60247833_KPIF_OR_EnrollmentGuide_2014_Bklt_FNL

Individuals and Families Oregon 2015Enrollment GuideA better choice for good healtha wide range of specialists test results online convenient facilities near youI can choose and change better care for healthier tomorrows my doctor anytimeI can email my doctor I’m part of the decisionfree to focus on you

Discover the Kaiser Permanente difference With health care and health coverage working seamlessly together, Kaiser Permanente is uniquely designed to be your partner in health so you can feel your best — in mind, body, and spirit.your choice of personalized care everything undertop doctors and attention one roofYou can choose and change You’re at the center of your care. You can do more and drive lessyour doctor anytime, for any Your doctors, nurses, and specialists, because many of our locationsreason. Our doctors are among all connected by your electronic include pharmacy, lab, X-raythe best. They love caring for health record, work together to services, and more.people and aren’t weighed help you manage your health.down by a lot of paperwork,so they can focus on you.lots of healthy online access healthier tomorrowsextras anytime, anywhere Every decision starts with what’sStay at your best with healthy It’s easy to stay involved in your best for you. That’s why our high-resources like farmers markets care. Use your computer or mobile quality care for conditions likeand wellness classes, many device to email your doctor’s office, cancer, heart disease, and diabetesof which are offered at no cost. schedule routine appointments, leads to better outcomes and view most lab test results, refill healthier tomorrows. most prescriptions, and more.kp.orgNote: Many features discussed in this book are available only to members receiving care at Kaiser Permanentemedical facilities.

Individuals and Families PlansA better choice for good healthWelcome to your Individuals and Families Plans Enrollment Guide. This guide willhelp you select the right health plan for your needs. Read on to learn why KaiserPermanente is the best choice. What’s inside Understanding health care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Experience the Kaiser Permanente difference. . . . . . . . . . . . . . . . . . . 3 Find a provider near you. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 When and how to enroll in your plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Comparing health plans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Dental insurance plans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Working out your rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 15 Important deadline Open enrollment ends February 15, 2015. See page 10 for details, and learn about special situations that may allow you to submit your application for health coverage after this date. Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer. 1 60247833 Oregon

Individuals and Families PlansUnderstanding health careHealth care coverage makes it easier to get the care you need. This includes all the doctors, nurses,and specialists that provide care and the facilities where you receive care. At Kaiser Permanente,we offer both care and coverage in one package. And now, thanks to the Affordable Care Act(ACA), no one can be denied because of a health problem. This law — also known as health carereform — means more peace of mind for you and your family. 15Health care Health coverage Health care reformAlmost everyone gets sick or hurt, Health coverage is a lot like the It’s now the law that most U.S.or needs medical help at some coverage people get to protect residents must have healthpoint. To get better, you usually their car or home. Without coverage. If you don’t haveneed care — like seeing a doctor, coverage, high medical bills can coverage for 3 months in a rowstaying in a hospital, taking wipe out savings and even lead or more, you may be charged amedication, or all of the above. to bankruptcy. Health coverage tax penalty. helps protect you financially.On top of that, health care helps ■ All our plans meet the standardskeep you healthy. Preventive care — ■ Each month, you pay a premium — of the new health care law.like mammograms and cholesterol also called a rate — to your healthlevel tests — can help you catch insurance provider. ■ You can buy one of our planshealth problems early, when they’re directly from us or through theeasier to treat. ■ When you need care, in most Health Insurance Marketplace — cases your health coverage will government-run websites whereHealth care includes: help you pay for it. you can buy health plans.■ Doctors’ office visits ■ If you have a family, you can cover ■ There are 4 types of Kaiser dependents up to the age of 26 Foundation Health Plan of the■ Hospital stays in a family plan. Northwest plans in the Marketplace — Bronze, Silver,■ Emergency Department ■ Do you need help paying Gold, and Catastrophic. for health coverage? Go to■ X-rays page 15 to learn more about ■ All plans offer the same basics, federal financial assistance. such as doctor visits, hospital■ Laboratory tests care, prescriptions, and preventive care at no cost.■ Prescription drugs ■ The plans differ in how much■ No-charge preventive care, like: you pay and when. For example, Bronze has lower monthly • Well-baby exams premiums but higher out-of- (under 24 months) pocket costs. Gold has higher premiums and lower out-of- • Well-woman visits pocket costs. • Immunizations • Health screenings • Prenatal exams • Vision examsHave questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.60247833 Oregon 2

Individuals and Families PlansExperience the Kaiser Permanente differenceGet what you need to live well — in one easy-to-use package. Take a look at everything that comeswith your plan, and you’ll agree that Kaiser Permanente is the best choice for your health.The experience … Without Kaiser Permanente With Kaiser Permanente*Choosing your doctor You have to hope that the doctor you You choose a doctor who’s right choose takes the insurance you have. for you. You can even view all ourMaking an appointment doctors’ profiles online. And you Calling and waiting to schedule an can change your doctor at any time. 15 appointment takes forever. You wish you could just hop online to do it. S chedule or cancel routineDuring your visit appointments with your doctor Your doctor flips through a big file, online or from your mobile device.Getting other services asking about your medical history. Y our doctor, backed by a secure,Visiting a specialist innovative electronic health record system, is always up to speed andRemembering your ready to take care of you.doctor’s instructions You go to 3 different locations At many locations, your doctor, to take lab tests, get X-rays, lab services, X-rays, and pharmacy or fill prescriptions. are all under one roof, so you can save time and do more in one visit. You show up hoping that your primary care doctor faxed When you arrive, your specialist or mailed your records. will have your health information right at his or her fingertips, making Take lots of notes during your visit or your care virtually seamless. listen carefully and trust your memory later. Now, was it ice, then heat? Y ou get a printed summary at the end of each visit. You can also view most test results online as soon as they’re available.Asking routine questions If you have questions for your doctor, E mail your doctor’s office andwithout a visit you probably need to call the office get a reply back, normally within and wait for a call back. 48 hours. To learn more about Kaiser Permanente, visit kp.org.*These features are available when you receive care at Kaiser Permanente facilities. Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer. 3 60247833 Oregon

Individuals and Families PlansThe power to chooseKaiser Permanente makes it easier to stay in charge of your health. It’s simple to makesmart choices when you have great doctors and convenient facilities. 15Your choice of Under-one-roof access Extra conveniencestop doctors You have a wide selection of skilled Save time and avoid driving all ■ Email your doctor’s officedoctors that you can choose from over town for care. You’ll have with routine questions.and change anytime, for any reason. many locations to choose from, and most of them offer multiple ■ Get same-day, after-hours,Our doctors: services under one roof. You can and weekend services at see your doctor, get a lab test most locations.■ Come from many of the top or an X-ray, and pick up your medical schools in the country medications — all without leaving ■ Receive personalized care from the building. And when you get doctors and staff who speak■ Work hand in hand with your care with fewer delays, you can more than one language. entire care team, who are all get better faster. connected by your electronic ■ Refill most prescriptions online health record with shipping at no charge.■ Don’t have excessive paperwork, ■ Make routine appointments so they can focus only on with a call or click. delivering the care you need ■ View recent office visits and most■ Care about their patients and test results online. love what they do ■ Call an advice nurse with access■ Have individual profiles on kp.org to your health information, 24/7. that you can browse to learn about their background and credentials ■ Travel freely; you’re covered for emergency care worldwide.These features are available when you receive care at Kaiser Permanente facilities.Hear examples of how Kaiser Permanente has helped different members at kp.org/kpcarestories.Your electronic Your doctor’s office Pharmacy, lab, X-rayhealth record bringsit all together Your record gets updated with No need for paperwork each visit to a Kaiser Permanente when you get services at our facility, so it’s always current. facilities — your doctor’s orders are already there.Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.60247833 Oregon 4

