- Platinum 90 HMO 0/10 + Child Dental Alt
- Platinum 90 HMO 0/10 + Child Dental Alt INF
- Platinum 90 HMO 0/20 + Child Dental
- Platinum 90 HMO 0/20 + Child Dental INF
- Platinum 90 HMO 250/30 + Child Dental Alt
- Platinum 90 HMO 250/30 + Child Dental Alt INF
- Gold 80 HMO 0/35 + Child Dental Alt
- Gold 80 HMO 0/35 + Child Dental Alt INF
- Gold 80 HMO 250/35 + Child Dental
- Gold 80 HMO 250/35 + Child Dental INF
- Gold 80 HMO 1000/40 + Child Dental Alt
- Gold 80 HMO 1000/40 + Child Dental Alt INF
- Gold 80 HMO 1750/15% + Child Dental Alt
- Gold 80 HMO 1750/15% + Child Dental Alt INF
- Gold 80 HMO 2250/35 + Child Dental
- Gold 80 HMO 2250/35 + Child Dental INF
- Silver 70 HMO 1900/65 + Child Dental Alt
- Silver 70 HMO 1900/65 + Child Dental Alt INF
- Silver 70 HMO 2300/65 + Child Dental Alt
- Silver 70 HMO 2300/65 + Child Dental Alt INF
- Silver 70 HMO 2500/55 + Child Dental
- Silver 70 HMO 2500/55 + Child Dental INF
- Silver 70 HMO 2500/55 + Child Dental w/o Contraceptives
- Silver 70 HMO 2950/65 + Child Dental Alt
- Silver 70 HMO 2950/65 + Child Dental Alt INF
- Silver 70 HDHP HMO 2850/25% + Child Dental
- Silver 70 HDHP HMO 2850/25% + Child Dental INF
- Bronze 60 HMO 5400/60 + Child Dental Alt
- Bronze 60 HMO 5400/60 + Child Dental Alt INF
- Bronze 60 HMO 6300/60 + Child Dental
- Bronze 60 HMO 6300/60 + Child Dental INF
- Bronze 60 HDHP HMO 7050/0 + Child Dental
- Bronze 60 HDHP HMO 7050/0 + Child Dental INF
Evidence of Coverage and Disclosure Forms
As part of the group contract, these Evidence of Coverage and Disclosure Form documents are made available for Small Business employers and brokers as part of their responsibility to provide members with the terms of coverage for their plan.
2024 Small Business Plans offered by Kaiser Permanente Northern California
2024 Small Business Plans offered by Kaiser Permanente Southern California
2024 Northern California grandfathered plans
2024 Southern California grandfathered plans
2023 Small Business Plans offered by Kaiser Permanente Northern California
2023 Small Business Plans offered by Kaiser Permanente Southern California
2023 Small Business Plans offered by Kaiser Permanente Insurance Company
2023 Northern California grandfathered plans
2023 Southern California grandfathered plans
- Platinum 90 HMO 0/10 + Child Dental Alt
- Platinum 90 HMO 0/10 + Child Dental Alt INF
- Platinum 90 HMO 0/20 + Child Dental
- Platinum 90 HMO 0/20 + Child Dental INF
- Platinum 90 HMO 250/30 + Child Dental Alt
- Platinum 90 HMO 250/30 + Child Dental Alt INF
- Gold 80 HMO 0/35 + Child Dental Alt
- Gold 80 HMO 0/35 + Child Dental Alt INF
- Gold 80 HMO 250/35 + Child Dental
- Gold 80 HMO 250/35 + Child Dental INF
- Gold 80 HMO 1000/40 + Child Dental Alt
- Gold 80 HMO 1000/40 + Child Dental Alt INF
- Gold 80 HMO 1750/15% + Child Dental Alt
- Gold 80 HMO 1750/15% + Child Dental Alt INF
- Gold 80 HMO 2250/35 + Child Dental
- Gold 80 HMO 2250/35 + Child Dental INF
