These electronic documents must be used as provided, without additions, deletions, or other modifications.

Kaiser Foundation Health Plan, Inc. Electronic Documents Policy This policy document constitutes the explicit, written permission of Kaiser Foundation Health Plan, Inc., (Health Plan) for the Purchaser to use the accompanying Health Plan Enrollment and Member electronic documents under the following conditions: These electronic documents must be used as provided, without additions, deletions, or other modifications. These electronic documents are being provided in English. Translation of these documents by any person/organization other than by Health Plan (or certified translation agencies authorized by Health Plan) is prohibited. Please contact your Health Plan account representative to learn which documents are available in other languages. These electronic documents may be posted to Purchaser Web sites. Health Plan will provide updated versions of these electronic documents if there are substantive language changes. Purchasers must transfer the updated versions to their sites as soon as reasonably possible, but not later than 30 days after receipt of an updated document. The Disclosure Form (DF) is subject to change. Health Plan will provide substantive DF language changes electronically to Purchasers. It is the Purchaser's responsibility to ensure that all changes are provided to employees. All electronic DF documents include a footnote containing an original issuance date to ensure accurate tracking. If you have questions about our Electronic Documents Policy, or questions about a specific request for an electronic document, please contact your account representative for assistance. Kaiser Foundation Health Plan, Inc. California Division

231396 ASCIP- MANHATTAN BEACH USD Summary of Benefits for Kaiser Permanente Senior Advantage (HMO) with Part D (10/1/15 9/30/16) The Services described below are covered only if all of the following conditions are satisfied: The Services are Medically Necessary and in accord with Medicare guidelines The Services are provided, prescribed, authorized, or directed by a Plan Physician and you receive the Services from Plan Providers inside our Southern California Region Service Area, except where specifically noted to the contrary in the Evidence of Coverage (EOC) Accumulation Period The Accumulation Period for this plan is 1/1/15 through 12/31/15 (calendar year). Plan Out-of-Pocket Maximum For Services subject to the maximum, you will not pay any more Cost Share for the rest of the calendar year if the Copayments and Coinsurance you pay for those Services add up to one of the following amounts: For self-only enrollment (a Family of one Member)... $1,500 per calendar year For any one Member in a Family of two or more Members... $1,500 per calendar year For an entire Family of two or more Members... $3,000 per calendar year Plan Deductible None Professional Services (Plan Provider office visits) You Pay Most Primary Care Visits for evaluations and treatment... No charge Most Specialty Care Visits for consultations, evaluations, and treatment... No charge Annual Wellness visit and the "Welcome to Medicare" preventive visit... No charge Routine physical exams... No charge Routine eye exams with a Plan Optometrist... No charge Hearing exams... No charge Urgent care consultations, evaluations, and treatment... No charge Physical, occupational, and speech therapy... No charge Outpatient Services You Pay Outpatient surgery and certain other outpatient procedures... No charge Allergy injections (including allergy serum)... No charge Most immunizations (including the vaccine)... No charge Most X-rays, annual mammograms, and laboratory tests... No charge Manual manipulation of the spine... No charge Hospitalization Services You Pay Room and board, surgery, anesthesia, X-rays, laboratory tests, and drugs... No charge Emergency Health Coverage You Pay Emergency Department visits... No charge Ambulance Services You Pay Ambulance Services... No charge Kaiser Foundation Health Plan, Inc., Southern California Region continues

continued Prescription Drug Coverage You Pay Most covered outpatient items in accord with our drug formulary guidelines... $5 for up to a 100-day supply Durable Medical Equipment (DME) You Pay Covered durable medical equipment for home use... No charge Mental Health Services You Pay Inpatient psychiatric care... No charge Individual outpatient mental health evaluation and treatment... No charge Group outpatient mental health treatment... No charge Chemical Dependency Services You Pay Inpatient detoxification... No charge Individual outpatient chemical dependency evaluation and treatment... No charge Group outpatient chemical dependency treatment... No charge Home Health Services You Pay Home health care (part-time, intermittent)... No charge Other You Pay Eyeglasses or contact lenses every 24 months... Amount in excess of $150 Allowance Skilled nursing facility care (up to 100 days per benefit period)... No charge External prosthetic and orthotic devices... No charge Ostomy and urological supplies... No charge This is a summary of the most frequently asked-about benefits. This chart does not explain benefits, Cost Share, out-of-pocket maximums, exclusions, or limitations, nor does it list all benefits and Cost Share amounts. For a complete explanation, please refer to the EOC. Please note that we provide all benefits required by law (for example, diabetes testing supplies). Kaiser Foundation Health Plan, Inc., Southern California Region 4190920.12.2.S000425302

2014 Summary of Benefits Original Medicare and Kaiser Permanente Senior Advantage (HMO) Group Plan Including Medicare Part D Prescription Drug Benefit Information Kaiser Foundation Health Plan, Inc. Northern and Southern California Regions A nonprofit corporation Health Maintenance Organization (HMO) January 1, 2014, through December 31, 2014 60152215

Section I Introduction to Summary of Benefits Thank you for your interest in Kaiser Permanente Senior Advantage (HMO). Our plan is offered by KAISER FOUNDATION HP, INC. which is also called Kaiser Permanente, a Medicare Advantage Health Maintenance Organization (HMO) that contracts with the Federal government. This Summary of Benefits shows the benefits available to a Medicare beneficiary under Original (Fee-for-Service) Medicare. As a member of Kaiser Permanente Senior Advantage (HMO) who receives coverage through an employer or trust fund, you may receive additional benefits. To get a complete list of your Kaiser Permanente Senior Advantage (HMO) benefits, please refer to your Evidence of Coverage (EOC). Contact your employer or trust fund or call Kaiser Permanente Senior Advantage (HMO) and ask for the Evidence of Coverage. You have choices in your health care As a Medicare beneficiary, you can choose from different Medicare options. One option is the Original (Fee-for-Service) Medicare Plan. Another option is a Medicare health plan, like Kaiser Permanente Senior Advantage (HMO), which is made available through your employer or trust fund. However, if you enroll in Original Medicare alone, you may endanger the coverage you receive through your employer or trust fund, and your benefits may be reduced. For information about the benefits available through your employer or trust fund, please see your Evidence of Coverage. No matter what you decide, you are still in the Medicare Program. Your employer or trust fund may restrict when you may join or leave its plan. Usually this is connected to your employer or trust fund's annual enrollment period. Please call your employer or trust fund for more information about enrollment periods. How can I compare my options? You can compare Kaiser Permanente Senior Advantage (HMO) and the Original Medicare Plan using this Summary of Benefits and the Kaiser Permanente Senior Advantage (HMO) Summary of Benefits. This Summary of Benefits lists only benefits covered by Original Medicare. The Kaiser Permanente Senior Advantage (HMO) Summary of Benefits lists the Kaiser Permanente Senior Advantage (HMO) benefits you receive through your employer or trust fund. As a member who receives Kaiser Permanente Senior Advantage (HMO) coverage through an employer or trust fund, you will receive all of the benefits that the Original Medicare plan offers, plus additional benefits purchased for you by your employer or trust fund, which may change from year to year. Where is Kaiser Permanente Senior Advantage (HMO) available? Northern California In Northern California, the service area for this plan includes: Alameda, Amador*, Contra Costa, El Dorado*, Fresno*, Kings*, Madera*, Marin, Mariposa*, Napa*, Placer*, Sacramento, San Francisco, San Joaquin, San Mateo, Santa Clara*, Solano, Sonoma*, Stanislaus, Sutter*, Tulare*, Yolo*, and Yuba* Counties, CA. You must live in one of these areas to join the plan. * denotes partial county Amador County: 95640, 95669. El Dorado County: 95613 14, 95619, 95623, 95633 35, 95651, 95664, 95667, 95672, 95682, 95762. Fresno County: 93242, 93602, 93606 07, 93609, 93611 13, 93616, 93618 19, 93624 27, 93630 31, 93646, 93648 52, 93654, 93656 57, 93660, 93662, 93667 68, 93675, 93701 12, I-1

