Individual and Family Enrollment Guide | Kaiser Permanente ... · open enrollment The open...

Healthy togetherCare and coverage that fits your life

2019 Enrollment | Washingtonkp.org/wa/if

Kaiser Permanente for Individuals and Families

http://kp.org/wa/if

Your doctor, your choiceChoose your doctor based on what’s important to you. Go to kp.org/wa/directory

for details about education, specialties, languages spoken, and more. You can also change

doctors at any time.

*Phone appointments are available when you get care at Kaiser Permanente facilities.†Prescriptions from online visits must be filled at a Kaiser Permanente medical office or by mail-order service.

More care options

How you get care is up to you. Choose a

phone appointment,* an online visit† or

Care Chat for issues that don't require an

exam, or come see us in person.

Many services under one roof

Do more in less time. In most of our facilities,

you can see your doctor, get a lab test, and pick up prescriptions — all

in a single trip.

Right care, right time

Get the care you need when you

need it with routine, specialty, urgent, and

emergency care. If you’re ever unsure where to go, call us for 24/7 care advice

by phone.

Welcome to care that fits your life

http://kp.org/wa/directory

Have questions? Call us at 1-800-358-8815. • Go to kp.org/wa/if. • Or contact your producer.


3 IF0001383-53-18 KPWA 2019

The right choice for your healthWelcome to your Kaiser Permanente for Individuals and Families enrollment guide. This guide will help you select the right health plan for your needs.

Important deadline for open enrollmentThe open enrollment period for 2019 coverage runs from November 1, 2018, through December 15, 2018. You can change or apply for coverage through Kaiser Permanente, or we can help you apply through Washington Healthplanfinder.

For coverage that starts on January 1, 2019, we must receive your Application for Health Coverage no later than December 15, 2018.

Enrolling during a special enrollment period

Are you getting married, having a baby, or losing your health coverage? You may also enroll or change your coverage throughout the year if you have a qualifying life event.

Visit kp.org/wa/if-sep for a list of qualifying life events

and instructions.

Visit kp.org/wa/if to compare plans, see if you qualify for federal financial assistance, calculate your rate, or apply online.

Simple steps to applyUse this guide to help you find a plan that works for you. Then, apply online or fill out a paper application.

Choose your health plan ................ 3

Find your rate ................................... 10

Learn about dental and vision coverage ......................... 25

Find a facility near you ................... 27

http://kp.org/wa/if

http://kp.org/wa/if-sep

http://kp.org/wa/if



4 IF0001383-53-18 KPWA 2019

*Prescriptions from online visits must be filled at a Kaiser Permanente medical office or by mail-order service.† These features are available when you get care at Kaiser Permanente facilities.

Choose how you connect to care

Online

Once you’ve registered for online services at kp.org/wa, you can participate in an online visit* or have a Care Chat with a clinician for common conditions. If your doctor practices at Kaiser Permanente, email your doctor's office anytime with nonurgent questions.

Phone

Get care guidance and advice by calling our 24-hour Consulting Nurse Service at 1-800-297-6877. You may also save a trip to your Kaiser Permanente doctor’s office by having a phone appointment for follow-up visits instead.†

Mobile appManage your care anytime, anywhere. Access many of the features on kp.org/wa with the Kaiser Permanente Washington mobile app. Learn more at kp.org/wa/mobile.

In person

Most of our care locations have many services under one roof,† so you can see your doctor, get lab services or X-rays, and pick up a prescription — all in the same trip. Or, schedule an appointment with a Core network provider in your area.

Online wellness tools

Visit kp.org/wa/health-wellness for wellness information, health calculators, fitness videos, podcasts, and recipes from world-class chefs.

Discounts for members

Enjoy discounts on products and services that can help you stay healthy — like gym memberships, massage therapy, and more. Explore your options at kp.org/wa/member-perks.

Your care, your wayGet care where, when, and how you want it. With more options to choose from, it’s easier to stay on top of your health.

http://kp.org/wa/if

http://kp.org/wa

http://kp.org/wa

http://kp.org/wa/mobile

http://kp.org/wa/health-wellness

http://kp.org/wa/member-perks



5 IF0001383-53-18 KPWA 2019

Choose your health plan Understanding health plansWe offer a variety of plans to fit your needs and budget. All of them offer the same quality care, but the way they split the costs is different. Learn more below.

Deductible plans

Gold, Silver, Bronze, CatastrophicWith a deductible plan, your monthly premium is lower, but you’ll have to reach a deductible. This means you’ll pay the full charges for most covered services until you reach a set amount known as your deductible. Then you’ll start paying less — just a copay or coinsurance. Depending on your plan, some services, like office visits or prescriptions, may be available at a copay or coinsurance before you meet your deductible.

HSA-qualified deductible plans

Silver, BronzeHSA-qualified deductible plans are deductible plans with a special feature. With this plan, you can set up a health savings account (HSA) to pay for health costs like copays, coinsurance, and deductible payments. And you won’t pay federal taxes on the money in this account.

You can use your HSA anytime to pay for care, including some services that may not be covered by your plan, such as eyeglasses, adult dental care, or chiropractic services.* And if you have money left in your HSA at the end of the year, it will roll over for you to use the next year.

*For a complete list of services you can use your HSA to pay for, see Publication 502, Medical and Dental Expenses, at irs.gov.

http://kp.org/wa/if



6 IF0001383-53-18 KPWA 20196

Choosing a plan based on your care needsIf you need a lot of care, you may want a plan with a higher monthly rate so that you pay less when you come in for care. If you don’t go to the doctor much, you may want a plan with a lower monthly rate, keeping in mind you’ll pay more if and when you do get care.

An example of costs when you get care

Let’s say you hurt your ankle. You visit your primary care doctor, who orders an X-ray. It’s just a sprain, so the doctor prescribes a generic pain medication. Here’s a sample of what you would pay out of pocket for these services with each type of health plan.

Monthly rate versus out-of-pocket costs

Plan levelWhat you pay for your monthly rate

What you pay when you get care (Emergency Department visit, lab test, etc.)

Gold

Silver

Bronze

Plan name Office visit X-rayGeneric

drug

Flex Gold ($1,150 deductible)

$255 or $15*

$104 or $21† $10

Flex Silver HD ($3,000 deductible)

$255 or $20*

$104 or $31† $10

Core Bronze HSA ($4,750 deductible)

$255 or $51†

$104 or $21†

$12 or $2.40†

*If the visit is one of the upfront visits not subject to deductible or if you’ve already met your deductible. †If you’ve met your deductible.

The costs above are estimates. To find out what the charge would be for common services, contact Member Services at 1-800-290-8900.

http://kp.org/wa/if

IF0001383-53-18 KPWA 2019

Flex Gold

Plan type Deductible

Features

Annual medical deductible(individual/family) $1,150/$2,300

Annual out-of-pocket maximum (individual/family) $6,500/$13,000

Benefits

Preventive care

Routine physical exam, mammograms, etc. No charge

Outpatient services (per visit or procedure)

Primary care office visit $15, deductible does not apply to first 5 office visits,* additional visits $15 after deductible

Specialty care office visit $40, deductible does not apply to first 5 office visits,* additional visits $40 after deductible

Most X-rays 20% after deductible

Most lab tests 20% after deductible

MRI, CT, PET 20% after deductible

Outpatient surgery 20% after deductible

Mental health visit $15, deductible does not apply to first 5 office visits,* additional visits $15 after deductible

Inpatient hospital care

Room and board, surgery, anesthesia, X-rays, lab tests, medications, mental health care

20% after deductible

Maternity

Routine prenatal care visits, first postpartum visit No charge

Delivery and inpatient well-baby care 20% after deductible

Emergency and urgent care

Emergency Department visit 20% after deductible

Urgent care visit $15, deductible does not apply to first 5 office visits,* additional visits $15 after deductible

Prescription drugs (up to a 30-day supply)

Tier 1: Preferred generic $10

Tier 2: Preferred brand $35

Tier 3: Non-preferred generic and brand 40% after deductible

Tier 4: Specialty 40% after deductible

Whole health

Healthy services: 10 chiropractic visits and 12 acupuncture visits

$15, deductible does not apply to first 5 office visits,* additional visits $15 after deductible

Here’s a quick look at how to use the chart

Annual deductibleYou need to pay this amount before your plan starts helping you pay for most covered services. Under this sample plan, you’d pay the full charges for covered services until you reach $1,150 for yourself or $2,300 for your family. Then you’d start paying copays or coinsurance.

KP Offered through Kaiser Permanente

M Offered through the Marketplace, Washington Healthplanfinder

Preventive care at no chargeMost preventive care services — including routine physical exams and mammograms — are covered at no charge. Plus, they’re not subject to the deductible.

Annual out-of-pocket maximumThis is the most you’ll pay for care during the calendar year before your plan starts paying 100% for most covered services. In this example, you’d never pay more than $6,500 for yourself and no more than $13,000 for your family for your copays, coinsurance, and deductible in a calendar year.

Covered before you reach the deductibleWith some services, you’ll only pay a copay or coinsurance, regardless of whether you’ve reached your deductible. Under this plan, the first 5 primary care visits are covered at a $15 copay — even before you meet your deductible. With our Flex plans, you get a set number of office visits covered before you reach the deductible.

CoinsuranceAfter reaching your deductible, this is a percentage of the charges that you may pay for covered services. Here, you’d pay 20% of the cost per day for your inpatient hospital care after you reach your deductible. Your plan would pay the rest for the remainder of the calendar year.

CopayThis is the set amount you pay for covered services, usually after you reach your deductible. In this example, you’d just pay a $15 copay for an urgent care visit if it’s one of the first 5 visits of the year; otherwise, you pay $15 after deductible.

KP M

Understanding the plans: benefit highlightsThe charts on the next few pages show you a sample of each plan’s benefits. Review the diagram below to help you understand how to read those charts.

*Upfront visits not subject to deductible are combined for all visits. Each service does not have its own set of upfront visits.


IF0001383-53-18 KPWA 2019

Core Basics Plus*

Flex Bronze Core Bronze HSA

Core Silver HSA

Plan type Deductible Deductible HSA-qualified HSA-qualified

Features

Annual medical deductible(individual/family) $7,900/$15,800 $5,500/$11,000 $4,750/$9,500 $3,000/$6,000

Annual out-of-pocket maximum (individual/family) $7,900/$15,800 $7,150/$14,300 $6,550/$13,100 $5,750/$11,500

Benefits

Preventive care

Routine physical exam, mammograms, etc. No charge No charge No charge No charge


Primary care office visitNo charge, deductible does not apply

to first 3 office visits,† additional visits no charge after deductible

$40, deductible does not apply to first 3 office visits,† additional visits

20% after deductible20% after deductible 10% after deductible

Specialty care office visit No charge after deductible 20% after deductible 20% after deductible 10% after deductible

Most X-rays No charge after deductible 20% after deductible 20% after deductible 10% after deductible

Most lab tests No charge after deductible 20% after deductible 20% after deductible 10% after deductible

MRI, CT, PET No charge after deductible 20% after deductible 20% after deductible 10% after deductible

Outpatient surgery No charge after deductible 20% after deductible 20% after deductible 10% after deductible

Mental health visitNo charge, deductible does not apply


No charge, deductible does not apply to first 3 office visits,†

additional visits 20% after deductible

20% after deductible 10% after deductible


Room and board, surgery, anesthesia, X-rays, lab tests, medications, mental health care No charge after deductible 20% after deductible 20% after deductible 10% after deductible

Maternity

Routine prenatal care visits, first postpartum visit No charge No charge No charge No charge

Delivery and inpatient well-baby care No charge after deductible 20% after deductible 20% after deductible 10% after deductible


Emergency Department visit No charge after deductible 20% after deductible 20% after deductible 10% after deductible

Urgent care visitNo charge, deductible does not apply





Tier 1: Preferred generic No charge after deductible $25 20% after deductible 10% after deductible

Tier 2: Preferred brand No charge after deductible 40% after deductible 40% after deductible 30% after deductible

Tier 3: Non-preferred generic and brand No charge after deductible 50% after deductible 50% after deductible 50% after deductible

Tier 4: Specialty No charge after deductible 50% after deductible 50% after deductible 50% after deductible

Whole health


No charge, deductible does not apply to first 3 office visits,† additional visits no charge after deductible





Financial assistance options with lower copays, coinsurance, and deductibles are available for certain plans, and for Native Alaskans and American Indians on Washington Healthplanfinder.

M KP M KP M KP

* Only applicants younger than 29, or applicants age 30 and older who provide a certificate from Washington Healthplanfinder demonstrating hardship or lack of affordable coverage, may purchase a Kaiser Permanente Catastrophic Core Basics Plus plan.

† Upfront visits not subject to deductible are combined for all visits. Each service does not have its own set of upfront visits. This plan summary is intended to highlight only some of the most frequently asked-about benefits and their copays, coinsurance, and deductibles. Please refer to the Evidence of Coverage for more details on your plan or for specific limitations and exclusions. To request a copy of the Evidence of Coverage, please call us at 1-800-290-8900 or contact your producer. For services subject to the deductible, you’ll have to pay health care expenses out of pocket until you meet your deductible. Most deductibles, copays, and coinsurance contribute to the out-of-pocket maximum. All plans offered and underwritten by Kaiser Foundation Health Plan of Washington.

http://kp.org/wa/if

IF0001383-53-18 KPWA 2019

VisitsPlus Silver HD

Flex Silver HD

Flex Silver

Flex Gold

Plan type Deductible Deductible Deductible Deductible

Features

Annual medical deductible(individual/family) $7,150/$14,300 $3,000/$6,000 $2,000/$4,000 $1,150/$2,300

Annual out-of-pocket maximum (individual/family) $7,150/$14,300 $7,900/$15,800 $7,900/$15,800 $6,500/$13,000

Benefits

Preventive care

Routine physical exam, mammograms, etc. No charge No charge No charge No charge


Primary care office visit $30 $20, deductible does not apply to

first 3 office visits,* additional visits $20 after deductible

$20, deductible does not apply to first 4 office visits,* additional visits

$20 after deductible



Specialty care office visit $55 $45, deductible does not apply to






Most X-rays No charge after deductible 30% after deductible 30% after deductible 20% after deductible

Most lab tests No charge after deductible 30% after deductible 30% after deductible 20% after deductible

MRI, CT, PET No charge after deductible 30% after deductible 30% after deductible 20% after deductible

Outpatient surgery No charge after deductible 30% after deductible 30% after deductible 20% after deductible

Mental health visit $30 $20, deductible does not apply to







Room and board, surgery, anesthesia, X-rays, lab tests, medications, mental health care No charge after deductible 30% after deductible 30% after deductible 20% after deductible

Maternity

Routine prenatal care visits, first postpartum visit No charge No charge No charge No charge

Delivery and inpatient well-baby care No charge after deductible 30% after deductible 30% after deductible 20% after deductible


Emergency Department visit No charge after deductible 30% after deductible 30% after deductible 20% after deductible

Urgent care visit $30$20, deductible does not apply to







Tier 1: Preferred generic $12 $10 $10 $10

Tier 2: Preferred brand $55 40% after deductible 40% after deductible $35

Tier 3: Non-preferred generic and brand 50% after deductible 50% after deductible 50% after deductible 40% after deductible

Tier 4: Specialty 50% after deductible 50% after deductible 50% after deductible 40% after deductible

Whole health

Healthy services: 10 in-network chiropractic visits and 12 acupuncture visits $30









Financial assistance options with lower copays, coinsurance, and deductibles are available for certain plans, and for Native Alaskans and American Indians on Washington Healthplanfinder.