Individuals and Families PlansExcellent careKaiser Permanente has one of the largest multispecialty medical groups in the country,which includes cardiologists, cardiac surgeons, and others.Personalized care Top specialty care for Leaders in preventionand attention healthier tomorrowsA care team that’s informed and Our doctors, nurses, and other We’re committed to preventivefocused on you can lead to better caregivers use an advanced care and overall wellness. To helphealth. From your doctor and care delivery system that Kaiser keep you from getting sick in thecaregivers — who are all connected Permanente pioneered. It’s had first place, we provide routineto your electronic health record a measurable impact on the appointments, preventive screenings,and keep up-to-date on how prevention, detection, and wellness programs, and much more.you’re doing — to our online treatment of conditions like cancer, As a result, we’re #1 in screeningsprograms and Wellness Coaching heart disease, stroke, and diabetes. for breast cancer in all our regions,by Phone service, your care is not We were also rated in the top 10 and were rated in the top 10one-size-fits-all. It’s personalized percent among cholesterol percent for cervical and colonto your needs and schedule. management programs for patients cancer screenings. Plus, 85 percent with cardiovascular conditions.* of our members who were diagnosed with high blood pressure now have their blood pressure under control, compared to 60 percent nationally.*,† These features are available when you receive care at Kaiser Permanente facilities.*R atings based on Breast Cancer Screening, Cervical Cancer Screening, Colorectal Cancer Screening, and Controlling High Blood Pressure 2013 ratings for commercial plans from the Healthcare Effectiveness Data and Information Set (HEDIS®) published by the National Committee for Quality Assurance. For more information, visit ncqa.org.† Kaiser Permanente program average is the weighted average of each regional health plan’s screening rate and its eligible population. Learn more about the doctors available in your area at kp.org/searchdoctors.Specialty care At home or on the goYour specialists are Get your health information onup to speed and ready your computer or mobile deviceto take care of you. to stay informed and in charge.Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer. 5 60247833 Oregon

Individuals and Families PlansYour health. Your way.We’re always here when you need us, however you need us. At Kaiser Permanente, you getmany services under one roof at most of our locations and can call an advice nurse 24/7.Online or through mobile, you can manage your family’s health needs anytime, anywhere.It’s easy to stay A website full Good health on the goconnected of healthy ideas Manage your care at home, work,Members registered on kp.org Get informed and inspired on or play with our mobile app, whichhave secure access to My Health our award-winning website, puts all the convenient features ofManager, the online tool that helps kp.org. Take charge of your My Health Manager right in the palmyou manage your family’s health health with articles, wellness of your hand. You can download thecare anytime, anywhere. topics, and health calculators. Kaiser Permanente app from the Our music channels, podcasts, App StoreSM or Google Play®.*With My Health Manager, fitness videos, and recipes fromyou can: world-class chefs can help you find new and interesting ways■ Email your doctor’s office to live well and thrive. with routine questions.■ Refill most prescriptions.■ View most lab test results.■ Schedule or cancel routine appointments.These features are available when you receive care at Kaiser Permanente facilities.*App Store is a service mark of Apple, Inc., and Google Play is a trademark of Google, Inc. For a guided tour of My Health Manager, visit kp.org/myhealthmanagertour.Top reasons to join You can choose Excellent careKaiser Permanente and change your doctor for conditions like cancer, heart anytime, for any reason. disease, and diabetes leads to healthier tomorrows.Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.60247833 Oregon 6

Individuals and Families PlansHealthy extrasGood health starts with helpful information and resources. That’s why you get lots of healthyextras that can help you stay educated on ways to live healthier in mind, body, and spirit.Learn something new Fresh food in the Maximize your health parking lotFit wellness into your schedule, Our personalized online wellnessno matter how busy you are. With Eating well is easier when you programs can help you lose weight,the many health classes offered bring home fresh food from our stay active, reduce stress, sleepat our facilities, there’s something farmers markets. They’re better, stop smoking, and muchfor everyone. Try classes on eating conveniently located at many of our more. You can also downloadwell, baby care, ongoing health facilities, so you can pick up some the Every Body Walk! app for yourconditions, and much more. healthy fruits and veggies after smartphone or mobile device fromClasses vary by location and your visit. the App Store or Google Play. It’s asome may require a fee. fun, interactive tool to help you create and maintain a daily walking routine.These features are available when you receive care at Kaiser Permanente facilities. Find tools, tips, and information for living well at kp.org/livewell.Under-one-roof Healthy extrasconvenience like on-site classes*and care online or by phone and farmers marketsmeans you can manage your help you stay well.health needs anytime, anywhere. *Some classes may require a fee.Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer. 7 60247833 Oregon

Individuals and Families PlansFind a provider near youHaving a wide selection of health care providers and convenient medical facilities is important.That’s why we have medical facilities and dental offices in 4 areas: southwest Washington, Salem,Longview, and the Portland metropolitan area. Our contracts with Northwest Permanente, P.C.,and Permanente Dental Associates offer you an even greater choice of participating providersthroughout the region.Locate a medical provider Our locationsJust visit kp.org/newmember, select your region For your convenience, we have 4 primary areas(in the upper left corner), then click on “Choose a within the Northwest service area where you can gopersonal physician” under “Getting Started.” You for care: southwest Washington, Salem, Longview,may choose a physician, physician’s assistant, or and the Portland metropolitan area. Each of thesenurse practitioner as your primary care participating areas has its own medical offices, medical center(s),provider in these departments: and urgent care facilities.g F amily Medicine for children and adults For more information on our medical facilities, visit buykp.org/facilities.g Internal Medicine for members age 18 and older Dental careg Ob-Gyn for female members (certified nurse- midwives also available) We have 17 dental offices in the Portland metro area, Salem, southwest Washington, and Longview, sog P ediatrics for members under age 18 there’s sure to be one near your home or work. Our dental group includes pediatric dentists, orthodontists,Our medical staff directory includes a listing of periodontists, oral surgeons, endodontists, andboth primary care and specialty care physicians prosthodontists.and providers, showing their education, gender,languages spoken, and more. For more information regarding our dental plans and services, please visit kp.org/dental/nw.You can download the current version of ourdirectory from the “Forms and Publications” sectionof the website. Or, to have a Medical Directory sentto you, simply contact:Member Service Contact Center1-800-813-20008 a.m. to 6 p.m.Monday through FridayTTY 711Language Interpretation Services 1-800-324-8010Talk to a new member specialistAs a new member, you can call our dedicated NewMember Help Desk at 1-888-491-1124, Mondaythrough Friday, 7 a.m. to 8 p.m., and Saturdays, 8 a.m.to 4:30 p.m., and talk with a specialist who can help youget the most out of your benefits quickly and easily.With just one call, we can assist you with selecting aprovider, transferring medical records andprescriptions, setting appointments, and more.Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.60247833 Oregon 8

Individuals and Families PlansNorthwest locations 5 Cowlitz N Longview SkamaniaColumbia 30 Clark Vancouver26 205Washington 84 Portland Multnomah ClackamasYamhill Vancouver 5 5 205 Salem Hillsboro 84 Polk 26 PortlandPlease note: Facility locations Beavertonare approximate. Facility 5location numbers on this map 217correspond with our larger Milwaukielocation map for the Kaiser TigardPermanente Northwest Tualatin 205Region. Oregon City Maps not to scaleHave questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer. 9 60247833 Oregon