93714 18, 93720 30, 93737, 93740 41, 93744 45, 93747, 93750, 93755, 93760 61, 93764 65, 93771 79, 93786, 93790 94, 93844, 93888. Kings County: 93230, 93232, 93242, 93631, 93656. Madera County: 93601 02, 93604, 93614, 93623, 93626, 93636 39, 93643 45, 93653, 93669, 93720. Mariposa County: 93601, 93623, 93653. Napa County: 94503, 94508, 94515, 94558 59, 94562, 94567, 94573 74, 94576, 94581, 94589 90, 94599, 95476. Placer County: 95602 04, 95626, 95648, 95650, 95658, 95661, 95663, 95668, 95677 78, 95681, 95692, 95703, 95722, 95736, 95746 47, 95765. Santa Clara County: 94022 24, 94035, 94039 43, 94085 89, 94301 06, 94309, 94550, 95002, 95008 09, 95011, 95013 15, 95020 21, 95026, 95030 33, 95035 38, 95042, 95044, 95046, 95050 56, 95070 71, 95076, 95101, 95103, 95106, 95108 13, 95115 36, 95138 41, 95148, 95150 61, 95164, 95170, 95172 73, 95190 94, 95196. Sonoma County: 94515, 94922 23, 94926 28, 94931, 94951 55, 94972, 94975, 94999, 95401 07, 95409, 95416, 95419, 95421, 95425, 95430 31, 95433, 95436, 95439, 95441 42, 95444, 95446, 95448, 95450, 95452, 95462, 95465, 95471 73, 95476, 95486 87, 95492. Sutter County: 95626, 95645, 95648, 95659, 95668, 95674, 95676, 95692, 95836 37. Tulare County: 93238, 93261, 93618, 93631, 93646, 93654, 93666, 93673. Yolo County: 95605, 95607, 95612, 95616 18, 95645, 95691, 95694 95, 95697 98, 95776, 95798 99. Yuba County: 95692, 95903, 95961. Southern California In Southern California, the service area for this plan includes: Kern*, Los Angeles*, Orange, Riverside*, San Bernardino*, San Diego*, and Ventura* Counties, CA. You must live in one of these areas to join the plan. * denotes partial county Kern County: 93203, 93205 06, 93215 16, 93220, 93222, 93224 26, 93238, 93240 41, 93243, 93250 52, 93263, 93268, 93276, 93280, 93285, 93287, 93301 09, 93311 14, 93380, 93383 90, 93501 02, 93504 05, 93518 19, 93531, 93536, 93560 61, 93581. Los Angeles County: 90001 84, 90086 91, 90093 96, 90099, 90101, 90189, 90201 02, 90209 13, 90220 24, 90230 33, 90239 42, 90245, 90247 51, 90254 55, 90260 67, 90270, 90272, 90274 75, 90277 78, 90280, 90290 96, 90301 12, 90401 11, 90501 10, 90601 10, 90623, 90630 31, 90637 40, 90650 52, 90660 62, 90670 71, 90701 03, 90706 07, 90710 17, 90723, 90731 34, 90744 49, 90755, 90801 10, 90813 15, 90822, 90831 35, 90840, 90842, 90844, 90846 48, 90853, 90895, 90899, 91001, 91003, 91006 12, 91016 17, 91020 21, 91023 25, 91030 31, 91040 43, 91046, 91066, 91077, 91101 10, 91114 18, 91121, 91123 26, 91129, 91182, 91184 85, 91188 89, 91199, 91201 10, 91214, 91221 22, 91224 26, 91301 11, 91313, 91316, 91321 22, 91324 31, 91333 35, 91337, 91340 46, 91350 57, 91361 62, 91364 65, 91367, 91371 72, 91376, 91380 87, 91390, 91392 96, 91401 13, 91416, 91423, 91426, 91436, 91470, 91482, 91495 96, 91499, 91501 08, 91510, 91521 23, 91526, 91601 12, 91614 18, 91702, 91706, 91709, 91711, 91714 16, 91722 24, 91731 35, 91740 41, 91744 50, 91754 56, 91765 73, 91775 76, 91778, 91780, 91788 93, 91801 04, 91896, 91899, 93243, I-2

93510, 93532, 93534 36, 93539, 93543 44, 93550 53, 93560, 93563, 93584, 93586, 93590 91, 93599. Riverside County: 91752, 92201 03, 92210 11, 92220, 92223, 92230, 92234 36, 92240 41, 92247 48, 92253, 92255, 92258, 92260 64, 92270, 92276, 92282, 92320, 92324, 92373, 92399, 92501 09, 92513 19, 92521 22, 92530 32, 92543 46, 92548, 92551 57, 92562 64, 92567, 92570 72, 92581 87, 92589 93, 92595 96, 92599, 92860, 92877 83. San Bernardino County: 91701, 91708 10, 91729 30, 91737, 91739, 91743, 91758 59, 91761 64, 91766, 91784 86, 91792, 92305, 92307 08, 92313 18, 92321 22, 92324 26, 92329, 92331, 92333 37, 92339 41, 92344 46, 92350, 92352, 92354, 92357 59, 92369, 92371 78, 92382, 92385 86, 92391 95, 92397, 92399, 92401 08, 92410 13, 92415, 92418, 92423, 92427, 92880. San Diego County: 91901 03, 91908 17, 91921, 91931 33, 91935, 91941 47, 91950 51, 91962 63, 91976 80, 91987, 92007 11, 92013 14, 92018 27, 92029 30, 92033, 92037 40, 92046, 92049, 92051 52, 92054 58, 92064 65, 92067 69, 92071 72, 92074 75, 92078 79, 92081 85, 92091 93, 92096, 92101 24, 92126 32, 92134 40, 92142 43, 92145, 92147, 92149 50, 92152 55, 92158 61, 92163 79, 92182, 92186 87, 92190 93, 92195 99. Ventura County: 90265, 91304, 91307, 91311, 91319 20, 91358 62, 91377, 93001 07, 93009 12, 93015 16, 93020 22, 93030 36, 93040 44, 93060 66, 93094, 93099, 93252. Who is eligible to join Kaiser Permanente Senior Advantage (HMO)? You can join Kaiser Permanente Senior Advantage (HMO) if you are enrolled in Medicare Part B and live in the service area. However, individuals with End-Stage Renal Disease generally are not eligible to enroll in Kaiser Permanente Senior Advantage (HMO) unless they are members of our organization and have been since their dialysis began. Can I choose my doctors? Kaiser Permanente Senior Advantage (HMO) has formed a network of doctors, specialists, and hospitals. You can only use doctors who are part of our network. The health providers in our network can change at any time. You can ask for a current provider directory. For an updated list, visit us at kp.org/medicare. Our customer service number is listed at the end of this introduction. What happens if I go to a doctor who s not in your network? If you choose to go to a doctor outside of our network, you must pay for these services yourself. Neither the plan nor the Original Medicare Plan will pay for these services except in limited situations (for example, emergency care). Where can I get my prescriptions if I join this plan? Kaiser Permanente Senior Advantage (HMO) has formed a network of pharmacies. You must use a network pharmacy to receive plan benefits. We may not pay for your prescriptions if you use an out-of-network pharmacy, except in certain cases. The pharmacies in our network can change at any time. You can ask for a pharmacy directory or visit us at http://www.kp.org/seniorrx. Our customer service number is listed at the end of this introduction. What if my doctor prescribes less than a month s supply? In consultation with your doctor or pharmacist, you may receive less than a month s supply of certain drugs. Also, if you live in a long-term care facility, you will receive less than a month s supply I-3