M KP M

*Upfront visits not subject to deductible are combined for all visits. Each service does not have its own set of upfront visits.This plan summary is intended to highlight only some of the most frequently asked-about benefits and their copays, coinsurance, and deductibles. Please refer to the Evidence of Coverage for more details on your plan or for specific limitations and exclusions. To request a copy of the Evidence of Coverage, please call us at 1-800-290-8900 or contact your producer. For services subject to the deductible, you’ll have to pay health care expenses out of pocket until you meet your deductible. Most deductibles, copays, and coinsurance contribute to the out-of-pocket maximum. All plans offered and underwritten by Kaiser Foundation Health Plan of Washington.

KPM

IF0001383-53-18 KPWA 2019


Cost Share Reduction (CSR) Plans You must qualify for and enroll in the CSR plans on this page through Washington Healthplanfinder.

VisitsPlus Silver 73 HD



Plan type Deductible Deductible Deductible

Features

Annual medical deductible(individual/family) $6,250/$12,500 $1,900/$3,800 $775/$1,550

Annual out-of-pocket maximum (individual/family) $6,250/$12,500 $1,900/$3,800 $775/$1,550

Benefits

Preventive care

Routine physical exam, mammograms, etc. No charge No charge No charge


Primary care office visit $20 $10 $5

Specialty care office visit $45 $20 $10

Most X-rays No charge after deductible No charge after deductible No charge after deductible

Most lab tests No charge after deductible No charge after deductible No charge after deductible

MRI, CT, PET No charge after deductible No charge after deductible No charge after deductible

Outpatient surgery No charge after deductible No charge after deductible No charge after deductible

Mental health visit $20 $10 $5


Room and board, surgery, anesthesia, X-rays, lab tests, medications, mental health care No charge after deductible No charge after deductible No charge after deductible

Maternity

Routine prenatal care visits, first postpartum visit No charge No charge No charge

Delivery and inpatient well-baby care No charge after deductible No charge after deductible No charge after deductible


Emergency Department visit No charge after deductible No charge after deductible No charge after deductible

Urgent care visit $20 $10 $5


Tier 1: Preferred generic $12 $10 $7

Tier 2: Preferred brand $50 $45 $30

Tier 3: Non-preferred generic and brand 50% after deductible 40% after deductible 40% after deductible

Tier 4: Specialty 50% after deductible 40% after deductible 40% after deductible

Whole health

Healthy services: 10 in-network chiropractic visits and 12 acupuncture visits $20 $10 $5

MM M

This plan summary is intended to highlight only some of the most frequently asked-about benefits and their copays, coinsurance, and deductibles. Please refer to the Evidence of Coverage for more details on your plan or for specific limitations and exclusions. To request a copy of the Evidence of Coverage, please call us at 1-800-290-8900 or contact your producer. For services subject to the deductible, you’ll have to pay health care expenses out of pocket until you meet your deductible. Most deductibles, copays, and coinsurance contribute to the out-of-pocket maximum. All plans offered and underwritten by Kaiser Foundation Health Plan of Washington.

IF0001383-53-18 KPWA 2019

Flex Silver 73

Flex Silver 87

Flex Silver 94

Plan type Deductible Deductible Deductible

Features

Annual medical deductible(individual/family) $1,900/$3,800 $525/$1,050 $150/$300

Annual out-of-pocket maximum (individual/family) $6,300/$12,600 $2,600/$5,200 $2,600/$5,200

Benefits

Preventive care

Routine physical exam, mammograms, etc. No charge No charge No charge


Primary care office visit $20, deductible does not apply to first 4 office visits,* additional visits $20 after deductible


No charge, deductible does not apply to first 4 office visits,* additional visits no charge

after deductible

Specialty care office visit $45, deductible does not apply to first 4 office visits,* additional visits $45 after deductible



Most X-rays 30% after deductible 10% after deductible 5% after deductible

Most lab tests 30% after deductible 10% after deductible 5% after deductible

MRI, CT, PET 30% after deductible 10% after deductible 5% after deductible

Outpatient surgery 30% after deductible 10% after deductible 5% after deductible

Mental health visit $20, deductible does not apply to first 4 office visits,* additional visits $20 after deductible



after deductible


Room and board, surgery, anesthesia, X-rays, lab tests, medications, mental health care 30% after deductible 10% after deductible 5% after deductible

Maternity

Routine prenatal care visits, first postpartum visit No charge No charge No charge

Delivery and inpatient well-baby care 30% after deductible 10% after deductible 5% after deductible


Emergency Department visit 30% after deductible 10% after deductible 5% after deductible

Urgent care visit $20, deductible does not apply to first 4 office visits,* additional visits $20 after deductible



after deductible


Tier 1: Preferred generic $10 $10 $7

Tier 2: Preferred brand 40% after deductible 30% after deductible 10% after deductible

Tier 3: Non-preferred generic and brand 50% after deductible 40% after deductible 40% after deductible

Tier 4: Specialty 50% after deductible 40% after deductible 40% after deductible

Whole health





after deductible


Cost Share Reduction (CSR) Plans You must qualify for and enroll in the CSR plans on this page through Washington Healthplanfinder.

M M M

*Upfront visits not subject to deductible are combined for all visits. Each service does not have its own set of upfront visits.This plan summary is intended to highlight only some of the most frequently asked-about benefits and their copays, coinsurance, and deductibles. Please refer to the Evidence of Coverage for more details on your plan or for specific limitations and exclusions. To request a copy of the Evidence of Coverage, please call us at 1-800-290-8900 or contact your producer. For services subject to the deductible, you’ll have to pay health care expenses out of pocket until you meet your deductible. Most deductibles, copays, and coinsurance contribute to the out-of-pocket maximum. All plans offered and underwritten by Kaiser Foundation Health Plan of Washington.



IF0001383-53-18 KPWA 2019

Find your rateUse the monthly rate charts on the following pages, or apply on kp.org/wa/if to have your rate calculated automatically. Along with your monthly rate, consider what you’ll need to pay when you get care.

What determines your rate?

Your rate is based on the following:• The plan you select • Where you live, based on your county• Your age on your start date (effective date)• If you use tobacco• If you add an optional dental rider for adult/

family members or pediatric only for family members 18 and younger

• If you qualify for federal financial assistance. Visit kp.org/wa/if or call us at 1-800-358-8815 to see if you may qualify for federal financial assistance.

Interested in a family plan?Find the rate for each family member, based on his or her age on the start date.• You• Your spouse/domestic partner• All adult children 21 through 25• Your 3 oldest children under 21

If you have more than 3 children under 21, you only have to pay for the 3 oldest. The other children under 21 will be covered at no charge.

The rates in the monthly rate charts apply to the counties below. Please check that your county is listed below.

Our service area

BentonColumbiaFranklinIslandKing

KitsapKittitasLewisMasonPierce

San JuanSkagitSnohomishSpokaneThurston

Walla WallaWhatcomWhitmanYakima

http://kp.org/wa/if

http://kp.org/wa/if

2019 Monthly rates Please note: These rates do not include the federal financial assistance you may be eligible to receive through Washington Healthplanfinder.

Rates are effective January 1, 2019, through December 31, 2019. All plans offered and underwritten by Kaiser Foundation Health Plan of Washington.*Only applicants 29 and younger, or applicants 30 and older who provide a certificate from Washington Healthplanfinder demonstrating hardship or lack of affordable coverage,

may purchase a Kaiser Permanente Catastrophic Core Basics Plus plan.

Age on 2019 effective date

Core Basics Plus*

Flex Bronze

CoreBronze

HSA

Core Silver HSA

VisitsPlus Silver HDVisitsPlus Silver 73 HDVisitsPlus Silver 87 HDVisitsPlus Silver 94 HD

Flex SilverHD

Flex SilverFlex Silver 73Flex Silver 87Flex Silver 94

Flex Gold

0–14 154.30 191.56 190.81 220.01 269.20 201.14 262.76 283.9915 168.02 208.58 207.77 239.57 293.13 219.02 286.12 309.2316 173.26 215.09 214.25 247.05 302.28 225.86 295.05 318.8917 178.50 221.60 220.74 254.53 311.43 232.69 303.98 328.5418 184.15 228.62 227.72 262.58 321.28 240.06 313.60 338.9319 189.80 235.63 234.70 270.63 331.14 247.42 323.21 349.3320 195.65 242.89 241.94 278.97 341.34 255.04 333.18 360.0921 201.70 250.40 249.42 287.60 351.90 262.93 343.48 371.2322 201.70 250.40 249.42 287.60 351.90 262.93 343.48 371.2323 201.70 250.40 249.42 287.60 351.90 262.93 343.48 371.2324 201.70 250.40 249.42 287.60 351.90 262.93 343.48 371.2325 202.51 251.40 250.42 288.75 353.31 263.98 344.85 372.7126 206.54 256.41 255.41 294.50 360.35 269.24 351.72 380.1427 211.38 262.42 261.39 301.40 368.79 275.55 359.97 389.0528 219.25 272.18 271.12 312.62 382.52 285.80 373.36 403.5329 225.70 280.20 279.10 321.82 393.78 294.22 384.35 415.4130 228.93 284.20 283.09 326.43 399.41 298.43 389.85 421.3531 233.77 290.21 289.08 333.33 407.85 304.74 398.09 430.2632 238.61 296.22 295.06 340.23 416.30 311.05 406.34 439.1733 241.64 299.98 298.81 344.54 421.58 314.99 411.49 444.7334 244.86 303.99 302.80 349.15 427.21 319.20 416.98 450.6735 246.48 305.99 304.79 351.45 430.02 321.30 419.73 453.6436 248.09 307.99 306.79 353.75 432.84 323.40 422.48 456.6137 249.70 310.00 308.78 356.05 435.65 325.51 425.23 459.5838 251.32 312.00 310.78 358.35 438.47 327.61 427.98 462.5539 254.55 316.00 314.77 362.95 444.10 331.82 433.47 468.4940 257.77 320.01 318.76 367.55 449.73 336.02 438.97 474.4341 262.61 326.02 324.74 374.46 458.17 342.33 447.21 483.3442 267.25 331.78 330.48 381.07 466.27 348.38 455.11 491.8843 273.71 339.79 338.46 390.27 477.53 356.80 466.10 503.7644 281.77 349.81 348.44 401.78 491.60 367.31 479.84 518.6145 291.25 361.58 360.16 415.29 508.14 379.67 495.99 536.0646 302.55 375.60 374.13 431.40 527.85 394.40 515.22 556.8547 315.26 391.38 389.84 449.52 550.02 410.96 536.86 580.2348 329.78 409.40 407.80 470.23 575.36 429.89 561.59 606.9649 344.10 427.18 425.51 490.65 600.34 448.56 585.98 633.3250 360.24 447.21 445.46 513.65 628.49 469.59 613.46 663.0251 376.17 467.00 465.17 536.37 656.29 490.36 640.59 692.3452 393.72 488.78 486.87 561.40 686.91 513.24 670.47 724.6453 411.47 510.82 508.82 586.70 717.88 536.38 700.70 757.3154 430.63 534.60 532.51 614.03 751.31 561.36 733.33 792.5855 449.79 558.39 556.21 641.35 784.74 586.33 765.96 827.8456 470.57 584.18 581.90 670.97 820.98 613.42 801.34 866.0857 491.54 610.22 607.84 700.88 857.58 640.76 837.06 904.6958 513.93 638.02 635.52 732.80 896.64 669.95 875.19 945.8959 525.03 651.79 649.24 748.62 916.00 684.41 894.08 966.3160 547.41 679.59 676.93 780.55 955.06 713.59 932.20 1007.5261 566.78 703.62 700.87 808.16 988.84 738.83 965.18 1043.1662 579.48 719.40 716.58 826.27 1011.01 755.40 986.82 1066.5463 595.42 739.18 736.29 849.00 1038.81 776.17 1013.95 1095.87

