Puget Sound Summary of Benefits
Effective Jan. 1, 2019 – Dec. 31, 2019

Premiums & Benefits: Page 1 & 2
Part D Prescription Drug Coverage: Page 3
Optional Dental Package: Page 3

Coverage provided by Kaiser Permanente

Cost shares listed are for a 30 day supply

Medicare Advantage Group Retirees

Large Group Sales and Account Management. Large Group Sales and Account Management.

Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.