost share applies). B. Alternative Care: Chiropractic, naturopathic, acupuncture ($0/visit), and massage therapy ($5/visit, 1 visits per year), with a combined $1,000 benefit maximum. C. Vision + Alternative Care: Bundle of Options A and B above. STEP 3: APPLY OR RENEW YOUR COVERAGE New groups: Complete the Small Business employer application and submit it to a Kaiser Permanente sales executive by the 0th of the month prior to the effective date. Renewing groups: If you would like to elect one of these options, please indicate your selection on the Renewal Decision Form and return it to your Kaiser Permanente account manager no later than the 15th of the month prior to your anniversary date. We will provide you with coverage options that best match the plan or plans your business offers today, but you can choose from any of our other plans available to small employers if you prefer. 1 If you have employees who both live and work outside our service area, we may be able to set them up on an Added Choice plan. Rates and approval subject to underwriting. POS OOA plans: Groups must meet underwriting requirements to purchase. 9

10 PLAN HIGHLIGHTS FOR BUNDLED PLAN OPTIONS SOLUTIONS FOR EMPLOYERS AND CHOICE FOR EMPLOYEES You re looking for more plan options, more services, and more doctor choices for your employees, but without the added complexity that usually comes with more plans. With us, you can get all of this and choose your contribution level. Select or 3 medical plans to offer your employees. There is a limit of one traditional plan per bundle and one point-of-service plan per bundle. As an employer, your contribution for each plan will be the same. It must be at least 50% but not more than 100% of the lowest-cost plan. Then each of your employees can choose the plan in the bundle that best meets his or her needs. If employees select a higher-cost plan, they will pay the difference. To help your employees choose the right plan, we will provide you with enrollment packages customized for the bundle you ve chosen. The package will explain the differences among all the plans so your employees can choose the features that are most important to them. PLAN OPTIONS METAL TIER Traditional Deductible HDHP POS PLATINUM KP OR PLATINUM 0/0 KP OR PLATINUM 50/0 KP OR PLATINUM 50/10 3T POS* KP OR PLATINUM 50/10 3T POS OOA* GOLD KP OR GOLD 0/30 KP OR GOLD 500/0 KP OR GOLD 1000/0 KP OR GOLD 1500/35 KP OREGON STANDARD GOLD PLAN SILVER KP OR SILVER 000/40* KP OREGON STANDARD SILVER PLAN BRONZE KP OR BRONZE 5000/50 *Offered only outside the health insurance exchange. KP OR BRONZE 6600/40 KP OR SILVER 700/5% HSA KP OR BRONZE 500/0 HSA KP OREGON STANDARD BRONZE HSA PLAN KP OR GOLD 600/35 3T POS* KP OR GOLD 600/35 3T POS OOA* KP OR GOLD 1000/35 3T POS* KP OR GOLD 1000/35 3T POS OOA* KP OR SILVER 500/40 3T POS* KP OR SILVER 500/40 3T POS OOA* Buy-up options Any of the above medical plans, when purchased directly through Kaiser Permanente, can be paired with a buy-up option listed below, with the exception of the Standard plans. A. Vision: $00/-year period vision hardware benefit and vision exam B. Alternative Care: $0 chiro/natur/acu, $5 massage/$1,000 max C. Vision + Alternative Care: Bundle of Options A and B above 10

11 PLAN HIGHLIGHTS FOR TRADITIONAL COPAY PLANS ENJOY WIDE ACCESS TO OUR UNIQUE INTEGRATED HEALTH CARE SYSTEM As a small employer, you know that when employees miss work, it can mean lost profits and business opportunities. What would it mean to you if employees could get most of their care during one appointment without running all over town for specialty appointments, labs, and X-ray services? Your employees can choose a medical office close to home or work where they will find a full range of health care services in one convenient location. And because almost everything is under one roof, care can be efficiently coordinated among physicians, specialists, lab personnel, pharmacists, and other medical staff. 11

12 TRADITIONAL COPAY PLANS PLAN NAME KP OR PLATINUM 0/0 KP OR GOLD 0/30 ANNUAL OUT-OF-POCKET MAXIMUM $3,000 per individual; $6,000 per family $5,50 per individual; $10,500 per family BENEFITS MEMBER PAYS OFFICE VISITS Preventive care $0 $0 Primary care $0 $30 Urgent care $40 $50 Specialty care $30 $40 Prenatal care $0 $0 Allergy shots and other injections $10 $10 Routine immunizations for children $0 $0 OUTPATIENT THERAPIES 1 Physical, occupational, and speech $30 $40 OUTPATIENT SURGERY $100 35% LAB $0 $30 X-RAY/DIAGNOSTIC TEST $0 $30 CT, MRI, AND PET SCANS $75 $300 INPATIENT HOSPITAL CARE $300/day, $1,500 per admit $500/day, $,500 per admit EMERGENCY DEPARTMENT VISIT $150 $300 AMBULANCE SERVICES $150 $00 MENTAL HEALTH SERVICES Inpatient psychiatric care $300 $500 Residential treatment $300 $500 Outpatient/day treatment $0 $30 CHEMICAL DEPENDENCY SERVICES Inpatient care $300 $500 Residential treatment $300 $500 Outpatient/day treatment $0 $30 DURABLE MEDICAL EQUIPMENT 0% 35% INFERTILITY SERVICES (diagnosis) 50% 50% DEPENDENT OUT-OF-AREA 0% coinsurance for up to 5 office visits, 5 X-rays, and 5 prescription fills 0% coinsurance for up to 5 office visits, 5 X-rays, and 5 prescription fills PHYSICIAN-REFERRED ALTERNATIVE CARE $30 $40 OUTPATIENT PRESCRIPTION DRUGS $5 generic; $15 preferred brand; $15 generic; $30 preferred brand; $50 non-preferred brand; 50% specialty $60 non-preferred brand; 50% specialty VISION HARDWARE PEDIATRIC No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses OUTPATIENT ADMINISTERED MEDICATIONS 0% 0% MATERNITY CARE Inpatient $300/day, $1,500 per admit $500/day, $,500 per admit 1 Rehabilitative, habilitative services, and neurodevelopmental therapy have separate limits of 30 visits each per calendar year. Referred chiropractic/naturopathic/acupuncture based upon medical criteria. 1

