2011 RATES

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

RATE AREA 1
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 1

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.
94002 94172 94282–91 94820 95035–38 95409 95602–05 95746–47
94005 94177 94293–98 94850 95042 95416 95607–21 95757–59
94010–11 94188 94301–06 94901 95044 95419 95623–26 95762–63
94014–28 94199 94309 94903–04 95046 95421 95628 95765
94030 94203–09 94401–04 94912–15 95050–56 95425 95630 95776
94035 94211 94497 94920 95070–71 95430–31 95632–35 95798–99
94037–44 94229–30 94501–03 94922–31 95076 95433 95638–40 95811–38
94060–66 94232 94505–31 94933 95101 95436 95645 95840–43
94070 94234–37 94533–53 94937–42 95103 95439 95648 95851–53
94074 94239–40 94555–83 94945–57 95106 95441–42 95650–52 95860
94080 94244 94585–92 94960 95108–13 95444 95655 95864–67
94083 94246–50 94595–99 94963–66 95115–36 95446 95658–64 95894
94085–89 94252 94601–15 94970–79 95138–41 95448 95667–74 95899
94101–05 94254 94617–24 94999 95148 95450 95676–78 95903
94107–12 94256–59 94649 95002 95150–61 95452 95680–83 95961
94114–34 94261–63 94659–62 95008–09 95164 95462 95687–88
94137 94267–69 94666 95011 95170 95465 95690–98
94139–47 94271 94701–10 95013–15 95172–73 95471–73 95703
94151 94273–74 94712 95020–21 95190–94 95476 95722
94156 94277 94720 95026 95196 95486–87 95736
94158–64 94279–80 94801–08 95030–33 95401–07 95492 95741–42

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

Or visit www.healthcoveragequotes.com
RATE AREA 1 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 $484 $446 $380 $469 $424 $350 $304 $197 $130 $296 $224 $162 $136 $144
1–18 242 223 190 235 212 175 152 99 65 148 112 81 68 72
19 255 235 199 248 224 183 159 101 66 154 116 82 73 75
20 272 251 212 264 238 194 167 105 68 163 123 86 75 78
21 287 264 223 278 251 205 175 109 73 171 130 91 78 83
22 301 278 235 292 264 214 184 113 75 179 136 98 81 87
23 315 290 246 305 276 223 192 117 76 187 142 103 83 93
24 326 300 255 316 285 231 200 121 79 195 149 108 86 98
25 339 312 264 329 297 239 208 126 82 203 154 113 89 103
26 349 322 273 338 306 247 215 130 85 210 162 118 93 106
27 359 331 280 349 315 255 223 135 88 217 166 122 97 109
28 370 341 289 359 324 263 230 138 90 224 171 126 99 114
29 381 352 297 370 334 270 235 143 95 229 176 130 103 118
30 391 360 305 379 342 277 240 147 97 234 181 134 105 122
31 401 369 313 389 351 284 245 151 100 239 185 137 107 125
32 411 379 320 398 360 290 250 156 102 244 190 142 110 128
33 417 384 325 404 365 295 255 161 105 249 194 145 115 131
34 421 388 329 408 369 301 260 166 109 254 199 148 119 135
35 425 392 332 412 373 306 265 172 113 258 204 152 123 138
36 430 396 335 416 376 310 270 178 117 263 209 155 127 141
37 434 400 338 421 380 315 275 184 120 268 214 159 130 144
38 438 404 341 425 384 319 281 189 122 274 221 162 133 145
39 443 408 345 429 388 323 287 195 125 279 228 165 135 149
40 447 412 348 433 392 327 293 200 129 286 235 171 139 155
41 451 416 352 438 395 331 299 206 130 292 243 177 141 160
42 456 420 356 442 399 336 304 214 135 297 251 186 147 168
43 460 424 358 446 403 342 310 223 140 302 260 193 153 175
44 465 429 362 451 407 350 317 231 145 309 265 199 158 180
45 470 433 366 455 412 357 323 240 150 315 273 206 164 187
46 474 437 370 460 416 366 331 250 156 323 281 214 169 194
47 481 443 377 466 421 374 340 260 163 332 292 223 177 201
48 487 449 385 473 427 383 352 270 169 342 302 232 184 210
49 495 456 395 480 433 392 362 280 176 353 310 241 192 218
50 502 463 406 487 440 403 373 289 183 364 320 250 198 226
51 512 472 416 497 449 414 384 300 191 375 330 260 207 235
52 522 481 426 506 458 424 395 311 197 385 339 270 215 245
53 533 491 436 517 467 434 407 321 206 397 350 280 224 254
54 543 501 448 527 476 445 420 332 215 410 361 290 233 262
55 560 516 459 543 490 456 430 340 223 419 369 300 242 271
56 577 531 469 559 505 466 440 347 231 429 377 311 252 282
57 594 547 478 576 520 476 451 359 241 440 387 320 262 289
58 612 564 487 593 536 485 462 366 250 451 397 329 271 298
59 627 578 497 608 549 495 475 374 256 462 406 339 279 307
60 639 589 506 620 560 504 486 383 264 474 417 350 287 316
61 652 601 517 632 571 514 496 394 272 484 426 359 295 324
62 665 613 527 645 583 524 506 403 278 494 435 366 302 331
63 679 626 538 658 594 536 516 410 285 503 443 373 310 338
64 692 638 549 671 606 546 526 423 292 513 454 380 317 344
65+ 1,204 1,204 1,056 1,204 1,204 1,204 1,204 1,204 1,056 1,204 1,204 1,056 1,204 1,204

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.healthcoveragequotes.com
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