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) 392-6700 for additional
information.
Please note: You will need Adobe
Acrobat Reader in order to open PDF documents.
Summary Plan Information | Cost
| Evidences of Coverage | HIPAA
Privacy Notices
Authorization To Release Information Forms | Contact The Plan Providers
SUMMARY OF PLAN INFORMATION | top
of page |
 - 2009 Quick Reference Sheet (File Size: 84kb)
- 2008 Quick Reference Sheet (File Size: 83kb) - Medical Plan Comparison (File Size: 122kb) - Kaiser $10 Co-pay Summary 2008 (File Size: 134kb) - Kaiser Hawaii Benefit Summary 2008 (File Size: 190kb) - Kaiser Northwest Benefit Summary 2008 (File Size: 34kb)
COST | top
of page |
- 2009 Medical Plan Rates (pg 1) (File Size: 99kb) - 2008 Medical Plan Rates (pg 1) (File Size: 100kb)
EVIDENCES OF COVERAGE | top
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- Kaiser Permanente $0 Co-pay Plan (File Size: 414kb) - Kaiser Permanente $10 Co-pay Plan (File Size: 419kb) - 2009 Blue Shield HMO, PPO, POS Summary (File Size: 389kb) - Blue Shield $5 Co-pay HMO Plan (File Size: 3,345kb) - Blue Shield $10 Co-pay HMO Plan (File Size: 3,345kb) - Blue Shield PPO (File Size: 3,526kb) - Blue Shield POS (File Size: 3,620kb) - Kaiser Northwest 2007 EOC (File Size: 511kb) - Kaiser Hawaii Member Handbook 2008 (File Size: 2,041kb)
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 |
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