of certain brand [and generic] drugs. Dispensing fewer drugs at a time can help reduce cost and waste in the Medicare Part D program, when this is medically appropriate. The amount you pay in these circumstances will depend on whether you are responsible for paying coinsurance (a percentage of the cost of the drug) or a copay (a flat dollar amount for the drug). If you are responsible for coinsurance for the drug, you will continue to pay the applicable percentage of the drug cost. If you are responsible for a copay for the drug, a daily cost-sharing rate will be applied. If your doctor decides to continue the drug after a trial period, you should not pay more for a month s supply than you otherwise would have paid. Contact your plan if you have questions about cost-sharing when less than a one-month supply is dispensed. Does my plan cover Medicare Part B or Part D drugs? Kaiser Permanente Senior Advantage (HMO) does cover both Medicare Part B prescription drugs and Medicare Part D prescription drugs. What is a prescription drug formulary? Kaiser Permanente Senior Advantage (HMO) uses a formulary. A formulary is a list of drugs covered by your plan to meet patient needs. We may periodically add, remove, or make changes to coverage limitations on certain drugs or change how much you pay for a drug. If we make any formulary change that limits our members ability to fill their prescriptions, we will notify the affected members before the change is made. We will send a formulary to you and you can see our complete formulary on our Web site at http://www.kp.org/seniorrx. If you are currently taking a drug that is not on our formulary or subject to additional requirements or limits, you may be able to get a temporary supply of the drug. You can contact us to request an exception or switch to an alternative drug listed on our formulary with your physician s help. Call us to see if you can get a temporary supply of the drug or for more details about our drug transition policy. How can I get extra help with my prescription drug plan costs or get extra help with other Medicare costs? You may be able to get extra help to pay for your prescription drug premiums and costs as well as get help with other Medicare costs. To see if you qualify for getting extra help, call: * 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week; and see http://www.medicare.gov Programs for People with Limited Income and Resources in the publication Medicare & You. * The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778; or * Your State Medicaid Office. What are my protections in this plan? Your employer or trust fund determines the benefits it will offer to its Medicare-eligible beneficiaries as well as eligibility requirements and share of cost (if any). As long as you meet your employer or trust fund's eligibility requirements and your employer or trust fund continues to offer Kaiser Permanente Senior Advantage (HMO), you may remain a Senior Advantage member through your employer or trust fund, as long as Kaiser Permanente offers Medicare coverage. Benefits, eligibility requirements, and share of cost (if any) are generally communicated during your annual open enrollment period. If your employer or trust fund decides to terminate its coverage through Kaiser Permanente Senior Advantage (HMO), you may be eligible to join the Individual Kaiser Permanente Senior Advantage Plan, or you can remain with Original Medicare. I-4

All Medicare Advantage Plans agree to stay in the program for a full calendar year at a time. Plan benefits and cost-sharing may change from calendar year to calendar year. Each year, plans can decide whether to continue to participate with Medicare Advantage. A plan may continue in their entire service area (geographic area where the plan accepts members) or choose to continue only in certain areas. Also, Medicare may decide to end a contract with a plan. Even if your Medicare Advantage Plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue for an additional calendar year, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area. As a member of Kaiser Permanente Senior Advantage (HMO), you have the right to request an organization determination, which includes the right to file an appeal if we deny coverage for an item or service, and the right to file a grievance. You have the right to request an organization determination if you want us to provide or pay for an item or service that you believe should be covered. If we deny coverage for your requested item or service, you have the right to appeal and ask us to review our decision. You may ask us for an expedited (fast) coverage determination or appeal if you believe that waiting for a decision could seriously put your life or health at risk, or affect your ability to regain maximum function. If your doctor makes or supports the expedited request, we must expedite our decision. Finally, you have the right to file a grievance with us if you have any type of problem with us or one of our network providers that does not involve coverage for an item or service. If your problem involves quality of care, you also have the right to file a grievance with the Quality Improvement Organization (QIO) for your state. Please refer to the Evidence of Coverage (EOC) for the QIO contact information. As a member of Kaiser Permanente Senior Advantage (HMO), you have the right to request a coverage determination, which includes the right to request an exception, the right to file an appeal if we deny coverage for a prescription drug, and the right to file a grievance. You have the right to request a coverage determination if you want us to cover a Part D drug that you believe should be covered. An exception is a type of coverage determination. You may ask us for an exception if you believe you need a drug that is not on our list of covered drugs. You can also ask for an exception to cost utilization rules, such as a limit on the quantity of a drug. If you think you need an exception, you should contact us before you try to fill your prescription at a pharmacy. Your doctor must provide a statement to support your exception request. If we deny coverage for your prescription drug(s), you have the right to appeal and ask us to review our decision. Finally, you have the right to file a grievance if you have any type of problem with us or one of our network pharmacies that does not involve coverage for a prescription drug. If your problem involves quality of care, you also have the right to file a grievance with the Quality Improvement Organization (QIO) for your state. Please refer to the Evidence of Coverage (EOC) for the QIO contact information. What is a Medication Therapy Management (MTM) Program? A Medication Therapy Management (MTM) Program is a free service we offer. You may be invited to participate in a program designed for your specific health and pharmacy needs. You may decide not to participate but it is recommended that you take full advantage of this covered service if you are selected. Contact Kaiser Permanente Senior Advantage (HMO) for more details. What types of drugs may be covered under Medicare Part B? Some outpatient prescription drugs may be covered under Medicare Part B. These may include, but are not limited to, the following types of drugs. Contact Kaiser Permanente Senior Advantage (HMO) for more details. I-5

-- Some Antigens: If they are prepared by a doctor and administered by a properly instructed person (who could be the patient) under doctor supervision. -- Osteoporosis Drugs: Injectable osteoporosis drugs for some women. -- Erythropoietin: By injection if you have end-stage renal disease (permanent kidney failure requiring either dialysis or transplantation) and need this drug to treat anemia. -- Hemophilia Clotting Factors: Self-administered clotting factors if you have hemophilia. -- Injectable Drugs: Most injectable drugs administered incident to a physician s service. -- Immunosuppressive Drugs: Immunosuppressive drug therapy for transplant patients if the transplant took place in a Medicare-certified facility and was paid for by Medicare or by a private insurance company that was the primary payer for Medicare Part A coverage. -- Some Oral Cancer Drugs: If the same drug is available in injectable form. -- Oral Anti-Nausea Drugs: If you are part of an anti-cancer chemotherapeutic regimen. -- Inhalation and Infusion Drugs administered through Durable Medical Equipment. Where can I find information on plan ratings? The Medicare program rates how well plans perform in different categories (for example, detecting and preventing illness, ratings from patients and customer service). If you have access to the web, you can find the Plan Ratings information by using the Find health & drug plans web tool on medicare.gov to compare the plan ratings for Medicare plans in your area. You can also call us directly to obtain a copy of the plan ratings for this plan. Our customer service number is listed below. Please call Kaiser Permanente for more information about Kaiser Permanente Senior Advantage (HMO). Visit us at kp.org/medicare or, call us: Customer Service Hours: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, 8:00 a.m. - 8:00 p.m. Pacific Current members should call toll-free (800) 443-0815 for questions related to the Medicare Advantage Program or the Medicare Part D Prescription Drug program. (TTY/TDD 711) Prospective members should call toll-free (800) 777-1238 for questions related to the Medicare Advantage Program or the Medicare Part D Prescription Drug program. (TTY/TDD 711) For more information about Medicare, please call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You can call 24 hours a day, 7 days a week. Or, visit http://www.medicare.gov on the web. This document may be available in other formats such as Braille, large print or other alternate formats. This document may be available in a non-english language. For additional information, call customer service at the phone number listed above. Este documento puede estar disponible en otros idiomas aparte del inglés. Si desea información adicional, llame a Servicio al Cliente al número de teléfono antes indicado. I-6

