KP WA Platinum 500 w/VX

Kaiser Foundation Health Plan of the Northwest

Check your company’s location

Enter your company’s principal ZIP or choose its county.Enter company’s ZIP or county

Annual in-network deductible: $500
Metal level: Platinum
Plan type: EPO
HSA-compatible plan: No (most common)

Compare with anotherCompare Plan documentsDocuments

Read benefits without entering employee information.

Plan benefits

All supported filed details, including known conditions and limits. This is not the entire insurance contract. Unknown does not mean $0 or not covered.

Search benefitsBenefit categoryCost rule

129 benefit rows

This EPO uses Kaiser Permanente’s Classic network and affiliated providers for routine care, generally coordinated through a Kaiser primary care team. Non-network care normally requires authorization, with separate emergency and travel-care rules.

Notes & source

Kaiser · Classic + Dental Choice · Issuer 23371. Confirm current provider participation and exact coverage in the plan documents.

Annual deductibles: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Medical deductible	In-network tier 1 individual: $500 In-network tier 1 family: $500 per person \| $1,000 per group In-network tier 1 coinsurance: 20.00% Out-of-network individual: Not Applicable Out-of-network family: per person not applicable \| per group not applicable Combined in/out-of-network individual: Not Applicable Combined in/out-of-network family: per person not applicable \| per group not applicable
Prescription drug deductible	In-network tier 1 individual: $0 In-network tier 1 family: $0 per person \| $0 per group In-network tier 1 coinsurance: 50.00% Out-of-network individual: Not Applicable Out-of-network family: per person not applicable \| per group not applicable Combined in/out-of-network individual: Not Applicable Combined in/out-of-network family: per person not applicable \| per group not applicable

Annual out-of-pocket limits: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Maximum Out of Pocket for Medical and Drug Benefits (Total)	In-network tier 1 individual: $6,200 In-network tier 1 family: $6,200 per person \| $12,400 per group Out-of-network individual: Not Applicable Out-of-network family: per person not applicable \| per group not applicable Combined in/out-of-network individual: Not Applicable Combined in/out-of-network family: per person not applicable \| per group not applicable

How costs are shared: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Combined medical and drug deductible Notes & source Whether covered medical and prescription costs count toward the same deductible.	No
Combined medical and drug spending limit Notes & source Whether covered medical and prescription costs count toward the same out-of-pocket limit.	Yes

Office and routine care: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Primary Care Visit to Treat an Injury or Illness Notes & source A visit with a primary care clinician for an illness or injury.	In-network tier 1 copay: $25.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Benefit details: Any differences in telehealth cost sharing from in-person services, applicable limitations, virtual provider referral requirements, or other virtual care (telehealth)-specific benefit characteristics can be found in the certificate and schedule of benefits. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Specialist Visit Notes & source A visit with a clinician who focuses on a particular condition or area of medicine.	In-network tier 1 copay: $35.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Other Practitioner Office Visit (Nurse, Physician Assistant) Notes & source An office visit with a nurse practitioner, physician assistant, or another listed clinician.	In-network tier 1 copay: $25.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Benefit details: Any differences in telehealth cost sharing from in-person services, applicable limitations, virtual provider referral requirements, or other virtual care (telehealth)-specific benefit characteristics can be found in the certificate and schedule of benefits. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Preventive Care/Screening/Immunization Notes & source Services intended to prevent illness or detect health problems early.	In-network tier 1 copay: $0.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Well Baby Visits and Care Notes & source Routine visits to check a baby’s health and development.	In-network tier 1 copay: $0.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Benefit details: Human donor milk must be covered as it is covered by the state base benchmark plan. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes

Tests and imaging: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Imaging (CT/PET Scans, MRIs) Notes & source Advanced scans used to examine the inside of the body.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Laboratory Outpatient and Professional Services Notes & source Laboratory testing without inpatient admission.	In-network tier 1 copay: $20.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
X-rays and Diagnostic Imaging Notes & source X-rays and other listed images used to help diagnose a health problem.	In-network tier 1 copay: $30.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Allergy Testing Notes & source Tests used to identify substances that trigger allergic reactions.	In-network tier 1 copay: $35.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential benefit variation: Not an essential health benefit Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes

Urgent and emergency care: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Urgent Care Centers or Facilities Notes & source Care at an urgent care center for problems that need prompt attention.	In-network tier 1 copay: $45.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Out-of-network copay: $45.00 Out-of-network coinsurance: Not Applicable Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Emergency Room Services Notes & source Evaluation and treatment of a medical emergency in an emergency department.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 20.00% Coinsurance after deductible Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Emergency Transportation/Ambulance Notes & source Ambulance or other listed transportation for an emergency.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 20.00% Coinsurance after deductible Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes

Hospital and surgery: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Notes & source The charge for using an outpatient facility, separate from a clinician’s professional fee.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Outpatient Surgery Physician/Surgical Services Notes & source The surgeon’s or other clinician’s services for surgery without inpatient admission.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Inpatient Hospital Services (e.g., Hospital Stay) Notes & source Hospital facility services after admission as an inpatient.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Benefit details: Supporting benefit crosswalk (SERFF submitted 2026-05-13): Inpatient - 20% Coinsurance after Deductible Kaiser Permanente at HomeTM $0 Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Inpatient Physician and Surgical Services Notes & source Clinicians’ professional services during an inpatient hospital stay.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Cosmetic Surgery Notes & source Surgery mainly intended to change appearance.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Benefit details: Covers cosmetic surgery when medically necessary. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential benefit variation: Additional essential health benefit Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Transplant Notes & source Medical care involving transplantation of an organ or tissue.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Reconstructive Surgery Notes & source Surgery to restore function or repair a body part affected by injury, illness, or a birth condition.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Benefit details: Coverage for reconstructive breast surgery and treatment of congenital anomalies is required and is covered under the state-base benchmark plan. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes

Mental health and substance use: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Mental/Behavioral Health Outpatient Services Notes & source Mental or behavioral health care without inpatient admission.	In-network tier 1 copay: $25.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Benefit details: All Non HSA plans: Mental health other services (non-office visits) are no charge. For more information refer to your EOC. All HSA plans: Mental health other services (non-office visits) is the same cost share as mental health office visits. For more information refer to your EOC. Any differences in telehealth cost sharing from in-person services, applicable limitations, virtual provider referral requirements, or other virtual care (telehealth)-specific benefit characteristics can be found in the certificate and schedule of benefits. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Mental/Behavioral Health Inpatient Services Notes & source Mental or behavioral health treatment during an inpatient stay.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Substance Abuse Disorder Outpatient Services Notes & source Treatment for substance use disorders without inpatient admission.	In-network tier 1 copay: $25.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Benefit details: All Non HSA plans: Substance Abuse other services (non-office visits) are no charge. For more information refer to your EOC. All HSA plans: Substance abuse other services (non-office visits) is the same cost share as mental health office visits. For more information refer to your EOC. Any differences in telehealth cost sharing from in-person services, applicable limitations, virtual provider referral requirements, or other virtual care (telehealth)-specific benefit characteristics can be found in the certificate and schedule of benefits. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Substance Abuse Disorder Inpatient Services Notes & source Treatment for substance use disorders during an inpatient stay.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes

Prescription drugs: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Generic Drugs Notes & source Medicines classified by the plan as generic drugs.	In-network tier 1 copay: $10.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Service limit: Yes Limit amount: 30 Limit unit: Days per Month Benefit details: Coverage is limited to a 30-day supply retail or 90-day supply mail order per fill or refill. For prescription contraceptive drugs coverage includes a twelve-month refill of contraceptive drugs obtained at one time by the enrollee, unless the enrollee requests a smaller supply or the prescribing provider instructs that the enrollee must receive a smaller supply. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Essential benefit variation: Other Law/Regulation Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Preferred Brand Drugs Notes & source Brand-name medicines placed in the plan’s preferred drug category.	In-network tier 1 copay: $25.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Service limit: Yes Limit amount: 30 Limit unit: Days per Month Benefit details: Coverage is limited to a 30-day supply retail or 90-day supply mail order per fill or refill. For prescription contraceptive drugs coverage includes a twelve-month refill of contraceptive drugs obtained at one time by the enrollee, unless the enrollee requests a smaller supply or the prescribing provider instructs that the enrollee must receive a smaller supply. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Essential benefit variation: Other Law/Regulation Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Non-Preferred Brand Drugs Notes & source Brand-name medicines outside the plan’s preferred drug category.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 50.00% Coverage: Covered Service limit: Yes Limit amount: 30 Limit unit: Days per Month Benefit details: Coverage is limited to a 30-day supply retail or 90-day supply mail order per fill or refill. For prescription contraceptive drugs coverage includes a twelve-month refill of contraceptive drugs obtained at one time by the enrollee, unless the enrollee requests a smaller supply or the prescribing provider instructs that the enrollee must receive a smaller supply. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Essential benefit variation: Other Law/Regulation Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Specialty Drugs Notes & source Medicines placed in the plan’s specialty category, often requiring special handling or monitoring.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 50.00% Coverage: Covered Service limit: Yes Limit amount: 30 Limit unit: Days per Month Benefit details: First fill allowed at a retail pharmacy. Additional fills must be provided at a specialty pharmacy. Coverage is limited to a 30-day supply for specialty and self-administrable cancer chemotherapy medications from a specialty pharmacy per fill or refill. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Essential benefit variation: Other Law/Regulation Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Supply limits and coverage conditions Notes & source Retail, mail-order and specialty prescription terms, with the source drug tiers and exceptions retained.	Generic Drugs; Preferred Brand Drugs; Non-Preferred Brand Drugs · Benefit details: Coverage is limited to a 30-day supply retail or 90-day supply mail order per fill or refill. For prescription contraceptive drugs coverage includes a twelve-month refill of contraceptive drugs obtained at one time by the enrollee, unless the enrollee requests a smaller supply or the prescribing provider instructs that the enrollee must receive a smaller supply. Specialty Drugs · Benefit details: First fill allowed at a retail pharmacy. Additional fills must be provided at a specialty pharmacy. Coverage is limited to a 30-day supply for specialty and self-administrable cancer chemotherapy medications from a specialty pharmacy per fill or refill.
Formulary tier 1 Notes & source Filed formulary tier. Mail-order availability refers to three-month in-network supply; coverage, supply limits and medication requirements still apply.	Drug category: Generic Three-month in-network mail order: Yes
Formulary tier 2 Notes & source Filed formulary tier. Mail-order availability refers to three-month in-network supply; coverage, supply limits and medication requirements still apply.	Drug category: Brand Three-month in-network mail order: Yes
Formulary tier 3 Notes & source Filed formulary tier. Mail-order availability refers to three-month in-network supply; coverage, supply limits and medication requirements still apply.	Drug category: Non-Preferred Brand, Specialty Drugs Three-month in-network mail order: Yes

Pregnancy and childbirth: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Prenatal and Postnatal Care Notes & source Care during pregnancy and after childbirth.	In-network tier 1 copay: $0.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Delivery and All Inpatient Services for Maternity Care Notes & source Care for childbirth and related inpatient services.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Abortion for Which Public Funding is Prohibited Notes & source The filing’s category for abortion services that cannot receive public funding.	In-network tier 1 copay: $0.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Benefit details: Coverage includes termination of pregnancy for all female members. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes

Therapy and recovery: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Hospice Services Notes & source Care focused on comfort and support near the end of life.	In-network tier 1 copay: $0.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Service limit: Yes Limit amount: 14 Limit unit: Days per Lifetime Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Home Health Care Services Notes & source Medical care delivered at home under a care plan.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Service limit: Yes Limit amount: 130 Limit unit: Visit(s) per Year Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Skilled Nursing Facility Notes & source Care in a facility providing skilled nursing or rehabilitation.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Service limit: Yes Limit amount: 60 Limit unit: Days per Year Benefit details: Coverage is limited to 60-inpatient days/year. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Outpatient Rehabilitation Services Notes & source Therapy to help restore abilities after illness or injury without inpatient admission.	In-network tier 1 copay: $35.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Service limit: Yes Limit amount: 25 Limit unit: Visit(s) per Year Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Habilitation Services Notes & source Therapy to help develop or maintain skills needed for daily activities.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Service limit: Yes Limit amount: 30 Limit unit: Days per Year Benefit details: Coverage for habilitative services is limited to 30-inpatient days/year. Coverage for habilitative services is limited to 25-outpatient visits/year. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Essential benefit variation: Other Law/Regulation Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Rehabilitative Speech Therapy Notes & source Therapy to restore speech, communication, or swallowing abilities.	In-network tier 1 copay: $35.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Service limit: Yes Limit amount: 30 Limit unit: Days per Year Benefit details: Coverage is limited to 30-inpatient days/year and 25- outpatient visits/year. Rehabilitative Speech Therapy and Rehabilitative Occupational and Rehabilitative Physical Therapy combine for 25 visits for Rehabilitative Services. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Essential benefit variation: Other Law/Regulation Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Rehabilitative Occupational and Rehabilitative Physical Therapy Notes & source Therapy to restore movement or the ability to carry out everyday tasks.	In-network tier 1 copay: $35.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Service limit: Yes Limit amount: 30 Limit unit: Days per Year Benefit details: Coverage is limited to 30-inpatient days/year and 25- outpatient visits/year. Rehabilitative Speech Therapy and Rehabilitative Occupational and Rehabilitative Physical Therapy combine for 25 visits for Rehabilitative Services. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Essential benefit variation: Other Law/Regulation Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Infusion Therapy Notes & source Treatment that delivers medicine or fluids through a needle or catheter.	In-network tier 1 copay: $35.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Benefit details: Covered under applicable benefit (such as office visit). Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Durable Medical Equipment Notes & source Medical equipment for repeated use, such as a wheelchair or home oxygen equipment.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes

Other services: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Infertility Treatment Notes & source Medical services to evaluate or treat difficulty becoming pregnant.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 50.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Chiropractic Care Notes & source Care provided by a chiropractor, including listed spinal or joint treatments.	In-network tier 1 copay: $35.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Service limit: Yes Limit amount: 10 Limit unit: Visit(s) per Year Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Hearing Aids Notes & source Devices that help improve hearing.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coverage: Covered Service limit: Yes Limit amount: 1 Limit unit: Item(s) per 3 Years Benefit details: Coverage is limited to an annual hearing exam and one hearing aid per ear every 3 years. Cochlear Implants for children are also covered. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Routine Foot Care Notes & source Regular foot care, such as listed nail or callus services.	In-network tier 1 copay: $35.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential benefit variation: Additional essential health benefit Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Acupuncture Notes & source Treatment using thin needles placed at specific points on the body.	In-network tier 1 copay: $35.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Dialysis Notes & source Treatment that filters the blood when the kidneys cannot do so adequately.	In-network tier 1 copay: $35.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Chemotherapy Notes & source Drug treatment used for cancer and certain other conditions.	In-network tier 1 copay: $35.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Benefit details: Covered under the base benchmark plan. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Radiation Notes & source Treatment using targeted radiation, commonly for cancer.	In-network tier 1 copay: $35.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Benefit details: Covered under the base benchmark plan; covered under applicable benefit (such as office visit). Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Diabetes Education Notes & source Instruction to help a person manage diabetes.	In-network tier 1 copay: $25.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Prosthetic Devices Notes & source Devices that replace a missing body part.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Temporomandibular joint (TMJ) treatment Notes & source Treatment for problems affecting the jaw joint and nearby muscles.	In-network tier 1 copay: $35.00 Copay after deductible In-network tier 1 coinsurance: Not Applicable Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Nutritional Counseling Notes & source Professional guidance on food choices and nutrition.	In-network tier 1 copay: $25.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Gender Affirming Care Notes & source Health services that support a person’s gender identity.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Benefit details: Gender Affirming Care includes health care services prescribed to treat any condition related to the individual's gender identity and may include primary care visits, specialty care, outpatient mental health services, prescription drug benefits, and surgical services. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential benefit variation: Other Law/Regulation Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Diabetes Care Management Notes & source Coordinated support for managing diabetes and its treatment.	In-network tier 1 copay: $25.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential benefit variation: Additional essential health benefit Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Inherited Metabolic Disorder - PKU Notes & source Care for phenylketonuria, an inherited condition affecting how the body processes part of dietary protein.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential benefit variation: Additional essential health benefit Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Hearing exams Notes & source Assessments of hearing; consult the filed benefit for limits and member costs.	In-network tier 1 copay: $35.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Benefit details: Coverage is limited to an initial assessment and one annual hearing exam. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential benefit variation: Additional essential health benefit Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Bariatric Surgery Notes & source Listed in the source exclusion summary. Check its exceptions and the issued contract for the exact terms.	Source statement: Bariatric Surgery is listed in the source exclusions; review the qualifications. Source exclusion context: 2027 SBC exclusions (not exhaustive): bariatric surgery; cosmetic surgery; adult dental care; infertility treatment (except artificial insemination); long-term care; non-emergency care when traveling outside the U.S.; private-duty nursing; routine foot care; weight loss programs. The SBC also lists infertility treatment without the artificial-insemination exception; confirm that wording with Kaiser. Check the coverage agreement for the complete exclusions and limitations.