13 PLAN HIGHLIGHTS FOR DEDUCTIBLE PLANS Our deductible plans offer various copays, coinsurance levels, deductibles, and out-of-pocket maximums to help you reduce your premiums. Just like our traditional copay plans, our deductible plans give your employees access to our broad range of primary care, specialty care, and hospital services. Many preventive services are covered in full without the need to satisfy a deductible. Because all the plans have an out-of-pocket maximum, employees know both their health and financial security are being protected. WHEN THE DEDUCTIBLE APPLIES The member will be charged the full costs of these services, until they reach their deductible. Ambulance services Chemical dependency care (inpatient/residential) Durable medical equipment (outpatient) Emergency services Home health services Inpatient hospitalization Mental health services (inpatient/residential) Outpatient or same-day surgery Skilled nursing facility services WHEN THE DEDUCTIBLE DOES NOT APPLY The member will be charged the copay or coinsurance for these services, regardless of whether they have met their deductible. Office visits for primary, preventive, and prenatal and postpartum care and for routine eye exams Hospice* Immunizations Prescription drugs* OUT-OF-POCKET MAXIMUM ON DEDUCTIBLE PLANS Amounts paid toward the deductible count toward the out-of-pocket maximum. All copays and coinsurance apply to the out-of- pocket maximum. After meeting the out-of-pocket maximum, no further costs apply for the remainder of the calendar year. Visit kp.org/deductibleplans for more details. *Some plans are different. Please check your benefit summary for details. 13

14 DEDUCTIBLE PLANS PLAN NAME ANNUAL DEDUCTIBLE Accumulates to annual out-of-pocket maximum KP OR PLATINUM 50/0 $50 per individual; $500 per family KP OR GOLD 500/0 $500 per individual; $1,000 per family 14 KP OR GOLD 1000/0 $1,000 per individual; $,000 per family KP OREGON STANDARD GOLD PLAN $1,000 per individual; $,000 per family KP OR GOLD 1500/35 $1,500 per individual; $3,000 per family Drug deductible $0 $0 $0 $0 $0 ANNUAL OUT-OF-POCKET MAXIMUM BENEFITS $,000 per individual; $4,000 per family $5,850 per individual; $11,700 per family $6,000 per individual; $1,000 per family MEMBER PAYS $6,850 per individual; $13,700 per family $6,000 per individual; $1,000 per family OFFICE VISITS Preventive care $0 $0 $0 $0 $0 Primary care $0 $0 $0 $0 $35 Urgent care $40 $40 $40 $60 $55 Specialty care $30 $30 $30 $40 $45 Prenatal care $0 $0 $0 0% t $0 Allergy shots and other injections $10 $10 $10 0% t $10 Routine immunizations for children $0 $0 $0 $0 $0 OUTPATIENT THERAPIES 1 Physical, occupational, and speech $30 $30 $30 $0 $45 OUTPATIENT SURGERY 10% t 0% t 0% t 0% t 0% t LAB $10 $0 $0 0% t $40 X-RAY/DIAGNOSTIC TEST $10 $0 $0 0% t $40 CT, MRI, AND PET SCANS $75 $300 $300 0% t $300 INPATIENT HOSPITAL CARE 10% t 0% t 0% t 0% t 0% t EMERGENCY DEPARTMENT VISIT 10% t 0% t 0% t 0% t 0% t AMBULANCE SERVICES 10% t 0% t 0% t 0% t 0% t MENTAL HEALTH SERVICES Inpatient psychiatric care 10% t 0% t 0% t 0% t 0% t Residential treatment 10% t 0% t 0% t 0% t 0% t Outpatient/day treatment $0 $0 $0 $0 $35 CHEMICAL DEPENDENCY SERVICES Inpatient care 10% t 0% t 0% t 0% t 0% t Residential treatment 10% t 0% t 0% t 0% t 0% t Outpatient/day treatment $0 $0 $0 $0 $35 DURABLE MEDICAL EQUIPMENT 10% t 0% t 0% t 0% t 0% t INFERTILITY SERVICES (diagnosis) 50% 50% 50% Not covered 50% DEPENDENT OUT-OF-AREA 0% coinsurance for up to 5 office visits, 5 X-rays, and 5 prescription fills 0% coinsurance for up to 5 office visits, 5 X-rays, and 5 prescription fills 0% coinsurance for up to 5 office visits, 5 X-rays, and 5 prescription fills Not covered 0% coinsurance for up to 5 office visits, 5 X-rays, and 5 prescription fills PHYSICIAN-REFERRED ALTERNATIVE CARE $30 $30 $30 Not covered $45 OUTPATIENT PRESCRIPTION DRUGS $5 generic; $15 $15 generic; $30 $10 generic; $0 $10 generic; $30 $10 generic; $0 preferred brand; $50 preferred brand; $60 preferred brand; $60 preferred brand; 50% preferred brand; $60 non-preferred brand; non-preferred brand; non-preferred brand; non-preferred brand; non-preferred brand; 50% specialty 50% specialty 50% specialty 50% specialty 50% specialty VISION HARDWARE PEDIATRIC No charge for 1 pair standard frames w/ lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses No charge for 1 pair standard frames w/ lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses No charge for 1 pair standard frames w/ lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses No charge for 1 pair standard frames w/ lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses No charge for 1 pair standard frames w/ lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses OUTPATIENT ADMINISTERED MEDICATIONS 10% t 0% t 0% t $0 0% t MATERNITY CARE Inpatient 10% t 0% t 0% t 0% t 0% t t Subject to deductible. 1 Rehabilitative, habilitative services, and neurodevelopmental therapy have separate limits of 30 visits each per calendar year. Referred chiropractic/naturopathic/acupuncture based upon medical criteria.