64+ 605.10 751.20 748.26 862.80 1055.70 788.79 1030.44 1113.69

Tobacco Non-User Rates

King County





Core Basics Plus*

Flex Bronze

CoreBronze

HSA

Core Silver HSA


Flex SilverHD


Flex Gold

0–14 154.30 191.56 190.81 220.01 269.20 201.14 262.76 283.9915 168.02 208.58 207.77 239.57 293.13 219.02 286.12 309.2316 173.26 215.09 214.25 247.05 302.28 225.86 295.05 318.8917 178.50 221.60 220.74 254.53 311.43 232.69 303.98 328.5418 220.98 274.34 273.26 315.09 385.54 288.07 376.32 406.7219 227.76 282.75 281.65 324.76 397.37 296.90 387.86 419.1920 234.78 291.47 290.32 334.77 409.61 306.05 399.81 432.1121 242.04 300.48 299.30 345.12 422.28 315.52 412.18 445.4822 242.04 300.48 299.30 345.12 422.28 315.52 412.18 445.4823 242.04 300.48 299.30 345.12 422.28 315.52 412.18 445.4824 242.04 300.48 299.30 345.12 422.28 315.52 412.18 445.4825 243.01 301.68 300.50 346.50 423.97 316.78 413.82 447.2626 247.85 307.69 306.49 353.40 432.41 323.09 422.07 456.1727 253.66 314.90 313.67 361.69 442.55 330.66 431.96 466.8628 263.10 326.62 325.34 375.15 459.02 342.97 448.04 484.2329 270.84 336.24 334.92 386.19 472.53 353.06 461.22 498.4930 274.72 341.04 339.71 391.71 479.29 358.11 467.82 505.6231 280.52 348.26 346.89 399.99 489.42 365.68 477.71 516.3132 286.33 355.47 354.08 408.28 499.56 373.26 487.60 527.0033 289.96 359.98 358.57 413.45 505.89 377.99 493.79 533.6834 293.84 364.78 363.36 418.98 512.65 383.04 500.38 540.8135 295.77 367.19 365.75 421.74 516.03 385.56 503.68 544.3736 297.71 369.59 368.14 424.50 519.40 388.08 506.98 547.9437 299.65 371.99 370.54 427.26 522.78 390.61 510.27 551.5038 301.58 374.40 372.93 430.02 526.16 393.13 513.57 555.0639 305.45 379.21 377.72 435.54 532.92 398.18 520.17 562.1940 309.33 384.01 382.51 441.06 539.67 403.23 526.76 569.3241 315.14 391.22 389.69 449.35 549.81 410.80 536.65 580.0142 320.70 398.14 396.58 457.28 559.52 418.06 546.13 590.2643 328.45 407.75 406.16 468.33 573.03 428.16 559.32 604.5144 338.13 419.77 418.13 482.13 589.93 440.78 575.81 622.3345 349.51 433.89 432.19 498.35 609.77 455.61 595.18 643.2746 363.06 450.72 448.96 517.68 633.42 473.27 618.26 668.2147 378.31 469.65 467.81 539.42 660.02 493.15 644.23 696.2848 395.74 491.28 489.36 564.27 690.43 515.87 673.91 728.3549 412.92 512.62 510.61 588.77 720.41 538.27 703.17 759.9850 432.28 536.66 534.56 616.38 754.19 563.51 736.15 795.6251 451.40 560.40 558.20 643.65 787.55 588.44 768.71 830.8152 472.46 586.54 584.24 673.67 824.29 615.89 804.57 869.5753 493.76 612.98 610.58 704.04 861.45 643.65 840.84 908.7754 516.76 641.52 639.01 736.83 901.57 673.63 880.00 951.0955 539.75 670.07 667.45 769.62 941.68 703.60 919.15 993.4156 564.68 701.02 698.28 805.16 985.18 736.10 961.61 1039.3057 589.85 732.27 729.40 841.06 1029.10 768.91 1004.47 1085.6358 616.72 765.62 762.63 879.37 1075.97 803.93 1050.22 1135.0759 630.03 782.15 779.09 898.35 1099.19 821.29 1072.89 1159.5760 656.90 815.50 812.31 936.66 1146.07 856.31 1118.65 1209.0261 680.13 844.35 841.04 969.79 1186.61 886.60 1158.21 1251.7962 695.38 863.28 859.90 991.53 1213.21 906.48 1184.18 1279.8563 714.50 887.02 883.55 1018.79 1246.57 931.40 1216.74 1315.05

64+ 726.12 901.44 897.90 1035.36 1266.84 946.55 1236.53 1336.43

Tobacco User Rates

King County





Core Basics Plus*

Flex Bronze

CoreBronze

HSA

Core Silver HSA


Flex SilverHD


Flex Gold

0–14 177.45 220.29 219.43 253.02 309.58 231.31 302.18 326.5915 193.22 239.87 238.93 275.51 337.10 251.87 329.04 355.6216 199.25 247.36 246.39 284.11 347.62 259.74 339.31 366.7217 205.28 254.84 253.85 292.70 358.15 267.60 349.58 377.8218 211.77 262.91 261.88 301.97 369.48 276.06 360.64 389.7719 218.27 270.97 269.91 311.23 380.81 284.53 371.70 401.7320 225.00 279.32 278.23 320.82 392.54 293.30 383.15 414.1121 231.96 287.96 286.83 330.74 404.69 302.37 395.00 426.9122 231.96 287.96 286.83 330.74 404.69 302.37 395.00 426.9123 231.96 287.96 286.83 330.74 404.69 302.37 395.00 426.9124 231.96 287.96 286.83 330.74 404.69 302.37 395.00 426.9125 232.88 289.11 287.98 332.06 406.30 303.58 396.58 428.6226 237.52 294.87 293.72 338.68 414.40 309.63 404.48 437.1627 243.09 301.78 300.60 346.62 424.11 316.88 413.96 447.4128 252.14 313.01 311.79 359.51 439.89 328.68 429.37 464.0629 259.56 322.23 320.97 370.10 452.84 338.35 442.01 477.7230 263.27 326.83 325.56 375.39 459.32 343.19 448.33 484.5531 268.84 333.75 332.44 383.33 469.03 350.45 457.81 494.7932 274.40 340.66 339.32 391.27 478.74 357.70 467.29 505.0433 277.88 344.98 343.63 396.23 484.81 362.24 473.21 511.4434 281.59 349.58 348.22 401.52 491.29 367.08 479.53 518.2735 283.45 351.89 350.51 404.16 494.53 369.50 482.69 521.6936 285.30 354.19 352.80 406.81 497.76 371.91 485.85 525.1037 287.16 356.49 355.10 409.46 501.00 374.33 489.01 528.5238 289.02 358.80 357.39 412.10 504.24 376.75 492.17 531.9439 292.73 363.41 361.98 417.39 510.71 381.59 498.49 538.7740 296.44 368.01 366.57 422.69 517.19 386.43 504.81 545.6041 302.01 374.92 373.46 430.62 526.90 393.69 514.29 555.8442 307.34 381.55 380.05 438.23 536.21 400.64 523.38 565.6643 314.76 390.76 389.23 448.81 549.16 410.32 536.02 579.3244 324.04 402.28 400.71 462.04 565.34 422.41 551.82 596.4045 334.94 415.81 414.19 477.59 584.37 436.62 570.38 616.4646 347.93 431.94 430.25 496.11 607.03 453.55 592.50 640.3747 362.55 450.08 448.32 516.95 632.52 472.60 617.39 667.2748 379.25 470.81 468.97 540.76 661.66 494.37 645.83 698.0149 395.72 491.26 489.34 564.24 690.39 515.84 673.87 728.3250 414.27 514.30 512.28 590.70 722.77 540.03 705.47 762.4751 432.60 537.05 534.94 616.83 754.74 563.92 736.68 796.2052 452.78 562.10 559.90 645.60 789.95 590.23 771.04 833.3453 473.19 587.44 585.14 674.71 825.56 616.83 805.80 870.9154 495.22 614.79 612.39 706.13 864.00 645.56 843.33 911.4655 517.26 642.15 639.64 737.55 902.45 674.28 880.85 952.0256 541.15 671.81 669.18 771.62 944.13 705.43 921.54 995.9957 565.27 701.76 699.01 806.01 986.22 736.87 962.62 1040.3958 591.02 733.72 730.85 842.73 1031.14 770.44 1006.47 1087.7859 603.78 749.56 746.63 860.92 1053.40 787.07 1028.19 1111.2660 629.53 781.52 778.46 897.63 1098.32 820.63 1072.04 1158.6561 651.79 809.17 806.00 929.38 1137.16 849.66 1109.96 1199.6362 666.41 827.31 824.07 950.22 1162.66 868.71 1134.84 1226.5363 684.73 850.06 846.73 976.34 1194.63 892.59 1166.05 1260.25

64+ 695.87 863.88 860.49 992.22 1214.06 907.11 1185.00 1280.73

Kitsap and Lewis counties






Core Basics Plus*

Flex Bronze

CoreBronze

HSA

Core Silver HSA


Flex SilverHD


Flex Gold

0–14 177.45 220.29 219.43 253.02 309.58 231.31 302.18 326.5915 193.22 239.87 238.93 275.51 337.10 251.87 329.04 355.6216 199.25 247.36 246.39 284.11 347.62 259.74 339.31 366.7217 205.28 254.84 253.85 292.70 358.15 267.60 349.58 377.8218 254.13 315.49 314.25 362.36 443.37 331.28 432.76 467.7319 261.92 325.16 323.89 373.47 456.97 341.44 446.04 482.0720 270.00 335.19 333.87 384.98 471.05 351.96 459.78 496.9321 278.35 345.55 344.20 396.89 485.62 362.84 474.00 512.3022 278.35 345.55 344.20 396.89 485.62 362.84 474.00 512.3023 278.35 345.55 344.20 396.89 485.62 362.84 474.00 512.3024 278.35 345.55 344.20 396.89 485.62 362.84 474.00 512.3025 279.46 346.93 345.58 398.48 487.56 364.29 475.90 514.3526 285.03 353.85 352.46 406.41 497.28 371.55 485.38 524.5927 291.71 362.14 360.72 415.94 508.93 380.26 496.75 536.8928 302.56 375.62 374.14 431.42 527.87 394.41 515.24 556.8729 311.47 386.67 385.16 444.12 543.41 406.02 530.41 573.2630 315.92 392.20 390.67 450.47 551.18 411.83 537.99 581.4631 322.60 400.49 398.93 459.99 562.84 420.54 549.37 593.7532 329.28 408.79 407.19 469.52 574.49 429.24 560.74 606.0533 333.46 413.97 412.35 475.47 581.78 434.69 567.85 613.7334 337.91 419.50 417.86 481.82 589.55 440.49 575.44 621.9335 340.14 422.26 420.61 485.00 593.43 443.39 579.23 626.0336 342.37 425.03 423.37 488.17 597.32 446.30 583.02 630.1337 344.59 427.79 426.12 491.35 601.20 449.20 586.81 634.2238 346.82 430.56 428.87 494.52 605.09 452.10 590.61 638.3239 351.27 436.09 434.38 500.87 612.85 457.91 598.19 646.5240 355.73 441.62 439.89 507.22 620.62 463.71 605.78 654.7241 362.41 449.91 448.15 516.75 632.28 472.42 617.15 667.0142 368.81 457.86 456.06 525.88 643.45 480.77 628.05 678.7943 377.72 468.91 467.08 538.58 658.99 492.38 643.22 695.1944 388.85 482.74 480.85 554.45 678.41 506.89 662.18 715.6845 401.93 498.98 497.02 573.11 701.24 523.95 684.46 739.7646 417.52 518.33 516.30 595.33 728.43 544.27 711.00 768.4547 435.05 540.10 537.98 620.34 759.03 567.12 740.87 800.7248 455.10 564.98 562.77 648.91 793.99 593.25 774.99 837.6149 474.86 589.51 587.20 677.09 828.47 619.01 808.65 873.9850 497.13 617.16 614.74 708.84 867.32 648.04 846.57 914.9651 519.12 644.45 641.93 740.20 905.69 676.70 884.01 955.4352 543.33 674.52 671.88 774.73 947.93 708.27 925.25 1000.0053 567.83 704.93 702.17 809.65 990.67 740.20 966.96 1045.0954 594.27 737.75 734.87 847.36 1036.80 774.67 1012.00 1093.7555 620.71 770.58 767.57 885.06 1082.94 809.14 1057.03 1142.4256 649.38 806.17 803.02 925.94 1132.96 846.51 1105.85 1195.1957 678.33 842.11 838.81 967.22 1183.46 884.25 1155.14 1248.4758 709.23 880.47 877.02 1011.27 1237.36 924.52 1207.76 1305.3359 724.53 899.47 895.95 1033.10 1264.07 944.48 1233.83 1333.5160 755.43 937.83 934.16 1077.15 1317.98 984.76 1286.44 1390.3861 782.15 971.00 967.20 1115.26 1364.60 1019.59 1331.95 1439.5662 799.69 992.77 988.89 1140.26 1395.19 1042.45 1361.81 1471.8363 821.68 1020.07 1016.08 1171.61 1433.56 1071.11 1399.26 1512.30

