2011 RATES

2011 RATES
Use these rate tables to compare rates
for the plans you're interested in.

RATE AREA 5
For new coverage effective
January through June 2011
Important information
about our rates
How to find your rate Try different combinations
Simply find your ZIP code in the list below to confirm Family members do not have to apply for the same plan.
your rate area. Then locate your desired plan on page 3. Each family member who qualifies will be enrolled under
Your rate will appear in the box where your age and rate his or her own plan at a separate rate. This allows you
area intersect with your plan. to select different plans for different family members,
depending on their needs. For example, you may select
Remember that for services subject to a deductible, you
the extra coverage offered by copayment plans for young
will have to pay health care expenses out of pocket until
children. But perhaps you might choose a less expensive
you meet your deductible. For information describing
deductible plan for yourself. Your spouse may want the tax
the benefits and limitations, cost-sharing amounts,
savings of an HSA–qualified deductible plan.1 The choice
premiums, and dental plans, please review the details
is yours.
in your enrollment material. To request a copy of the
Membership Agreement or Certificate of Insurance for Medicare-eligible subscribers
a particular plan, please call us at 1-800-494-5314 or If you are 65+ years of age and Medicare eligible or are
contact your agent or broker. under age 65 and entitled to Medicare on the basis of
Social Security disability, you may be eligible for lower
What determines your rate
rates under Kaiser Permanente Senior Advantage.
Your rate is based on the following:
Please call 1-800-290-3829 for information.
n the plan you select
n where you live, based on your ZIP code
n your age as of January 1, 2011
If you move and change your home ZIP code, your
monthly rate will change.

ZIP codes for Rate Area 5

Please verify that your ZIP code is listed below. If your ZIP code is not listed, contact us at 1-800-494-5314 for
information on other rate areas.
92201–03 92230 92240–41 92252–56 92260–64 92270 92282 92292
92210–11 92234–36 92247–48 92258 92268 92274–78 92284–86

1
Tax references relate to federal income tax only.

2 Have a question? We’re here to help. Call 1-800-569-1156.

Or get a quote or apply online visit www.KaiserHealthCoverage.com
RATE AREA 5 January–June 2011

Copayment plans Deductible plans HSA-qualified deductible plans

40/4000 0/5000
Age 40/3000 50/5000 0/1500 0/2700 30/2700
25 40 50 20/500 25/1000 30/1500 40/2000 NM WM
range NM1 NM1 w/HSA w/HSA w/HSA
w/HSA1 w/HSA1
<1 $472 $435 $367 $452 $408 $339 $294 $200 $132 $287 $216 $156 $138 $146
1–18 235 218 185 227 205 168 146 100 66 143 108 78 69 73
19 249 230 194 239 216 176 153 102 67 149 112 79 74 76
20 265 244 207 254 230 187 161 106 68 157 119 84 76 79
21 279 257 218 268 242 198 168 111 74 165 125 88 79 85
22 294 271 229 282 254 207 177 114 77 173 131 95 83 88
23 307 283 239 294 266 215 185 119 77 180 138 99 85 95
24 318 294 249 305 275 222 194 122 80 188 144 103 87 99
25 330 304 257 317 285 230 201 128 84 196 149 109 90 103
26 340 314 266 327 295 239 208 131 86 204 156 113 95 108
27 350 322 273 337 303 246 215 136 89 210 160 118 98 111
28 361 332 282 347 312 254 221 140 91 216 165 122 100 116
29 372 342 289 356 321 261 227 145 96 221 169 125 103 120
30 381 351 297 365 330 267 231 149 98 226 175 130 106 123
31 391 360 305 374 339 274 237 153 101 230 178 132 109 127
32 400 369 311 384 347 279 241 158 103 235 184 138 112 130
33 406 374 317 391 352 284 246 163 107 240 187 140 117 132
34 410 378 320 394 356 290 251 168 111 245 193 143 121 136
35 415 383 323 398 360 295 256 175 114 249 197 147 124 140
36 418 386 327 402 363 299 261 180 119 254 202 150 129 143
37 422 389 329 406 365 304 266 186 122 259 207 153 131 146
38 427 393 332 410 370 308 272 191 123 265 212 156 134 147
39 431 397 337 414 374 311 276 197 127 270 220 158 138 151
40 436 402 339 418 376 316 283 204 131 275 227 165 141 157
41 440 406 343 422 382 320 288 209 131 282 234 171 143 162
42 444 410 348 427 385 325 294 217 136 286 242 179 149 171
43 449 413 349 430 388 330 299 226 142 292 251 186 155 177
44 453 418 353 436 393 338 306 234 147 298 256 193 160 183
45 458 421 356 439 396 344 311 243 152 304 264 199 166 189
46 462 427 361 444 402 353 320 253 158 311 272 207 172 196
47 469 431 367 449 406 361 329 264 165 320 282 215 179 204
48 475 438 375 455 410 370 339 274 172 330 292 223 186 212
49 482 444 384 463 418 378 349 284 178 340 299 232 194 221
50 490 451 395 470 424 389 360 294 185 351 309 241 201 230
51 498 459 405 479 431 399 371 304 194 362 319 251 210 239
52 509 469 415 488 440 409 382 315 200 372 328 261 218 249
53 519 479 425 498 450 419 393 326 209 384 338 271 227 257
54 529 487 437 508 458 429 405 337 218 395 348 279 237 266
55 546 503 447 524 473 440 415 344 226 404 356 289 245 275
56 562 518 457 539 486 450 425 352 234 414 364 300 255 285
57 579 532 465 554 501 459 436 364 244 425 374 309 266 294
58 596 549 474 572 516 468 447 371 253 436 384 318 275 303
59 611 563 484 586 529 477 458 378 260 447 393 328 283 311
60 623 574 493 598 540 486 469 388 267 457 402 338 292 320
61 636 585 504 609 550 496 479 399 275 466 410 347 299 329
62 648 598 514 623 562 506 488 408 282 476 419 353 306 336
63 661 609 525 635 573 517 498 416 288 485 428 360 314 342
64 674 622 535 647 584 527 508 429 296 495 438 366 321 348
65+ 1,220 1,220 1,069 1,220 1,220 1,220 1,220 1,220 1,069 1,220 1,220 1,069 1,220 1,220

1
These plans are offered by Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP).

Get a faster response when you apply online. It’s easy and convenient! 3

Visit www.KaiserHealthCoverage.com.
 CHOOSE GOOD HEALTH

Kaiser Permanente for Individuals and Families

Visit www.KaiserHealthCoverage.com,
call 1-800-569-1156

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