15 DEDUCTIBLE PLANS PLAN NAME ANNUAL DEDUCTIBLE Accumulates to annual out-of-pocket maximum KP OR SILVER 000/40 $,000 per individual; $4,000 per family KP OREGON STANDARD SILVER PLAN $,500 per individual; $5,000 per family 15 KP OR SILVER 3500/40 $3,500 per individual; $7,000 per family KP OR BRONZE 5000/50 $5,000 per individual; $10,000 per family KP OR BRONZE 6600/40 $6,600 per individual; $13,00 per family Drug deductible $0 $0 $0 $700 $400 ANNUAL OUT-OF-POCKET MAXIMUM BENEFITS $7,350 per individual; $14,700 per family $7,350 per individual; $14,700 per family $7,350 per individual; $14,700 per family MEMBER PAYS $7,150 per individual; $14,300 per family $7,150 per individual; $14,300 per family OFFICE VISITS Preventive care $0 $0 $0 $0 $0 Primary care $40 $40 $40 $50 $40 Urgent care $50 $70 $70 30% t $100 t Specialty care $50 $80 $50 $60 t 50% t Prenatal care $0 30% t $0 $0 $0 Allergy shots and other injections $10 30% t $10 $10 $10 Routine immunizations for children $0 $0 $0 $0 $0 OUTPATIENT THERAPIES 1 Physical, occupational, and speech $50 $40 $50 $60 t 50% t OUTPATIENT SURGERY 30% t 30% t 30% t 30% t 50% t LAB $40 30% t $40 30% t 50% t X-RAY/DIAGNOSTIC TEST $40 30% t $40 30% t 50% t CT, MRI, AND PET SCANS 30% t 30% t 30% t 30% t 50% t INPATIENT HOSPITAL CARE 30% t 30% t 30% t 30% t 50% t EMERGENCY DEPARTMENT VISIT 30% t 30% t 30% t 30% t 50% t AMBULANCE SERVICES 30% t 30% t 30% t 30% t 50% t MENTAL HEALTH SERVICES Inpatient psychiatric care 30% t 30% t 30% t 30% t 50% t Residential treatment 30% t 30% t 30% t 30% t 50% t Outpatient/day treatment $40 $40 $40 $50 50% t CHEMICAL DEPENDENCY SERVICES Inpatient care 30% t 30% t 30% t 30% t 50% t Residential treatment 30% t 30% t 30% t 30% t 50% t Outpatient/day treatment $40 $40 $40 $50 50% t DURABLE MEDICAL EQUIPMENT 30% t 30% t 30% t 30% t 50% t INFERTILITY SERVICES (diagnosis) 50% Not covered 50% 50% 50% DEPENDENT OUT-OF-AREA 0% coinsurance for up to 5 office visits, 5 X-rays, and 5 prescription fills Not covered 0% coinsurance for up to 5 office visits, 5 X-rays, and 5 prescription fills 0% coinsurance for up to 5 office visits, 5 X-rays, and 5 prescription fills 0% coinsurance for up to 5 office visits, 5 X-rays, and 5 prescription fills PHYSICIAN-REFERRED ALTERNATIVE CARE $50 Not covered $50 $60 50% OUTPATIENT PRESCRIPTION DRUGS $5 generic; $60 $30 generic; 30% $30 generic; $50 $15 generic; $60 $30 generic; $50 preferred brand; preferred brand; preferred brand; 30% preferred brand; 50% preferred brand; 30% 50% non-preferred 50% non-preferred non-preferred brand; non-preferred brand; non-preferred brand; brand; 50% after Rx brand; 50% after Rx 50% specialty 50% specialty 50% specialty deductible deductible VISION HARDWARE PEDIATRIC No charge for 1 pair standard frames w/ lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses No charge for 1 pair standard frames w/ lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses No charge for 1 pair standard frames w/ lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses No charge for 1 pair standard frames w/ lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses No charge for 1 pair standard frames w/ lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses OUTPATIENT ADMINISTERED MEDICATIONS 30% t $0 30% t 30% t 50% t MATERNITY CARE Inpatient 30% t 30% t 30% t 30% t 50% t t Subject to deductible. 1 Rehabilitative, habilitative services, and neurodevelopmental therapy have separate limits of 30 visits each per calendar year. Referred chiropractic/naturopathic/acupuncture based upon medical criteria.

16 PLAN HIGHLIGHTS FOR HSA-QUALIFIED HIGH DEDUCTIBLE HEALTH PLANS Health savings account (HSA) qualified plans encourage employees to become more involved with their own health care spending and their own health. If you re struggling with the high cost of health care, this could be a good option for you. An HSA is an easy-to-administer, tax-exempt account that is paired with an HSA-qualified high deductible plan. It allows your employees to pay for current health expenses and save for future qualified expenses on a tax-free basis.* Individual members own these accounts and keep their HSA if they change jobs or become unemployed. Unlike a flexible spending account, there is no use it or lose it provision. Instead, unused contributions roll over each year and can be used for future medical expenses, including long-term care and insurance. Employers and/or individuals can contribute to these accounts. Annual contributions from all sources are limited to the amount of the HSA-qualified plan deductible. More detailed information can be found in IRS publication 50. Unlike financial savings vehicles like IRAs, HSAs have the potential to offer triple tax savings with: Tax-free contributions Tax-free investment earnings Tax-free withdrawals for qualified medical expenses *The tax references in this brochure relate to federal income tax only. Consult with your financial or tax adviser for more information about state income tax laws. 16

17 HSA-QUALIFIED HIGH DEDUCTIBLE HEALTH PLANS PLAN NAME KP OR SILVER 700/5% HSA KP OR BRONZE 500/0 HSA ANNUAL DEDUCTIBLE Accumulates to annual out-of-pocket maximum $,700 per individual; $5,400 per family $5,00 per individual; $10,400 per family KP OREGON STANDARD BRONZE HSA PLAN $6,550 per individual; $13,100 per family Drug deductible $0 $0 $0 ANNUAL OUT-OF-POCKET MAXIMUM BENEFITS $5,400 per individual; $10,800 per family $6,550 per individual; $13,100 per family MEMBER PAYS $6,550 per individual; $13,100 per family OFFICE VISITS Preventive care 0% 0% $0 Primary care 5% t $0 t 0% t Urgent care 5% t 50% t 0% t Specialty care 5% t $30 t 0% t Prenatal care 0% 0% 0% t Allergy shots and other injections 5% t 50% t 0% t Routine immunizations for children 0% 0% $0 OUTPATIENT THERAPIES 1 Physical, occupational, and speech 5% t $30 t 0% t OUTPATIENT SURGERY 5% t 50% t 0% t LAB 5% t 50% t 0% t X-RAY/DIAGNOSTIC TEST 5% t 50% t 0% t CT, MRI, AND PET SCANS 5% t 50% t 0% t INPATIENT HOSPITAL CARE 5% t 50% t 0% t EMERGENCY DEPARTMENT VISIT 5% t 50% t 0% t AMBULANCE SERVICES 5% t 50% t 0% t MENTAL HEALTH SERVICES Inpatient psychiatric care 5% t 50% t 0% t Residential treatment 5% t 50% t 0% t Outpatient/day treatment 5% t $0 t 0% t CHEMICAL DEPENDENCY SERVICES Inpatient care 5% t 50% t 0% t Residential treatment 5% t 50% t 0% t Outpatient/day treatment 5% t $0 t 0% t DURABLE MEDICAL EQUIPMENT 5% t 50% t 0% t INFERTILITY SERVICES (diagnosis) 50% t 50% t Not covered DEPENDENT OUT-OF-AREA 0% t coinsurance for up to 5 office visits, 5 X-rays, and 5 prescription fills 0% t coinsurance for up to 5 office visits, 5 X-rays, and 5 prescription fills Not covered PHYSICIAN-REFERRED ALTERNATIVE CARE 5%t $30 t Not covered OUTPATIENT PRESCRIPTION DRUGS VISION HARDWARE PEDIATRIC $0 generic; $40 preferred brand; 30% non-preferred brand; 50% t specialty No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses $0 generic; 50% preferred brand; 50% non-preferred brand; 50% t specialty No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses 0% t generic; 0% preferred brand; 0% non-preferred brand; 0% t specialty No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses OUTPATIENT ADMINISTERED MEDICATIONS 5% t 50% t 0% t MATERNITY CARE Inpatient 5% t 50% t 0% t t Subject to deductible. 1 Rehabilitative, habilitative services, and neurodevelopmental therapy have separate limits of 30 visits each per calendar year. Referred chiropractic/naturopathic/acupuncture based upon medical criteria. 17

