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2012 Colorado Health Benefit Plan Description Form Kaiser Foundation Health Plan of Colorado KP 5000/40/Rx Denver/Boulder Small Group PART A: TYPE OF COVERAGE 1. Health Maintenance Organization (HMO)TYPE

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What is your plan may exclude?

Your plan may exclude certain features or benefits that are not required by law.

Who is required to file your plan may exclude?

Employers who offer employee benefit plans may be required to file your plan may exclude.

How to fill out your plan may exclude?

You can fill out your plan may exclude by providing information about the features and benefits that are excluded.

What is the purpose of your plan may exclude?

The purpose of your plan may exclude is to provide transparency about the benefits offered by an employee benefit plan.

What information must be reported on your plan may exclude?

You must report the specific features and benefits that are excluded from your plan.