Individuals and Families PlansWhen and how to enroll in your planOnce you understand why you need health care coverage, the next steps are knowing when andhow to enroll and finding out if you qualify for federal financial assistance.Enrolling during an annual open enrollment periodThere’s a deadline to apply for health care coverage. To enroll during this 2015 open enrollmentYou can apply starting November 15, 2014, through period, you must make sure we receive yourFebruary 15, 2015. This is called the open enrollment completed Application for Health Coverage —period. It’s when you can enroll in health plans along with your first month’s premium —through the Health Insurance Marketplace or directly no later than February 15, 2015.through Kaiser Permanente.Open enrollment period — November 15, 2014, through February 15, 2015If you want your coverage to start on: Your completed application and first month’s premium must be received by: January 1, 2015 November 15, 2014 — December 15, 2014 February 1, 2015 December 16, 2014 — January 15, 2015 March 1, 2015 January 16, 2015 — February 15, 2015Enrolling during a special enrollment periodYou may change or apply for health care coverage dependent. In some situations, if you are aware of aduring an annual open enrollment period. Outside of triggering event that will occur in the future, you maythe open enrollment period, you may enroll or change be able to apply for new coverage prior to theyour coverage if you experience a situation known as a triggering event. For example, if you know you willtriggering event. For example, if you get married, have lose coverage, you have 60 days before your loss ofa baby, or lose coverage because you lose your job coverage and 60 days after your loss of coverage to— all triggering events — you will have a special apply for health coverage. Please refer to the chart forenrollment period. If your triggering event occurs effective dates on page 13.during open enrollment, you also will have a specialenrollment period and your health coverage effective You have many important decisions to make aboutdate may vary from open enrollment effective dates. your health care coverage, and we’re committed to helping you understand how these changes willGenerally, a special enrollment period lasts 60 days impact you and your family. If you have any questions,after the triggering event occurs. That means if you’ve we’re here to help.experienced a triggering event, you have 60 days fromthe date of the triggering event to change or apply for (continues on next page)health care coverage for yourself and/or yourFor more detailed information on your specific special event, please call 1-800-494-5314.Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.60247833 Oregon 10

Individuals and Families PlansTriggering events Gaining or becoming a dependent:Loss of health care coverage: You have a baby, adopt a child, get married, or register in a domestic partnership. Placement of a foster child isIf you lose health plan coverage because you didn’t pay also a triggering event if your plan includes coverage foryour premiums or contributions or because your plan a foster child. You do not need to be a current memberwas rescinded, these do not qualify as triggering events. to purchase a health plan for you or your family if youThis special enrollment period begins 60 days before experience this triggering event.the loss of coverage and lasts 60 days after the lossof coverage. Permanent relocation:1. Y ou lose your employer health plan coverage You moved to a new location and have a different for the following reasons: choice of health plans, or you were recently released from incarceration. ■ You lose your job. Change in eligibility for federal financial ■ Your work hours are reduced, so you no longer assistance through the Health Insurance qualify for health coverage. Marketplace: ■ The person who covers you on his/her employer Your income level changes and, as a result, you qualify health plan dies. or no longer qualify for federal tax credits. Your eligibility to enroll in a health plan with reduced costs ■ You are a dependent on the employer’s health plan (cost-share reduction) changes. For more information and your marital status changes due to a legal about eligibility for federal financial assistance, visit separation or divorce, so your eligibility as a healthcare.gov or call 1-800-318-2596. You can also call dependent ends. us at 1-800-494-5314. ■ You lose eligibility for coverage through your Your eligibility for your employer health employer because you no longer live or work in the coverage changes: service area, and no other group health coverage is available to you. Your employer discontinues or changes your current coverage options so that you become newly eligible for ■ You or your dependent meets or exceeds the federal financial assistance for premium payments. maximum lifetime benefits of your health plan because of one specific claim. Immigration status change: ■ You are part of a group of employees who are no You were not previously entitled to enroll in health plan longer offered coverage from your employer. coverage through the Health Insurance Marketplace because you were not lawfully present in the United ■ A dependent child has a birthday and no longer States. You may only enroll in a plan offered through qualifies as a dependent on his/her parent’s health the Health Insurance Marketplace. For more plan. information about enrolling, visit healthcare.gov or call 1-800-318-2596. You can also call us at 1-800-494-5314. ■ Your employer stops contributing premium payments for your group health coverage. (continues on next page) ■ Your COBRA coverage is exhausted. ■ Your retiree coverage is terminated or substantially eliminated when your employer declares federal Chapter 11 bankruptcy. ■ You lose your eligibility for coverage because the person who covered you on the employer health plan becomes entitled to Medicare.2. Your individual plan, Medicaid, Medicare, or other governmental coverage (but not a special Medicaid program) ends.Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer. 11 60247833 Oregon

Individuals and Families Plans(continued from previous page)Coverage as an American Indian/ Applying by mail or faxNative Alaskan: New applicantsThe Health Insurance Marketplace determines that youare eligible for a special enrollment period each month ■ If you are sending in a paper application, we mustto enroll in or change health plan coverage through the receive your paper application within 60 days of yourHealth Insurance Marketplace. You may only do this triggering event. You will need to provide yourthrough the Health Insurance Marketplace. For triggering event and the date of your event on yourinformation about enrolling through the Health Insurance paper application. Your paper application must beMarketplace, visit healthcare.gov or call 1-800-318-2596. received with your first month’s premium. In someYou can also call us at 1-800-494-5314. instances, you may apply 60 days before your triggering event occurs so you don’t lose health careDetermination by the Health Insurance coverage.Marketplace: ■ Mail or fax your Application for Health CoverageThe Health Insurance Marketplace determines that form within 60 days of your triggering event. Be sureyou are entitled to a special enrollment period due to to include your first month’s premium. Checks mustextraordinary circumstances, an error, misrepresentation be mailed and cannot be faxed.or inaction of the Health Insurance Marketplace, or forany other reason that the Health Insurance Marketplace ■ If you apply close to the end of your specialmay determine in accordance with applicable law. enrollment period, be sure we receive your Application for Health Coverage form before yourTriggering-event confirmation special enrollment period ends.required Current Kaiser Permanente membersIf you are a new applicant, you will need to provide thetriggering event and date of the event under Step 1 on ■ You must submit an Account Change Form. You willyour Application for Health Coverage form. need to provide your triggering event and the date of the event on the Account Change Form. AnyIf you are a current Kaiser Permanente member and change to your premium will be reflected in your nextwant to change your plan due to a triggering event, month’s invoice.please use an Account Change Form. You will needto provide your triggering event and date of the ■ Mail or fax your Account Change Form within 60 daysevent under Section B on this form. Please call of your triggering event.1-800-494-5314 to request an Account Change Form. ■ If you apply near the end of your special enrollmentApplying online period, be sure we receive your Account Change Form before your special enrollment period ends.■ If you are a new applicant applying online, you will need to provide your triggering event and date of By submitting a signed application or Account the event during the online application process. You Change Form, you are confirming that a triggering must apply within 60 days of your triggering event. In event occurred. If we decide that the triggering event some instances, you may apply 60 days before your did not occur, we may take legal action including, but triggering event occurs so you don’t lose health care not limited to, terminating your coverage coverage. retroactively. (continues on next page)Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.60247833 Oregon 12