18 KAISER PERMANENTE CONSUMER-DIRECTED PLANS An easier approach to consumer-directed care When it comes to health care, you expect plans that are simple and easy to use not just for you, but for your employees. You need financial account options that give you flexibility and control over your health care dollars. And you want it all from a trusted partner who can guide you every step of the way. That s the solution you get with health payment accounts administered through Kaiser Permanente. MOBILE ACCESS KEEPS EMPLOYEES CONNECTED Employees with iphone and Android devices can download our Balance Tracker app and check balances and account activity on the go. For extra convenience, employees with HRA and FSA plans can avoid paperwork by submitting financial account claims and other information using their smartphone cameras. 1 You can choose from 3 categories of health payment accounts health reimbursement arrangement (HRA), health savings account (HSA), and flexible spending account (FSA) to create an approach that works for your business. And with our enhanced administrative capabilities, you can combine a variety of plans with these accounts to get a solution that lets you spend less time managing your employees health care expenses and more time moving your business forward. A dedicated team of support specialists makes sure you and your employees get the help you need to make the most of your health care solution with Kaiser Permanente. You get: Administrative support from setup to day-to-day management Flexible account options Integrated enrollment and eligibility management A convenient portal for administration Automated reports and notifications on balances, reimbursements, and more Your employees get: A convenient method of payment or reimbursement, no matter which type of account you offer The ability to access and manage their personal health information and health payment account just by signing on to kp.org Live phone support For more information on consumer-directed health plans, please contact your sales executive or account manager. iphone is a trademark of Apple, Inc., registered in the U.S. and other countries. Android is a trademark of Google, Inc. 18

19 KAISER PERMANENTE CONSUMER-DIRECTED PLANS Product pairings Take advantage of Kaiser Permanente s paired consumer-directed health care offerings by choosing the plan and health payment account that work for you. HRA HSA FSA Employees can use funds contributed by you to pay for qualified medical expenses on a tax-free basis. There are several HRA types available, from broad to more limited coverage, with options for point-of-service payment using our health payment card or convenient automatic reimbursement. These employee-owned accounts can be used to pay for qualified medical expenses, including services not covered under the Kaiser Permanente health plan. The money your employees contribute to their HSAs through payroll withholding isn t considered part of their wages, so they won t be taxed on it. They can also contribute after-tax funds. Mutual fund investment options are available with HSAs as well. With a medical FSA, your employees make pretax contributions to an account they can use to pay for a wide range of qualified expenses such as doctor visits, prescription drugs, and lab tests, including services not covered under the Kaiser Permanente health plan. A dependent care FSA can be used for expenses such as child care. The integrated difference You can choose from a variety of deductibles, copays, and coinsurance for your employees and their families. In addition to the flexibility of these health payment account options, you get the unmatched quality of our integrated care delivery system. So your employees receive better care that s more efficient which means healthier outcomes for them, less time away from work, and lower costs for you. And you get a partner committed to protecting your employees and building a stronger future for your business. 1 Applies only to HRA and FSA. Refer to IRS Publication 50 for a list of qualified medical and dental expenses. Refer to IRS Publication 503 for a list of qualified child and dependent care expenses. 3 Except for self-funded groups. 4 For HSAs, employers may choose to have their employees billed for the administrative fees. The tax references in this flier relate to federal income tax only. Consult with your financial or tax advisor for information about state income tax laws. Information may have changed since publication. KAISER PERMANENTE S HEALTH PAYMENT ACCOUNTS HRA HSA FSA $3.75 per account per month $3.5 per account per month $3.75 per account per month Account fees are per employee account per month. They ll be billed monthly to the employer, separate from the premium. 3 There are no additional setup fees for standard account types and no transaction or annual debit card fees. 4 HELPFUL TOOLS AND RESOURCES HSA calculators Visit kp.org/deductibleplans and click Resources to see how much you can save by using our tax savings and future value calculators. Online access, 4/7 Check your account balances, view transactions, make contributions, request reimbursements, and more through kp.org. Mobile access Download our secure HRA/HSA/FSA Balance Tracker app to your smartphone or tablet to view and manage your account on the go. Customer support Call our Health Payment Services team at , Monday through Friday (except holidays), 5 a.m. to 7 p.m. Pacific time. 19

20 PLAN HIGHLIGHTS FOR ADDED CHOICE POINT-OF-SERVICE PLANS CHOICE AND FLEXIBILITY Would you like to give your employees the opportunity to keep their current doctor or have the option of seeing any licensed provider for covered services at any time? Do you have employees who travel for extended periods and need access to routine care? We offer the option to see any licensed provider in the nation for covered services along with exclusive access to select providers.* With our solution, your employees can: Go to a select provider and receive quality care at an affordable price (Tier 1 benefits). Go to a preferred (PPO) provider anywhere in the nation and receive care with higher copays and coinsurance. Go to non-participating providers nationwide and receive care with higher member cost-sharing and limits on coverage. Members may need to make their own financial arrangements. See the detailed plan information and Evidence of Coverage for more information. Visit kp.org/medicalstaff to locate Tier 1 providers. Visit kp.org/addedchoice to locate Tier providers. Tier services in a 3-tier plan are provided by PPO providers and facilities. Refer to the Evidence of Coverage for a complete definition of PPO providers and facilities. Tier 3 services in a 3-tier plan are provided by non-participating providers and facilities. Refer to the Evidence of Coverage for a complete definition of non-participating providers and facilities. Deductible and out-of-pocket maximum amounts cross accumulate between tiers 1 and. There is a separate deductible and out-ofpocket maximum amount in Tier 3, which does not accumulate across any other tiers. * See the 018 Evidence of Coverage for a complete description of services and providers covered under a plan, including a definition of select provider. 0

21 PLAN HIGHLIGHTS FOR ADDED CHOICE POINT-OF-SERVICE PLANS If you re looking for choice and convenience, we ve got a solution our Added Choice point-of-service (POS) plan. Added Choice members have access to all that Kaiser Permanente offers, plus the option to seek covered services from licensed providers across the country. BENEFIT TIERS Added Choice offers 3 levels of coverage, called tiers. Members can move from 1 tier to another to get care. The choices members make determine which doctors they see, which medical facilities they use, and how much they pay. TIER 1 SELECT PROVIDERS* Members choose a provider from Kaiser Permanente or The Portland Clinic, conveniently located throughout our service area. With a referral, members can also choose other contracted community providers and facilities. This tier has the lowest out-of-pocket costs. $ TIER PPO PROVIDERS* $$ Members choose a preferred provider (PPO) from the First Choice Health Network or the First Health Network. This is a good choice for those who want to keep their current PPO provider or who live outside our service area. TIER 3 NON-PARTICIPATING PROVIDERS* $$$ Members choose a nonparticipating provider nationwide. Non-participating providers include any licensed providers who are not select providers or PPO providers. This tier has the highest outof-pocket costs. *See your Evidence of Coverage (EOC) or visit kp.org/addedchoice for definitions of select provider, PPO provider, and non-participating provider. This brochure is not a contract. Plan details are provided in the EOC. To obtain an EOC for a particular plan, contact Member Services. In the event of any conflict between this brochure and the EOC, the EOC prevails. 1

22 PLAN HIGHLIGHTS FOR ADDED CHOICE POINT-OF-SERVICE PLANS PPO NETWORK: MORE CHOICE, GREATER FLEXIBILITY With the Kaiser Permanente Added Choice plan, members have access to a wide choice of providers, facilities, and hospitals n the First Choice Health Network and First Health Network. Washington 9 hospitals 1,175 facilities 39,100 practitioners Oregon 63 hospitals 491 facilities 18,445 practitioners For a full list of PPO providers and facilities, visit kp.org/addedchoice.