- Silver 70 HMO 1900/65 + Child Dental Alt
- Silver 70 HMO 1900/65 + Child Dental Alt INF
- Silver 70 HMO 2300/65 + Child Dental Alt
- Silver 70 HMO 2300/65 + Child Dental Alt INF
- Silver 70 HMO 2500/55 + Child Dental
- Silver 70 HMO 2500/55 + Child Dental INF
- Silver 70 HMO 2500/55 + Child Dental w/o Contraceptives
- Silver 70 HMO 2950/65 + Child Dental Alt
- Silver 70 HMO 2950/65 + Child Dental Alt INF
- Silver 70 HDHP HMO 2850/25% + Child Dental
- Silver 70 HDHP HMO 2850/25% + Child Dental INF
- Bronze 60 HMO 5400/60 + Child Dental Alt
- Bronze 60 HMO 5400/60 + Child Dental Alt INF
- Bronze 60 HMO 6300/60 + Child Dental
- Bronze 60 HMO 6300/60 + Child Dental INF
- Bronze 60 HDHP HMO 7050/0 + Child Dental
- Bronze 60 HDHP HMO 7050/0 + Child Dental INF
- $0-$3,200 Deductible Plan with HSA Option 16374
- $0-$3,200 Deductible Plan with HSA Option INF 16376
- $5 Copayment Plan 4467
- $15 Copayment Plan 4465
- $20 Copayment Plan 4471
- $30 Copayment Plan 4475
- $30 Copayment Plan INF 10469
- $30-$1,000 Deductible Plan 4240
- $30-$1,500 Deductible Plan 4241
- $30-$1,500 Deductible Plan with HRA 4224
- $30-$2,500 Deductible Plan with HRA 4223
- $30-$3,200 Deductible Plan with HSA Option 16369
- $40-$2,000 Deductible Plan 4243
- $50 Copayment Plan 4476
- $0-$2,000 Deductible Plan with HSA Option 4234
- 2024 Sample NCAL KFHP Chiropractic Acupuncture Benefit 4001
- $0-$3,200 Deductible Plan with HSA Option 16374
- $0-$3,200 Deductible Plan with HSA Option INF 16376
- $5 Copayment Plan 4467
- $15 Copayment Plan 4465
- $20 Copayment Plan 4471
- $30 Copayment Plan 4475
- $30 Copayment Plan INF 10469
- $30-$1,000 Deductible Plan 4240
- $30-$1,500 Deductible Plan 4241
- $30-$1,500 Deductible Plan with HRA 4224
- $30-$2,500 Deductible Plan with HRA 4223
- $30-$3,200 Deductible Plan with HSA Option 16369
- $40-$2,000 Deductible Plan 4243
- $50 Copayment Plan 4476
- $0-$2,000 Deductible Plan with HSA Option 4234
- 2024 Sample NCAL KFHP Chiropractic Acupuncture Benefit 4001
- Platinum 90 HMO 0/10 + Child Dental Alt
- Platinum 90 HMO 0/10 + Child Dental Alt INF
- Platinum 90 HMO 0/20 + Child Dental
- Platinum 90 HMO 0/20 + Child Dental INF
- Gold 80 HMO 0/30 + Child Dental Alt
- Gold 80 HMO 0/30 + Child Dental Alt INF
- Gold 80 HMO 250/35 + Child Dental
- Gold 80 HMO 250/35 + Child Dental INF
- Gold 80 HMO 1000/40 + Child Dental Alt
- Gold 80 HMO 1000/40 + Child Dental Alt INF
- Gold 80 HDHP HMO 1600/15% + Child Dental Alt
- Gold 80 HDHP HMO 1600/15% + Child Dental Alt INF
- Gold 80 HRA HMO 2250/35 + Child Dental
- Gold 80 HRA HMO 2250/35 + Child Dental INF
- Silver 70 HMO 1900/65 + Child Dental Alt
- Silver 70 HMO 1900/65 + Child Dental Alt INF
- Silver 70 HMO 2300/65 + Child Dental Alt
- Silver 70 HMO 2300/65 + Child Dental Alt INF
- Silver 70 HMO 2500/55 + Child Dental
- Silver 70 HMO 2500/55 + Child Dental INF
- Silver 70 HMO 2500/55 + Child Dental w/o Contraceptives
- Silver 70 HMO 2800/65 + Child Dental Alt
- Silver 70 HMO 2800/65 + Child Dental Alt INF