Individuals and Families Plans(continued from previous page)Effective datesYour coverage start date will depend on the triggering event that you experience. Please review this chart to see youreffective date.Type Receipt of application or Account Effective date Change FormLoss of health care coverage First day of the month following theor change in eligibility for On or before the last date of coverage last date of coverageemployer coverage due tochanges in employer coverage After loss of coverage or change in First day of the following month employer coverage: between theMarriage or domestic 1st and the 15th of the month First day of the second followingpartnership registration After loss of coverage or change in monthBirth, adoption, or placement employer coverage: between thefor adoption or foster care 16th and the last day of the month First day of the month followingPermanent relocation, release receipt of applicationfrom incarceration, change Any day of the month Date of birth, adoption, or placementin eligibility for federal for adoption or foster carefinancial assistance, change in Any day of the monthimmigration status or statusas an American Indian/Native Between the 1st and 15th of the month First day of the following monthAlaskanDetermination by the Health Between the 16th and the last day First day of the second followingInsurance Marketplace of the month month Any day of the month Any day of the month as determined by the Health Insurance Marketplace, including a retroactive dateSigning up for coverage if you qualify for federal financial assistanceYou may qualify for financial assistance from the To learn more about the Health Insurance Marketplacefederal government to help pay your premiums and/or and its requirements for special enrollment periodsout-of-pocket expenses. To qualify for federal financial and triggering events, visit healthcare.gov or callassistance, you must enroll in your Kaiser Foundation 1-800-318-2596. You can also call us at 1-800-494-5314.Health Plan of the Northwest plan or any other issuer’s We can help you apply for a Kaiser Foundation Healthplan(s) through the Health Insurance Marketplace. Plan of the Northwest plan on the Health Insurance Marketplace, too.Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer. 13 60247833 Oregon

Individuals and Families PlansSimple steps to enroll 1. Choose a plan Pick the plan that’s right for you. You can cover your entire family under the same plan or separate plans. 2. Confirm your rate area Check the “Working out your rate” section on page 24 to see whether your home ZIP code is listed. If it isn’t, call us at 1-800-494-5314, or contact your producer. 3. See if you’re eligible for federal financial assistance You may be eligible for federal financial assistance from the federal government for your 2015 Kaiser Foundation Health Plan of the Northwest health plan. If you qualify, the federal government will pay any federal financial assistance to Kaiser Foundation Health Plan of the Northwest on your behalf. Help may be available for: ■ Monthly premiums ■ Out-of-pocket costs, such as copayments, coinsurance, or deductibles See “You may qualify for federal financial assistance” on page 15 for more information. If you’re eligible, you must purchase your Kaiser Foundation Health Plan of the Northwest plan through the Health Insurance Marketplace to get assistance. If you’re not eligible, continue to step 4. 4. Complete your application Complete an online application at buykp.org/apply or use a paper application. If you’re working with a producer, be sure to complete that section of the application. 5. Select your payment method Payment for your first month’s coverage by check, money order, debit card, or credit card is required with your application. 6. Sign the application form Please make sure you’ve signed everywhere indicated on the application. If your application is missing any information, signatures, or payment, this may delay your effective date or cancel your application. 7. Submit the application form with payment and all necessary documentation ■ Online: For the fastest response, enroll online today at buykp.org/apply. Or if you’re working with a producer, use the personalized link he or she has provided. ■ Fax: 1-866-920-6473 ■ Mail: Kaiser Permanente Individuals and Families Plans P.O. Box 23219 San Diego, CA 92193-9921Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.60247833 Oregon 14

Individuals and Families PlansYou may qualify for financial assistance If you need help paying for health care, you may qualify for federal financial assistance. Under health care reform, the federal government will provide financial assistance for people with qualifying incomes. Here’s some information to help you find out whether you may be eligible.Federal financial assistance What should you do next?is available Go to healthcare.gov to see if you qualify for assistance.You can apply for financial assistance from the federal You’ll also be able to enroll in one of our plans there.government to help pay for care and coverage underour new 2015 plans. Please note that if you have the option of receiving health coverage through your employer, you may notg Help with premiums and out-of-pocket expenses be eligible for federal financial assistance. (deductibles, copayments, coinsurance) will be available only if you buy your Kaiser Foundation To avoid being double billed, if you enroll in a plan Health Plan of the Northwest coverage through the through the Health Insurance Marketplace, you must Health Insurance Marketplace. cancel your current plan through Kaiser Foundation Health Plan of the Northwest by calling our Memberg If you are eligible, the federal government will pay the Service Contact Center on or before the effective date financial assistance to us directly. of your new plan.g A ssistance will be on a sliding scale, based on What if you don’t qualify modified adjusted gross income and family size. for assistance?Do you qualify for assistance with You have two choices:monthly premiums? g Y ou can still purchase your ACA-compliant planThis chart shows the approximate (estimated) family through the Health Insurance Marketplace.income levels that qualify people for help. The numberschange slightly every year, so it’s important to contact g O r you can continue your coverage directly withus directly. The chart below is just a guide. us — that’s easiest.NUMBER OF PEOPLE ANNUAL FAMILY INCOME Either way, your plan will offer the same benefits IN HOUSEHOLD LEVELS TO QUALIFY and services. 1 $46,680 or below Have questions? 2 $62,920 or below 3 $79,160 or below We’ve got answers. We’ll help you decide which 4 $95,400 or below plan is best for you, even if you apply through 5 $111,640 or below healthcare.gov. Call our Member Service Contact 6 $127,880 or below Center at 1-800-759-0584 (TTY 711 for the deaf, 7 $144,120 or below hard of hearing, or speech impaired), or contact 8 $160,360 or below your producer.You can also use our online calculator to find out ifyou may qualify for federal financial assistance. Just goto buykp.org.Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer. 15 60247833 Oregon

Individuals and Families PlansComparing health plansBronze, Silver, Gold — there are different types of plans that work in different ways, dependingon how you want to pay for services. You can choose one plan for your entire family or separateplans for different family members. If your family members choose different plans, each planwill have a separate deductible and out-of-pocket maximum.All our plans include no-charge Our copayment planspreventive care Copayment plans have set fees for many coveredNo matter which Kaiser Foundation Health Plan of services and no medical deductibles.the Northwest plan you choose, there is nocharge for preventive care. This kind of care can ■ With copayments, you know in advance howhelp keep you healthy by providing an early alert much you’ll pay for things like doctor’s office visits.for many health conditions. That way, they canbe treated before they become serious. How it works*Here are some examples of preventive Let’s say you hurt your ankle. You visit your primary carecare services: doctor, who orders an X-ray. It’s just a sprain, so the doctor prescribes a generic pain medication.g Routine preventive physical exams ■ With the KP OR Gold 0/20 copayment plan, you wouldg Well-child exams (under 24 months)g Well-woman visits pay a separate copayment and coinsurance for each ofg Annual flu shots the covered services you received. You do not have tog Routine preventive laboratory tests reach a deductible.g Autism screenings ■ In this case, you would pay a $20 copay for the doctor’sg Mammogram screenings office visit, 30 percent coinsurance for the X-ray, and ag Contraceptive care and counseling $10 copay for the generic drug.g Breastfeeding support ■ Your copays and coinsurance would contribute to your out-of-pocket maximum.For a complete list of our preventive careservices, visit kp.org/prevention.*Please note this is only an example of how a plan works. See the “Health plan benefit highlights” chart starting on page 19 for more detailed information.Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.60247833 Oregon 16

