Self Insured PPO Plans

A guide to your Health Plan Benefits: Summary Plan Description (Health Plan Booklet).

Changes to your plan since the last printed Summary Plan Description.

Amendment Date Amendment Participation
Amendment Date10/10/2025Amendment Summary of Material Modifications - Electronic Distribution of Plan DocumentsParticipationAll Plan Participants
Amendment Date07/30/2024Amendment Summary of Material Modifications - Changing Plans & Weight Loss (Bariatric) SurgeryParticipationAll Plan Participants
Amendment Date12/01/2023Amendment Summary of Material Modifications - RSV Vaccine and OzempicParticipationAll Plan Participants
Amendment Date08/01/2023Amendment Summary of Material Modifications - End of COVID PHE ParticipationAll Plan Participants
Amendment Date11/22/2022Amendment Summary of Material Modifications - Plan Changes Eff 01.01.2023ParticipationAll Plan Participants
Amendment Date06/23/2021Amendment Summary of Material Modifications - New Utilization Management Program ManagerParticipationAll Plan Participants
Amendment Date03/16/2021Amendment Summary of Material Modifications - PPO Health Plan ChangesParticipationAll Eligible Plan Participants and Dependents

Insured Kaiser Permanente Plan

A guide to your Kaiser Permanente Plan Benefits: Summary Plan Description (Health Plan Booklet).