Deductible HMO Plan with HRA

Glossary

Your Kaiser Permanente Deductible HMO Plan with a health reimbursement arrangement (HRA) is not just health coverage — it's a partnership in health.

You receive preventive care services at little or no cost to you, and online features let you manage most of your care around the clock.

Your benefits include:

• a personal doctor for routine medical care
• copays or coinsurance for most covered services after you meet your deductible
• no referrals needed for certain specialties, like optometry and obstetrics/gynecology
• an out-of-pocket maximum that limits how much you'll spend on most covered services each year
• no additional coinsurance needed for eligible services after the annual out-of-pocket maximum is met
• a tax-advantaged reimbursement arrangement* with funds contributed by your employer to help cover qualified medical expenses^†

* The tax references in this document relate to federal income tax only. Consult with your financial or tax adviser for information about state income tax laws.

† To view the list of qualified medical expenses defined under Internal Revenue Code Section 213(d), see IRS Publication 502, Medical and Dental Expenses.

Your Evidence of Coverage or Summary Plan Description contains a complete explanation of benefits, exclusions, and limitations. The information provided here is not intended nor designed to serve as your Evidence of Coverage.

Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, 404-364-7000