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
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 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

1
Tax references relate to federal income tax only.

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

Or to get a quote or apply online click here.
RATE AREA 1 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 $466 $429 $363 $447 $403 $334 $290 $197 $130 $283 $213 $154 $136 $144
1–18 233 215 182 224 202 167 145 99 65 141 107 77 68 72
19 246 226 192 236 213 174 151 101 66 147 110 78 73 75
20 261 241 204 251 226 185 159 105 68 155 117 82 75 78
21 276 255 215 265 239 195 166 109 73 163 124 87 78 83
22 290 267 225 278 251 204 175 113 75 170 130 93 81 87
23 303 279 236 290 262 212 183 117 76 178 135 98 83 93
24 313 289 245 301 272 220 191 121 79 186 142 103 86 98
25 326 300 254 313 282 227 198 126 82 194 147 107 89 103
26 336 310 262 322 291 235 205 130 85 200 154 112 93 106
27 346 318 269 332 299 243 212 135 88 207 158 116 97 109
28 356 328 278 342 309 251 219 138 90 213 163 120 99 114
29 367 338 286 352 317 257 224 143 95 218 167 124 103 118
30 376 346 293 361 326 264 228 147 97 223 172 128 105 122
31 385 355 301 370 334 270 233 151 100 227 176 131 107 125
32 395 364 308 379 342 276 238 156 102 232 181 135 110 128
33 401 370 313 385 347 281 243 161 105 237 185 138 115 131
34 405 374 316 389 351 286 248 166 109 242 190 141 119 135
35 409 377 319 393 355 291 253 172 113 246 195 145 123 138
36 413 381 322 397 358 295 257 178 117 251 199 148 127 141
37 417 384 325 401 361 300 262 184 120 255 204 151 130 144
38 421 388 328 405 365 304 268 189 122 261 210 154 133 145
39 426 392 332 408 369 308 273 195 125 266 217 157 135 149
40 430 396 335 412 372 312 279 200 129 272 224 163 139 155
41 434 401 339 417 376 316 285 206 130 278 231 168 141 160
42 438 405 343 421 380 320 289 214 135 283 239 177 147 168
43 443 407 345 425 383 326 295 223 140 287 248 184 153 175
44 447 412 348 430 387 333 302 231 145 294 253 190 158 180
45 452 416 352 434 391 340 308 240 150 300 260 196 164 187
46 456 421 356 438 396 348 316 250 156 308 268 204 169 194
47 462 426 363 443 401 356 324 260 163 316 278 212 177 201
48 469 432 371 450 406 365 335 270 169 326 287 221 184 210
49 476 438 379 457 412 374 345 280 176 336 295 229 192 218
50 483 445 390 464 418 384 355 289 183 346 305 238 198 226
51 492 453 400 472 426 394 366 300 191 357 315 248 207 235
52 502 463 409 482 435 404 376 311 197 367 323 257 215 245
53 512 472 419 492 444 413 388 321 206 378 333 267 224 254
54 523 481 431 501 452 424 400 332 215 390 344 276 233 262
55 538 496 441 517 466 435 409 340 223 399 351 286 242 271
56 554 511 451 532 480 444 419 347 231 408 359 296 252 282
57 571 526 460 548 494 453 430 359 241 419 369 305 262 289
58 588 542 468 564 509 462 440 366 250 430 378 314 271 298
59 603 556 478 579 523 471 452 374 256 440 387 323 279 307
60 615 567 487 590 533 480 463 383 264 451 397 333 287 316
61 627 578 497 602 543 490 472 394 272 461 406 342 295 324
62 640 590 507 615 555 499 482 403 278 470 414 348 302 331
63 653 601 518 626 565 510 492 410 285 479 422 355 310 338
64 666 614 527 639 577 520 501 423 292 489 433 362 317 344
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.KaiserHealthCoverage.com
 CHOOSE GOOD HEALTH

Kaiser Permanente for Individuals and Families

Visit www.KaiserHealthCoverage.com ,
0or call 1-800-569-1156.

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