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California – Northern

Our plan options

You have 3 plan options to choose from:
2021 Enrollment Guide View

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
    code
    591

Self Plus One


  • Bi-weekly
    $600.32

  • Monthly
    $1,300.70

  • Enrollment
    code
    593

Self and Family


  • Bi-weekly
    $555.53

  • Monthly
    $1,203.65

  • Enrollment
    code
    592

Self Only


  • Bi-weekly
    $138.12

  • Monthly
    $299.26

  • Enrollment
    code
    594

Self Plus One


  • Bi-weekly
    $371.05

  • Monthly
    $803.95

  • Enrollment
    code
    596

Self and Family


  • Bi-weekly
    $326.26

  • Monthly
    $706.90

  • Enrollment
    code
    595

Self Only


  • Bi-weekly
    $75.24

  • Monthly
    $163.02

  • Enrollment
    code
    KC1

Self Plus One


  • Bi-weekly
    $186.78

  • Monthly
    $404.69

  • Enrollment
    code
    KC3

Self and Family


  • Bi-weekly
    $176.06

  • Monthly
    $381.46

  • Enrollment
    code
    KC2
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
    code
    591

Self Plus One


  • Bi-weekly
    category 1
    $593.13

  • Bi-weekly
    category 2
    $571.57

  • Enrollment
    code
    593

Self and Family


  • Bi-weekly
    category 1
    $547.72

  • Bi-weekly
    category 2
    $524.30

  • Enrollment
    code
    592

Self Only


  • Bi-weekly
    category 1
    $134.76

  • Bi-weekly
    category 2
    $124.70

  • Enrollment
    code
    594

Self Plus One


  • Bi-weekly
    category 1
    $363.86

  • Bi-weekly
    category 2
    $342.30

  • Enrollment
    code
    596

Self and Family


  • Bi-weekly
    category 1
    $318.45

  • Bi-weekly
    category 2
    $295.03

  • Enrollment
    code
    595

Self Only


  • Bi-weekly
    category 1
    $72.23

  • Bi-weekly
    category 2
    $62.45

  • Enrollment
    code
    KC1

Self Plus One


  • Bi-weekly
    category 1
    $179.59

  • Bi-weekly
    category 2
    $158.03

  • Enrollment
    code
    KC3

Self and Family


  • Bi-weekly
    category 1
    $169.02

  • Bi-weekly
    category 2
    $146.13

  • Enrollment
    code
    KC2
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

2021 Benefits & Rates View

 

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.

Ready to enroll?

To sign up, write down the enrollment code above. You will be asked to provide it during the sign-up process. Then click below to visit OPM.gov or contact your employing agency or retirement office for next steps and other information.
Enroll online at OPM.gov These are highlights of the FEHB enrollment process. Please refer directly to opm.gov and your employing agency or retirement office for FEHB coverage effective dates, enrollment procedures and deadlines, and other information.

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.

Learn more about care for growing families >

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