Dental and vision: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Routine Eye Exam (Adult) Notes & source A regular adult vision exam, separate from treatment for an eye disease or injury.	In-network tier 1 copay: $25.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential benefit variation: Not an essential health benefit Excluded from in-network spending limit: Yes Excluded from out-of-network spending limit: Yes
Routine Eye Exam for Children Notes & source Regular vision exams for children.	In-network tier 1 copay: $0.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Service limit: Yes Limit amount: 1 Limit unit: Exam(s) per Year Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Eye Glasses for Children Notes & source Prescription eyeglasses for children.	In-network tier 1 copay: $0.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Service limit: Yes Limit amount: 1 Limit unit: Item(s) per Year Benefit details: Coverage is limited to one frame and one pair (two lenses)/ calendar year or contacts (in lieu of glasses). Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Dental Check-Up for Children Notes & source Routine dental exams for children.	In-network tier 1 copay: $0.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Service limit: Yes Limit amount: 2 Limit unit: Visit(s) per Year Out-of-network copay: $0.00 Out-of-network coinsurance: Not Applicable Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Basic Dental Care - Child Notes & source Dental services classified as basic care for children, such as listed fillings.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 50.00% Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 50.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Orthodontia - Child Notes & source Treatment to align children’s teeth or jaws, such as braces.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 50.00% Coverage: Covered Benefit details: Medically necessary orthodontia must be covered. Out-of-network copay: Not Applicable Out-of-network coinsurance: 50.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Major Dental Care - Child Notes & source Dental services classified as major care for children.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 50.00% Coverage: Covered Benefit details: Quantitative limits apply; see essential health benefits base benchmark plan. Out-of-network copay: Not Applicable Out-of-network coinsurance: 50.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Dental Anesthesia Notes & source Anesthesia used during dental treatment.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential benefit variation: Additional essential health benefit Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes
Adult Vision Hardware Notes & source Adult vision devices, such as listed eyeglasses or contact lenses.	In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: Not Applicable Coverage: Covered Service limit: Yes Limit amount: 250 Limit unit: Dollars per 2 Years Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential benefit variation: Not an essential health benefit Excluded from in-network spending limit: Yes Excluded from out-of-network spending limit: Yes

Network and access: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Provider network Notes & source The insurer’s name for the network linked to this plan. Check the current provider directory to confirm a doctor or hospital participates.	Classic + Dental Choice
Specialist referral Notes & source Whether the plan generally requires a referral before seeing a specialist. Check the listed exceptions.	Yes
Referral details Notes & source The insurer’s explanation of when specialist referrals are needed.	A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services, Mental Health Services, Obstetrics/Gynecology, Occupational Health, Ophthalmology, and Optometry (routine eye exams), and Social Services.
Provider tiers Notes & source Whether in-network providers are grouped into tiers with different member costs.	No
National network Notes & source Whether the filing lists a national provider network; this does not confirm any particular provider participates.	No
Care outside the country Notes & source Whether the filing lists coverage outside the country; restrictions may apply.	Yes
International care details Notes & source The insurer’s explanation of coverage and restrictions outside the country.	Emergency medical conditions, including prescription drugs.
Care outside the service area Notes & source Whether the filing lists coverage away from the plan’s normal service area.	Yes
Outside-area care details Notes & source The insurer’s explanation of care covered away from the normal service area.	Emergency medical conditions, including prescription drugs.