64+ 835.04 1036.65 1032.60 1190.66 1456.86 1088.52 1422.00 1536.89

Tobacco User Rates

Kitsap and Lewis counties





Core Basics Plus*

Flex Bronze

CoreBronze

HSA

Core Silver HSA


Flex SilverHD


Flex Gold

0–14 168.03 208.60 207.79 239.60 293.16 219.04 286.15 309.2715 182.97 227.15 226.26 260.89 319.22 238.51 311.58 336.7616 188.68 234.24 233.32 269.04 329.19 245.96 321.31 347.2717 194.39 241.33 240.38 277.18 339.15 253.40 331.03 357.7818 200.54 248.96 247.99 285.95 349.88 261.42 341.51 369.1019 206.69 256.60 255.59 294.72 360.61 269.44 351.98 380.4220 213.06 264.51 263.47 303.80 371.72 277.74 362.83 392.1421 219.65 272.69 271.62 313.20 383.22 286.33 374.05 404.2722 219.65 272.69 271.62 313.20 383.22 286.33 374.05 404.2723 219.65 272.69 271.62 313.20 383.22 286.33 374.05 404.2724 219.65 272.69 271.62 313.20 383.22 286.33 374.05 404.2725 220.53 273.78 272.70 314.45 384.75 287.48 375.55 405.8926 224.92 279.23 278.14 320.71 392.42 293.20 383.03 413.9727 230.19 285.77 284.66 328.23 401.61 300.07 392.00 423.6728 238.76 296.41 295.25 340.44 416.56 311.24 406.59 439.4429 245.79 305.14 303.94 350.47 428.82 320.40 418.56 452.3830 249.30 309.50 308.29 355.48 434.95 324.99 424.55 458.8531 254.58 316.04 314.81 362.99 444.15 331.86 433.52 468.5532 259.85 322.59 321.32 370.51 453.35 338.73 442.50 478.2533 263.14 326.68 325.40 375.21 459.10 343.02 448.11 484.3134 266.66 331.04 329.74 380.22 465.23 347.61 454.10 490.7835 268.41 333.22 331.92 382.73 468.29 349.90 457.09 494.0236 270.17 335.40 334.09 385.23 471.36 352.19 460.08 497.2537 271.93 337.58 336.26 387.74 474.43 354.48 463.07 500.4938 273.69 339.77 338.44 390.24 477.49 356.77 466.07 503.7239 277.20 344.13 342.78 395.25 483.62 361.35 472.05 510.1940 280.71 348.49 347.13 400.26 489.75 365.93 478.04 516.6641 285.99 355.04 353.65 407.78 498.95 372.80 487.01 526.3642 291.04 361.31 359.89 414.99 507.77 379.39 495.62 535.6643 298.07 370.03 368.59 425.01 520.03 388.55 507.59 548.5944 306.85 380.94 379.45 437.54 535.36 400.00 522.55 564.7645 317.18 393.76 392.22 452.26 553.37 413.46 540.13 583.7746 329.48 409.03 407.43 469.79 574.83 429.50 561.07 606.4047 343.31 426.21 424.54 489.53 598.97 447.53 584.64 631.8748 359.13 445.84 444.10 512.08 626.56 468.15 611.57 660.9849 374.73 465.20 463.38 534.31 653.77 488.48 638.13 689.6850 392.30 487.02 485.11 559.37 684.43 511.39 668.05 722.0351 409.65 508.56 506.57 584.11 714.70 534.01 697.60 753.9652 428.76 532.28 530.20 611.36 748.04 558.92 730.15 789.1353 448.09 556.28 554.10 638.92 781.77 584.11 763.06 824.7154 468.96 582.18 579.91 668.67 818.17 611.32 798.60 863.1255 489.82 608.09 605.71 698.43 854.58 638.52 834.13 901.5256 512.45 636.18 633.69 730.69 894.05 668.01 872.66 943.1657 535.29 664.53 661.93 763.26 933.90 697.79 911.56 985.2058 559.67 694.80 692.08 798.02 976.44 729.57 953.08 1030.0859 571.75 709.80 707.02 815.25 997.52 745.32 973.65 1052.3160 596.13 740.07 737.17 850.02 1040.06 777.10 1015.17 1097.1961 617.22 766.25 763.25 880.08 1076.85 804.59 1051.08 1136.0062 631.06 783.43 780.36 899.81 1100.99 822.63 1074.64 1161.4763 648.41 804.97 801.82 924.56 1131.26 845.25 1104.19 1193.40

64+ 658.95 818.06 814.86 939.59 1149.66 858.99 1122.15 1212.81

Spokane County






Core Basics Plus*

Flex Bronze

CoreBronze

HSA

Core Silver HSA


Flex SilverHD


Flex Gold

0–14 168.03 208.60 207.79 239.60 293.16 219.04 286.15 309.2715 182.97 227.15 226.26 260.89 319.22 238.51 311.58 336.7616 188.68 234.24 233.32 269.04 329.19 245.96 321.31 347.2717 194.39 241.33 240.38 277.18 339.15 253.40 331.03 357.7818 240.65 298.75 297.59 343.14 419.85 313.70 409.81 442.9219 248.03 307.92 306.71 353.66 432.73 323.32 422.38 456.5020 255.67 317.41 316.16 364.56 446.07 333.29 435.39 470.5721 263.58 327.22 325.94 375.84 459.86 343.60 448.86 485.1222 263.58 327.22 325.94 375.84 459.86 343.60 448.86 485.1223 263.58 327.22 325.94 375.84 459.86 343.60 448.86 485.1224 263.58 327.22 325.94 375.84 459.86 343.60 448.86 485.1225 264.64 328.53 327.25 377.34 461.70 344.97 450.66 487.0626 269.91 335.08 333.76 384.86 470.90 351.84 459.63 496.7727 276.23 342.93 341.59 393.88 481.94 360.09 470.40 508.4128 286.51 355.69 354.30 408.53 499.87 373.49 487.91 527.3329 294.95 366.16 364.73 420.56 514.59 384.48 502.27 542.8530 299.17 371.40 369.94 426.57 521.94 389.98 509.46 550.6231 305.49 379.25 377.77 435.59 532.98 398.23 520.23 562.2632 311.82 387.10 385.59 444.61 544.02 406.48 531.00 573.9033 315.77 392.01 390.48 450.25 550.92 411.63 537.73 581.1834 319.99 397.25 395.69 456.26 558.27 417.13 544.92 588.9435 322.10 399.87 398.30 459.27 561.95 419.88 548.51 592.8236 324.21 402.48 400.91 462.28 565.63 422.62 552.10 596.7037 326.31 405.10 403.52 465.28 569.31 425.37 555.69 600.5838 328.42 407.72 406.12 468.29 572.99 428.12 559.28 604.4639 332.64 412.96 411.34 474.30 580.35 433.62 566.46 612.2340 336.86 418.19 416.55 480.32 587.70 439.12 573.64 619.9941 343.18 426.04 424.38 489.34 598.74 447.36 584.42 631.6342 349.25 433.57 431.87 497.98 609.32 455.27 594.74 642.7943 357.68 444.04 442.30 510.01 624.03 466.26 609.10 658.3144 368.22 457.13 455.34 525.04 642.43 480.00 627.06 677.7245 380.61 472.51 470.66 542.71 664.04 496.15 648.15 700.5246 395.37 490.83 488.91 563.75 689.79 515.40 673.29 727.6947 411.98 511.45 509.45 587.43 718.77 537.04 701.57 758.2548 430.96 535.01 532.92 614.49 751.88 561.78 733.89 793.1849 449.67 558.24 556.06 641.18 784.53 586.18 765.75 827.6250 470.76 584.42 582.13 671.24 821.32 613.66 801.66 866.4351 491.58 610.27 607.88 700.93 857.64 640.81 837.12 904.7652 514.51 638.74 636.24 733.63 897.65 670.70 876.17 946.9653 537.71 667.53 664.92 766.70 938.12 700.94 915.67 989.6554 562.75 698.62 695.89 802.41 981.81 733.58 958.32 1035.7455 587.79 729.71 726.85 838.11 1025.49 766.22 1000.96 1081.8356 614.94 763.41 760.42 876.82 1072.86 801.61 1047.19 1131.7957 642.35 797.44 794.32 915.91 1120.69 837.35 1093.87 1182.2558 671.61 833.76 830.50 957.63 1171.73 875.48 1143.69 1236.0959 686.10 851.76 848.43 978.30 1197.02 894.38 1168.38 1262.7860 715.36 888.08 884.61 1020.02 1248.07 932.52 1218.21 1316.6261 740.66 919.50 915.90 1056.10 1292.21 965.51 1261.30 1363.2062 757.27 940.11 936.43 1079.78 1321.19 987.15 1289.57 1393.7663 778.09 965.96 962.18 1109.47 1357.52 1014.30 1325.03 1432.08

64+ 790.74 981.66 977.82 1127.51 1379.58 1030.79 1346.58 1455.36

Tobacco User Rates

Spokane County





Core Basics Plus*

Flex Bronze

CoreBronze

HSA

Core Silver HSA


Flex SilverHD


Flex Gold

0–14 175.29 217.61 216.76 249.94 305.82 228.50 298.50 322.6115 190.87 236.95 236.02 272.15 333.00 248.81 325.03 351.2916 196.82 244.35 243.39 280.65 343.39 256.57 335.18 362.2617 202.78 251.74 250.76 289.14 353.79 264.34 345.32 373.2218 209.20 259.71 258.69 298.29 364.98 272.70 356.25 385.0319 215.61 267.67 266.62 307.44 376.17 281.07 367.17 396.8420 222.26 275.92 274.84 316.91 387.77 289.73 378.49 409.0721 229.13 284.45 283.34 326.71 399.76 298.69 390.19 421.7222 229.13 284.45 283.34 326.71 399.76 298.69 390.19 421.7223 229.13 284.45 283.34 326.71 399.76 298.69 390.19 421.7224 229.13 284.45 283.34 326.71 399.76 298.69 390.19 421.7225 230.05 285.59 284.47 328.02 401.36 299.88 391.75 423.4026 234.63 291.28 290.14 334.55 409.35 305.86 399.56 431.8427 240.13 298.11 296.94 342.40 418.95 313.03 408.92 441.9628 249.07 309.20 307.99 355.14 434.54 324.67 424.14 458.4129 256.40 318.30 317.06 365.59 447.33 334.23 436.63 471.9030 260.06 322.86 321.59 370.82 453.73 339.01 442.87 478.6531 265.56 329.68 328.39 378.66 463.32 346.18 452.23 488.7732 271.06 336.51 335.19 386.50 472.91 353.35 461.60 498.8933 274.50 340.78 339.44 391.40 478.91 357.83 467.45 505.2234 278.17 345.33 343.98 396.63 485.31 362.61 473.69 511.9635 280.00 347.60 346.24 399.24 488.50 365.00 476.82 515.3436 281.83 349.88 348.51 401.86 491.70 367.39 479.94 518.7137 283.66 352.15 350.78 404.47 494.90 369.78 483.06 522.0938 285.50 354.43 353.04 407.09 498.10 372.17 486.18 525.4639 289.16 358.98 357.58 412.31 504.50 376.94 492.42 532.2140 292.83 363.53 362.11 417.54 510.89 381.72 498.67 538.9541 298.33 370.36 368.91 425.38 520.49 388.89 508.03 549.0842 303.60 376.90 375.43 432.90 529.68 395.76 517.01 558.7843 310.93 386.00 384.49 443.35 542.47 405.32 529.49 572.2744 320.10 397.38 395.83 456.42 558.46 417.27 545.10 589.1445 330.87 410.75 409.14 471.77 577.25 431.31 563.44 608.9646 343.70 426.68 425.01 490.07 599.64 448.03 585.29 632.5847 358.13 444.60 442.86 510.65 624.82 466.85 609.87 659.1448 374.63 465.08 463.26 534.18 653.60 488.36 637.97 689.5149 390.90 485.28 483.38 557.37 681.99 509.56 665.67 719.4550 409.23 508.04 506.05 583.51 713.97 533.46 696.89 753.1951 427.33 530.51 528.43 609.32 745.55 557.05 727.71 786.5052 447.26 555.25 553.08 637.74 780.33 583.04 761.66 823.1953 467.43 580.29 578.02 666.50 815.51 609.32 795.99 860.3054 489.20 607.31 604.93 697.53 853.48 637.70 833.06 900.3755 510.96 634.33 631.85 728.57 891.46 666.08 870.13 940.4356 534.56 663.63 661.03 762.22 932.64 696.84 910.32 983.8757 558.39 693.22 690.50 796.20 974.21 727.90 950.90 1027.7358 583.83 724.79 721.95 832.47 1018.58 761.06 994.21 1074.5459 596.43 740.43 737.54 850.44 1040.57 777.49 1015.67 1097.7360 621.86 772.01 768.99 886.70 1084.94 810.64 1058.98 1144.5461 643.86 799.32 796.19 918.07 1123.32 839.31 1096.44 1185.0362 658.29 817.24 814.04 938.65 1148.51 858.13 1121.03 1211.5963 676.40 839.71 836.42 964.46 1180.09 881.73 1151.85 1244.91

64+ 687.39 853.35 850.02 980.13 1199.28 896.07 1170.57 1265.15

Mason, Pierce, and Thurston counties






Core Basics Plus*

Flex Bronze

CoreBronze

HSA

Core Silver HSA


Flex SilverHD


Flex Gold

0–14 175.29 217.61 216.76 249.94 305.82 228.50 298.50 322.6115 190.87 236.95 236.02 272.15 333.00 248.81 325.03 351.2916 196.82 244.35 243.39 280.65 343.39 256.57 335.18 362.2617 202.78 251.74 250.76 289.14 353.79 264.34 345.32 373.2218 251.04 311.65 310.43 357.95 437.98 327.24 427.50 462.0319 258.73 321.21 319.95 368.92 451.41 337.28 440.61 476.2020 266.71 331.10 329.81 380.29 465.32 347.67 454.18 490.8821 274.96 341.35 340.01 392.06 479.71 358.43 468.23 506.0622 274.96 341.35 340.01 392.06 479.71 358.43 468.23 506.0623 274.96 341.35 340.01 392.06 479.71 358.43 468.23 506.0624 274.96 341.35 340.01 392.06 479.71 358.43 468.23 506.0625 276.06 342.71 341.37 393.62 481.63 359.86 470.10 508.0826 281.56 349.54 348.17 401.47 491.22 367.03 479.47 518.2127 288.16 357.73 356.33 410.88 502.74 375.63 490.71 530.3528 298.88 371.04 369.59 426.17 521.44 389.61 508.97 550.0929 307.68 381.97 380.47 438.71 536.80 401.08 523.95 566.2830 312.08 387.43 385.91 444.98 544.47 406.81 531.44 574.3831 318.68 395.62 394.07 454.39 555.98 415.42 542.68 586.5232 325.27 403.81 402.23 463.80 567.50 424.02 553.92 598.6733 329.40 408.93 407.33 469.68 574.69 429.39 560.94 606.2634 333.80 414.39 412.77 475.96 582.37 435.13 568.43 614.3635 336.00 417.12 415.49 479.09 586.21 438.00 572.18 618.4136 338.20 419.85 418.21 482.23 590.04 440.86 575.93 622.4537 340.40 422.59 420.93 485.37 593.88 443.73 579.67 626.5038 342.60 425.32 423.65 488.50 597.72 446.60 583.42 630.5539 347.00 430.78 429.09 494.78 605.39 452.33 590.91 638.6540 351.40 436.24 434.53 501.05 613.07 458.07 598.40 646.7541 357.99 444.43 442.69 510.46 624.58 466.67 609.64 658.8942 364.32 452.28 450.51 519.47 635.62 474.91 620.41 670.5343 373.12 463.21 461.39 532.02 650.97 486.38 635.39 686.7244 384.12 476.86 474.99 547.70 670.15 500.72 654.12 706.9745 397.04 492.90 490.97 566.13 692.70 517.57 676.13 730.7546 412.44 512.02 510.01 588.08 719.57 537.64 702.35 759.0947 429.76 533.52 531.43 612.78 749.79 560.22 731.85 790.9748 449.56 558.10 555.92 641.01 784.33 586.03 765.56 827.4149 469.08 582.34 580.06 668.85 818.39 611.48 798.80 863.3450 491.07 609.64 607.26 700.21 856.76 640.15 836.26 903.8251 512.80 636.61 634.12 731.19 894.66 668.46 873.25 943.8052 536.72 666.31 663.70 765.29 936.39 699.65 913.99 987.8353 560.91 696.34 693.62 799.79 978.61 731.19 955.19 1032.3654 587.03 728.77 725.92 837.04 1024.18 765.24 999.68 1080.4455 613.16 761.20 758.22 874.29 1069.75 799.29 1044.16 1128.5256 641.48 796.36 793.24 914.67 1119.16 836.21 1092.39 1180.6457 670.07 831.86 828.60 955.44 1169.05 873.48 1141.08 1233.2758 700.59 869.75 866.34 998.96 1222.30 913.27 1193.05 1289.4459 715.71 888.52 885.04 1020.52 1248.69 932.98 1218.81 1317.2860 746.23 926.41 922.79 1064.04 1301.93 972.77 1270.78 1373.4561 772.63 959.18 955.43 1101.68 1347.99 1007.18 1315.73 1422.0362 789.95 980.68 976.85 1126.38 1378.21 1029.76 1345.23 1453.9163 811.67 1007.65 1003.71 1157.35 1416.10 1058.07 1382.22 1493.89