Individuals and Families PlansOur deductible plans How it works*Deductible plans have lower monthly rates. If you Let’s say you hurt your ankle. You visit your primary careneed care, you’ll usually pay full charge for most doctor, who orders an X-ray. It’s just a sprain, so the doctorcovered services until you reach a set amount known prescribes a generic pain medication.as your deductible. On the KP OR Silver 1500/30 deductible plan, youDeductible plans with family coverage have both an would have to pay $1,500 out of pocket before beingindividual deductible and a family deductible. That eligible to pay only a copay or coinsurance for certainmeans that one member of the family can meet the covered services.lower individual deductible and be eligible forcoinsurance or copayments before the higher family ■ However, our Silver deductible plan offers genericdeductible is satisfied. Similarly, one family member drugs and some office visits for just a copay before thecan meet the individual out-of-pocket maximum deductible is met.before the family out-of-pocket maximum is met. ■ So, in this example, you would just pay a $30 copay for the■ Once you’ve reached your deductible, you’ll pay a doctor’s office visit and a $15 copay for the generic drug. copayment or coinsurance for most covered services for the rest of the contract year until you reach your ■ These copays would contribute toward your out-of- out-of-pocket maximum. pocket maximum but not toward your deductible. You would pay full charges for the X-ray, and this amount■ Most preventive care services will be covered at would be applied to your deductible. After reaching your no charge even before you reach your deductible. deductible, you would pay a 30 percent coinsurance for any other X-rays. ■ All the charges you pay for covered services, including all copays, coinsurance, and deductible payments, apply to your out-of-pocket maximum.*Please note this is only an example of how a plan works. See the “Health plan benefit highlights” chart starting on page 19 for more detailed information. Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer. 17 60247833 Oregon

Individuals and Families PlansOur HSA-qualified deductible plans How it works*With HSA-qualified deductible plans, you can open a Let’s say you hurt your ankle. You visit your primary carehealth savings account (HSA) that allows you to pay doctor, who orders an X-ray. It’s just a sprain, so the doctorfor qualified medical expenses with tax-deductible or prescribes a generic pain medication.pretax dollars. ■ With the KP OR Bronze 4500/50/HSA plan, you would pay■ You can contribute tax-deductible or pretax dollars full charge for most covered services until you reach your into an HSA and use this money to help pay for $4,500 deductible. eligible medical expenses, such as copayments, coinsurance, and deductible payments for services ■ However, if you open and fund an HSA, you can pay covered under your health plan. for your deductible, copays, and coinsurance with tax- deductible or pretax dollars. There is no charge for■ You can also use your HSA dollars for services most preventive care services even before you meet that may not be covered under your health plan, your deductible. such as eyeglasses and laser eye surgery, dental care, acupuncture, and chiropractic services. For ■ So, in this example, you pay the first $4,500 of a complete list of qualified medical expenses, your medical and pharmacy expenses out-of-pocket. see Publication 502, Medical and Dental Expenses, However, if you have money available in your HSA, you at irs.gov. can be reimbursed from your health savings account. After meeting the $4,500 deductible, you start paying only■ Tax references relate to federal income tax only. a copay or coinsurance for most covered services. For more information, consult your financial or tax adviser. To learn more about health savings ■ If you haven’t met your deductible, you pay full charge accounts, visit irs.gov/publications/p969/ar02.html for the doctor’s office visit, the X-ray, and the medication. or call 1-800-829-1040. If you’ve already reached your deductible, you pay only a $50 copay for the doctor’s office visit, 30 percentThe HSA-qualified deductible plans for families coinsurance for the X-ray, and a $20 copay for the generic drug.Deductibles and out-of-pocket maximums workdifferently in our traditional deductible plans versus our ■ All the charges you pay for covered services, includingHSA-qualified deductible plans for family coverage. all copays, coinsurance, and deductible payments, apply to your out-of-pocket maximum.Under our HSA-qualified deductible family plans, thereis no individual member deductible or out-of-pocketmaximum. Instead, all plans have a family deductibleand out-of-pocket maximum, which can be met bythe expenses of one or more family members towarda combined family deductible and out-of-pocketmaximum. Once the combined expenses of all coveredfamily members reach the applicable deductible orout-of-pocket maximum, the deductible or out-of-pocketmaximum will be considered satisfied for all familymembers for the remainder of the contract year.*Please note this is only an example of how a plan works. See the “Health plan benefit highlights” chart starting on page 19 for more detailed information.Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.60247833 Oregon 18

Individuals and Families PlansHealth plan benefit highlightsSee the “Health plan benefit highlights” chart starting on the next page for an overview of whatyou can expect to pay for services under our plans. This will help you understand which onebest meets your needs. For traditional deductible plans, keep in mind that most of the amountsshown apply only after you reach your deductible. To get an idea of what you might pay beforereaching your deductible, check out our resources at kp.org/treatmentestimates.Here’s a quick look at how to use the chart. Annual deductiblePlan type KP OR Silver You need to pay this amount before your plan startsFeatures 1500/30 helping you pay for most covered services. Under thisIndividual plan annual deductible Deductible sample plan, you’d pay the full charge for most(subscriber only) services until you reach $1,500 for yourself or $3,000Family plan annual deductible $1,500 for your family. Then you’d start paying copayments(individual/family) $1,500/$3,000 (copays) or coinsurance.Individual plan annual out-of-pocket maximum(subscriber only) $6,350 Annual out-of-pocket maximumFamily plan annual out-of-pocket maximum $6,350/$12,700(individual/family) This is the most you’ll pay for care during a policy periodBenefits No charge (usually a year) before your plan starts paying 100 percentPreventive care for most covered services. In this example, you’d neverRoutine physical exam, mammograms, etc. $30 pay more than $6,350 for yourself and no more thanOutpatient services (per visit or procedure) $50 $12,700 for your family for your deductible, copayments,Primary care office visit 30% after deductible and coinsurance in a contract year.Specialty care office visit 30% after deductibleMost X-rays $250 Preventive care at no chargeMost lab tests 30% after deductibleMRI, CT, PET $30 Most preventive care services — including routineOutpatient surgery physical exams and mammograms — are covered atMental health visit 30% after deductible no charge. Plus, they’re not subject to the deductible.Inpatient hospital care (per admission)Room and board, surgery, anesthesia, X-rays, No charge Not subject to the deductiblelab tests, medications 30% after deductibleMaternity Some services are always covered at a copay orRoutine prenatal care visit, $350 coinsurance, regardless of whether you’ve reachedfirst postpartum visit $50 your deductible. Under this plan, primary care visitsDelivery and inpatient well-baby care are covered at a $30 copay — even before you meetEmergency and urgent care Generic: $15 your deductible. With our Silver deductible plans,Emergency Department visit Preferred brand: $45 primary care, specialty care, and urgent care visits areUrgent care visit after $250 deductible not subject to the deductible.Prescription drugs Non-preferred brand and specialty: 30% after $250 deductible CoinsurancePlan pharmacy (up to a 30-day supply) Generic: $30 After reaching your deductible, you may start payingMail-order (up to a 90-day supply) Preferred brand: $90 a percentage of the total cost for certain services. after $250 deductible Here, you’d pay 30 percent of the cost per day Non-preferred brand and specialty: 30% for your inpatient hospital care after you reach your after $250 deductible deductible. Your plan would pay the rest for the remainder of the contract year. Copayment This is the set amount you pay for certain services, usually after you reach your deductible. In this example, you’d start paying a $350 copay for Emergency Department visits whether or not you have met your deductible. For these plans, there is an out-of-pocket maximum.Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer. 19 60247833 Oregon