23 ADDED CHOICE POINT-OF-SERVICE PLANS PLAN NAME KP OR PLATINUM 50/10 3T POS KP OR GOLD 600/35 3T POS ANNUAL DEDUCTIBLE Accumulates to annual out-of-pocket maximum Tier 1 Tier Tier 3 Tier 1 Tier Tier 3 $50 per individual; $500 per family $500 per individual; $1,000 per family 3 $750 per individual; $1,500 per family $600 per individual; $1,00 per family $1,800 per individual; $3,600 per family $4,500 per individual; $9,000 per family Drug deductible $0 $0 $0 $0 $0 $0 ANNUAL OUT-OF-POCKET MAXIMUM $,000 per individual; $4,000 per family $3,000 per individual; $6,000 per family $6,000 per individual; $1,000 per family $,500 per individual; $5,000 per family $6,000 per individual; $1,000 per family $8,000 per individual; $16,000 per family BENEFITS MEMBER PAYS OFFICE VISITS Preventive care $0 $0 35% t $0 $0 50% t Primary care $10 $5 35% t $35 $60 50% t Urgent care $40 $55 35% t $60 $80 50% t Specialty care $0 $35 35% t $45 $70 50% t Prenatal care $0 $0 35% t $0 $0 50% t Allergy shots and other injections $10 $0 35% t $10 $30 50% t Routine immunizations for children $0 $0 35% t $0 $0 50% t OUTPATIENT THERAPIES 1 Physical, occupational, and speech $0 $35 35% t $45 $70 50% t OUTPATIENT SURGERY 10% t 5% t 35% t 30% t 50% t 50% t LAB 10% t 5% t 35% t $35 40% t 50% t X-RAY/DIAGNOSTIC TEST $10 $5 35% t 30% 40% t 50% t CT, MRI, AND PET SCANS $100 5% t 35% t $00 t 50% t 50% t INPATIENT HOSPITAL CARE 10% t 5% t 35% t 30% t 50% t 50% t EMERGENCY DEPARTMENT VISIT $100 t 30% t AMBULANCE SERVICES 10% Not covered 10% t 30% t Not covered 50% t MENTAL HEALTH SERVICES Inpatient psychiatric care 10% t 5% t 35% t 30% t 50% t 50% t Residential treatment 10% t 5% t 35% t 30% t 50% t 50% t Outpatient/day treatment $10 $5 35% t $35 $60 50% t CHEMICAL DEPENDENCY SERVICES Inpatient care 10% t 5% t 35% t 30% t 50% t 50% t Residential treatment 10% t 5% t 35% t 30% t 50% t 50% t Outpatient/day treatment $10 $5 35% t $35 $60 50% t DURABLE MEDICAL EQUIPMENT 0% t 35% t 45% t 30% t 50% t 50% t INFERTILITY SERVICES (diagnosis) 50% 50% 50% 50% 50% 50% DEPENDENT OUT-OF-AREA Not covered Not covered Not covered Not covered Not covered Not covered PHYSICIAN-REFERRED ALTERNATIVE CARE $0 Not covered Not covered $45 Not covered Not covered OUTPATIENT PRESCRIPTION DRUGS $10 generic; $0 $15 generic; $30 $10 generic; $0 $5 generic; $75 preferred brand; preferred brand; preferred brand; preferred brand; $50 non-preferred Not covered 50% non-preferred $60 non-preferred Not covered 50% non-preferred brand; 50% brand; brand; brand; 50% specialty 50% specialty 50% specialty specialty VISION HARDWARE PEDIATRIC No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses 50% t for 1 pair standard frames w/ lenses or 6-month supply contact lenses per calendar year; 50% t for low vision aid from selected list or for medically necessary contact lenses No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses 50% t for 1 pair standard frames w/ lenses or 6-month supply contact lenses per calendar year; 50% t for low vision aid from selected list or for medically necessary contact lenses OUTPATIENT ADMINISTERED MEDICATIONS 10% t 5% t 35% t 30% t 50% t 50% t MATERNITY CARE Inpatient 10% t 5% t 35% t 30% t 50% t 50% t t Subject to deductible. 1 Rehabilitative, habilitative services, and neurodevelopmental therapy have separate limits of 30 visits each per calendar year. Referred chiropractic/naturopathic/acupuncture based upon medical criteria.

24 ADDED CHOICE POINT-OF-SERVICE PLANS PLAN NAME ANNUAL DEDUCTIBLE Accumulates to annual out-of-pocket maximum KP OR GOLD 1000/35 3T POS Tier 1 Tier Tier 3 $1,000 per individual; $,000 per family $,000 per individual; $4,000 per family $6,000 per individual; $1,000 per family Drug deductible $0 $0 $0 ANNUAL OUT-OF-POCKET MAXIMUM $3,000 per individual; $6,000 per family $5,000 per individual; $10,000 per family $9,000 per individual; $18,000 per family BENEFITS MEMBER PAYS OFFICE VISITS Preventive care $0 $0 50% t Primary care $35 $60 50% t Urgent care $75 $100 50% t Specialty care $45 $70 50% t Prenatal care $0 $0 50% t Allergy shots and other injections $10 $30 50% t Routine immunizations for children $0 $0 50% t OUTPATIENT THERAPIES 1 Physical, occupational, and speech $45 $70 50% t OUTPATIENT SURGERY 5% t 40% t 50% t LAB $35 40% t 50% t X-RAY/DIAGNOSTIC TEST $35 40% t 50% t CT, MRI, AND PET SCANS $00 40% t 50% t INPATIENT HOSPITAL CARE 5% t 40% t 50% t EMERGENCY DEPARTMENT VISIT AMBULANCE SERVICES 0% Not covered 0% t MENTAL HEALTH SERVICES Inpatient psychiatric care 5% t 40% t 50% t Residential treatment 5% t 40% t 50% t Outpatient/day treatment $35 $60 50% t CHEMICAL DEPENDENCY SERVICES Inpatient care 5% t 40% t 50% t Residential treatment 5% t 40% t 50% t Outpatient/day treatment $35 $60 50% t DURABLE MEDICAL EQUIPMENT 5% t 40% t 50% t INFERTILITY SERVICES (diagnosis) 50% 50% 50% t DEPENDENT OUT-OF-AREA Not covered Not covered Not covered PHYSICIAN-REFERRED ALTERNATIVE CARE $45 Not covered Not covered OUTPATIENT PRESCRIPTION DRUGS $10 generic; $0 preferred brand; $60 non-preferred brand; 50% specialty 5% t Not covered $5 generic; $75 preferred brand; 50% non-preferred brand; 50% specialty VISION HARDWARE PEDIATRIC No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses 50% t for 1 pair standard frames w/ lenses or 6-month supply contact lenses per calendar year; 50% t for low vision aid from selected list or for medically necessary contact lenses OUTPATIENT ADMINISTERED MEDICATIONS 5% 40% 50% t MATERNITY CARE Inpatient 5% t 40% t 50% t t Subject to deductible. 1 Rehabilitative, habilitative services, and neurodevelopmental therapy have separate limits of 30 visits each per calendar year. Referred chiropractic/naturopathic/acupuncture based upon medical criteria. 4