64+ 824.87 1024.04 1020.03 1176.17 1439.13 1075.28 1404.69 1518.18

Tobacco User Rates

Mason, Pierce, and Thurston counties





Core Basics Plus*

Flex Bronze

CoreBronze

HSA

Core Silver HSA


Flex SilverHD


Flex Gold

0–14 177.45 220.29 219.43 253.02 309.58 231.31 302.18 326.5915 193.22 239.87 238.93 275.51 337.10 251.87 329.04 355.6216 199.25 247.36 246.39 284.11 347.62 259.74 339.31 366.7217 205.28 254.84 253.85 292.70 358.15 267.60 349.58 377.8218 211.77 262.91 261.88 301.97 369.48 276.06 360.64 389.7719 218.27 270.97 269.91 311.23 380.81 284.53 371.70 401.7320 225.00 279.32 278.23 320.82 392.54 293.30 383.15 414.1121 231.96 287.96 286.83 330.74 404.69 302.37 395.00 426.9122 231.96 287.96 286.83 330.74 404.69 302.37 395.00 426.9123 231.96 287.96 286.83 330.74 404.69 302.37 395.00 426.9124 231.96 287.96 286.83 330.74 404.69 302.37 395.00 426.9125 232.88 289.11 287.98 332.06 406.30 303.58 396.58 428.6226 237.52 294.87 293.72 338.68 414.40 309.63 404.48 437.1627 243.09 301.78 300.60 346.62 424.11 316.88 413.96 447.4128 252.14 313.01 311.79 359.51 439.89 328.68 429.37 464.0629 259.56 322.23 320.97 370.10 452.84 338.35 442.01 477.7230 263.27 326.83 325.56 375.39 459.32 343.19 448.33 484.5531 268.84 333.75 332.44 383.33 469.03 350.45 457.81 494.7932 274.40 340.66 339.32 391.27 478.74 357.70 467.29 505.0433 277.88 344.98 343.63 396.23 484.81 362.24 473.21 511.4434 281.59 349.58 348.22 401.52 491.29 367.08 479.53 518.2735 283.45 351.89 350.51 404.16 494.53 369.50 482.69 521.6936 285.30 354.19 352.80 406.81 497.76 371.91 485.85 525.1037 287.16 356.49 355.10 409.46 501.00 374.33 489.01 528.5238 289.02 358.80 357.39 412.10 504.24 376.75 492.17 531.9439 292.73 363.41 361.98 417.39 510.71 381.59 498.49 538.7740 296.44 368.01 366.57 422.69 517.19 386.43 504.81 545.6041 302.01 374.92 373.46 430.62 526.90 393.69 514.29 555.8442 307.34 381.55 380.05 438.23 536.21 400.64 523.38 565.6643 314.76 390.76 389.23 448.81 549.16 410.32 536.02 579.3244 324.04 402.28 400.71 462.04 565.34 422.41 551.82 596.4045 334.94 415.81 414.19 477.59 584.37 436.62 570.38 616.4646 347.93 431.94 430.25 496.11 607.03 453.55 592.50 640.3747 362.55 450.08 448.32 516.95 632.52 472.60 617.39 667.2748 379.25 470.81 468.97 540.76 661.66 494.37 645.83 698.0149 395.72 491.26 489.34 564.24 690.39 515.84 673.87 728.3250 414.27 514.30 512.28 590.70 722.77 540.03 705.47 762.4751 432.60 537.05 534.94 616.83 754.74 563.92 736.68 796.2052 452.78 562.10 559.90 645.60 789.95 590.23 771.04 833.3453 473.19 587.44 585.14 674.71 825.56 616.83 805.80 870.9154 495.22 614.79 612.39 706.13 864.00 645.56 843.33 911.4655 517.26 642.15 639.64 737.55 902.45 674.28 880.85 952.0256 541.15 671.81 669.18 771.62 944.13 705.43 921.54 995.9957 565.27 701.76 699.01 806.01 986.22 736.87 962.62 1040.3958 591.02 733.72 730.85 842.73 1031.14 770.44 1006.47 1087.7859 603.78 749.56 746.63 860.92 1053.40 787.07 1028.19 1111.2660 629.53 781.52 778.46 897.63 1098.32 820.63 1072.04 1158.6561 651.79 809.17 806.00 929.38 1137.16 849.66 1109.96 1199.6362 666.41 827.31 824.07 950.22 1162.66 868.71 1134.84 1226.5363 684.73 850.06 846.73 976.34 1194.63 892.59 1166.05 1260.25

64+ 695.87 863.88 860.49 992.22 1214.06 907.11 1185.00 1280.73

Benton, Franklin, Kittitas, and Yakima counties






Core Basics Plus*

Flex Bronze

CoreBronze

HSA

Core Silver HSA


Flex SilverHD


Flex Gold

0–14 177.45 220.29 219.43 253.02 309.58 231.31 302.18 326.5915 193.22 239.87 238.93 275.51 337.10 251.87 329.04 355.6216 199.25 247.36 246.39 284.11 347.62 259.74 339.31 366.7217 205.28 254.84 253.85 292.70 358.15 267.60 349.58 377.8218 254.13 315.49 314.25 362.36 443.37 331.28 432.76 467.7319 261.92 325.16 323.89 373.47 456.97 341.44 446.04 482.0720 270.00 335.19 333.87 384.98 471.05 351.96 459.78 496.9321 278.35 345.55 344.20 396.89 485.62 362.84 474.00 512.3022 278.35 345.55 344.20 396.89 485.62 362.84 474.00 512.3023 278.35 345.55 344.20 396.89 485.62 362.84 474.00 512.3024 278.35 345.55 344.20 396.89 485.62 362.84 474.00 512.3025 279.46 346.93 345.58 398.48 487.56 364.29 475.90 514.3526 285.03 353.85 352.46 406.41 497.28 371.55 485.38 524.5927 291.71 362.14 360.72 415.94 508.93 380.26 496.75 536.8928 302.56 375.62 374.14 431.42 527.87 394.41 515.24 556.8729 311.47 386.67 385.16 444.12 543.41 406.02 530.41 573.2630 315.92 392.20 390.67 450.47 551.18 411.83 537.99 581.4631 322.60 400.49 398.93 459.99 562.84 420.54 549.37 593.7532 329.28 408.79 407.19 469.52 574.49 429.24 560.74 606.0533 333.46 413.97 412.35 475.47 581.78 434.69 567.85 613.7334 337.91 419.50 417.86 481.82 589.55 440.49 575.44 621.9335 340.14 422.26 420.61 485.00 593.43 443.39 579.23 626.0336 342.37 425.03 423.37 488.17 597.32 446.30 583.02 630.1337 344.59 427.79 426.12 491.35 601.20 449.20 586.81 634.2238 346.82 430.56 428.87 494.52 605.09 452.10 590.61 638.3239 351.27 436.09 434.38 500.87 612.85 457.91 598.19 646.5240 355.73 441.62 439.89 507.22 620.62 463.71 605.78 654.7241 362.41 449.91 448.15 516.75 632.28 472.42 617.15 667.0142 368.81 457.86 456.06 525.88 643.45 480.77 628.05 678.7943 377.72 468.91 467.08 538.58 658.99 492.38 643.22 695.1944 388.85 482.74 480.85 554.45 678.41 506.89 662.18 715.6845 401.93 498.98 497.02 573.11 701.24 523.95 684.46 739.7646 417.52 518.33 516.30 595.33 728.43 544.27 711.00 768.4547 435.05 540.10 537.98 620.34 759.03 567.12 740.87 800.7248 455.10 564.98 562.77 648.91 793.99 593.25 774.99 837.6149 474.86 589.51 587.20 677.09 828.47 619.01 808.65 873.9850 497.13 617.16 614.74 708.84 867.32 648.04 846.57 914.9651 519.12 644.45 641.93 740.20 905.69 676.70 884.01 955.4352 543.33 674.52 671.88 774.73 947.93 708.27 925.25 1000.0053 567.83 704.93 702.17 809.65 990.67 740.20 966.96 1045.0954 594.27 737.75 734.87 847.36 1036.80 774.67 1012.00 1093.7555 620.71 770.58 767.57 885.06 1082.94 809.14 1057.03 1142.4256 649.38 806.17 803.02 925.94 1132.96 846.51 1105.85 1195.1957 678.33 842.11 838.81 967.22 1183.46 884.25 1155.14 1248.4758 709.23 880.47 877.02 1011.27 1237.36 924.52 1207.76 1305.3359 724.53 899.47 895.95 1033.10 1264.07 944.48 1233.83 1333.5160 755.43 937.83 934.16 1077.15 1317.98 984.76 1286.44 1390.3861 782.15 971.00 967.20 1115.26 1364.60 1019.59 1331.95 1439.5662 799.69 992.77 988.89 1140.26 1395.19 1042.45 1361.81 1471.8363 821.68 1020.07 1016.08 1171.61 1433.56 1071.11 1399.26 1512.30

64+ 835.04 1036.65 1032.60 1190.66 1456.86 1088.52 1422.00 1536.89

Tobacco User Rates

Benton, Franklin, Kittitas, and Yakima counties





Core Basics Plus*

Flex Bronze

CoreBronze

HSA

Core Silver HSA


Flex SilverHD


Flex Gold

0–14 177.45 220.29 219.43 253.02 309.58 231.31 302.18 326.5915 193.22 239.87 238.93 275.51 337.10 251.87 329.04 355.6216 199.25 247.36 246.39 284.11 347.62 259.74 339.31 366.7217 205.28 254.84 253.85 292.70 358.15 267.60 349.58 377.8218 211.77 262.91 261.88 301.97 369.48 276.06 360.64 389.7719 218.27 270.97 269.91 311.23 380.81 284.53 371.70 401.7320 225.00 279.32 278.23 320.82 392.54 293.30 383.15 414.1121 231.96 287.96 286.83 330.74 404.69 302.37 395.00 426.9122 231.96 287.96 286.83 330.74 404.69 302.37 395.00 426.9123 231.96 287.96 286.83 330.74 404.69 302.37 395.00 426.9124 231.96 287.96 286.83 330.74 404.69 302.37 395.00 426.9125 232.88 289.11 287.98 332.06 406.30 303.58 396.58 428.6226 237.52 294.87 293.72 338.68 414.40 309.63 404.48 437.1627 243.09 301.78 300.60 346.62 424.11 316.88 413.96 447.4128 252.14 313.01 311.79 359.51 439.89 328.68 429.37 464.0629 259.56 322.23 320.97 370.10 452.84 338.35 442.01 477.7230 263.27 326.83 325.56 375.39 459.32 343.19 448.33 484.5531 268.84 333.75 332.44 383.33 469.03 350.45 457.81 494.7932 274.40 340.66 339.32 391.27 478.74 357.70 467.29 505.0433 277.88 344.98 343.63 396.23 484.81 362.24 473.21 511.4434 281.59 349.58 348.22 401.52 491.29 367.08 479.53 518.2735 283.45 351.89 350.51 404.16 494.53 369.50 482.69 521.6936 285.30 354.19 352.80 406.81 497.76 371.91 485.85 525.1037 287.16 356.49 355.10 409.46 501.00 374.33 489.01 528.5238 289.02 358.80 357.39 412.10 504.24 376.75 492.17 531.9439 292.73 363.41 361.98 417.39 510.71 381.59 498.49 538.7740 296.44 368.01 366.57 422.69 517.19 386.43 504.81 545.6041 302.01 374.92 373.46 430.62 526.90 393.69 514.29 555.8442 307.34 381.55 380.05 438.23 536.21 400.64 523.38 565.6643 314.76 390.76 389.23 448.81 549.16 410.32 536.02 579.3244 324.04 402.28 400.71 462.04 565.34 422.41 551.82 596.4045 334.94 415.81 414.19 477.59 584.37 436.62 570.38 616.4646 347.93 431.94 430.25 496.11 607.03 453.55 592.50 640.3747 362.55 450.08 448.32 516.95 632.52 472.60 617.39 667.2748 379.25 470.81 468.97 540.76 661.66 494.37 645.83 698.0149 395.72 491.26 489.34 564.24 690.39 515.84 673.87 728.3250 414.27 514.30 512.28 590.70 722.77 540.03 705.47 762.4751 432.60 537.05 534.94 616.83 754.74 563.92 736.68 796.2052 452.78 562.10 559.90 645.60 789.95 590.23 771.04 833.3453 473.19 587.44 585.14 674.71 825.56 616.83 805.80 870.9154 495.22 614.79 612.39 706.13 864.00 645.56 843.33 911.4655 517.26 642.15 639.64 737.55 902.45 674.28 880.85 952.0256 541.15 671.81 669.18 771.62 944.13 705.43 921.54 995.9957 565.27 701.76 699.01 806.01 986.22 736.87 962.62 1040.3958 591.02 733.72 730.85 842.73 1031.14 770.44 1006.47 1087.7859 603.78 749.56 746.63 860.92 1053.40 787.07 1028.19 1111.2660 629.53 781.52 778.46 897.63 1098.32 820.63 1072.04 1158.6561 651.79 809.17 806.00 929.38 1137.16 849.66 1109.96 1199.6362 666.41 827.31 824.07 950.22 1162.66 868.71 1134.84 1226.5363 684.73 850.06 846.73 976.34 1194.63 892.59 1166.05 1260.25