Individuals and Families PlansHealth plan benefit highlights KP OR Catastrophic KP OR Bronze KP OR Bronze KP OR Bronze KP OR Silver 5000/50% 4500/50 HSA 4500/50 2500/35 StandardPlan type Deductible HSA-qualified Deductible HSA Standard DeductibleFeatures HSA-qualified $4,500 $4,500 $9,000/$9,000 $4,500/$9,000 $2,500Individual plan annual deductible $6,600 $5,000 $2,500/$5,000(subscriber only) $10,000/$10,000 $6,350 $6,350 $12,700/$12,700 $6,350/$12,700 $6,350Family plan annual deductible $6,600/$13,200 $6,350 $6,350/$12,700(individual/family) $12,700/$12,700 No charge No charge No chargeIndividual plan annual out-of-pocket $6,600 No charge $50 after deductible $50maximum (subscriber only) $70 after deductible $70 $35 $60 after deductible 30% after deductible 20% after deductible $70Family plan annual out-of-pocket $6,600/$13,200 $100 after deductible 30% after deductible 20% after deductible 30% after deductiblemaximum (individual/family) 50% after deductible $500 after deductible $500 after deductible 30% after deductible 50% after deductible 30% after deductible 20% after deductible 30% after deductibleBenefits 50% after deductible $50 after deductible $50 30% after deductible 50% after deductible $70Preventive care $100 after deductible $500 per day 20% after deductible (up to $2,000) 30% after deductibleRoutine physical exam, mammograms, etc. No charge 50% after deductible after deductible No charge 30% after deductibleOutpatient services (per visit or procedure) 50% after deductible No charge 20% after deductible 30% after deductible $500 per dayPrimary care office visit First 3 office visits no charge. 50% after deductible (up to $2,000) 20% after deductible 30% after deductible Additional visits no charge after deductible $70 $90 50% after deductible $500 after deductible after deductible. $120 after deductible $70 after deductible Generic: $25 Generic: $15 Preferred brand: 50% after Preferred brand: $50Specialty care office visit No charge after deductible Generic: $20 Generic: $20 Non-preferred brand Preferred brand: $80 Preferred brand: $50 $500 deductible and specialty: 50%Most X-rays No charge after deductible Non-preferred brand Non-preferred brand Non-preferred brand and specialty: 50% and specialty: 30% and specialty: 50% after Generic: $30Most lab tests No charge after deductible (All after deductible) (All after deductible) Preferred brand: $100 $500 deductible Non-preferred brandMRI, CT, PET No charge after deductible Generic: $40 Generic: $40 Generic: $50 Preferred brand: $160 Preferred brand: $100 and specialty: 50%Outpatient surgery No charge after deductible Non-preferred brand Non-preferred brand Preferred brand: 50% after $500 deductible Included (see kp.org/Mental health visit First 3 office visits no charge. and specialty: 50% and specialty: 30% livehealthy) Additional visits no charge (All after deductible) (All after deductible) Non-preferred brand and specialty: 50% after after deductible. Included (see kp.org/ Included (see kp.org/ livehealthy) livehealthy) $500 deductibleInpatient hospital care (per admission) Included (see kp.org/Room and board, surgery, anesthesia, No charge after deductible livehealthy)X-rays, lab tests, medicationsMaternity No charge after deductibleRoutine prenatal care visit,first postpartum visitDelivery and inpatient well-baby care No charge after deductibleEmergency and urgent care No charge after deductibleEmergency Department visit No charge after deductibleUrgent care visitPrescription drugsPlan pharmacy (up to a 30-day supply) No charge after deductibleMail-order (up to a 90-day supply) No charge after deductibleOther Services Included (see kp.org/ChooseHealthy™ discounts, as well as livehealthy)other wellness and health programsAll plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232This is a summary of the most frequently asked-about benefits. For specific plan information about the plans referred to in this brochure, see the following forms: for HSA-qualifieddeductible plans: BOIDHDHP0115, EOIDHDHP0115; for deductible plans: BOIDDED0115, EOIDDED0115; for traditional copayment plans: BOIDTRAD0115, EOIDTRAD0115; for thecatastrophic plan: BOIDCAT0115, EOIDCAT0115. Detailed information about your plan is in the Evidence of Coverage. To request a copy of the Evidence of Coverage or the forms listedabove, please call the Member Service Contact Center. For services subject to the deductible, you will have to pay health care expenses out of pocket until you meet your deductible.Most deductibles, copayments, and coinsurance contribute to the out-of-pocket maximum. You’ll find more disclosures online at kp.org/disclosures.Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.60247833 Oregon 20

Individuals and Families PlansHealth plan benefit highlights KP OR Silver KP OR Silver KP OR Standard KP OR Gold KP OR Gold 1750/25% HSA 1500/30 Gold Plan 1000/20 0/20Plan type HSA-qualified Deductible Deductible Deductible CopaymentFeaturesIndividual plan annual deductible $1,750 $1,500 $1,300 $1,000 None(subscriber only) $3,500/$3,500 $1,500/$3,000 $1,300/$2,600 $1,000/$2,000 None/NoneFamily plan annual deductible(individual/family) $5,000 $6,350 $6,350 $6,350 $6,350Individual plan annual out-of-pocket $10,000/$10,000 $6,350/$12,700 $6,350/$12,700 $6,350/$12,700 $6,350/$12,700maximum (subscriber only)Family plan annual out-of-pocket No charge No chargemaximum (individual/family) $30 $20Benefits $50 $40 30% after deductible 30%Preventive care 30% after deductible 30% $250 $250Routine physical exam, mammograms, etc. No charge 30% after deductible No charge No charge 30% $30 $20Outpatient services (per visit or procedure) 30% after deductible $500 per dayPrimary care office visit 25% after deductible $20 $20 (up to $2,000) No charge $40 $40Specialty care office visit 25% after deductible 30% after deductible 10% after deductible 20% after deductible No charge 10% after deductible 20% after deductible $500 per dayMost X-rays 25% after deductible $350 10% after deductible $150 (up to $2,000) $50 10% after deductible 20% after deductibleMost lab tests 25% after deductible $40 $20 $250 $40MRI, CT, PET 25% after deductibleOutpatient surgery 25% after deductibleMental health visit 25% after deductibleInpatient hospital care (per admission)Room and board, surgery, anesthesia, 25% after deductible 10% after deductible 20% after deductibleX-rays, lab tests, medicationsMaternity No charge 10% after deductible No chargeRoutine prenatal care visit,first postpartum visitDelivery and inpatient well-baby care 25% after deductible 10% after deductible 20% after deductibleEmergency and urgent care 25% after deductible 10% after deductible $250Emergency Department visit 25% after deductible $60 $40Urgent care visitPrescription drugsPlan pharmacy (up to a 30-day supply) Generic: $15 Generic: $15 Generic: $10 Generic: $10 Generic: $10 Preferred brand: $45 Preferred brand: $45 after Preferred brand: $30 Preferred brand: $30 Preferred brand: $30 Non-preferred brand Non-preferred brand Non-preferred brand Non-preferred brand $250 deductible and specialty: 50% and specialty: 20% and specialty: 30% and specialty: 25% Non-preferred brand (All after deductible) and specialty: 30% after $250 deductibleMail-order (up to a 90-day supply) Generic: $30 Generic: $30 Generic: $20 Generic: $20 Generic: $20 Preferred brand: $90 Preferred brand: $90 after Preferred brand: $60 Preferred brand: $60 Preferred brand: $60Other Services Non-preferred brand Non-preferred brand Non-preferred brand Non-preferred brandChooseHealthy™ discounts, as well as $250 deductible and specialty: 50% and specialty: 30%other wellness and health programs and specialty: 25% Non-preferred brand and specialty:20% Included (see kp.org/ (All after deductible) and specialty: 30% after livehealthy) $250 deductible Included (see kp.org/ Included (see kp.org/ Included Included (see kp.org/ livehealthy) livehealthy) kp.org/livehealthy livehealthy)All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232This is a summary of the most frequently asked-about benefits. For specific plan information about the plans referred to in this brochure, see the following forms: for HSA-qualifieddeductible plans: BOIDHDHP0115, EOIDHDHP0115; for deductible plans: BOIDDED0115, EOIDDED0115; for traditional copayment plans: BOIDTRAD0115, EOIDTRAD0115. Detailedinformation about your plan is in the Evidence of Coverage. To request a copy of the Evidence of Coverage or the forms listed above, please call the Member Service Contact Center. Forservices subject to the deductible, you will have to pay health care expenses out of pocket until you meet your deductible. Most deductibles, copayments, and coinsurance contribute tothe out-of-pocket maximum. You’ll find more disclosures online at kp.org/disclosures.Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer. 21 60247833 Oregon

