2021 Kaiser Permanente Small Group Plan Documents

Compare Plan Options

Compare Your Options Plan Brochure

Documents listed here are current as of April 3, 2021.

Summaries of Benefits and Coverage - English

Core Bronze HSA
Core Silver HSA
Core Silver
Core VisitsPlus Silver LX
Core VisitsPlus Silver LX - EO
Core VisitsPlus Gold HD LX
Core VisitsPlus Gold LX
Core VisitsPlus Gold LX - EO
Core VisitsPlus Platinum LX

Connect Virtual Plus Silver
Connect Virtual Plus Gold
Access PPO Bronze HSA
Access PPO Silver HSA
Access PPO VisitsPlus Silver LD LX
Access PPO VisitsPlus Silver LX
Access PPO VisitsPlus Silver LX - EO

Access PPO VisitsPlus Gold LX
Access PPO VisitsPlus Gold HD LX
Access PPO VisitsPlus Platinum HD LX
Access PPO VisitsPlus Platinum LX
Elect PPO VisitsPlus Silver LX
Elect PPO VisitsPlus Gold LX
Elect PPO VisitsPlus Platinum LX

Summaries of Benefits and Coverage - Español

Core Bronze HSA - Español
Core Silver HSA - Español
Core Silver - Español
Core VisitsPlus Silver LX - Español
Core VisitsPlus Silver LX - EO - Español
Core VisitsPlus Gold HD LX - Español
Core VisitsPlus Gold LX - Español
Core VisitsPlus Gold LX - EO - Español
Core VisitsPlus Platinum LX - Español

Connect Virtual Plus Silver - Español
Connect Virtual Plus Gold - Español
Access PPO Bronze HSA - Español
Access PPO Silver HSA - Español
Access PPO VisitsPlus Silver LD LX - Español
Access PPO VisitsPlus Silver LX - Español
Access PPO VisitsPlus Silver LX - EO - Español

Access PPO VisitsPlus Gold LX - Español
Access PPO VisitsPlus Gold HD LX - Español
Access PPO VisitsPlus Platinum HD LX - Español
Access PPO VisitsPlus Platinum LX - Español
Elect PPO VisitsPlus Silver LX - Español
Elect PPO VisitsPlus Gold LX - Español
Elect PPO VisitsPlus Platinum LX - Español

Evidence of Coverage

2021 Core Bronze HSA
2021 Core Silver HSA
2021 Core Silver
2021 Core VisitsPlus Silver LX
2021 Core VisitsPlus Silver LX-EO
2021 Core VisitsPlus Gold HD LX
2021 Core VisitsPlus Gold LX
2021 Core VisitsPlus Gold LX-EO

2021 Core VisitsPlus Platinum LX
2021 Connect Virtual Plus Silver
2021 Connect Virtual Plus Gold
2021 Access PPO Bronze HSA
2021 Access PPO Silver HSA
2021 Access PPO VisitsPlus Silver LD LX
2021 Access PPO VisitsPlus Silver LX

2021 Access PPO VisitsPlus Silver LX EO
2021 Access PPO VisitsPlus Gold LX
2021 Access PPO VisitsPlus Gold HD LX
2021 Access PPO VisitsPlus Platinum HD LX
2021 Access PPO VisitsPlus Platinum LX
2021 Elect PPO VisitsPlus Silver LX
2021 Elect PPO VisitsPlus Gold LX
2021 Elect PPO VisitsPlus Platinum LX

Medical Benefit Summaries

Core Bronze H.S.A.
Core Silver H.S.A.
Core Silver
Core VisitsPlus Silver LX
Core VisitsPlus Silver LX-EO
Core VisitsPlus Gold HD LX
Core VisitsPlus Gold LX
Core VisitsPlus Gold LX-EO
Core VisitsPlus Platinum LX

Connect Virtual Plus Silver
Connect Virtual Plus Gold
Access PPO Bronze HSA
Access PPO Silver HSA
Access PPO VisitsPlus Silver LD LX
Access PPO VisitsPlus Silver LX
Access PPO VisitsPlus Silver LX EO

Access PPO VisitsPlus Gold LX
Access PPO VisitsPlus Gold HD LX
Access PPO VisitsPlus Platinum HD LX
Access PPO VisitsPlus Platinum LX
Elect PPO VisitsPlus Silver LX
Elect PPO VisitsPlus Gold LX
Elect PPO VisitsPlus Platinum LX

Dental Benefits Summaries

Adult Dental Plan Flyer
Adult Dental without Rates - Standard

Adult Dental without Rates - Basic
Pediatric Dental Plan Flyer

Pediatric Dental without Rates

EO = employee only
HD = High Deductible
LX = Lab and X-ray