64+ 695.87 863.88 860.49 992.22 1214.06 907.11 1185.00 1280.73

Island, San Juan, Skagit, Snohomish, and Whatcom counties






Core Basics Plus*

Flex Bronze

CoreBronze

HSA

Core Silver HSA


Flex SilverHD


Flex Gold

0–14 177.45 220.29 219.43 253.02 309.58 231.31 302.18 326.5915 193.22 239.87 238.93 275.51 337.10 251.87 329.04 355.6216 199.25 247.36 246.39 284.11 347.62 259.74 339.31 366.7217 205.28 254.84 253.85 292.70 358.15 267.60 349.58 377.8218 254.13 315.49 314.25 362.36 443.37 331.28 432.76 467.7319 261.92 325.16 323.89 373.47 456.97 341.44 446.04 482.0720 270.00 335.19 333.87 384.98 471.05 351.96 459.78 496.9321 278.35 345.55 344.20 396.89 485.62 362.84 474.00 512.3022 278.35 345.55 344.20 396.89 485.62 362.84 474.00 512.3023 278.35 345.55 344.20 396.89 485.62 362.84 474.00 512.3024 278.35 345.55 344.20 396.89 485.62 362.84 474.00 512.3025 279.46 346.93 345.58 398.48 487.56 364.29 475.90 514.3526 285.03 353.85 352.46 406.41 497.28 371.55 485.38 524.5927 291.71 362.14 360.72 415.94 508.93 380.26 496.75 536.8928 302.56 375.62 374.14 431.42 527.87 394.41 515.24 556.8729 311.47 386.67 385.16 444.12 543.41 406.02 530.41 573.2630 315.92 392.20 390.67 450.47 551.18 411.83 537.99 581.4631 322.60 400.49 398.93 459.99 562.84 420.54 549.37 593.7532 329.28 408.79 407.19 469.52 574.49 429.24 560.74 606.0533 333.46 413.97 412.35 475.47 581.78 434.69 567.85 613.7334 337.91 419.50 417.86 481.82 589.55 440.49 575.44 621.9335 340.14 422.26 420.61 485.00 593.43 443.39 579.23 626.0336 342.37 425.03 423.37 488.17 597.32 446.30 583.02 630.1337 344.59 427.79 426.12 491.35 601.20 449.20 586.81 634.2238 346.82 430.56 428.87 494.52 605.09 452.10 590.61 638.3239 351.27 436.09 434.38 500.87 612.85 457.91 598.19 646.5240 355.73 441.62 439.89 507.22 620.62 463.71 605.78 654.7241 362.41 449.91 448.15 516.75 632.28 472.42 617.15 667.0142 368.81 457.86 456.06 525.88 643.45 480.77 628.05 678.7943 377.72 468.91 467.08 538.58 658.99 492.38 643.22 695.1944 388.85 482.74 480.85 554.45 678.41 506.89 662.18 715.6845 401.93 498.98 497.02 573.11 701.24 523.95 684.46 739.7646 417.52 518.33 516.30 595.33 728.43 544.27 711.00 768.4547 435.05 540.10 537.98 620.34 759.03 567.12 740.87 800.7248 455.10 564.98 562.77 648.91 793.99 593.25 774.99 837.6149 474.86 589.51 587.20 677.09 828.47 619.01 808.65 873.9850 497.13 617.16 614.74 708.84 867.32 648.04 846.57 914.9651 519.12 644.45 641.93 740.20 905.69 676.70 884.01 955.4352 543.33 674.52 671.88 774.73 947.93 708.27 925.25 1000.0053 567.83 704.93 702.17 809.65 990.67 740.20 966.96 1045.0954 594.27 737.75 734.87 847.36 1036.80 774.67 1012.00 1093.7555 620.71 770.58 767.57 885.06 1082.94 809.14 1057.03 1142.4256 649.38 806.17 803.02 925.94 1132.96 846.51 1105.85 1195.1957 678.33 842.11 838.81 967.22 1183.46 884.25 1155.14 1248.4758 709.23 880.47 877.02 1011.27 1237.36 924.52 1207.76 1305.3359 724.53 899.47 895.95 1033.10 1264.07 944.48 1233.83 1333.5160 755.43 937.83 934.16 1077.15 1317.98 984.76 1286.44 1390.3861 782.15 971.00 967.20 1115.26 1364.60 1019.59 1331.95 1439.5662 799.69 992.77 988.89 1140.26 1395.19 1042.45 1361.81 1471.8363 821.68 1020.07 1016.08 1171.61 1433.56 1071.11 1399.26 1512.30

64+ 835.04 1036.65 1032.60 1190.66 1456.86 1088.52 1422.00 1536.89

Tobacco User Rates

Island, San Juan, Skagit, Snohomish, and Whatcom counties





Core Basics Plus*

Flex Bronze

CoreBronze

HSA

Core Silver HSA


Flex SilverHD


Flex Gold

0–14 177.45 220.29 219.43 253.02 309.58 231.31 302.18 326.5915 193.22 239.87 238.93 275.51 337.10 251.87 329.04 355.6216 199.25 247.36 246.39 284.11 347.62 259.74 339.31 366.7217 205.28 254.84 253.85 292.70 358.15 267.60 349.58 377.8218 211.77 262.91 261.88 301.97 369.48 276.06 360.64 389.7719 218.27 270.97 269.91 311.23 380.81 284.53 371.70 401.7320 225.00 279.32 278.23 320.82 392.54 293.30 383.15 414.1121 231.96 287.96 286.83 330.74 404.69 302.37 395.00 426.9122 231.96 287.96 286.83 330.74 404.69 302.37 395.00 426.9123 231.96 287.96 286.83 330.74 404.69 302.37 395.00 426.9124 231.96 287.96 286.83 330.74 404.69 302.37 395.00 426.9125 232.88 289.11 287.98 332.06 406.30 303.58 396.58 428.6226 237.52 294.87 293.72 338.68 414.40 309.63 404.48 437.1627 243.09 301.78 300.60 346.62 424.11 316.88 413.96 447.4128 252.14 313.01 311.79 359.51 439.89 328.68 429.37 464.0629 259.56 322.23 320.97 370.10 452.84 338.35 442.01 477.7230 263.27 326.83 325.56 375.39 459.32 343.19 448.33 484.5531 268.84 333.75 332.44 383.33 469.03 350.45 457.81 494.7932 274.40 340.66 339.32 391.27 478.74 357.70 467.29 505.0433 277.88 344.98 343.63 396.23 484.81 362.24 473.21 511.4434 281.59 349.58 348.22 401.52 491.29 367.08 479.53 518.2735 283.45 351.89 350.51 404.16 494.53 369.50 482.69 521.6936 285.30 354.19 352.80 406.81 497.76 371.91 485.85 525.1037 287.16 356.49 355.10 409.46 501.00 374.33 489.01 528.5238 289.02 358.80 357.39 412.10 504.24 376.75 492.17 531.9439 292.73 363.41 361.98 417.39 510.71 381.59 498.49 538.7740 296.44 368.01 366.57 422.69 517.19 386.43 504.81 545.6041 302.01 374.92 373.46 430.62 526.90 393.69 514.29 555.8442 307.34 381.55 380.05 438.23 536.21 400.64 523.38 565.6643 314.76 390.76 389.23 448.81 549.16 410.32 536.02 579.3244 324.04 402.28 400.71 462.04 565.34 422.41 551.82 596.4045 334.94 415.81 414.19 477.59 584.37 436.62 570.38 616.4646 347.93 431.94 430.25 496.11 607.03 453.55 592.50 640.3747 362.55 450.08 448.32 516.95 632.52 472.60 617.39 667.2748 379.25 470.81 468.97 540.76 661.66 494.37 645.83 698.0149 395.72 491.26 489.34 564.24 690.39 515.84 673.87 728.3250 414.27 514.30 512.28 590.70 722.77 540.03 705.47 762.4751 432.60 537.05 534.94 616.83 754.74 563.92 736.68 796.2052 452.78 562.10 559.90 645.60 789.95 590.23 771.04 833.3453 473.19 587.44 585.14 674.71 825.56 616.83 805.80 870.9154 495.22 614.79 612.39 706.13 864.00 645.56 843.33 911.4655 517.26 642.15 639.64 737.55 902.45 674.28 880.85 952.0256 541.15 671.81 669.18 771.62 944.13 705.43 921.54 995.9957 565.27 701.76 699.01 806.01 986.22 736.87 962.62 1040.3958 591.02 733.72 730.85 842.73 1031.14 770.44 1006.47 1087.7859 603.78 749.56 746.63 860.92 1053.40 787.07 1028.19 1111.2660 629.53 781.52 778.46 897.63 1098.32 820.63 1072.04 1158.6561 651.79 809.17 806.00 929.38 1137.16 849.66 1109.96 1199.6362 666.41 827.31 824.07 950.22 1162.66 868.71 1134.84 1226.5363 684.73 850.06 846.73 976.34 1194.63 892.59 1166.05 1260.25

64+ 695.87 863.88 860.49 992.22 1214.06 907.11 1185.00 1280.73

Columbia, Walla Walla, and Whitman counties






Core Basics Plus*

Flex Bronze

CoreBronze

HSA

Core Silver HSA


Flex SilverHD


Flex Gold

0–14 177.45 220.29 219.43 253.02 309.58 231.31 302.18 326.5915 193.22 239.87 238.93 275.51 337.10 251.87 329.04 355.6216 199.25 247.36 246.39 284.11 347.62 259.74 339.31 366.7217 205.28 254.84 253.85 292.70 358.15 267.60 349.58 377.8218 254.13 315.49 314.25 362.36 443.37 331.28 432.76 467.7319 261.92 325.16 323.89 373.47 456.97 341.44 446.04 482.0720 270.00 335.19 333.87 384.98 471.05 351.96 459.78 496.9321 278.35 345.55 344.20 396.89 485.62 362.84 474.00 512.3022 278.35 345.55 344.20 396.89 485.62 362.84 474.00 512.3023 278.35 345.55 344.20 396.89 485.62 362.84 474.00 512.3024 278.35 345.55 344.20 396.89 485.62 362.84 474.00 512.3025 279.46 346.93 345.58 398.48 487.56 364.29 475.90 514.3526 285.03 353.85 352.46 406.41 497.28 371.55 485.38 524.5927 291.71 362.14 360.72 415.94 508.93 380.26 496.75 536.8928 302.56 375.62 374.14 431.42 527.87 394.41 515.24 556.8729 311.47 386.67 385.16 444.12 543.41 406.02 530.41 573.2630 315.92 392.20 390.67 450.47 551.18 411.83 537.99 581.4631 322.60 400.49 398.93 459.99 562.84 420.54 549.37 593.7532 329.28 408.79 407.19 469.52 574.49 429.24 560.74 606.0533 333.46 413.97 412.35 475.47 581.78 434.69 567.85 613.7334 337.91 419.50 417.86 481.82 589.55 440.49 575.44 621.9335 340.14 422.26 420.61 485.00 593.43 443.39 579.23 626.0336 342.37 425.03 423.37 488.17 597.32 446.30 583.02 630.1337 344.59 427.79 426.12 491.35 601.20 449.20 586.81 634.2238 346.82 430.56 428.87 494.52 605.09 452.10 590.61 638.3239 351.27 436.09 434.38 500.87 612.85 457.91 598.19 646.5240 355.73 441.62 439.89 507.22 620.62 463.71 605.78 654.7241 362.41 449.91 448.15 516.75 632.28 472.42 617.15 667.0142 368.81 457.86 456.06 525.88 643.45 480.77 628.05 678.7943 377.72 468.91 467.08 538.58 658.99 492.38 643.22 695.1944 388.85 482.74 480.85 554.45 678.41 506.89 662.18 715.6845 401.93 498.98 497.02 573.11 701.24 523.95 684.46 739.7646 417.52 518.33 516.30 595.33 728.43 544.27 711.00 768.4547 435.05 540.10 537.98 620.34 759.03 567.12 740.87 800.7248 455.10 564.98 562.77 648.91 793.99 593.25 774.99 837.6149 474.86 589.51 587.20 677.09 828.47 619.01 808.65 873.9850 497.13 617.16 614.74 708.84 867.32 648.04 846.57 914.9651 519.12 644.45 641.93 740.20 905.69 676.70 884.01 955.4352 543.33 674.52 671.88 774.73 947.93 708.27 925.25 1000.0053 567.83 704.93 702.17 809.65 990.67 740.20 966.96 1045.0954 594.27 737.75 734.87 847.36 1036.80 774.67 1012.00 1093.7555 620.71 770.58 767.57 885.06 1082.94 809.14 1057.03 1142.4256 649.38 806.17 803.02 925.94 1132.96 846.51 1105.85 1195.1957 678.33 842.11 838.81 967.22 1183.46 884.25 1155.14 1248.4758 709.23 880.47 877.02 1011.27 1237.36 924.52 1207.76 1305.3359 724.53 899.47 895.95 1033.10 1264.07 944.48 1233.83 1333.5160 755.43 937.83 934.16 1077.15 1317.98 984.76 1286.44 1390.3861 782.15 971.00 967.20 1115.26 1364.60 1019.59 1331.95 1439.5662 799.69 992.77 988.89 1140.26 1395.19 1042.45 1361.81 1471.8363 821.68 1020.07 1016.08 1171.61 1433.56 1071.11 1399.26 1512.30

64+ 835.04 1036.65 1032.60 1190.66 1456.86 1088.52 1422.00 1536.89

Tobacco User Rates

Columbia, Walla Walla, and Whitman counties



27 IF0001383-53-18 KPWA 2019

Covered eye care

All of our medical plans have adult vision exams included, subject to applicable cost shares. Glasses and contacts are not covered. For members 18 and younger, pediatric vision exams are included, as well as glasses or contact lenses for children at no cost.* Visit kp.org/wa/ eyecare for Kaiser Permanente Eye Care locations in Washington. Or check the Core network directory at kp.org/wa/directory.