Individuals and Families PlansDental insurance plansWith our optional Kaiser Permanente Individuals and Families dental plans, you get thecomprehensive benefits you need and the high quality of care you’ve come to expect. There is nowaiting period — you can begin receiving your covered services the moment your coverage takeseffect. And with three plan designs to choose from, you’re sure to find one that meets your needs.The Kaiser Permanente difference QualityWe believe total health starts with outstanding dental Our dental professionals consistently exceed rigorousand oral care. That’s why we hire top-notch dentists national standards. For more than 22 years, we’veand hygienists. It’s why every member gets a received the highest level of accreditation from thepersonalized prevention and treatment plan. And Accreditation Association for Ambulatory Health Careit’s why we cover preventive care that many other (AAAHC). Currently, we’re the only dental practice inplans don’t. the Pacific Northwest with AAAHC accreditation.Choice How to make appointmentsFor your first appointment, we’ll schedule you with a Our dental offices are open Monday through Friday.dentist and dental hygienist at the location that works We also offer Saturday hours for hygienist services andbest for you. You may choose to keep that dentist and emergencies at most dental offices. To make anhygienist as your personal dental care providers. If you appointment, please call our Appointment Centerprefer, you can request to be transferred to different from 6:30 a.m. to 6 p.m., Monday through Friday, andproviders. You can always change your dentist or 7:30 a.m. to 4 p.m., Saturday.dental hygienist at any time. Portland: 503-286-6868 Salem: 503-370-4311Convenience Vancouver: 360-254-9158 Longview: 360-575-4800We have 17 dental offices in the Portland metro area, For more information regarding our dental plans andsouthwest Washington, Longview, and Salem, so services, please visit kp.org/dental/nw.there’s sure to be one near your home or work. Ourdental group includes pediatric dentists, orthodontists,periodontists, oral surgeons, endodontists, andprosthodontists.Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.60247833 Oregon 22

Individuals and Families Plans KP OR Dental 100 KP OR Dental 80H KP OR Dental 80LDental plans Child Adult Child Adult Child Adult (18 or younger) (19 or older) (18 or younger) (19 or older) (18 or younger) (19 or older)FeaturesBenefit maximum Does not apply $1,000 Does not apply $1,000 Does not apply No maximum $350/$700 Does not apply $350/$700 Does not applyOut-of-pocket maximum (individual/family) $350/$700 Does not apply $0 $100/$300 $0 $100/$300Deductible (individual/family) $50/$150 $50/$150Benefits (subject to deductible unless otherwise noted)Preventive and diagnostic services No charge 20% coinsurance (not subject to deductible) 20% coinsurance (not subject to deductible) 75% coinsuranceBasic restorative services 20% coinsurance 75% coinsurance 50% coinsurance 75% coinsuranceOral surgery, endodontics, and periodontics 20% coinsurance 50% coinsurance 50% coinsuranceMajor restorative services 50% coinsurance 50% coinsurance 50% coinsurance Monthly ratesAge on 2015 KP OR Dental 100 KP OR Dental 80H KP OR Dental 80L To calculate the rate of your dental plan for you and youreffective date entire family, add the rate for each family member based $34.59 $22.93 $27.18 on their age. For children who are under 21 and covered <21 38.97 27.03 34.80 under the same dental plan, include a rate for no more 21–29 41.46 28.76 37.03 than the 3 oldest children. 30–34 42.95 29.79 38.35 35–39 47.49 32.94 42.41 Note: All family members must enroll in a pediatric dental 40–44 52.71 36.56 47.07 plan unless you confirm on your application that you 45–49 56.68 39.31 50.61 and your family members are enrolled in another Health 50–54 61.52 42.67 54.94 Insurance Marketplace–certified pediatric dental plan. 55–59 63.18 43.82 56.42 60–64 64.38 44.66 57.49 65+This brochure provides summaries of various plans and is not a contract. Dental plan details are provided in your Evidence of Coverage.For specific plan information about dental plans, see the following forms: EOIDIFAMILYDNT0115, EOIDFAMILYDNTDED0115–Evidence of Coverage; BOIDFAMILYDNT0115,BOIDFAMILYDNTDED0115–Benefit Summaries; FOIDFAMILYDNT0115—Face Sheet. Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer. 23 60247833 Oregon

Individuals and Families PlansWorking out your rateWe’re here to help you find the best plan for your needs. Use the following rate chart and plancost worksheet on page 25 to help you evaluate your plan options.What determines your rate? Although family members can enroll in different plans, there are some advantages to enrolling familyYour rate is based on the following: members in the same plan:■ The plan you select ■ Children can be covered under your plan until they reach age 26, whether or not they’re in school, living■ Your county at home, or away from the family. But they need to be on the same plan as you.■ Your age at the time of your effective date ■ If you have more than 3 children under age 21 on■ Whether you use tobacco the same plan, you will only be charged for the 3 oldest. Other children under 21 are covered at no■ If you add a pediatric dental plan for family additional cost. If you have a child-only account and members age 18 and younger everyone on the account is under age 21, you will only be charged for the subscriber and the 3 oldestIf you move and change your home ZIP code, your children under age 21.monthly rate may change. If you move to a ZIP codethat isn’t covered by Kaiser Permanente, your coverage ■ For example, to determine the rate for a family plan,may not continue. a family of 6 (2 adults and 4 children under 21) would calculate their rate by adding the rate for both adultsRates are determined based on each person’s age on plus the rate for each of the 3 oldest children for athe plan’s effective date, whether they apply individually combined family rate. The 4th child (youngest) wouldor as a family. For example, if your 29th birthday is on be no additional cost.February 14 and you submit your completed applicationon January 15, you’ll have an effective date of February 1 ■ You may want to consider different plans withand the rate for a 28-year-old. different rates for various family members based on your family’s needs. However, you may pay moreHowever, if you submit your application on January 16, if you have more than 3 children under age 21your effective date will be March 1. Since this is after who are not covered under the same plan.your birthday, you’ll have the rate for a 29-year-old. Preventive care at no extra chargeSimilarly, if you’re purchasing coverage for your family,each family member’s rate will be based on his or her As you review the rates, remember that manyage on the effective date. (Families are only charged preventive care services are available at no chargefor a maximum of 3 children under age 21 who before you reach your deductible. That means youare applying for the same plan.) get a wide range of services that can help you stay healthy — including general immunizations, diabetesOur service area 97330–31, 97333, 97339, 97370 and cancer screenings, counseling for smoking and 97004, 97009, 97011, 97013, 97015, 97017, alcohol abuse, and more. For a complete list ofBenton County 97022–23, 97027, 97034–36, 97038, 97042, 97045, preventive care services, visit kp.org/prevention.Clackamas County 97049, 97055, 97067–68, 97070, 97086, 97089, 97222, 97267–69Columbia County All ZIP codesHood River County 97014Linn County 97321–22, 97335, 97348, 97355, 97358, 97360,Marion County 97374, 97377, 97389 97002, 97020, 97026, 97032, 97071, 97137,Multnomah County 97301–03, 97305–14, 97317, 97325, 97342, 97346,Polk County 97352, 97358, 97362, 97373, 97375, 97381,Washington County 97383–85, 97392Yamhill County All ZIP codes All ZIP codes All ZIP codes All ZIP codesHave questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.60247833 Oregon 24