- Silver 70 HDHP HMO 2700/25% + Child Dental
- Silver 70 HDHP HMO 2700/25% + Child Dental INF
- Bronze 60 HMO 5400/60 + Child Dental Alt
- Bronze 60 HMO 5400/60 + Child Dental Alt INF
- Bronze 60 HMO 6300/65 + Child Dental
- Bronze 60 HMO 6300/65 + Child Dental INF
- Bronze 60 HDHP HMO 7000/0 + Child Dental
- Bronze 60 HDHP HMO 7000/0 + Child Dental INF
- Platinum 90 HMO 0/10 + Child Dental Alt
- Platinum 90 HMO 0/10 + Child Dental Alt INF
- Platinum 90 HMO 0/20 + Child Dental
- Platinum 90 HMO 0/20 + Child Dental INF
- Gold 80 HMO 0/30 + Child Dental Alt
- Gold 80 HMO 0/30 + Child Dental Alt INF
- Gold 80 HMO 250/35 + Child Dental
- Gold 80 HMO 250/35 + Child Dental INF
- Gold 80 HMO 1000/40 + Child Dental Alt
- Gold 80 HMO 1000/40 + Child Dental Alt INF
- Gold 80 HDHP HMO 1600/15% + Child Dental Alt
- Gold 80 HDHP HMO 1600/15% + Child Dental Alt INF
- Gold 80 HRA HMO 2250/35 + Child Dental
- Gold 80 HRA HMO 2250/35 + Child Dental INF
- Silver 70 HMO 1900/65 + Child Dental Alt
- Silver 70 HMO 1900/65 + Child Dental Alt INF
- Silver 70 HMO 2300/65 + Child Dental Alt
- Silver 70 HMO 2300/65 + Child Dental Alt INF
- Silver 70 HMO 2500/55 + Child Dental
- Silver 70 HMO 2500/55 + Child Dental INF
- Silver 70 HMO 2500/55 + Child Dental w/o Contraceptives
- Silver 70 HMO 2800/65 + Child Dental Alt
- Silver 70 HMO 2800/65 + Child Dental Alt INF
- Silver 70 HDHP HMO 2700/25% + Child Dental
- Silver 70 HDHP HMO 2700/25% + Child Dental INF
- Bronze 60 HMO 5400/60 + Child Dental Alt
- Bronze 60 HMO 5400/60 + Child Dental Alt INF
- Bronze 60 HMO 6300/65 + Child Dental
- Bronze 60 HMO 6300/65 + Child Dental INF
- Bronze 60 HDHP HMO 7000/0 + Child Dental
- Bronze 60 HDHP HMO 7000/0 + Child Dental INF
- $0-$3,000 Deductible Plan with HSA Option 15063
- $0-$3,000 Deductible Plan with HSA Option INF 15068
- $5 Copayment Plan 4467
- $15 Copayment Plan 4465
- $20 Copayment Plan 4471
- $30 Copayment Plan 4475
- $30 Copayment Plan INF 10469
- $30-$1,000 Deductible Plan 4240
- $30-$1,500 Deductible Plan 4241
- $30-$1,500 Deductible Plan with HRA 4224
- $30-$2,500 Deductible Plan with HRA 4223
- $30-$3,000 Deductible Plan with HSA Option 4230
- $40-$2,000 Deductible Plan 4243
- $50 Copayment Plan 4476
- $0-$2,000 Deductible Plan with HSA Option 4234
- 2023 Sample NCAL KFHP Chiropractic Acupuncture Benefit 4001
- $0-$3,000 Deductible Plan with HSA Option 15066
- $0-$3,000 Deductible Plan with HSA Option INF 15070
- $5 Copayment Plan 4463
- $15 Copayment Plan 4464
- $20 Copayment Plan 4469
- $30 Copayment Plan 4473
- $30 Copayment Plan INF 10468
- $30-$1,000 Deductible Plan 4245
- $30-$1,500 Deductible Plan 4225
- $30-$1,500 Deductible Plan with HRA 4229
- $30-$2,500 Deductible Plan with HRA 4228
- $30-$3,000 Deductible Plan with HSA Option 4238
- $40-$2,000 Deductible Plan 4226
- $50 Copayment Plan 4477
- $0-$2,000 Deductible Plan with HSA Option 4235
- 2023 Sample SCAL KFHP Chiropractic Acupuncture Benefit 4002