If you have any questions about this plan s benefits or costs, please contact Kaiser Permanente for details. Section II Summary of Benefits Benefit Original Medicare IMPORTANT INFORMATION 1 - Premium and Other Important Information 2 - Doctor and Hospital Choice (For more information, see Emergency Care - #15 and Urgently Needed Care - #16.) In 2013 the monthly Part B Premium was $104.90 and may change for 2014 and the annual Part B deductible amount was $147 and may change for 2014. If a doctor or supplier does not accept assignment, their costs are often higher, which means you pay more. Most people will pay the standard monthly Part B premium. However, some people will pay a higher premium because of their yearly income (over $85,000 for singles, $170,000 for married couples). For more information about Part B premiums based on income, call Medicare at 1-800- MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. You may go to any doctor, specialist or hospital that accepts Medicare. SUMMARY OF BENEFITS INPATIENT CARE 3 - Inpatient Hospital Care (includes Substance Abuse and Rehabilitation Services) In 2013 the amounts for each benefit period were: Days 1-60: $1,184 deductible Days 61-90: $296 per day Days 91-150: $592 per lifetime reserve day These amounts may change for 2014. Call 1-800-MEDICARE (1-800-633-4227) for information about lifetime reserve days. Lifetime reserve days can only be used once. A benefit period starts the day you go into a hospital or skilled nursing facility. It ends when you go for 60 days in a row without hospital or skilled nursing care. If you go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have. II-1

Benefit Original Medicare 4 - Inpatient Mental Health Care In 2013 the amounts for each benefit period were: Days 1-60: $1,184 deductible Days 61-90: $296 per day Days 91-150: $592 per lifetime reserve day 5 - Skilled Nursing Facility (SNF) (in a Medicare-certified skilled nursing facility) These amounts may change for 2014. You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital. In 2013 the amounts for each benefit period after at least a 3-day Medicare-covered hospital stay were: Days 1-20: $0 per day Days 21-100: $148 per day These amounts may change for 2014. 100 days for each benefit period. A benefit period starts the day you go into a hospital or SNF. It ends when you go for 60 days in a row without hospital or skilled nursing care. If you go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have. 6 - Home Health Care (includes medically necessary intermittent skilled nursing care, home health aide services, and rehabilitation services, etc.) $0 copay. 7 - Hospice You pay part of the cost for outpatient drugs and inpatient respite care. You must get care from a Medicare-certified hospice. OUTPATIENT CARE 8 - Doctor Office Visits 20% coinsurance 9 - Chiropractic Services Supplemental routine care not covered 20% coinsurance for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part). 10 - Podiatry Services Supplemental routine care not covered. 20% coinsurance for medically necessary foot care, including care for medical conditions affecting the lower limbs. II-2

Benefit 11 - Outpatient Mental Health Care 12 - Outpatient Substance Abuse Care Original Medicare 20% coinsurance for most outpatient mental health services Specified copayment for outpatient partial hospitalization program services furnished by a hospital or community mental health center (CMHC). Copay cannot exceed the Part A inpatient hospital deductible. Partial hospitalization program is a structured program of active outpatient psychiatric treatment that is more intense than the care received in your doctor s or therapist s office and is an alternative to inpatient hospitalization. 20% coinsurance 13 - Outpatient Services 20% coinsurance for the doctor s services Specified copayment for outpatient hospital facility services Copay cannot exceed the Part A inpatient hospital deductible. 20% coinsurance for ambulatory surgical center facility services 14 - Ambulance Services (medically necessary ambulance services) 15 - Emergency Care (You may go to any emergency room if you reasonably believe you need emergency care.) 16 - Urgently Needed Care (This is NOT emergency care, and in most cases, is out of the service area.) 20% coinsurance 20% coinsurance for the doctor s services Specified copayment for outpatient hospital facility emergency services. Emergency services copay cannot exceed Part A inpatient hospital deductible for each service provided by the hospital. You don t have to pay the emergency room copay if you are admitted to the hospital as an inpatient for the same condition within 3 days of the emergency room visit. Not covered outside the U.S. except under limited circumstances. 20% coinsurance, or a set copay If you are admitted to the hospital within 3 days for the same condition, you pay $0 for the urgently-needed-care visit. NOT covered outside the U.S. except under limited circumstances. II-3

Benefit 17 - Outpatient Rehabilitation Services (Occupational Therapy, Physical Therapy, Speech and Language Therapy) Original Medicare 20% coinsurance Medically necessary physical therapy, occupational therapy, and speech and language pathology services are covered. OUTPATIENT MEDICAL SERVICES AND SUPPLIES 18 - Durable Medical Equipment (includes wheelchairs, oxygen, etc.) 19 - Prosthetic Devices (includes braces, artificial limbs and eyes, etc.) 20 - Diabetes Programs and Supplies 21 - Diagnostic Tests, X-Rays, Lab Services, and Radiology Services 22 - Cardiac and Pulmonary Rehabilitation Services 20% coinsurance 20% coinsurance 20% coinsurance for Medicare-covered medical supplies related to prosthetics, splints, and other devices. 20% coinsurance for diabetes self-management training 20% coinsurance for diabetes supplies 20% coinsurance for diabetic therapeutic shoes or inserts 20% coinsurance for diagnostic tests and x-rays $0 copay for Medicare-covered lab services Lab Services: Medicare covers medically necessary diagnostic lab services that are ordered by your treating doctor when they are provided by a Clinical Laboratory Improvement Amendments (CLIA) certified laboratory that participates in Medicare. Diagnostic lab services are done to help your doctor diagnose or rule out a suspected illness or condition. Medicare does not cover most supplemental routine screening tests, like checking your cholesterol. 20% coinsurance for Cardiac Rehabilitation services 20% coinsurance for Pulmonary Rehabilitation services 20% coinsurance for Intensive Cardiac Rehabilitation services PREVENTIVE SERVICES 23 - Preventive Services No coinsurance, copayment or deductible for the following: - Abdominal Aortic Aneurysm Screening - Bone Mass Measurement. Covered once every 24 months (more often if medically necessary) if you meet certain medical conditions. - Cardiovascular Screening - Cervical and Vaginal Cancer Screening. Covered once every 2 years. Covered once a year for women with Medicare at high risk. - Colorectal Cancer Screening II-4