Individuals and Families Plans Rate calculatorTo figure out the total rate for your health plan for you and your family, just follow these steps:1. List everyone you want to cover: 4. For children who are covered under the same plan, ■ Yourself include a rate for the 3 oldest children under 21. ■ Your spouse ■ All your adult children ages 21 through 25 5. If you are not opting out of pediatric dental, please ■ Your children under 21 add the appropriate additional rate for each of the 3 oldest children 18 and younger.2. F ind your preferred plan in the rate chart on 6. A dd up the rates. the next page. The worksheet below can help. Go to buykp.org/apply3. F ind the rate for each family member, based on age. or call us or your producer for assistance.Federal assistance and your rateIf you qualify for federal financial assistance, these rates do not apply to you. The federal government will payany federal financial assistance to Kaiser Foundation Health Plan of the Northwest on your behalf. To learnmore, read the “You may qualify for federal financial assistance” section on page 15.Plan choice Your monthly rate worksheet C ABFamily member name Family member age Rate for plan A Rate for plan B Rate for plan C $$$ $$$ $$$ $$$ $$$ $$$Subtotal for health plan premium $$$Pediatric dental plan KP OR Dental 80H (add $22.93 per ____ x $22.93 = $___________ ____ x $22.93 = $___________ ____ x $22.93 = $___________child 18 and younger) $ $ $Total premiumHave questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer. 25 60247833 Oregon

Individuals and Families Plans2015 Monthly rates Please note: These rates do not include the federal financial assistance you may be eligible for. Tobacco non-user premiumsAge on KP OR KP OR Bronze KP OR KP OR KP OR Silver KP OR Silver KP OR KP OR KP OR KP OR 2015 Catastrophic Bronze Bronze 2500/35 1750/25% Silver Standard Gold Goldeffective 5000/50% 4500/50 Standard 1500/30 Gold Plan 1000/20 0/20 date HSA Standard 4500/50 HSA HSA <21 $129 $144 $144 $156 21–24 $82 $91 $95 $112 $122 $122 203 227 226 245 129 143 150 177 193 192 203 228 227 246 25 130 143 151 178 193 192 207 232 232 251 26 132 146 154 181 197 196 212 238 237 257 27 135 150 158 185 202 201 220 247 246 266 28 140 155 163 192 209 208 227 254 253 274 29 145 160 168 198 216 215 230 258 257 278 30 147 162 171 201 219 218 235 263 262 284 31 150 165 174 205 223 222 240 268 268 290 32 153 169 178 209 228 227 243 272 271 293 33 155 171 180 212 231 230 246 276 275 297 34 157 173 183 215 234 233 247 277 276 299 35 158 174 184 216 235 234 249 279 278 301 36 159 175 185 218 237 236 251 281 280 303 37 160 177 186 219 239 237 252 283 282 305 38 161 178 187 220 240 239 256 286 285 309 39 163 180 190 223 243 242 259 290 289 313 40 165 182 192 226 246 245 264 295 295 319 41 168 186 196 230 251 250 268 301 300 325 42 171 189 199 234 255 254 275 308 307 332 43 175 194 204 240 261 260 283 317 316 342 44 181 199 210 247 269 268 292 328 327 354 45 187 206 217 256 278 277 304 340 339 367 46 194 214 226 265 289 288 317 355 354 383 47 202 223 235 277 301 300 331 371 370 401 48 211 233 246 289 315 313 346 387 386 418 49 220 243 257 302 329 327 362 405 404 438 50 231 255 269 316 344 342 378 423 422 457 51 241 266 280 330 359 358 395 443 442 478 52 252 278 294 345 376 374 413 463 461 500 53 264 291 307 361 393 391 432 485 483 523 54 276 305 321 378 411 409 452 506 504 546 55 288 318 335 395 430 427 473 529 528 572 56 302 333 351 413 450 447 494 553 551 597 57 315 348 367 431 470 467 516 578 576 624 58 329 364 383 451 491 488 527 591 589 638 59 336 371 391 461 502 499 550 616 614 665 60 351 387 408 480 523 520 569 638 636 688 61 363 401 423 497 541 539 582 652 650 704 62 371 410 432 508 554 551 598 670 668 723 63 382 421 444 522 569 566 609 681 678 735 64+ 387 429 450 531 579 576Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.60247833 Oregon 26

Individuals and Families Plans2015 Monthly rates Please note: These rates do not include the federal financial assistance you may be eligible for. Tobacco user premiumsAge on KP OR KP OR Bronze KP OR KP OR KP OR Silver KP OR Silver KP OR KP OR KP OR KP OR 2015 Catastrophic 5000/50% Bronze Bronze 2500/35 1750/25% Silver Standard Gold Goldeffective 4500/50 HSA 4500/50 Standard 1500/30 Gold Plan 1000/20 0/20 date HSA Standard HSA <21 $129 $144 $144 $156 21–24 $82 $91 $95 $112 $122 $122 243 272 271 294 155 171 180 212 231 230 244 273 273 295 25 156 172 181 213 232 231 249 279 278 301 26 159 175 185 217 237 236 255 285 284 308 27 163 179 189 223 242 241 264 296 295 320 28 169 186 196 231 251 250 272 305 304 329 29 174 192 202 238 259 257 276 309 308 334 30 176 194 205 241 262 261 282 316 315 341 31 180 198 209 246 268 267 288 322 321 348 32 183 203 213 251 274 272 291 326 325 352 33 186 205 216 254 277 276 295 331 330 357 34 188 208 219 258 281 279 297 333 332 359 35 190 209 221 259 283 281 299 335 334 362 36 191 211 222 261 284 283 301 337 336 364 37 192 212 223 263 286 285 303 339 338 366 38 193 213 225 265 288 287 307 344 343 371 39 196 216 228 268 292 290 311 348 347 376 40 198 219 231 271 296 294 316 355 353 383 41 202 223 235 276 301 299 322 361 360 390 42 205 227 239 281 306 305 330 370 368 399 43 210 232 245 288 314 312 340 380 379 411 44 217 239 252 297 323 321 351 393 392 425 45 224 247 261 307 334 332 365 408 407 441 46 233 257 271 318 347 345 380 426 424 459 47 242 268 282 332 361 360 397 445 444 481 48 254 280 295 347 378 376 415 465 463 502 49 265 292 308 362 394 392 434 486 485 525 50 277 306 322 379 413 411 453 508 506 548 51 289 319 337 396 431 429 474 532 530 574 52 303 334 352 414 451 449 496 556 554 600 53 316 349 368 433 472 469 519 581 580 628 54 331 366 385 453 494 491 542 607 605 656 55 346 382 402 473 516 513 567 635 633 686 56 362 399 421 495 539 537 592 664 662 716 57 378 417 440 517 564 561 619 694 692 749 58 395 436 460 541 589 586 633 709 707 765 59 404 446 470 553 602 599 660 739 737 798 60 421 465 490 576 628 624 683 765 763 826 61 436 481 507 597 650 646 698 782 780 845 62 446 492 518 610 664 661 717 804 801 868 63 458 505 533 627 683 679 729 816 813 882 64+ 465 513 540 636 693 690Have questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer. 27 60247833 Oregon

Individuals and Families PlansHave questions? Call us at 1-800-494-5314. • Go to buykp.org/apply. • Or contact your producer.60247833 Oregon 28



It’s time to choose betterLearn more about Kaiser Permanente at kp.org or call us toll freeat 1-800-494-5314, or contact your producer. For TTY for the deaf,hard of hearing, or speech impaired, call 711.For updates about health care reform, visit kp.org/reform. Kaiser Foundation Health Plan of the Northwest kp.org 500 NE Multnomah St., Suite 100, Portland, OR 97232Please recycle. This material was produced from eco-responsible resources.KPIF 60251908 2015