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