NON-MEDICARE HEALTH PLANS

Eligible retirees have four (4) Non-Medicare plans available to choose from. Please click on the following links to find the information you are looking for, or contact the Retirement Services Department at (408) 794-1000 for additional information.

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Summary Plan Information | Cost | Evidence of Coverage | HIPAA Privacy Notices

Authorization To Release Information Forms | Contact The Plan Providers

SUMMARY OF PLAN INFORMATION | top of page |

- 2012 Quick Reference Sheet (File Size: 69kb)

- 2011 $25 Co-Pay Non-Medicare Plan Comparison (File Size: 132kb)

- 2012 KP $25 Benefits Summary (File Size: 117kb)

- Blue Shield Traveling Benefits - FAQs (File Size: 65kb)

COST | top of page |

- 2012 Medical Plan Rates (pg1) (File Size: 117kb)

EVIDENCES OF COVERAGE | top of page |

- 2012 KP Traditional Plan EOC (File Size: 5,220kb)

- 2011 BSC $25 HMO EOC (File Size: 415kb)

- 2011 BSC $25 POS EOC (File Size: 544kb)

- 2011 BSC $25 PPO EOC (File Size: 519kb)

HIPAA PRIVACY NOTICES | top of page |

- California Kaiser Permanente (File Size: 573kb)

- Blue Shield of California (File Size: 76kb)

- Northwest Kaiser Permanente (File Size: 44kb)

AUTHORIZATION TO RELEASE INFORMATION FORMS | top of page |

- California Kaiser Permanente (File Size: 103kb)

- Blue Shield of California (File Size: 61kb)

- Northwest Kaiser Permanente (File Size: 360kb)

CONTACT THE PLAN PROVIDERS | top of page |

	Kaiser Permanente 1-800-464-4000 Group #: 887
	Blue Shield of California 1-800-837-4481 Group #’s: HMO (H11186) PPO (975567) POS (MH0161)