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
July through December 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 might want
Remember that for services subject to a deductible, you
the predictable cost share of a copayment plan, while your
will have to pay health care expenses out of pocket until
spouse might be interested in the lower premium of a
you meet your deductible. For information describing
deductible plan. The choice is yours.
the benefits and limitations, cost-sharing amounts,
premiums, and dental plans, please review the details Medicare-eligible subscribers
in your enrollment material. To request a copy of the If you are 65+ years of age and Medicare eligible or are
Membership Agreement or Certificate of Insurance for under age 65 and entitled to Medicare on the basis of
a particular plan, please call us at 1-800-494-5314 or Social Security disability, you may be eligible for lower
contact your agent or broker. rates under Kaiser Permanente Senior Advantage.
Please call 1-800-290-3829 for information.
What determines your rate
Your rate is based on the following:
n the plan you select
n where you live, based on your ZIP code
n your age as of July 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

2 Have a question? We’re here to help. Call 1-800-494-5314.

Or contact your agent or broker today!
RATE AREA 5 July–December 2011

Copayment plans Deductible plans HSA-qualified deductible plans

Age on 40/4000 0/5000
40/3000 50/5000 0/1500 0/2700 30/2700
July 1, 25 40 50 20/500 25/1000 30/1500 40/2000 NM WM
NM1 NM1 w/HSA w/HSA w/HSA
2011 w/HSA1 w/HSA1
<1 $490 $452 $384 $476 $430 $355 $308 $200 $132 $300 $227 $164 $138 $146
1–18 245 226 192 238 215 177 154 100 66 150 113 82 69 73
19 259 238 202 251 227 185 161 102 67 156 117 83 74 76
20 276 254 215 267 241 197 169 106 68 165 125 88 76 79
21 291 268 226 282 255 208 177 111 74 173 132 93 79 85
22 305 281 238 296 267 217 186 114 77 181 138 99 83 88
23 319 294 249 309 279 225 195 119 77 189 144 104 85 95
24 330 304 258 320 289 234 203 122 80 198 151 109 87 99
25 343 316 267 333 301 242 211 128 84 206 156 114 90 103
26 354 326 276 343 310 250 218 131 86 213 164 119 95 108
27 364 336 283 353 319 258 225 136 89 220 168 124 98 111
28 375 346 293 364 329 267 233 140 91 226 173 128 100 116
29 386 356 301 375 338 274 238 145 96 232 178 132 103 120
30 396 365 309 384 347 281 243 149 98 237 183 136 106 123
31 406 374 317 394 356 287 248 153 101 242 187 139 109 127
32 416 384 324 403 364 293 253 158 103 247 193 144 112 130
33 422 389 329 409 370 299 258 163 107 252 197 147 117 132
34 427 393 333 414 374 305 264 168 111 257 202 150 121 136
35 431 397 336 418 377 310 269 175 114 261 207 154 124 140
36 435 401 340 422 381 314 274 180 119 267 212 158 129 143
37 439 405 343 426 385 319 279 186 122 272 217 161 131 146
38 444 409 346 430 389 323 285 191 123 278 223 164 134 147
39 448 413 350 435 393 327 290 197 127 283 231 167 138 151
40 453 417 353 439 397 331 296 204 131 289 238 173 141 157
41 457 422 357 443 401 336 303 209 131 295 246 179 143 162
42 462 426 361 448 405 341 308 217 136 301 254 188 149 171
43 467 430 363 452 409 347 314 226 142 306 264 196 155 177
44 471 434 367 457 413 354 321 234 147 313 269 202 160 183
45 476 439 371 461 417 361 327 243 152 319 277 209 166 189
46 481 443 375 466 421 371 336 253 158 327 285 217 172 196
47 487 449 382 472 427 379 345 264 165 337 295 225 179 204
48 494 455 391 479 432 388 356 274 172 347 306 235 186 212
49 501 462 400 486 439 397 366 284 178 357 314 244 194 221
50 509 469 411 493 446 409 378 294 185 369 324 253 201 230
51 519 478 421 503 454 419 389 304 194 380 335 264 210 239
52 529 488 431 513 464 429 400 315 200 390 344 274 218 249
53 540 498 442 523 473 440 413 326 209 403 354 284 227 257
54 551 507 454 534 482 451 425 337 218 415 365 293 237 266
55 567 523 465 550 497 462 435 344 226 424 374 304 245 275
56 584 538 475 566 512 473 446 352 234 434 382 315 255 285
57 602 555 484 583 527 482 457 364 244 446 392 324 266 294
58 620 571 494 601 543 491 468 371 253 457 403 334 275 303
59 635 585 504 616 556 501 481 378 260 468 412 344 283 311
60 648 597 513 628 568 511 492 388 267 480 422 354 292 320
61 661 609 524 641 579 521 502 399 275 490 431 363 299 329
62 674 621 534 654 590 531 513 408 282 500 441 371 306 336
63 688 634 546 667 602 543 523 416 288 510 449 378 314 342
64 701 646 556 680 614 553 533 429 296 520 460 385 321 348
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 buykp.org/apply or call your agent or broker.

 CHOOSE GOOD HEALTH

Kaiser Permanente for Individuals and Families

Visit buykp.org/apply,
call 1-800-494-5314,
or contact your agent
or broker.

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