25 ADDED CHOICE POINT-OF-SERVICE PLANS PLAN NAME KP OR SILVER 500/40 3T POS ANNUAL DEDUCTIBLE Accumulates to annual out-of-pocket maximum Tier 1 Tier Tier 3 $,500 per individual; $5,000 per family $4,500 per individual; $9,000 per family $6,500 per individual; $13,000 per family Drug deductible $0 $0 $0 ANNUAL OUT-OF-POCKET MAXIMUM $6,500 per individual; $13,000 per family $7,350 per individual; $14,700 per family $1,500 per individual; $5,000 per family BENEFITS MEMBER PAYS OFFICE VISITS Preventive care $0 $0 50% t Primary care $40 $60 50% t Urgent care $55 $75 50% t Specialty care $50 $70 50% t Prenatal care $0 $0 50% t Allergy shots and other injections $10 $30 50% t Routine immunizations for children $0 $0 50% t OUTPATIENT THERAPIES 1 Physical, occupational, and speech $50 $70 50% t OUTPATIENT SURGERY 30% t 40% t 50% t LAB $40 40% t 50% t X-RAY/DIAGNOSTIC TEST $40 40% t 50% t CT, MRI, AND PET SCANS 30% t 40% t 50% t INPATIENT HOSPITAL CARE 30% t 40% t 50% t EMERGENCY DEPARTMENT VISIT AMBULANCE SERVICES 0% Not covered 0% t MENTAL HEALTH SERVICES Inpatient psychiatric care 30% t 40% t 50% t Residential treatment 30% t 40% t 50% t Outpatient/day treatment $40 $60 50% t CHEMICAL DEPENDENCY SERVICES Inpatient care 30% t 40% t 50% t Residential treatment 30% t 40% t 50% t Outpatient/day treatment $40 $60 50% t DURABLE MEDICAL EQUIPMENT 30% t 40% t 50% t INFERTILITY SERVICES (diagnosis) 50% 50% 50% t DEPENDENT OUT-OF-AREA Not covered Not covered Not covered PHYSICIAN-REFERRED ALTERNATIVE CARE $50 Not covered Not covered OUTPATIENT PRESCRIPTION DRUGS $30 generic; $40 preferred brand; $50 non-preferred brand; 50% specialty 30% t Not covered $30 generic; $60 preferred brand; 50% non-preferred brand; 50% specialty VISION HARDWARE PEDIATRIC No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses 50% t for 1 pair standard frames w/ lenses or 6-month supply contact lenses per calendar year; 50% t for low vision aid from selected list or for medically necessary contact lenses OUTPATIENT ADMINISTERED MEDICATIONS 30% t 40% t 50% t MATERNITY CARE Inpatient 30% t 40% t 50% t t Subject to deductible. 1 Rehabilitative, habilitative services, and neurodevelopmental therapy have separate limits of 30 visits each per calendar year. Referred chiropractic/naturopathic/acupuncture based upon medical criteria. 5

26 ADDED CHOICE POINT-OF-SERVICE OUT-OF-AREA PLANS PLAN NAME ANNUAL DEDUCTIBLE Accumulates to annual out-of-pocket maximum KP OR PLATINUM 50/10 3T POS OOA Tier 1 Tier Tier 3 $50 per individual; $500 per family $50 per individual; $500 per family $750 per individual; $1,500 per family Drug deductible $0 $0 $0 ANNUAL OUT-OF-POCKET MAXIMUM $,000 per individual; $4,000 per family $,000 per individual; $4,000 per family $6,000 per individual; $1,000 per family BENEFITS MEMBER PAYS OFFICE VISITS Preventive care $0 $0 35% t Primary care $10 $10 35% t Urgent care $40 $40 35% t Specialty care $0 $0 35% t Prenatal care $0 $0 35% t Allergy shots and other injections $10 $10 35% t Routine immunizations for children $0 $0 35% t OUTPATIENT THERAPIES 1 Physical, occupational, and speech $0 $0 35% t OUTPATIENT SURGERY 10% t 10% t 35% t LAB 10% t 10% t 35% t X-RAY/DIAGNOSTIC TEST $10 $10 35% t CT, MRI, AND PET SCANS $100 $100 35% t INPATIENT HOSPITAL CARE 10% t 10% t 35% t EMERGENCY DEPARTMENT VISIT AMBULANCE SERVICES 10% Not covered 10% t MENTAL HEALTH SERVICES Inpatient psychiatric care 10% t 10% t 35% t Residential treatment 10% t 10% t 35% t Outpatient/day treatment $10 $10 35% t CHEMICAL DEPENDENCY SERVICES Inpatient care 10% t 10% t 35% t Residential treatment 10% t 10% t 35% t Outpatient/day treatment $10 $10 35% t DURABLE MEDICAL EQUIPMENT 0% t 0% t 45% t INFERTILITY SERVICES (diagnosis) 50% 50% 50% DEPENDENT OUT-OF-AREA Not covered Not covered Not covered PHYSICIAN-REFERRED ALTERNATIVE CARE $0 Not covered Not covered OUTPATIENT PRESCRIPTION DRUGS $10 generic; $0 preferred brand; $50 non-preferred brand; 50% specialty Not covered $10 generic; $0 preferred brand; $50 non-preferred brand; 50% specialty $100 t VISION HARDWARE PEDIATRIC No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses 50% t for 1 pair standard frames w/ lenses or 6-month supply contact lenses per calendar year; 50% t for low vision aid from selected list or for medically necessary contact lenses OUTPATIENT ADMINISTERED MEDICATIONS 10% t 10% t 35% t MATERNITY CARE Inpatient 10% t 10% t 35% t t Subject to deductible. 1 Rehabilitative, habilitative services, and neurodevelopmental therapy have separate limits of 30 visits each per calendar year. Referred chiropractic/naturopathic/acupuncture based upon medical criteria. 6

