Our plan options
High Option
Plan Features
- No deductible
- Lowest copays for services and prescription drugs
Best option if you
- Anticipate frequent care visits
- Want predictable and low out-of-pocket costs
Standard Option
Plan Features
- Lower premiums than High Option
- Predictable copays
- Low $100 deductible
Best option if you
- Want a lower premium and predictable out-of-pocket costs
Basic Option
Plan Features
- Lowest premium option
- Lower copays for office visits and urgent care services than our Standard Option
- $500 deductible (does not apply to preventive care, office visits, urgent care, prescription drugs and more)
Best option if you
- Are in good overall health
- Want to pay the lowest premiums
2021 plan rates
Self Only
Bi-weekly$226.67
Monthly$491.12
Enrollment
code591
Self Plus One
Bi-weekly$600.32
Monthly$1,300.70
Enrollment
code593
Self and Family
Bi-weekly$555.53
Monthly$1,203.65
Enrollment
code592
Self Only
Bi-weekly$138.12
Monthly$299.26
Enrollment
code594
Self Plus One
Bi-weekly$371.05
Monthly$803.95
Enrollment
code596
Self and Family
Bi-weekly$326.26
Monthly$706.90
Enrollment
code595
Self Only
Bi-weekly$75.24
Monthly$163.02
Enrollment
codeKC1
Self Plus One
Bi-weekly$186.78
Monthly$404.69
Enrollment
codeKC3
Self and Family
Bi-weekly$176.06
Monthly$381.46
Enrollment
codeKC2
| High Option | Standard Option | Basic Option | |||||||
| Enrollment Code | Bi-Weekly | Monthly | Enrollment Code | Bi-Weekly | Monthly | Enrollment Code | Bi-Weekly | Monthly | |
| Self Only | 591 | $226.67 | $491.12 | 594 | $138.12 | $299.26 | KC1 | $75.24 | $163.02 |
| Self Plus One | 593 | $600.32 | $1,300.70 | 596 | $371.05 | $803.95 | KC3 | $186.78 | $404.69 |
| Self and Family | 592 | $555.53 | $1,203.65 | 595 | $326.26 | $706.90 | KC2 | $176.06 | $381.46 |
Enrollees covering themselves and one other eligible family member may choose either the Self Plus One or Self and Family enrollment type, whichever has a lower premium.
These rates do not apply to all enrollees. If you are in a special enrollment category, please refer to the FEHBP Program website or contact the agency or Tribal Employer which maintains your health benefits enrollment.
Self Only
Bi-weekly
category 1$223.31
Bi-weekly
category 2$213.25
Enrollment
code591
Self Plus One
Bi-weekly
category 1$593.13
Bi-weekly
category 2$571.57
Enrollment
code593
Self and Family
Bi-weekly
category 1$547.72
Bi-weekly
category 2$524.30
Enrollment
code592
Self Only
Bi-weekly
category 1$134.76
Bi-weekly
category 2$124.70
Enrollment
code594
Self Plus One
Bi-weekly
category 1$363.86
Bi-weekly
category 2$342.30
Enrollment
code596
Self and Family
Bi-weekly
category 1$318.45
Bi-weekly
category 2$295.03
Enrollment
code595
Self Only
Bi-weekly
category 1$72.23
Bi-weekly
category 2$62.45
Enrollment
codeKC1
Self Plus One
Bi-weekly
category 1$179.59
Bi-weekly
category 2$158.03
Enrollment
codeKC3
Self and Family
Bi-weekly
category 1$169.02
Bi-weekly
category 2$146.13
Enrollment
codeKC2
| High Option | Standard Option | Basic Option | |||||||
| Enrollment Code | Bi-Weekly Category 1 | Bi-Weekly Category 2 | Enrollment Code | Bi-Weekly Category 1 | Bi-Weekly Category 2 | Enrollment Code | Bi-Weekly Category 1 | Bi-Weekly Category 2 | |
| Self Only | 591 | $223.31 | $213.25 | 594 | $134.76 | $124.70 | KC1 | $72.23 | $62.45 |
| Self Plus One | 593 | $593.13 | $571.57 | 596 | $363.86 | $342.30 | KC3 | $179.59 | $158.03 |
| Self and Family | 592 | $547.72 | $524.30 | 595 | $318.45 | $295.03 | KC2 | $169.02 | $146.13 |
Enrollees covering themselves and one other eligible family member may choose either the Self Plus One or Self and Family enrollment type, whichever has a lower premium.
These rates do not apply to all enrollees. If you are in a special enrollment category, please refer to the FEHBP Program website or contact the agency or Tribal Employer which maintains your health benefits enrollment.
2021 Summary of Benefits
| High Option | Standard Option | Basic Option | |
|---|---|---|---|
| Deductible | None | $100 | $500 |
| 2021 Benefits and Services | |||
| Outpatient services | |||
| Preventive care | $0 | $0 | $0 |
| Telehealth | $0 | $0 | $0 |
| Primary care office visit | $15 | $30 | $25 |
| Specialty care office visit | $25 | $40 | $35 |
| Laboratory tests | $0 | $101 | 20%1 |
| X-rays | $0 | $101 | 20%1 |
| Chiropractic services – 20 visits per year | $15 | $15 | $15 |
| Maternity | |||
| Routine prenatal care and postpartum visit | $0 | $0 | $0 |
| Delivery | $250 | $5001 | 20%1 |
| Hospital services | |||
| Outpatient surgery | $50 | $2001 | 20%1 |
| Inpatient hospital | $250 | $5001 | 20%1 |
| Emergency and urgent care | |||
| Urgent care | $15 | $30 | $25 |
| Emergency care | $100 | $1501 | 20%1 |
| Ambulance | $50 | $1501 | 20%1 |
| Prescription drugs | |||
| Generic | $10 | $15 | $15 |
| Brand | $40 | $50 | $60 |
| Specialty | $100 | $150 | $200 |
| Out-of-pocket maximum | $2,000 | $3,000 | $5,500 |
1Deductible applies.
Notes:
- Deductible and out-of-pocket maximum amounts are per person, but no more than 2 times per family.
- Coinsurance (%) is based on our allowance.
- Telehealth options include video, phone, email and more.
- Prescription drug copayments are for a 30-day supply at Kaiser Permanente pharmacies. You pay only 2 copays for up to a 100-day supply for most drugs through Kaiser Permanente’s mail-order program.
This is a summary of the features of the Kaiser Permanente health plan. Before making a final decision, please read the Plan’s Federal brochure (RI 73-003). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.
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Care for growing families
There’s no better place to plan, start, and raise your family because you’re all at the center of everything we do. Check out what you get with your health plan and discover how your dollars go further with Kaiser Permanente.
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