Benefit Original Medicare - Diabetes Screening - Influenza Vaccine - Hepatitis B Vaccine for people with Medicare who are at risk - HIV Screening. $0 copay for the HIV screening, but you generally pay 20% of the Medicare-approved amount for the doctor s visit. HIV screening is covered for people with Medicare who are pregnant and people at increased risk for the infection, including anyone who asks for the test. Medicare covers this test once every 12 months or up to three times during a pregnancy. - Breast Cancer Screening (Mammogram). Medicare covers screening mammograms once every 12 months for all women with Medicare age 40 and older. Medicare covers one baseline mammogram for women between ages 35-39. - Medical Nutrition Therapy Services Nutrition therapy is for people who have diabetes or kidney disease (but aren t on dialysis or haven t had a kidney transplant) when referred by a doctor. These services can be given by a registered dietitian and may include a nutritional assessment and counseling to help you manage your diabetes or kidney disease - Personalized Prevention Plan Services (Annual Wellness Visits) - Pneumococcal Vaccine. You may only need the Pneumonia vaccine once in your lifetime. Call your doctor for more information. - Prostate Cancer Screening - Prostate Specific Antigen (PSA) test only. Covered once a year for all men with Medicare over age 50. - Smoking and Tobacco Use Cessation (counseling to stop smoking and tobacco use). Covered if ordered by your doctor. Includes two counseling attempts within a 12-month period. Each counseling attempt includes up to four face-to-face visits. - Screening and behavioral counseling interventions in primary care to reduce alcohol misuse - Screening for depression in adults - Screening for sexually transmitted infections (STI) and highintensity behavioral counseling to prevent STIs - Intensive behavioral counseling for Cardiovascular Disease (bi-annual) - Intensive behavioral therapy for obesity - Welcome to Medicare Preventive Visits (initial preventive physical exam) When you join Medicare Part B, then you are eligible as follows. During the first 12 months of your new Part B coverage, you can get either a Welcome to Medicare Preventive Visits or an Annual Wellness Visit. After your first 12 months, you can get one Annual Wellness Visit every 12 months. II-5

Benefit 24 - Kidney Disease and Conditions Original Medicare 20% coinsurance for renal dialysis 20% coinsurance for kidney disease education services PRESCRIPTION DRUG BENEFITS 25 - Outpatient Prescription Drugs Most drugs are not covered under Original Medicare. You can add prescription drug coverage to Original Medicare by joining a Medicare Prescription Drug Plan, or you can get all your Medicare coverage, including prescription drug coverage, by joining a Medicare Advantage Plan or a Medicare Cost Plan that offers prescription drug coverage. OUTPATIENT MEDICAL SERVICES AND SUPPLIES 26 - Dental Services Preventive dental services (such as cleaning) not covered. 27 - Hearing Services Supplemental routine hearing exams and hearing aids not covered. 20% coinsurance for diagnostic hearing exams. 28 - Vision Services 20% coinsurance for diagnosis and treatment of diseases and conditions of the eye, including an annual glaucoma screening for people at risk Supplemental routine eye exams and eyeglasses (lenses and frames) not covered. Medicare pays for one pair of eyeglasses or contact lenses after cataract surgery. Wellness/Education and Other Supplemental Benefits & Services Over-the-Counter Items Transportation (Routine) Acupuncture and Other Alternative Therapies Not covered. Not covered. Not covered. Not covered. II-6

Section III More information about our plan General exclusions (services our plan does not cover) The following is a summary of excluded services and items, please refer to the Evidence of Coverage for complete details. These services and items are not covered by our plan unless they are covered by Original Medicare or they are described otherwise in the Evidence of Coverage: Care in a licensed intermediate care facility. Chiropractic services, except for manual manipulation of the spine to correct subluxation in accord with Medicare guidelines (or if covered under your group's plan). Comfort, convenience, or luxury equipment or features. Cosmetic surgery or procedures. Custodial care unless it is provided with covered skilled nursing care and/or skilled rehabilitation services. Dental care and dental X-rays. Elective or voluntary enhancement procedures or services. Experimental medical and surgical procedures, equipment, and medications. Full-time nursing care in your home. Hearing aids or exams to fit hearing aids, unless covered under your group's plan. Homemaker services, including basic household assistance. Meals delivered to your home. Orthopedic shoes and supportive devices, unless the shoes are part of a leg brace or for persons with diabetic foot disease. Physical examinations related to employment, insurance, licensing, court orders, parole, or probation. Private duty nurses. Reconstructive surgery that offers only a minimal improvement in appearance or is performed to alter or reshape normal structures of the body in order to improve appearance. Routine foot care. Services or items not approved by the Food and Drug Administration (FDA) that by law require FDA approval in order to be sold in the United States. Services provided to veterans in Veterans Affairs (VA) facilities and services for conditions arising from military service that the law requires the Department of Veterans Affairs to provide. Services (such as eye surgery or contact lenses to reshape the eye) for the purpose of correcting refractive defects of the eye such as myopia, hyperopia, or astigmatism. Services that are not reasonable and not necessary according to the standards of the Original Medicare plan. Transportation by car, taxi, bus, gurney van, wheelchair van, and any other type of transportation (other than a licensed ambulance). III-1

Travel and lodging expenses. When a service is not covered, all services related to the noncovered service are excluded. This exclusion does not apply to services we would otherwise cover to treat complications of the noncovered service. Case management We have case management programs for members who have difficulty managing multiple chronic conditions. This program partners with nurses, social workers, and your primary care physician to address your needs. It provides education and teaches self-care skills to properly manage your chronic conditions. If you are interested in these programs, please ask your primary care physician for more information. Privacy practices Kaiser Permanente will protect the privacy of your protected health information in accord with applicable law. To learn more about our privacy practices, please refer to the Evidence of Coverage or kp.org to view our Notice of Privacy Practices. III-2

Multi-language Interpreter Services English: We have free interpreter services to answer any questions you may have about our health or drug plan. To get an interpreter, just call us at 1-800-443-0815. Someone who speaks English/Language can help you. This is a free service. Spanish: Tenemos servicios de intérprete sin costo alguno para responder cualquier pregunta que pueda tener sobre nuestro plan de salud o medicamentos. Para hablar con un intérprete, por favor llame al 1-800-443-0815. Alguien que hable español le podrá ayudar. Este es un servicio gratuito. Chinese Mandarin: 我 们 提 供 免 费 的 翻 译 服 务, 帮 助 您 解 答 关 于 健 康 或 药 物 保 险 的 任 何 疑 问 如 果 您 需 要 此 翻 译 服 务, 请 致 电 1-800-443-0815 我 们 的 中 文 工 作 人 员 很 乐 意 帮 助 您 这 是 一 项 免 费 服 务 Chinese Cantonese: 您 對 我 們 的 健 康 或 藥 物 保 險 可 能 存 有 疑 問, 為 此 我 們 提 供 免 費 的 翻 譯 服 務 如 需 翻 譯 服 務, 請 致 電 1-800-443-0815 我 們 講 中 文 的 人 員 將 樂 意 為 您 提 供 幫 助 這 是 一 項 免 費 服 務 Tagalog: Mayroon kaming libreng serbisyo sa pagsasaling-wika upang masagot ang anumang mga katanungan ninyo hinggil sa aming planong pangkalusugan o panggamot. Upang makakuha ng tagasaling-wika, tawagan lamang kami sa 1-800-443-0815. Maaari kayong tulungan ng isang nakakapagsalita ng Tagalog. Ito ay libreng serbisyo. French: Nous proposons des services gratuits d'interprétation pour répondre à toutes vos questions relatives à notre régime de santé ou d'assurance-médicaments. Pour accéder au service d'interprétation, il vous suffit de nous appeler au 1-800-443-0815. Un interlocuteur parlant Français pourra vous aider. Ce service est gratuit. Vietnamese: Chúng tôi có dịch vụ thông dịch miễn phí để trả lời các câu hỏi về chương sức khỏe và chương trình thuốc men. Nếu quí vị cần thông dịch viên xin gọi 1-800-443-0815 sẽ có nhân viên nói tiếng Việt giúp đỡ quí vị. Đây là dịch vụ miễn phí. German: Unser kostenloser Dolmetscherservice beantwortet Ihren Fragen zu unserem Gesundheits- und Arzneimittelplan. Unsere Dolmetscher erreichen Sie unter 1-800-443-0815. Man wird Ihnen dort auf Deutsch weiterhelfen. Dieser Service ist kostenlos. Korean: 당사는 의료 보험 또는 약품 보험에 관한 질문에 답해 드리고자 무료 통역 서비스를 제공하고 있습니다. 통역 서비스를 이용하려면 전화 1-800-443-0815 번으로 문의해 주십시오. 한국어를 하는 담당자가 도와 드릴 것입니다. 이 서비스는 무료로 운영됩니다. Y0043_N009556 accepted 60134608 CA

