1Dental benefits provided by Dominion National.
2With 50% coinsurance.
3Not available with Kaiser Permanente Medicare Advantage Care Plus (HMO-POS), Kaiser Permanente Medicare Advantage Value Baltimore (HMO), Kaiser Permanente Medicare Advantage Value MD (HMO), and Kaiser Permanente Medicare Advantage Liberty (HMO) plans. Members are responsible for any charged amounts for covered services that exceed the annual allowance maximum of $1,200. Coverage limited to inside the United States and its territories. See your Evidence of Coverage for details.
4Hearing aid allowance can only be used for hearing aids purchased at Kaiser Permanente audiology centers.
5Please refer to your Evidence of Coverage for details. OTC benefits may change each year on January 1. Each order must be at least $20. Any unused portion of the quarterly benefit limit will not carry forward to the next quarter. Your order may not exceed your quarterly benefit limit. Limitations and restrictions may apply. Cash, check, credits cards, or money orders are not accepted.
6OTC allowance based on plan type.
7Silver&Fit is not available with Kaiser Permanente Medicare Advantage (HMO) Value Balt, Kaiser Permanente Medicare Advantage (HMO) Value MD, or Kaiser Permanente Medicare Advantage (HMO) Value DC plans. The Silver&Fit program is provided by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH). Silver&Fit is a registered trademark of ASH and used with permission herein. All programs and services are not available in all areas. Participating fitness centers and fitness chains may vary by location and are subject to change.
8Kits are subject to change and once selected cannot be exchanged.
9Twenty-four one-way rides per contract year. For nonemergency transportation only.