Adding dental coverage

Oral health is an important part of your overall health. When you select a Kaiser Permanente medical plan, you can choose to add dental coverage — for yourself, for your children, or for your entire family.

These Delta Dental plans give you the freedom to see any dentist, and you receive better benefits when you see a Delta Dental participating dentist.

Choosing a dentist

You may choose a dentist from two networks: Delta Dental PPO or Delta Dental Premier. To find a participating, in-network dentist in your area, visit deltadentalwa.com and use the Find a Dentist tool.

Delta Dental network dentists provide treatments at discounted rates and file all claims paperwork for you. Delta Dental will pay its portion and you’re only responsible for your stated deductibles, coinsurance, and any amounts in excess of the plan maximums.

If you choose a non-participating (out-of-network) dentist, you're responsible for having the dentist complete your claim forms and for ensuring the claims are submitted to Delta Dental. Claim payments to out-of-network dentists are based on actual charges or Delta Dental’s maximum allowable fees for non-participating dentists, whichever is less. You’re then responsible for any balance remaining after Delta Dental pays.

For questions or to locate a participating provider, please visit deltadentalwa.com or call Delta Dental at 1-800-554-1907.

Choosing a plan

We work with Delta Dental of Washington to offer you dental coverage when paired with one of our medical plans.

A federal mandate requires dental coverage for anyone 18 and younger. You can buy this coverage separately or with a family dental plan.

Learn about vision and dental coverageAdult/family planThe optional adult/family plan includes dental coverage for everyone covered on the medical plan.

• This plan is available for adults or families who purchase their medical plan directly from Kaiser Permanente.

• Adults or families who purchase their medical plan through Washington Healthplanfinder can also purchase their family dental plan there.

Pediatric-only planThe pediatric-only plan includes dental coverage for those 18 and younger only.

• This plan is available if you purchase your medical plan directly from Kaiser Permanente.

• If you purchase your medical plan through Washington Healthplanfinder you will be required to purchase pediatric dental coverage for those 18 and younger through Washington Healthplanfinder.

*Vision hardware must be prescribed and purchased at a Kaiser Permanente Eye Care location or contracted provider.

http://kp.org/wa/if

http://kp.org/wa/eyecare

http://kp.org/wa/eyecare




28 IF0001383-53-18 KPWA 2019

This is a brief summary of benefits and does not constitute a contract. For complete plan information, please refer to your Delta Dental of Washington benefits booklet. Kaiser Permanente refers to Kaiser Foundation Health Plan of Washington.All dental plans offered and underwritten by Delta Dental of Washington.

TMJ = temporomandibular joint *Includes dental providers in the Delta Dental PPOSM and Delta Dental Premier® networks † For families with two or more children ‡ Covered for members 18 and younger**Requires preauthorization

Summary of benefitsAdult/family plan Pediatric-only plan

Pediatric (18 and younger)

Adult (19 or older) Only for those 18 and younger

Delta Dental participating

dentist*

Non-participating

dentist

Delta Dental participating

dentist*

Non-participating

dentist

Delta Dental participating dentist* Non-participating dentist

Annual maximum Unlimited$1,250

$1,000 annual TMJ maximum$5,000 lifetime TMJ maximum

Unlimited

Annual deductibleWaived on diagnostic and preventive benefits

$85 / child $50 / adult $85 / child

Out-of-pocketmaximum

$350 / child$700 / family† Not applicable Not applicable $350 / child

$700 / family† Not applicable

Diagnostic and preventiveExams, prophylaxis, fluoride, X-rays, sealants

100% 100% 100% 100% 100% 100%

RestorativeRestorations (includes posterior composites‡), endodontics, periodontics, oral surgery**

30% 30% 50% 50% 30% 30%

MajorCrowns,** dentures, partials, bridges, implants, and TMJ treatment for adults 19 or older

50% 50% 50% 50% 50% 50%

Orthodontia**

(medically necessary)CoinsuranceLifetime maximum

50% Unlimited

Not covered 50% Unlimited

Rates Adult/family plan Pediatric-only planIndividual only $45.76 This plan bills only for the first three 18 and younger

Individual + spouse $91.54 1 Individual (<19) $40.16

Individual + child(ren) $101.78 2 Individual (<19) $80.31

Individual + family $161.84 3 Individual (<19) $120.47

©2018 Kaiser Foundation Health Plan of Washington

Seattle and Spokane Close UpLorem ipsum dolor sit amet, bibendum vel a, sodales accumsan potenti lobortis.

Bellevue

FactoriaRainier

Renton

RedmondCapitolHill

Northgate

Northshore

Silverdale

Everett

Lynnwood

Kent

Federal Way

Burien

Puyallup

DowntownSeattle

Olympia

Port Orchard

Poulsbo

Tacoma

TacomaSouth

N

90

405

5

5

5

WESTERN WASHINGTON

SPOKANE AREA*

Lidgerwood

Riverfront

KendallYards

South HillLincolnHeights

Veradale

90

90

Northpointe

Kaiser Permanente Medical Office Locations

BellevueBothellBurienEverettFederal WayKentLynnwoodOlympiaPort Orchard

PoulsboPuyallupRedmondRentonSeattle (4)SilverdaleSpokane (7)Spokane ValleyTacoma

AlderwoodBallardBellevue VillageCrossroadsDes MoinesFairwoodGig HarborGreenwood

Rainier AvenueRedmondSammamishSilver LakeSnoqualmieUniversity VillageWest Seattle

CareClinic by Kaiser Permanente at Bartell Drugs

*Some Kaiser Permanente Spokane locations were formerly named Columbia Medical Associates

Black

http://kp.org/wa/if


29 IF0001383-53-18 KPWA 2019

Find a facility near youOur goal is to make it as easy and convenient as possible for you to get the care you need when you need it. Please refer to the map below and on the following page, or visit kp.org/wa/directory and select Core to find the location nearest you.


*Some Kaiser Permanente Spokane locations were formerly named Columbia Medical Associates.


Seattle and Spokane Close UpLorem ipsum dolor sit amet, bibendum vel a, sodales accumsan potenti lobortis.

Bellevue

FactoriaRainier

Renton

RedmondCapitolHill

Northgate

Northshore

Silverdale

Everett

Lynnwood

Kent

Federal Way

Burien

Puyallup

DowntownSeattle

Olympia

Port Orchard

Poulsbo

Tacoma

TacomaSouth

N

90

405

5

5

5

WESTERN WASHINGTON

SPOKANE AREA*

Lidgerwood

Riverfront

KendallYards

South HillLincolnHeights

Veradale

90

90

Northpointe

Kaiser Permanente Medical Office Locations

BellevueBothellBurienEverettFederal WayKentLynnwoodOlympiaPort Orchard

PoulsboPuyallupRedmondRentonSeattle (4)SilverdaleSpokane (7)Spokane ValleyTacoma

AlderwoodBallardBellevue VillageCrossroadsDes MoinesFairwoodGig HarborGreenwood

Rainier AvenueRedmondSammamishSilver LakeSnoqualmieUniversity VillageWest Seattle

CareClinic by Kaiser Permanente at Bartell Drugs

*Some Kaiser Permanente Spokane locations were formerly named Columbia Medical Associates

Black


http://kp.org/wa/if



30 IF0001383-53-18 KPWA 2019

Core network provider locations

Kaiser Permanente Medical Centers

Network Medical Centers

Network Hospitals

WESTERN WASHINGTON (NORTH) WESTERN WASHINGTON (CENTRAL)

Everett

Marysville

Darrington

Langley

Camano Island

Coupeville

Freeland

Granite Falls

ArlingtonStanwood

La Conner

Lakewood

Puyallup

Bellevue

Tacoma

Renton

Redmond

Sammamish

Bothell

Lynnwood

Poulsbo

Silverdale

Port OrchardBremerton

Seattle

Federal Way

Olympia

Centralia

Kent

BurienVashon

Shelton

Gig HarborMount Vernon

Sedro-Woolley

Oak Harbor

CENTRAL & EASTERN WASHINGTON

Milton-Freewater

Walla Walla

Dayton

Cle Elum

Deer Park

SpokaneCoeurd’Alene

Fairfield

Troy

MoscowPullman

Colfax

Garfield

St. John

Medical Lake

Cheney

Ellensburg

Naches

YakimaWapato

Toppenish

Grandview

Prosser

BentonCity

Richland

Pasco

Kennewick

Sunnyside

Selah

Waitsburg

Burlington

Ferndale

BlaineLynden

Everson

Bellingham

N

Anacortes

Friday Harbor

East Sound

Lopez Island

Please check kp.org/wa/provider-directory for the most up-to-date listing of all network providers or call Member Services.

90

90

90

5

5

82


Option 1 Black

http://kp.org/wa/if

http://kp.org/wa/provider-directory



31 IF0001383-53-18 KPWA 2019

Important disclosure information Kaiser Foundation Health Plan of Washington | Kaiser Foundation Health Plan of Washington Options, Inc.

Understanding your health plan

RCW.48.43.510 and WAC 284-43-5130

Your health plan is designed to help you live your healthiest life. To achieve that, it’s important that you understand your plan’s benefits, coverage, and policies. Upon request, Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc. (collectively referred to as “Kaiser Permanente” within this document) will provide you with the following information:

• A list of covered benefits, including prescription drug benefits, if any; exclusions, reductions, and limitations to covered benefits, and any definition of medical necessity on which they may be based.

• Information on how members may be involved in decisions about benefits.

• A list of coverage policies for pharmacy benefits, including how drugs are added or removed from the drug formulary.

• Information on policies for protecting the confidentiality of health information.

• Information on premiums and enrollee cost-sharing requirements.

• A summary explanation of the complaints and appeals processes.

• Point-of-service plan availability and how the plan operates.

• A copy of the plan’s current drug formulary for prescription drug coverage.

• A list of participating primary care and specialty care providers, including network arrangements that restrict access to providers within the plan network.

• A list of all available disclosure items, in addition to the above, as required by law.

Pharmacy benefit information

WAC 284-43-5040, WAC 284-43-5110, and WAC 284-43-5170

The following information applies only to health plans that have pharmacy benefits. This information is detailed in your plan’s benefits booklet.

Your right to safe and effective pharmacy services

State and federal laws establish standards to assure safe and effective pharmacy services, and to guarantee your right to know what drugs are covered under this plan and what coverage limitations are in your contract. If you would like more information about the drug coverage policies under your plan, or if you have a question or a concern about your pharmacy benefit, please contact Member Services.

If you would like to know more about your rights under the law, or if you think anything you received from your plan may not conform to the terms of your contract, you may contact the Washington State Office of the Insurance Commissioner toll-free at 1-800-562-6900. If you have a concern about the pharmacists or pharmacies serving you, please call the Washington State Department of Health toll-free at 1-800-525-0127.

Does this plan limit or exclude certain drugs my health care provider may prescribe, or encourage substitutions for some drugs?

Kaiser Permanente, working with pharmacists and physicians, has developed a drug formulary. A drug formulary is a list of preferred pharmaceutical products, supplies, and devices. Nonformulary drugs are not covered unless approved by your health plan as medically necessary or may be subject to a higher cost than formulary drugs, depending on the benefits of your specific plan.

Generic drugs will be dispensed unless a suitable generic is not available. If you elect to purchase a brand-name drug instead of the generic equivalent (if available), and it is not medically necessary, you will be responsible for payment of the additional cost

http://kp.org/wa/if



32 IF0001383-53-18 KPWA 2019

above the generic drug charge in addition to your plan pharmacy cost share.

Over-the-counter drugs, supplies and devices not requiring a prescription under state law or regulations, drugs and injections for anticipated illness while traveling, drugs and injections for cosmetic purposes, and vitamins—including most prescription vitamins — are generally excluded from all plans. Exclusion of other categories of drugs will depend on your specific coverage plan. For example, drugs for treatment of sexual dysfunction are not covered unless your health plan covers treatment of sexual dysfunction. Contact Member Services to request a copy of the drug formulary for your specific plan. The drug formulary is also available at kp.org/wa/formulary.

When can my plan change the approved drug list (formulary)? If a change occurs, will I have to pay more to use a drug I had been using?

Changes to the plan’s drug formulary are implemented on an ongoing basis, based on an established evaluation process. The evaluation process includes review of scientific studies. The scientific studies reviewed must have been published in health care journals or other publications in which original manuscripts are published only after having been critically reviewed for scientific accuracy, validity, and reliability by unbiased independent experts.

Your care provider or pharmacist will notify you when you refill a prescription if the prescribed drug is no longer included in the plan’s drug formulary. When a drug has been removed from the plan formulary, it will not be covered unless your plan, at its discretion, elects to cover the drug for a limited time, or the drug may be subject to a higher cost depending on the benefits of your specific plan.

What should I do if I want a change from limitations, exclusions, substitutions, or cost increases for drugs specified in this plan?

• Benefit changes — Customization of your drug benefit occurs only through the contract process. Employer groups may choose to purchase higher or lower drug benefits each year when they renew their group contract. Individual and family contract benefits are renewed each year.

• Formulary substitution — Although individuals are

not allowed to customize any plan drug formularies, health care providers can prescribe nonformulary medications for patients through a pharmacy exception process. The plan health care provider, in coordination with the plan pharmacy, will determine the medical appropriateness of substitutions. If a medical exception (substitution) is not approved, the patient is responsible for the full charge for the drug. Nonformulary drugs may be subject to a higher cost.

How much do I have to pay to get a prescription filled?

