Medical Plan Documents

EPO Medical Benefit Plan - 7/1/2020

EPO COVID-19 Testing Plan Amendment

PPO&HD Medical Benefit Plan - 7/1/2020

PPO&HD COVID-19 Testing Plan Amendment

Dental Plan Documents

Dental Plan Document (Plans A, B & C)

Vision Plan Documents

Vision A (UMR)

Vision B (VSP)

Vision C (VSP)

VSP Rules and Regulations

SBC – Kaiser Permanente Plans

SBC-KP-HMO 40 - 7/1/2020-6/30/2021 ~ 7/1/2021-6/30/2022

SBC-KP-HMO 45 - 7/1/2020-6/30/2021 ~ 7/1/2021-6/30/2022

SBC-KP-DHMO 750 - 7/1/2020-6/30/2021 ~ 7/1/2021-6/30/2022

SBC-KP-DHMO 1000 - 7/1/2020-6/30/2021 ~ 7/1/2021-6/30/2022

SBC-KP-DHMO 1500 - 7/1/2020-6/30/2021 ~ 7/1/2021-6/30/2022

SBC-KP-DHMO 2500 - 7/1/2020-6/30/2021 ~ 7/1/2021-6/30/2022

SBC-KP-HDHP 1500 - 7/1/2020-6/30/2021 ~ 7/1/2021-6/30/2022

SBC-KP-HDHP 2500 - 7/1/2020-6/30/2021 ~ 7/1/2021-6/30/2022

EOC - Kaiser Permanente Plans

EOC-KP-HMO 40

EOC-KP-HMO 45

EOC-KP-DHMO 750

EOC-KP-DHMO 1000

EOC-KP-DHMO 1500

EOC-KP-DHMO 2500

EOC-KP-HDHP 2500

Summary of Benefits and Coverage (SBC)

SBC-EPO3 - 1/1/2021-6/30/2021 ~ 7/1/2021-12/31/2021

SBC-EPO4 - 1/1/2021-6/30/2021 ~ 7/1/2021-12/31/2021

SBC-EPO5 - 1/1/2021-6/30/2021 ~ 7/1/2021-12/31/2021

SBC-EPO6 - 1/1/2021-6/30/2021 ~ 7/1/2021-12/31/2021

SBC-HDHP 2 - 1/1/2021-6/30/2021 ~ 7/1/2021-12/31/2021

SBC-HD2800 - 1/1/2021-6/30/2021 ~ 7/1/2021-12/31/2021

SBC-HDHP 3 - 1/1/2021-6/30/2021 ~ 7/1/2021-12/31/2021

SBC-HD3500 - 1/1/2021-6/30/2021 ~ 7/1/2021-12/31/2021

SBC-HDHP 4 - 1/1/2021-6/30/2021 ~ 7/1/2021-12/31/2021

SBC-HDHP 5 - 1/1/2021-6/30/2021 ~ 7/1/2021-12/31/2021

SBC-PPO2 - 1/1/2021-6/30/2021 ~ 7/1/2021-12/31/2021

SBC-PPO3 - 1/1/2021-6/30/2021 ~ 7/1/2021-12/31/2021

SBC-PPO4 - 1/1/2021-6/30/2021 ~ 7/1/2021-12/31/2021

SBC-PPO5 - 1/1/2021-6/30/2021 ~ 7/1/2021-12/31/2021

SBC-PPO6 - 1/1/2021-6/30/2021 ~ 7/1/2021-12/31/2021

SBC-PPO7 - 1/1/2021-6/30/2021 ~ 7/1/2021-12/31/2021

SBC-PPO8 - 1/1/2021-6/30/2021 ~ 7/1/2021-12/31/2021