WRAP Document

A guide to your Health Plan Benefits: Summary Plan Description WRAP Document (WRAP Document)

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

Amendment Date Amendment Participation
Amendment Date2023Amendment Wrap DocumentParticipation All Eligible Plan Participants

Kaiser Permanente HMO Core Plan

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 DateNovember 17, 2020Amendment New COBRA Options - CorrectionParticipationAll Eligible Participants
Amendment DateNovember 13, 2020Amendment New COBRA OptionsParticipationAll Eligible Plan Participants
Amendment DateAugust 19, 2020Amendment Extended Eligibility due to COVID-19ParticipationAll Eligible Plan Participants
Amendment DateMarch 20, 2020Amendment SMM - Response to COVID-19 OutbreakParticipationAll Eligible Plan Participants
Amendment DateMarch 10, 2023Amendment Eligibility RulesParticipation
Amendment DateJanuary 1, 2024Amendment Nondiscrimination Notice - Kaiser Permanente - 2024Participation
Amendment DateMay 1, 2024Amendment Benefit Summary - Kaiser - Core HMO - 2024Participation

Kaiser Permanente PPO Buy-Up Plan

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 DateNovember 17, 2020Amendment New COBRA Options - CorrectionParticipationAll Eligible Plan Participants
Amendment DateNovember 13, 2020Amendment New COBRA OptionsParticipationAll Eligible Plan Participants
Amendment DateAugust 19, 2020Amendment Extended Eligibility due to COVID-19ParticipationAll Eligible Plan Participants
Amendment DateMarch 20, 2020Amendment SMM - Response to COVID-19 OutbreakParticipationAll Eligible Plan Participants
Amendment DateMarch 10, 2023Amendment Eligibility Rules - 2023ParticipationAll Eligible Plan Participants
Amendment DateJanuary 1, 2024Amendment Nondiscrimination Notice - Kaiser Permanente - 2024ParticipationAll Eligible Plan Participants
Amendment DateMay 1, 2024Amendment Benefit Summary - Kaiser - Buy Up - 2024ParticipationAll Eligible Plan Participants

Delta Dental of WA Plan

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

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

Amendment Date Amendment Participation
Amendment DateOctober 1, 2013Amendment Privacy Statement - Delta Dental of WAParticipationAll Participants
Amendment DateMarch 10, 2023Amendment Eligibility Rules - 2023Participation
Amendment DateMay 1, 2024Amendment Delta Dental - Benefit Summary - 2024Participation

Other Benefits