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KPS Health Plans

KPS Health Plans offers plans with different coverage levels and prices from catastrophic and moderate to enriched and tax-advantaged options available to people living in all areas of Washington State.

No Primary Care Physician (PCP) is needed and no referrals are required. Click here for the provider directory.

Click on the green "Sound Harbor Elite," "Essential Plus," "Sound Harbor Essential Five" or "The Healthy Investor™" titles below or links at the left to jump to pages describing the plans in detail.

 
Sound Harbor Elite
  • Annual deductible: $1,000
    • Hospital inpatient copay: $250 copay per day with 3-day copay maximum
      ($750) per admission
    • Benefit: 70%
    • Annual coinsurance maximum: $5,000
    • Preventive care: covered (no deductible) to $250 per year
    • Prescription drugs: covered to $2,000 per year; no deductible for generic drugs; $200 deductible for preferred and non-preferred brand-name drugs
    • Maternity: covered
    • Vision exam: covered (no deductible; exam is included in Preventive Care benefit)
    • Not covered: vision lenses and frames
 
Essential Plus
  • Annual deductible: $2,000
    • Office visits: no deductible and 100% paid after $30 copay for first 3 visits per year; following visits paid at 70% after annual deductible
    • Benefit: 70%
    • Annual coinsurance maximum: $6,000
    • Preventive care: covered (no deductible) to $250 per year
    • Prescription drugs: covered to $2,000 per year; only generic drugs are covered (a pharmacy discount program is included for preferred and non-preferred brand-name drugs)
    • Vision exam: covered (no deductible; exam is included in Preventive Care benefit)
    • Not covered: brand-name drugs, maternity, vision lenses and frames
 
Sound Harbor Essential Five
  • Annual deductible: $2,500 or $5,000
    • Benefit: 80%
    • Annual coinsurance maximum: $10,000 or $20,000 corresponding to
      annual deductible shown above
    • Preventive care: covered (no deductible for annual routine physical
      and well-baby care) to $200 maximum per year
    • Vision exam: covered (after deductible; included in Preventive Care benefit)
    • Not covered: prescription drugs, maternity, vision lenses and frames
 
The Healthy Investor™ (HSA-qualified plan)
  • Individual/Family Plan with prescription drug coverage
  • Individual/Family Plan without prescription drug coverage
    • Annual deductible:
      Individual - $1,750 or $2,600; Family - $3,500 or $5,150
    • Benefit: 80%
    • Annual coinsurance maximum:
      Individual - $3,250 or $2,400; Family - $6,500 or $4,850
    • Preventive care: covered (no deductible for annual routine physical
      and well-baby care) to $300 maximum per year
    • Prescription drugs (two options): no coverage; or covered to $2,000
      per year after annual deductible
    • Vision exam: covered (after deductible; included in Preventive Care benefit)
    • Not covered: maternity, vision lenses and frames