27 ADDED CHOICE POINT-OF-SERVICE OUT-OF-AREA PLANS PLAN NAME KP OR GOLD 600/35 3T POS OOA ANNUAL DEDUCTIBLE Accumulates to annual out-of-pocket maximum Tier 1 Tier Tier 3 $600 per individual; $1,00 per family $600 per individual; $1,00 per family $4,500 per individual; $9,000 per family Drug deductible $0 $0 $0 ANNUAL OUT-OF-POCKET MAXIMUM $,500 per individual; $5,000 per family $4,500 per individual; $9,000 per family $8,000 per individual; $16,000 per family BENEFITS OFFICE VISITS Preventive care $0 $0 50% t Primary care $35 $35 50% t Urgent care $60 $60 50% t Specialty care $45 $45 50% t Prenatal care $0 $0 50% t Allergy shots and other injections $10 $10 50% t Routine immunizations for children $0 $0 50% t OUTPATIENT THERAPIES 1 Physical, occupational, and speech $45 $45 50% t OUTPATIENT SURGERY 30% t 30% t 50% t LAB $35 $35 50% t X-RAY/DIAGNOSTIC TEST 30% 30% 50% t CT, MRI, AND PET SCANS $00 t $00 t 50% t INPATIENT HOSPITAL CARE 30% t 30% t 50% t EMERGENCY DEPARTMENT VISIT 30% t AMBULANCE SERVICES 30% t Not covered 50% t MENTAL HEALTH SERVICES Inpatient psychiatric care 30% t 30% t 50% t Residential treatment 30% t 30% t 50% t Outpatient/day treatment $35 $35 50% t CHEMICAL DEPENDENCY SERVICES Inpatient care 30% t 30% t 50% t Residential treatment 30% t 30% t 50% t Outpatient/day treatment $35 $35 50% t DURABLE MEDICAL EQUIPMENT 30% t 30% t 50% t INFERTILITY SERVICES (diagnosis) 50% 50% 50% DEPENDENT OUT-OF-AREA Not covered Not covered Not covered PHYSICIAN-REFERRED ALTERNATIVE CARE $45 Not covered Not covered OUTPATIENT PRESCRIPTION DRUGS $10 generic; $0 preferred brand; $60 non-preferred brand; 50% specialty Not covered $10 generic; $0 preferred brand; $60 non-preferred brand; 50% specialty VISION HARDWARE PEDIATRIC No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses 50% t for 1 pair standard frames w/ lenses or 6-month supply contact lenses per calendar year; 50% t for low vision aid from selected list or for medically necessary contact lenses OUTPATIENT ADMINISTERED MEDICATIONS 30% t 30% t 50% t MATERNITY CARE Inpatient 30% t 30% t 50% t t Subject to deductible. 1 Rehabilitative, habilitative services, and neurodevelopmental therapy have separate limits of 30 visits each per calendar year. Referred chiropractic/naturopathic/acupuncture based upon medical criteria. 7

28 ADDED CHOICE POINT-OF-SERVICE OUT-OF-AREA PLANS PLAN NAME KP OR GOLD 1000/35 3T POS OOA ANNUAL DEDUCTIBLE Accumulates to annual out-of-pocket maximum Tier 1 Tier Tier 3 $1,000 per individual; $,000 per family $1,000 per individual; $,000 per family $6,000 per individual; $1,000 per family Drug deductible $0 $0 $0 ANNUAL OUT-OF-POCKET MAXIMUM $3,500 per individual; $7,000 per family $3,500 per individual; $7,000 per family $9,000 per individual; $18,000 per family BENEFITS MEMBER PAYS OFFICE VISITS Preventive care $0 $0 50% t Primary care $35 $35 50% t Urgent care $75 $75 50% t Specialty care $45 $45 50% t Prenatal care $0 $0 50% t Allergy shots and other injections $10 $10 50% t Routine immunizations for children $0 $0 50% t OUTPATIENT THERAPIES 1 Physical, occupational, and speech $45 $45 50% t OUTPATIENT SURGERY 30% t 30% t 50% t LAB $35 $35 50% t X-RAY/DIAGNOSTIC TEST $35 $35 50% t CT, MRI, AND PET SCANS $300 $300 50% t INPATIENT HOSPITAL CARE 30% t 30% t 50% t EMERGENCY DEPARTMENT VISIT AMBULANCE SERVICES 0% Not covered 0% t MENTAL HEALTH SERVICES Inpatient psychiatric care 30% t 30% t 50% t Residential treatment 30% t 30% t 50% t Outpatient/day treatment $35 $35 50% t CHEMICAL DEPENDENCY SERVICES Inpatient care 30% t 30% t 50% t Residential treatment 30% t 30% t 50% t Outpatient/day treatment $35 $35 50% t DURABLE MEDICAL EQUIPMENT 30% t 30% t 50% t INFERTILITY SERVICES (diagnosis) 50% 50% 50% t DEPENDENT OUT-OF-AREA Not covered Not covered Not covered PHYSICIAN-REFERRED ALTERNATIVE CARE $45 Not covered Not covered OUTPATIENT PRESCRIPTION DRUGS $10 generic; $0 preferred brand; $60 non-preferred brand; 50% specialty Not covered $10 generic; $0 preferred brand; $60 non-preferred brand; 50% specialty 30% t VISION HARDWARE PEDIATRIC No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses 50% t for 1 pair standard frames w/ lenses or 6-month supply contact lenses per calendar year; 50% t for low vision aid from selected list or for medically necessary contact lenses OUTPATIENT ADMINISTERED MEDICATIONS 5% 5% 50% t MATERNITY CARE Inpatient 30% t 30% t 50% t t Subject to deductible. 1 Rehabilitative, habilitative services, and neurodevelopmental therapy have separate limits of 30 visits each per calendar year. Referred chiropractic/naturopathic/acupuncture based upon medical criteria. 8

29 ADDED CHOICE POINT-OF-SERVICE OUT-OF-AREA PLANS PLAN NAME KP OR SILVER 500/40 3T POS OOA ANNUAL DEDUCTIBLE Accumulates to annual out-of-pocket maximum Tier 1 Tier Tier 3 $,500 per individual; $5,000 per family $,500 per individual; $5,000 per family $5,000 per individual; $10,000 per family Drug deductible $0 $0 $0 ANNUAL OUT-OF-POCKET MAXIMUM $6,500 per individual; $13,000 per family $7,150 per individual; $14,300 per family $1,000 per individual; $4,000 per family BENEFITS OFFICE VISITS Preventive care $0 $0 50% t Primary care $40 $40 50% t Urgent care $55 $55 50% t Specialty care $50 $50 50% t Prenatal care $0 $0 50% t Allergy shots and other injections $10 $10 50% t Routine immunizations for children $0 $0 50% t OUTPATIENT THERAPIES 1 Physical, occupational, and speech $50 $50 50% t OUTPATIENT SURGERY 40% t 40% t 50% t LAB 40% t 40% t 50% t X-RAY/DIAGNOSTIC TEST 40% t 40% t 50% t CT, MRI, AND PET SCANS 40% t 40% t 50% t INPATIENT HOSPITAL CARE 40% t 40% t 50% t EMERGENCY DEPARTMENT VISIT 40% t AMBULANCE SERVICES 0% Not covered 0% t MENTAL HEALTH SERVICES Inpatient psychiatric care 40% t 40% t 50% t Residential treatment 40% t 40% t 50% t Outpatient/day treatment $40 $40 50% t CHEMICAL DEPENDENCY SERVICES Inpatient care 40% t 40% t 50% t Residential treatment 40% t 40% t 50% t Outpatient/day treatment $40 $40 50% t DURABLE MEDICAL EQUIPMENT 40% t 40% t 50% t INFERTILITY SERVICES (diagnosis) 50% 50% 50% t DEPENDENT OUT-OF-AREA Not covered Not covered Not covered PHYSICIAN-REFERRED ALTERNATIVE CARE $50 Not covered Not covered OUTPATIENT PRESCRIPTION DRUGS $0 generic; $40 preferred brand; $50 non-preferred brand; 50% specialty Not covered $0 generic; $40 preferred brand; $50 non-preferred brand; 50% specialty VISION HARDWARE PEDIATRIC No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses No charge for 1 pair standard frames w/lenses or 6-month supply contact lenses per calendar year; no charge for low vision aid from selected list or for medically necessary contact lenses 50% t for 1 pair standard frames w/ lenses or 6-month supply contact lenses per calendar year; 50% t for low vision aid from selected list or for medically necessary contact lenses OUTPATIENT ADMINISTERED MEDICATIONS 40% t 40% t 50% t MATERNITY CARE Inpatient 40% t 40% t 50% t t Subject to deductible. 1 Rehabilitative, habilitative services, and neurodevelopmental therapy have separate limits of 30 visits each per calendar year. Referred chiropractic/naturopathic/acupuncture based upon medical criteria. 9