Health accounts: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
HSA-compatible plan Notes & source Whether the filing identifies the plan as HSA-compatible; your personal ability to contribute also depends on other rules.	No
Filed employer account contribution Notes & source Whether the plan filing includes an employer HSA or HRA contribution; it does not describe your employer’s actual contribution.	No
HSA in source plan name Notes & source Source name evidence only; this does not establish personal HSA eligibility.	No

Plan features and exclusions: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Wellness program Notes & source Whether the filing lists a program intended to support healthy habits.	Yes
Condition support programs Notes & source Programs listed to help members manage ongoing health conditions.	Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
Unique plan design Notes & source Whether the insurer marked the benefit design as distinct in its filing.	Yes
Plan exclusions Notes & source Services or situations the insurer lists as excluded from coverage.	2027 SBC exclusions (not exhaustive): bariatric surgery; cosmetic surgery; adult dental care; infertility treatment (except artificial insemination); long-term care; non-emergency care when traveling outside the U.S.; private-duty nursing; routine foot care; weight loss programs. The SBC also lists infertility treatment without the artificial-insemination exception; confirm that wording with Kaiser. Check the coverage agreement for the complete exclusions and limitations.
Pregnancy notice Notes & source Whether the filing indicates a pregnancy-related notice requirement.	No
Child-only coverage Notes & source How the filing describes coverage offered for children without an enrolled adult.	Allows Adult and Child-Only

Standardized coverage examples: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Having a baby example	Example deductible: $500 Example copays: $200 Example coinsurance: $1,600 Example uncovered costs: $60
Managing diabetes example	Example deductible: $0 Example copays: $700 Example coinsurance: $10 Example uncovered costs: $0
Simple fracture example	Example deductible: $500 Example copays: $300 Example coinsurance: $300 Example uncovered costs: $0

Filing assumptions: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Calculated actuarial value Notes & source An estimate of the share of covered costs the plan pays for a standard population, not your expected spending.	0.882885270465678
Insurer actuarial value Notes & source The insurer’s estimate of the plan’s share of covered costs for a standard population.	88.30%
Tier 1 filing assumption Notes & source The use of tier 1 providers assumed in the filing, not a prediction of your care.	100%
Composite premium available Notes & source Whether the filing offers a shared premium rate instead of separate age-based rates.	No

Plan identifiers and filing context: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Plan ID Notes & source The identifier used to distinguish this plan in the filing.	23371WA1140017
Plan variation ID Notes & source Identifies this plan’s specific version of benefits and cost sharing.	23371WA1140017-00
Plan variation name Notes & source The insurer’s name for this version of the plan.	KP WA Platinum 500 w/VX
Cost-sharing variation Notes & source The filed category for this version of the plan’s member costs.	Standard Platinum Off Exchange Plan
Product ID Notes & source The identifier for the product family this plan belongs to.	23371WA114
Network ID Notes & source Identifies this plan’s provider network within this insurer’s filing.	WAN003
Service area ID Notes & source Identifies the area where the insurer offers this plan.	WAS004
Drug list ID Notes & source Identifies the prescription drug list referenced by this plan.	WAF015
Marketplace status Notes & source Whether the filing describes the plan as offered through the health insurance marketplace.	Off the Exchange
New or existing plan Notes & source Whether the insurer filed this as a new or continuing plan.	Existing
Effective date Notes & source The start date listed for this plan in the filing.	1/1/2027
Expiration date Notes & source The end date listed in the filing; a blank does not mean coverage continues indefinitely.	12/31/2027
Plan name	KP WA Platinum 500 w/VX
Legal issuer	Kaiser Foundation Health Plan of the Northwest
Plan type	EPO

Unknown or not provided (14)