The amount of your out-of-pocket expense (cost share) depends on the specific pharmacy coverage you or your employer has purchased and on the medication prescribed. In general, the prescription copay or coinsurance amount applies for up to a 30-day supply of each covered prescription. If the actual charge for the drug is less than your cost share, you will pay only the actual charge for the drug. If your provider prescribes a noncovered medication, you will pay the actual charge for the drug.

If you have pharmacy coverage with a tiered cost share benefit, you will pay a lower cost share for generic drugs, and higher cost share for brand-name drugs. In addition, nonformulary drugs may be subject to a higher cost share.

Do I have to use certain pharmacies to pay the least out of my own pocket under this health plan?

Yes, you need to have your prescriptions filled at a Kaiser Permanente-designated pharmacy except for drugs dispensed for emergency services. All Kaiser Permanente medical offices have pharmacies located within the clinic. Additional retail pharmacies are also under contract to provide covered prescription drugs for members. When you use Kaiser Permanente-designated pharmacies, covered drugs are subject to the plan cost share. If you elect to purchase a noncovered drug, you will pay the actual charge for the drug. The plan directory of providers available at kp.org/wa lists pharmacies in your area.

You may be eligible to receive an emergency fill for certain prescription drugs filled outside of Kaiser Permanente’s business hours or when Kaiser Permanente cannot reach the prescriber

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33 IF0001383-53-18 KPWA 2019

for consultation. You will pay a cost share for your emergency prescription drug fill. Refer to your Benefits Booklet for more information. A list of prescription drugs eligible for emergency fills is available on the pharmacy website at kp.org/wa/formulary. Members can request an emergency fill by calling 1-855-505-8107.

Call Member Services to find out which pharmacies are in your area, or if you anticipate needing to fill a prescription when you are traveling.

How many days supply of most medications can I get without paying another copay or other repeating charge?

Your plan contract allows up to a 30-day supply of prescription or refill per cost share amount. If you get a three-month supply of a maintenance drug, you will be charged three pharmacy cost share amounts. Depending on your plan, additional savings may be available for maintenance drugs through Kaiser Permanente mail-order services.

What other pharmacy services does my health plan cover?

A mail-order prescription refill service is available. Contact Member Services for your plan’s specific mail-order pharmacy benefits. At Kaiser Foundation Health Plan of Washington, the Pharmacy Department is involved in the development of clinical roadmaps and clinical guidelines. The Pharmacy Department participates in, or plays a role in, medication use and disease management programs for smoking cessation and for conditions such as diabetes, HIV/AIDS, asthma, depression, migraine headache, GERD (gastroesophageal reflux disease), and heart problems.

How we protect your personal information

Your health is our number one priority, and part of caring for you is keeping your personal information safe. Our policies and procedures are designed to protect your personal information in written, verbal, and electronic forms. Specifically:

• We’ll protect your right to access, review, amend, and receive copies of your medical records.

• We’ll protect the confidentiality of your health care

information by instituting physical, technical, and administrative controls throughout the organization to protect the use and disclosure of oral, hard copy, and electronic personal health information. We train our employees on these policies and procedures. Employees who violate our confidentiality and security policies are subject to disciplinary action.

• We use and share your personal information to provide treatment, receive and provide payment for health care services, and conduct health care operations.

• We won’t release patient-identifiable health information to third parties without your written permission or authorization except as permitted or required by law.

• We may use health information to support utilization review, quality assessment and measurement, billing, claims management, audits, accreditation, and other health care operations.

• We won’t release detailed utilization information to employers when it might identify individual patients unless permitted or required by law.

For information regarding our privacy practices, you can view our Notice of Privacy Practices at kp.org/wa or call Member Services at 1-888-901-4636. If you are speech- or hearing-impaired, please call the TTY WA Relay at 1-800-833-6388 or 711.

Understanding your plan coverage

Treatment coverage

Your treatment and service coverage is determined by your specific health plan. If you ever have any concerns or questions regarding your coverage, contact Member Services for assistance.

For a particular treatment or service to be covered, it must be:

• Provided or arranged by a Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc. health care provider (depending on your plan), except for emergency care and urgent care outside of the Kaiser Permanente service area. Kaiser Foundation Health Plan of Washington Options, Inc. members may self-refer to care from any licensed health care provider in the

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34 IF0001383-53-18 KPWA 2019

United States at a lower benefit level.• Covered by the Kaiser Foundation Health Plan of

Washington or Kaiser Foundation Health Plan of Washington Options, Inc. plan in which you are enrolled. To ask about coverage for a specific treatment or service, contact Member Services.

Utilization reviews

At Kaiser Permanente, we provide or authorize your medical care based on what is appropriate and necessary for the condition being treated or diagnosed. We do not use financial incentives to encourage our providers to withhold care from members. Our doctors are free to make their own decisions. However, some treatments and services require a utilization review (or coverage review) by the plan.

A utilization review determines whether a treat ment or service is covered under the terms of your coverage agreement. It does not determine whether a provider may render services or whether you may choose to purchase a medical service on your own. Utilization reviews may occur at different times relative to the services you receive. It may occur before you receive the services, at the same time you receive services, or after you receive services.

During a utilization review, we will:

• Evaluate whether a specific health care service, procedure, or setting is necessary, appropriate, effective, and efficient for the condition in question; or

• Monitor the use of a specific health care service, procedure, or setting.

Some treatments and services are subject to utilization reviews based on criteria developed by Kaiser Permanente or another organization. In some cases, a service for which we have conducted a utilization review may not be deemed medically necessary, as defined in the plan’s clinical review criteria.

If you believe you need a specific type of care, talk to your health care provider. He or she will discuss it with you and recommend the most appropriate care. For more information about utilization reviews, or for a written explanation of our criteria for a specific service, contact Member Services.

A pre-service review (or preauthorization) is a specific type of utilization review that occurs prior to you

receiving services. Some care requires a referral from your personal physician but does not require preauthorization. However, certain services do require pre-service review to be covered. In addition, the service must be covered by your health plan for you to receive the coverage benefit.

Usually, your provider will arrange for pre-service review when necessary. If a treatment or service is not authorized, you’ll receive a written explanation of the reason for the denial, your right to appeal the decision, and the appeal process.

Kaiser Permanente will not deny coverage retroactively for preauthorized services that have already been provided to the member. Exceptions are if there has been an intentional misrepresentation of a material fact by the patient, member, or provider of services; if coverage was obtained based on inaccurate, false, or misleading information on the enrollment application; or if premiums have not been paid.

Grievances and appeals processes

If you ever have a concern, request, complaint, or compliment, we encourage you to let us know. Kaiser Permanente offers grievance, coverage decision (including exceptions), and appeals processes. Generally, grievances are complaints regarding the quality of care you receive, or the quality of service we provide, including problems getting appointments and disrespectful or rude staff behavior.

Coverage decisions are decisions about what your plan will and won’t cover. These types of decisions could include an exception for a prescription drug that isn’t on our list of covered drugs or a request for a drug at a lower out-of-pocket cost.

An appeal is a formal way of asking us to review and change a coverage decision we’ve made. You have the right to appeal any coverage decision. The type of appeal, and timeframe for resolution, depends on what is being denied. We’ll tell you how to appeal in the letter we send you explaining our denial decision. We quickly review appeals involving urgently needed care and act as fast as necessary, given the clinical urgency of the condition. Reviews that are clinically urgent will take no longer than 72 hours.

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Kaiser Permanente Nondiscrimination Notice and Language Access Services

KAISER PERMANENTE NONDISCRIMINATION NOTICE Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc. (“Kaiser Permanente”) comply with applicable federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or any other basis protected by applicable federal, state, or local law. We also: Provide free aids and services to people with disabilities to help ensure effective communication, such as:

• Qualified sign language interpreters • Written information in other formats (large print, audio, and accessible electronic formats) • Assistive devices (magnifiers, Pocket Talkers, and other aids)

Provide free language services to people whose primary language is not English, such as: • Qualified interpreters • Information written in other languages

If you need these services, contact Kaiser Permanente. If you believe that Kaiser Permanente has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, sex, sexual orientation, or gender identity, you can file a grievance. Please call us if you need help submitting a grievance. The Civil Rights Coordinator will be notified of all grievances related to discrimination. Kaiser Permanente Phone: 206-630-4636 Toll-free: 1-888-901-4636

TTY Washington Relay Service: 1-800-833-6388 or 711 TTY Idaho Relay Service: 1-800-377-3529 or 711

Electronically: kp.org/wa/feedback

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services 200 Independence Avenue SW., Room 509F HHH Building Washington, DC 20201 1-800-368-1019, 800-537-7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

For Medicare Advantage Plans Only: Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.

© 2018 Kaiser Foundation Health Plan of Washington H5050_XB0001444_56_18 accepted 2018-XB-7_ACA_Notice_Taglines

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LANGUAGE ACCESS SERVICES English: ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-888-901-4636 (TTY: 1-800-833-6388 or 711). Español (Spanish): ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-888-901-4636 (TTY: 1-800-833-6388 / 711). 中文 (Chinese)：注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-888-901-4636 (TTY: 1-800-833-6388 / 711)。 Tiếng Việt (Vietnamese): CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-888-901-4636 (TTY: 1-800-833-6388 / 711). 한국어(Korean): 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-888-901-4636 (TTY: 1-800-833-6388 / 711) 번으로 전화해 주십시오. Русский (Russian): ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-888-901-4636 (телетайп: 1-800-833-6388 / 711). Filipino (Tagalog): PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-888-901-4636 (TTY: 1-800-833-6388 / 711). Українська (Ukrainian): УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером 1-888-901-4636 (телетайп: 1-800-833-6388 / 711).

ភាសាខ្មែរ (Khmer)៖ របយ័ត៖ េ េបើសិនអកនិខ្យមរ, េ សជំនួខ្យផក េ យមិនគិតល គឺចនសំប់បំេ រអក។ ចូរទូ រស័ព 1-888-901-4636 (TTY: 1-800-833-6388 / 711)។ 日本語 (Japanese): 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。 1-888-901-4636 (TTY: 1-800-833-6388 / 711) まで、お電話にてご連絡ください。 አማርኛ (Amharic) ፥ ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-888-901-4636 (መስማት ለተሳናቸው: 1-800-833-6388 / 711). Oromiffa (Oromo): XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-888-901-4636 (TTY: 1-800-833-6388 / 711). ਪੰਜਾਬੀ (Punjabi) ਧਿਆਨ ਧਿਓ: ਜੇ ਤਸੁੀਂ ਪੰਜਾਬੀ ਬੋਲਿ ੇਹੋ, ਤਾਂ ਭਾਸਾ ਧ ਿੱ ਚ ਸਹਾਇਤਾ ਸੇ ਾ ਤੁਹਾਡ ੇਲਈ ਮੁਫਤ ਉਪਲਬਿ ਹ।ੈ 1-888-901-4636 (TTY: 1-800-833-6388 / 711) ‘ਤੇ ਕਾਲ ਕਰੋ।

تتوافر اللغوية المساعدة خدمات فإن اللغة، اذكر تتحدث كنت إذا :ملحوظة في ومعلومات مساعدة على الحصول حق لديكم :(Arabic) العربية : (6388-833-800-1 / 711) .والبكم الصم هاتف رقم 4636-901-888-1 برقم اتصل .بالمجان لك

Deutsch (German): ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-888-901-4636 (TTY: 1-800-833-6388 / 711).

ພາສາລາວ (Lao): ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວ ້ າພາສາລາວ, ການບໍ ລິ ການຊ່ວຍເຫ ຼື ອດ້ານພາສາ, ໂດຍບໍ່ ເສັຽຄ່າ, ແມ່ນມີ ພ້ອມ ໃຫ້ທ່ານ. ໂທຣ 1-888-901-4636 (TTY: 1-800-833-6388 / 711). Srpsko-hrvatski (Serbo-Croatian): OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 1-888-901-4636 (TTY- Telefon za osobe sa oštećenim govorom ili sluhom: 1-800-833-6388 / 711). Français (French): ATTENTION: Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1-888-901-4636 (ATS: 1-800-833-6388 / 711). Română (Romanian): ATENȚIE: Dacă vorbiți limba română, vă stau la dispoziție servicii de asistență lingvistică, gratuit. Sunați la 1-888-901-4636 (TTY: 1-800-833-6388 / 711). Adamawa (Fulfulde): MAANDO: To a waawi Adamawa, e woodi ballooji-ma to ekkitaaki wolde caahu. Noddu 1-888-901-4636 (TTY: 1-800-833-6388 / 711).

می فراهم شما برای رايگان بصورت زبانی تسهيالت کنيد، می گفتگو فارسی زبان به اگر :توجه :(Farsi) فارسی .بگيريد تماس (TTY: 1-800-833-6388 / 711) 4636-901-888-1 با .باشد

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37 IF0001383-53-18 KPWA 2019

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38 IF0001383-53-18 KPWA 2019

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Care is just a click awayOnline tools designed to make your life easier

New member?Visit kp.org/wa/newmember to get started. It’s easy to register at kp.org/wa, choose your doctor, transfer your prescriptions, and find the member guide for your plan. If you choose a doctor at Kaiser Permanente medical offices, you can also schedule your first routine appointment online. And if you need help, just give the new member team a call at 1-888-844-4607.

Already a member?Manage your care online anytime at kp.org/wa. If you haven’t already, go to kp.org/wa/register so you can start using your secure online member website to refill most prescriptions, have an online visit* for routine health issues, or view coverage documents. If you get your care at Kaiser Permanente, you can also go online to review medical records or lab results, and email your doctor's office non-urgent questions.

*Prescriptions from online visits must be filled at a Kaiser Permanente medical office or by mail-order service.

http://kp.org/wa/newmember

http://kp.org/wa

http://kp.org/wa

http://kp.org/wa/register

The right choice for a healthier youHaving a good health plan is important. So is getting quality care. With Kaiser Permanente, you get both.

Kaiser Foundation Health Plan of Washington 601 Union St., Suite 3100

Seattle, WA 98101

facebook.com/kaiserpermanentewashington

Stay connected to good health

@kpwashington

Want to learn more?Visit kp.org/wa/if or call us at 1-800-358-8815. (For TTY, call 711.)

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