30 PLAN HIGHLIGHTS FOR SENIOR ADVANTAGE Your commitment to high-quality health care for your employees doesn t have to end when they become eligible for Medicare. You can offer your Medicare-eligible employees the same access to our physicians, services, and facilities that our other members enjoy. Kaiser Permanente Senior Advantage (HMO) picks up where Medicare leaves off, combining original Medicare coverage and Kaiser Permanente traditional coverage as well as features unique to Senior Advantage (such as an outside service area benefit and health club benefit) into one comprehensive plan. TO ENROLL IN KAISER PERMANENTE GROUP SENIOR ADVANTAGE Plan members must obtain Medicare Parts A and B and must complete the Kaiser Permanente Senior Advantage enrollment form. EMPLOYERS WITH 1 19 TOTAL EMPLOYEES Medicare-eligible employees and/or their dependents who enroll in Senior Advantage will receive Senior Advantage rates and benefits. (In most cases, Medicare is primary for groups with fewer than 0 employees.) EMPLOYERS WITH 0 50 TOTAL EMPLOYEES Actively working Medicare-eligible employees and/or their dependents may remain on the active plan with active rates and benefits. They may enroll in the Senior Advantage plan and receive active rates and group Senior Advantage benefits. (Medicare is secondary for groups of 0 or more when the member is actively working.) Different rules apply for those who are eligible for Medicare due to disability or end stage renal disease. Contact your Kaiser Foundation Health Plan of the Northwest representative for more information. 30

31 SENIOR ADVANTAGE PLAN PLAN NAME ANNUAL DEDUCTIBLE 018 SENIOR ADVANTAGE No deductible ANNUAL OUT-OF-POCKET MAXIMUM $1,000 BENEFITS OFFICE VISITS Preventive care MEMBER PAYS Primary care $0 Urgent care $5 Specialty care $0 Prenatal care $0 Allergy shots and other injections $10 Routine immunizations $0 OUTPATIENT THERAPIES 1 Physical, occupational, and speech $0 OUTPATIENT SURGERY $50 LAB $0 X-RAY/DIAGNOSTIC TEST $0 CT, MRI, AND PET SCANS $0 $0 INPATIENT HOSPITAL CARE $00 per admission EMERGENCY DEPARTMENT VISIT $50 AMBULANCE SERVICES $100 MENTAL HEALTH SERVICES Inpatient psychiatric care Residential treatment $100 Outpatient/day treatment $0 CHEMICAL DEPENDENCY SERVICES Inpatient care $00 Residential treatment $100 Outpatient/day treatment $0 DURABLE MEDICAL EQUIPMENT 0%; $0 for certain diabetic supplies OUTSIDE SERVICE AREA ($1,000 maximum per year) 0% PHYSICIAN-REFERRED ALTERNATIVE CARE $0 $00 OUTPATIENT PRESCRIPTION DRUGS 3 VISION HARDWARE $0 generic; $40 brand $100 for lenses, frames, or contact lenses every calendar years OUTPATIENT ADMINISTERED MEDICATIONS 15% FITNESS PROGRAM Access to Silver&Fit fitness program, which includes no-cost membership at participating local health clubs 1 Rehabilitative, habilitative services, and neurodevelopmental therapy have separate limits of 30 visits each per calendar year. CHP network only. Self-referred massage is limited to 1 visits per calendar year at a $5 copay per massage. There is a $1,000 limit per calendar year on all alternative care services. 3 The Part D prescription drug gap begins when total drug costs (Kaiser Permanente share plus your copay or coinsurance) for the year to date total $3,750. Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. Benefits, premiums and/or copays/coinsurance may change on January 1 of each year and at other times in accord with your group s contract with us. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. 31

32 PLAN HIGHLIGHTS FOR PRESCRIPTION DRUGS, ALTERNATIVE CARE, VISION, AND DENTAL OUTPATIENT PRESCRIPTION DRUGS The Kaiser Permanente formulary applies to all plans. Members get up to a 30-day supply for each copay (up to a 90-day supply of eligible drugs for copays when using our mail-delivery pharmacy). All of these plans are Medicare Part D creditable. View our formulary at kp.org/formulary. ADDITIONAL PRESCRIPTION OPTIONS FOR ADDED CHOICE PLANS Members on an Added Choice plan have the option of filling their prescriptions through MedImpact. When a member fills a prescription at a MedImpact pharmacy, the plan covers up to a 30-day supply of generic drugs. To locate a pharmacy, go to kp.org/addedchoice. ALTERNATIVE CARE (SELF-REFERRED) Many of our plans include self-referred alternative care, including chiropractic care. Self-referred alternative care is available through The CHP Group network providers in our service area with an annual benefit maximum of $1,000. Visit chpgroup.com for a list of providers. If purchased with Added Choice plans, members may use their benefit at CHP, PPO, and other non-participating providers and facilities. VISION HARDWARE AND ROUTINE EYE EXAM Many of our plans can be purchased to include coverage for adult vision hardware and routine eye exams. All plans include coverage for children 18 and younger. Vision hardware must be prescribed and purchased at Kaiser Permanente. If added to Added Choice plans, members may use their benefit at select facilities, PPO, and other nonparticipating providers and facilities. Visit kp00.org for more information DENTAL COVERAGE Investing in dental health helps keep your employees happy, healthy, and productive. Our Traditional HMO dental plans allow you to choose from a wide range of options and mix and match deductibles or office visit copays for any plan combination. If you would like more flexibility, the Dental Choice PPO plans are designed for choice providing comprehensive coverage, while allowing members to see any dentist. 3