Unknown or not provided: KP WA Platinum 500 w/VX
Benefit	KP WA Platinum 500 w/VX
Specialty drug coinsurance cap How costs are shared	Not supplied in selected filing
Hospital copay day limit How costs are shared	Unknown
Primary care visits before cost sharing How costs are shared	Not supplied in selected filing
Primary care copays before other charges How costs are shared	Unknown
Filed contribution amount Health accounts	Not supplied in selected filing
Plan design Plan features and exclusions	Unknown
Adult dental waiting period Plan features and exclusions	Not supplied in selected filing
Waiting period length Plan features and exclusions	Not supplied in selected filing
Tier 2 filing assumption Filing assumptions	Unknown
Essential benefit premium share Filing assumptions	Not supplied in selected filing
Children’s dental allocation Filing assumptions	Not supplied in selected filing
Rate description Filing assumptions	Not supplied in selected filing
Child-only plan ID Plan identifiers and filing context	Not supplied in selected filing
Tribal cost-sharing variation Plan identifiers and filing context	Not supplied in selected filing

Explore your options

Compare related Small Group plans

Find a plan to compare

Search 2027 plans only. Availability depends on your county and coverage start.

Plan 1 of 12

Plan documents

2027 · Public plan ID 23371WA1140017 · Benefit variant 23371WA1140017-00

Summary of Benefits and Coverage (SBC)

Document notes

Original identity review: Original 2027 SBC retrieved and identity-reviewed October 28. Supplements fill only reviewed display gaps; the complete coverage agreement and current provider participation still require confirmation. Local copy retained; extracted text is review evidence, not a reconciled coverage contract.

Carrier document index

Document notes

Carrier source index; formats and available documents vary. Original 2027 SBC retrieved and identity-reviewed October 28. Supplements fill only reviewed display gaps; the complete coverage agreement and current provider participation still require confirmation.

Clark, Cowlitz. Availability still depends on the coverage start and employer eligibility.

See what these plans could cost your group

Estimate this plan and compare alternatives here, with the existing comparison PDF.

KP WA Platinum 500 w/VX

Check your company’s location

Plan benefits

▾Network overview

▾Annual deductibles (2)

Medical deductible

Prescription drug deductible

▾Annual out-of-pocket limits (1)

Maximum Out of Pocket for Medical and Drug Benefits (Total)

▾How costs are shared (2)

Combined medical and drug deductible

Combined medical and drug spending limit

▾Office and routine care (5)

Primary Care Visit to Treat an Injury or Illness

Specialist Visit

Other Practitioner Office Visit (Nurse, Physician Assistant)

Preventive Care/Screening/Immunization

Well Baby Visits and Care

▾Tests and imaging (4)

Imaging (CT/PET Scans, MRIs)

Laboratory Outpatient and Professional Services

X-rays and Diagnostic Imaging

Allergy Testing

▾Urgent and emergency care (3)

Urgent Care Centers or Facilities

Emergency Room Services

Emergency Transportation/Ambulance

▾Hospital and surgery (7)

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

Outpatient Surgery Physician/Surgical Services

Inpatient Hospital Services (e.g., Hospital Stay)

Inpatient Physician and Surgical Services

Cosmetic Surgery

Transplant

Reconstructive Surgery

▾Mental health and substance use (4)

Mental/Behavioral Health Outpatient Services

Mental/Behavioral Health Inpatient Services

Substance Abuse Disorder Outpatient Services

Substance Abuse Disorder Inpatient Services

▾Prescription drugs (8)

Generic Drugs

Preferred Brand Drugs

Non-Preferred Brand Drugs

Specialty Drugs

Supply limits and coverage conditions

Formulary tier 1

Formulary tier 2

Formulary tier 3

▾Pregnancy and childbirth (3)

Prenatal and Postnatal Care

Delivery and All Inpatient Services for Maternity Care

Abortion for Which Public Funding is Prohibited

▾Therapy and recovery (9)

Hospice Services

Home Health Care Services

Skilled Nursing Facility

Outpatient Rehabilitation Services

Habilitation Services

Rehabilitative Speech Therapy

Rehabilitative Occupational and Rehabilitative Physical Therapy

Infusion Therapy

Durable Medical Equipment

▾Other services (17)

Infertility Treatment

Chiropractic Care

Hearing Aids

Routine Foot Care

Acupuncture

Dialysis

Chemotherapy

Radiation

Diabetes Education

Prosthetic Devices

Temporomandibular joint (TMJ) treatment

Nutritional Counseling

Gender Affirming Care

Diabetes Care Management

Inherited Metabolic Disorder - PKU

Hearing exams