Russian: Если у вас возникнут вопросы относительно страхового или медикаментного плана, вы можете воспользоваться нашими бесплатными услугами переводчиков. Чтобы воспользоваться услугами переводчика, позвоните нам по телефону 1-800-443-0815. Вам окажет помощь сотрудник, который говорит по-pусски. Данная услуга бесплатная. Arabic: ا ننا نقدم خدمات المترجم الفوري المجانية للا جابة عن ا ي ا سي لة تتعلق بالصحة ا و جدول الا دوية لدينا. للحصول على مترجم فوري ليس عليك سوى الاتصال بنا على 5180-344-008-1. سيقوم شخص.بمساعدتك. هذه خدمة مجانية ما يتحدث العربية Hindi: हम र स व स थ य य दव क य जन क ब र म आपक कस भ प रश न क जव ब द न क लए हम र प स म फ त द भ षय स व ए उपलब ध ह. एक द भ षय प र प त करन क लए, बस हम 1-800-443-0815 पर फ न कर. क ई व य क त ज हन द ब लत ह आपक मदद कर सकत ह. यह एक म फ त स व ह. Italian: È disponibile un servizio di interpretariato gratuito per rispondere a eventuali domande sul nostro piano sanitario e farmaceutico. Per un interprete, contattare il numero 1-800-443-0815. Un nostro incaricato che parla Italianovi fornirà l'assistenza necessaria. È un servizio gratuito. Portugués: Dispomos de serviços de interpretação gratuitos para responder a qualquer questão que tenha acerca do nosso plano de saúde ou de medicação. Para obter um intérprete, contacte-nos através do número 1-800-443-0815. Irá encontrar alguém que fale o idioma Português para o ajudar. Este serviço é gratuito. French Creole: Nou genyen sèvis entèprèt gratis pou reponn tout kesyon ou ta genyen konsènan plan medikal oswa dwòg nou an. Pou jwenn yon entèprèt, jis rele nou nan 1-800-443-0815. Yon moun ki pale Kreyòl kapab ede w. Sa a se yon sèvis ki gratis. Polish: Umożliwiamy bezpłatne skorzystanie z usług tłumacza ustnego, który pomoże w uzyskaniu odpowiedzi na temat planu zdrowotnego lub dawkowania leków. Aby skorzystać z pomocy tłumacza znającego język polski, należy zadzwonić pod numer 1-800-443-0815. Ta usługa jest bezpłatna. Japanese: 当 社 の 健 康 健 康 保 険 と 薬 品 処 方 薬 プランに 関 するご 質 問 にお 答 えするため に 無 料 の 通 訳 サービスがありますございます 通 訳 をご 用 命 になるには 1-800-443-0815 にお 電 話 ください 日 本 語 を 話 す 人 者 が 支 援 いたします これは 無 料 のサービス です

Kaiser Foundation Health Plan, Inc. 393 E. Walnut St. Pasadena, CA 91188-8514 Member Service Contact Center 1-800-443-0815 (TTY 711) toll free Seven days a week, 8 a.m. to 8 p.m. kp.org/medicare Please recycle.

Locations KAISER PERMANENTE Locations It s easy to find the care you need, when you need it. On average, our California members have a Kaiser Permanente location within 8 miles of home. And since most of our facilities offer many services under one roof, you can take care of a variety of health care needs with every visit. Convenient access Many of our facilities offer same-day, after-hours, and weekend services. Some locations have specialty, after-hours, ob-gyn, and pediatric services available as well. When you re away from home When you join Kaiser Permanente in California, you re enrolled in either our Northern or Southern California Region. If you visit any other Kaiser Permanente region outside of where you live, you can receive care as a visiting member. Find a location near you Search by ZIP code or keyword at kp.org/facilities, or download our free Kaiser Permanente app for your smartphone or mobile device and use the location finder. 86416

Locations Northern California Northern California The following information can help you find Kaiser Permanente and affiliated facilities in your community. San Mateo Fresno County Maps not to scale n Kaiser Permanente medical centers (hospital and medical offices) Kaiser Permanente medical offices Affiliated plan hospitals Affiliated medical offices 86416

Locations Northern California City Facility Address Alameda Alameda Medical Offices 2417 Central Ave. Antioch n Antioch Medical Center 4501 Sand Creek Road Delta Fair Medical Offices 3400 Delta Fair Blvd. Bolinas Bolinas Family Practice 88 Mesa Road Campbell Campbell Medical Offices 220 E. Hacienda Ave. Clovis Clovis Medical Offices 2071 E. Herndon Ave. Daly City Daly City Medical Offices 395 Hickey Blvd. Davis Davis Medical Offices 1955 Cowell Blvd. Elk Grove Elk Grove Medical Offices 9201 Big Horn Blvd. Elk Grove Promenade Medical Offices 10305 Promenade Pkwy. Fairfield Fairfield Medical Offices 1550 Gateway Blvd. Folsom Folsom Medical Offices 2155 Iron Point Road Fremont n Fremont Medical Center 39400 Paseo Padre Pkwy. Fresno n Fresno Medical Center 7300 N. Fresno St. First Street Medical Offices 4785 N. First St. Gilroy Gilroy Medical Offices 7520 Arroyo Circle Hayward n Hayward Medical Center 27400 Hesperian Blvd. Lincoln Lincoln Medical Offices 1900 Dresden Drive Livermore Livermore Medical Offices 3000 Las Positas Road Manteca n Manteca Medical Center 1777 W. Yosemite Ave. Manteca Medical Offices 1721 W. Yosemite Ave. Martinez Martinez Medical Offices 200 Muir Road Mill Valley Mill Valley Medical Offices 750 Redwood Hwy. Milpitas Milpitas Medical Offices 770 E. Calaveras Blvd. Modesto n Modesto Medical Center 4601 Dale Road Bangs Avenue Medical Offices Dale Road Medical Offices Modesto Medical Offices Standiford Avenue Medical Offices Cornerstone Family Practice Medical Group Family Health Care Medical Group 4125 Bangs Ave. 3800 Dale Road 4601 Dale Road 1320 Standiford Ave. 1444 Florida Ave. 1320 Celeste Drive n Kaiser Permanente medical centers (hospital and medical offices) Locations are in bold. Kaiser Permanente medical offices Affiliated plan hospitals Affiliated medical offices 86416

Locations Northern California City Facility Address Mountain View Mountain View Medical Offices 555 Castro St. 565 Castro St. Napa Napa Medical Offices 3285 Claremont Way 1675 Permanente Way Novato Novato Medical Offices 97 San Marin Drive Oakhurst Oakhurst Medical Offices 40595 Westlake Drive Oakland n Oakland Medical Center 280 W. MacArthur Blvd. Patterson First Care Medical Center 101 N. Third St. Petaluma Petaluma Medical Offices 3900 Lakeville Hwy. Pinole Pinole Medical Offices 1301 Pinole Valley Road Pleasanton Pleasanton Medical Offices 7601 Stoneridge Drive Point Reyes Station Point Reyes Medical Clinic 3 Sixth St. West Marin Medical Center 11150 State Route 1 Rancho Cordova Rancho Cordova Medical Offices 10725 International Drive Redwood City n Redwood City Medical Center 1150 Veterans Blvd. Richmond n Richmond Medical Center 901 Nevin Ave. Rohnert Park Rohnert Park Medical Offices 5900 State Farm Drive Roseville n Roseville Medical Center 1600 Eureka Road Roseville Medical Offices Riverside 1001 Riverside Ave. Sacramento n Sacramento Medical Center 2025 Morse Ave. n South Sacramento Medical Center 6600 Bruceville Road Fair Oaks Boulevard Medical Offices 2345 Fair Oaks Blvd. Point West Medical Offices 1650 Response Road San Bruno Bayhill Medical Offices 801 Traeger Ave. 851 Traeger Ave. San Bruno Medical Offices 901 El Camino Real Sneath Lane Medical Offices 1001 Sneath Lane 1011 Sneath Lane San Francisco n San Francisco Medical Center 2425 Geary Blvd. San Jose n San Jose Medical Center 250 Hospital Pkwy. San Leandro n San Leandro Medical Center 2500 Merced St. (Scheduled to open spring 2014.) San Mateo San Mateo Medical Offices 1000 Franklin Pkwy. San Rafael n San Rafael Medical Center 99 Montecillo Road Downtown San Rafael Medical Offices 3rd St. 1033 Third St. n Kaiser Permanente medical centers (hospital and medical offices) Locations are in bold. Kaiser Permanente medical offices Affiliated plan hospitals Affiliated medical offices 86416

Locations Northern California City Facility Address San Ramon San Ramon Medical Offices 2500 Merced St. (Scheduled to open fall 2013.) Santa Clara n Santa Clara Medical Center 700 Lawrence Expwy. Santa Clara Arques Medical Offices 1263 Arques Ave. Santa Clara Medical Offices 710 Lawrence Expwy. Santa Rosa n Santa Rosa Medical Center 401 Bicentennial Way Santa Rosa Richard Stein Medical Offices 3925 Old Redwood Hwy. 3975 Old Redwood Hwy. Selma Selma Medical Offices 2651 Highland Ave. South San Francisco n South San Francisco Medical Center 1200 El Camino Real Stinson Beach Stinson Beach Medical Center 3419 State Route 1 Stockton Stockton Medical Offices 7373 West Lane Dameron Hospital 1 525 W. Acacia St. Tracy Tracy Medical Offices 2185 W. Grant Line Road Turlock Rodney Avilla, DO 2101 Geer Road Jagmohan Bhinder, MD 1860 Colorado Ave. Maryam Esho, MD 1729 N. Olive Ave. Nirbhai Hundal, MD 1516 Colorado Ave. Puliadi Kumar, MD 1110 Delbon Ave. Turlock Pediatric Medical Group 1100 Delbon Ave. Union City Union City Medical Offices 3551 Whipple Road 3553 Whipple Road 3555 Whipple Road Vacaville n Vacaville Medical Center 1 Quality Drive Vallejo n Vallejo Medical Center 975 Sereno Drive Walnut Creek n Walnut Creek Medical Center 1425 S. Main St. Park Shadelands Medical Offices 320 Lennon Lane n Kaiser Permanente medical centers (hospital and medical offices) Locations are in bold. Kaiser Permanente medical offices Affiliated plan hospitals Affiliated medical offices 86416

Locations Southern California Sierra Nevada Mountains China Lake Naval Weapons Center Southern California The following information can help you find Kaiser Permanente and affiliated facilities in your community. Kern County area Tehachapi Mountains Edwards Air Force Base San Bernardino National Forest Mission Hills San Bernardino Mountains Cleveland National Forest San Jacinto Mountains San Bernardino National Forest Santa Rosa Mountains Anza-Borrego Desert State Park Cleveland National Forest Maps not to scale n Kaiser Permanente medical centers (hospital and medical offices) Kaiser Permanente medical offices Affiliated plan hospitals Affiliated medical offices 86416

Locations Southern California City Facility Address Aliso Viejo Aliso Viejo Medical Offices 24502 Pacific Park Drive Anaheim n Orange County Anaheim 3440 E. La Palma Ave. Medical Center Anaheim Hills Medical Offices 5475 E. La Palma Ave. Anaheim Kraemer Medical Offices 3460 E. La Palma Ave., Building 1 3430 E. La Palma Ave., Building 2 Euclid Medical Offices 1188 N. Euclid St. Lakeview Medical Offices 411 N. Lakeview Ave. Bakersfield Central Medical Offices 3733 San Dimas St. Chester Avenue Medical Offices 2531 Chester Ave. Coffee Road Medical Offices 4801 Coffee Road Discovery Plaza Medical Offices 1200 Discovery Drive East Hills Medical Offices 3700 Mall View Road Ming Medical Offices 8800 Ming Ave. Stockdale Medical Offices 3501 Stockdale Hwy. San Joaquin Community Hospital 2615 Chester Ave. Emergency services 1 Baldwin Park n Baldwin Park Medical Center 1011 Baldwin Park Blvd. Bellflower Bellflower Medical Offices 9400 E. Rosecrans Ave. Rosecrans Medical Offices 9333 E. Rosecrans Ave. Bonita Bonita Medical Offices 3955 Bonita Road Brea Brea Medical Offices 1900 E. Lambert Road Camarillo Camarillo 2620 Las Posas Road 2620 E. Las Posas Road Medical Offices Carlsbad Carlsbad Medical Offices 6860 Avenida Encinas Carson Carson Medical Offices 18600 South Figuero St. (Scheduled to open summer 2013.) Chino Chino Medical Offices 11911 Central Ave. City of Industry Crossroads Medical Offices 12801 Crossroads Pkwy. S. Claremont Indian Hill Medical Offices 250 W. San Jose St. Colton Colton Medical Offices 789 E. Cooley Drive Corona Corona Medical Offices 2055 Kellogg Ave. Cudahy Cudahy Medical Offices 7825 Atlantic Ave. Culver City Playa Vista Medical Offices 5620 Mesmer Ave. Diamond Bar Diamond Bar Medical Offices 1336 Bridgegate Drive Downey n Downey Medical Center 9333 E. Imperial Hwy. Garden Medical Offices 9353 E. Imperial Hwy. Orchard Medical Offices 9449 E. Imperial Hwy. El Cajon Bostonia Medical Offices 1630 E. Main St. El Cajon Medical Offices 250 Travelodge Drive n Kaiser Permanente medical centers (hospital and medical offices) Locations are in bold. Kaiser Permanente medical offices Affiliated plan hospitals Affiliated medical offices 86416

Locations Southern California City Facility Address Escondido Escondido Medical Offices 732 N. Broadway Palomar Health Downtown Campus Palomar Medical Center Emergency services 1 555 E. Valley Pkwy. 2185 W. Citracado Pkwy. Foothill Ranch Foothill Ranch Medical Offices 26882 Towne Centre Drive Fontana n Fontana Medical Center 9961 Sierra Ave. Garden Grove Garden Grove Medical Offices 12100 Euclid St. Gardena Gardena Medical Offices 15446 S. Western Ave. Glendale Glendale Orange Street 501 N. Orange St. Medical Offices Huntington Beach Huntington Beach Medical Offices 18081 Beach Blvd. Harbor City n South Bay Medical Center 25825 S. Vermont Ave. Huntington Beach Huntington Beach Medical Offices 18081 Beach Blvd. Indio Kaiser Permanente Indio 46-900 Monroe St. Medical Offices John F. Kennedy Memorial 47111 Monroe St. Hospital Emergency services 1 Inglewood Inglewood Medical Offices 110 N. La Brea Ave. Irvine n Orange County Irvine Medical Center 6640 Alton Pkwy. Alton/Sand Canyon Medical Offices 6650 Alton Pkwy. 6670 Alton Pkwy. Barranca Medical Offices 6 Willard Joshua Tree Hi-Desert Medical Center 6601 White Feather Road Emergency services 1 La Mesa La Mesa Medical Offices 8080 Parkway Drive Rancho San Diego Medical Offices 3875 Avocado Blvd. La Palma La Palma Medical Offices 5 Centerpointe Drive Lancaster Lancaster Medical Offices 43112 N. 15th St. W. Women s Health Office (Ob-Gyn) 44105 15th St. W. Antelope Valley Hospital 1600 W. Avenue J Emergency services 1 Long Beach Long Beach Medical Offices 3900 E. Pacific Coast Hwy. Los Angeles n Los Angeles Medical Center 4867 W. Sunset Blvd. n West Los Angeles Medical Center 6041 Cadillac Ave. Culver Marina Medical Offices 12001 W. Washington Blvd. East Los Angeles Medical Offices 5119 E. Pomona Blvd. South Los Angeles Medical Offices 1550 W. Manchester Ave. Lynwood Lynwood Medical Offices 3830 Martin Luther King Jr. Blvd. Mission Hills Mission Hills Medical Offices 11001 Sepulveda Blvd. Mission Viejo Mission Viejo Medical Offices 23781 Maquina Ave. n Kaiser Permanente medical centers (hospital and medical offices) Locations are in bold. Kaiser Permanente medical offices Affiliated plan hospitals Affiliated medical offices 86416

Locations Southern California City Facility Address Montebello Montebello Medical Offices 1550 Town Center Drive Moreno Valley Moreno Valley Medical Center 27200 Iris Ave. Medical Office Building 2 Heacock Medical Offices 12815 Heacock St. Iris Medical Offices 27350 Iris Ave. Murrieta Rancho Springs Medical Center 25500 Medical Center Drive North Hollywood North Hollywood Medical Offices 5250 Lankershim Blvd. (Scheduled to open summer 2013.) Norwalk Norwalk Medical Offices 12501 E. Imperial Hwy. Oceanside Oceanside Medical Offices 3609 Ocean Ranch Blvd. Ontario n Ontario Medical Center 2295 S. Vineyard Ave. Oxnard Oxnard 2103 East Gonzales 2103 E. Gonzales Road Road Medical Offices Oxnard 2200 East Gonzales Road 2200 E. Gonzales Road Medical Offices Palm Desert Kaiser Permanente 75-036 Gerald Ford Drive Palm Desert Medical Offices Palm Springs Kaiser Permanente 1100 N. Palm Canyon Drive Palm Springs Medical Offices Desert Regional Medical Center 1150 N. Indian Canyon Drive Emergency services 1 Palmdale Palmdale Medical Offices 4502 E. Avenue S Panorama City n Panorama City Medical Center 13651 Willard St. Pasadena Pasadena Medical Offices 3280 E. Foothill Blvd. Rancho Cucamonga Rancho Cucamonga Medical Offices 10850 Arrow Route Redlands Redlands Medical Offices 1301 California St. Riverside n Riverside Medical Center 10800 Magnolia Ave. San Bernardino San Bernardino Medical Offices 1717 Date Place San Diego n San Diego Medical Center/ 4647 Zion Ave. Kaiser Foundation Hospital Carmel Valley Medical Offices 3851 Shaw Ridge Road (Scheduled to open spring 2013.) Clairemont Mesa Medical Offices 7060 Clairemont Mesa Blvd. Mission Bay Medical Offices 3033 Bunker Hill St. Otay Mesa Medical Offices 4650 Palm Ave. 4660 Palm Ave. Point Loma Medical Offices 3250 Fordham St. 3420 Kenyon St. Rancho Bernardo Medical Offices 17140 Bernardo Center Drive Vandever Medical Offices 4405 Vandever Ave. San Dimas San Dimas Medical Offices 1255 W. Arrow Hwy. n Kaiser Permanente medical centers (hospital and medical offices) Locations are in bold. Kaiser Permanente medical offices Affiliated plan hospitals Affiliated medical offices 86416

Locations Southern California City Facility Address San Juan Capistrano San Juan Capistrano Medical Offices 30400 Camino Capistrano San Marcos San Marcos Medical Offices 400 Craven Road Santa Ana Harbor MacArthur Medical Offices 3401 S. Harbor Blvd. Santa Ana Medical Offices 1900 E. Fourth St. Santa Clarita Canyon Country Medical Offices 26415 Carl Boyer Drive Santa Clarita Medical Offices 27107 Tourney Road Simi Valley Simi Valley Medical Offices 3900 Alamo St. Temecula Temecula Medical Offices 27309 Madison Ave. Thousand Oaks Thousand Oaks 365 East Hillcrest 365 E. Hillcrest Drive Drive Medical Offices Thousand Oaks 145 Hodencamp 145 Hodencamp Road Road Medical Offices Thousand Oaks 322 East Thousand 322 E. Thousand Oaks Blvd. Oaks Boulevard Medical Offices Torrance Torrance Medical Offices 20790 Madrona Ave. Tustin Tustin Ranch Medical Offices 2521 Michelle Drive (Scheduled to open early 2014.) Upland Upland Medical Offices 1183 E. Foothill Blvd. Ventura Ventura 2601 East Main Street 2601 E. Main St. Medical Offices Ventura 888 South Hill Road 888 S. Hill Road Medical Offices Ventura 1000 South Hill Road 1000 S. Hill Road Medical Offices Community Memorial Hospital 147 N. Brent St. of San Buenaventura Emergency services 1 Victorville High Desert/Victorville Medical Offices 14011 Park Ave. Vista Vista Medical Offices 780 Shadowridge Drive West Covina West Covina Medical Offices 1249 S. Sunset Ave. Whittier Whittier Medical Offices 12470 Whittier Blvd. Wildomar Wildomar Medical Offices 36450 Inland Valley Drive Inland Valley Medical Center 36485 Inland Valley Drive Woodland Hills n Woodland Hills Medical Center 5601 De Soto Ave. Erwin Street Medical Offices 21263 Erwin St. Yorba Linda Yorba Linda Medical Offices 22550 Savi Ranch Pkwy. 1 Affiliated plan facilities provide selected inpatient and/or outpatient hospital and emergency services. The information in this guide is current as of the date of publication (July 2013). If you have questions about the information in this guide, please contact our Member Service Call Center at 1-800-464-4000 (1-800-777-1370 for the hearing/speech impaired), weekdays from 7 a.m. to 7 p.m. and weekends from 7 a.m. to 3 p.m. n Kaiser Permanente medical centers (hospital and medical offices) Locations are in bold. Kaiser Permanente medical offices Affiliated plan hospitals Affiliated medical offices 86416