January 1 – December 31, 2024 Evidence of Coverage Your Medicare Health Benefits and Services as a Member of Kaiser Permanente Senior Advantage Group Plan (HMO) offered to Washington PEBB This document gives you the details about your Medicare health care coverage from January 1 to December 31, 2024. This is an important legal document. Please keep it in a safe place. For questions about this document, please contact Member Services at 1-877-221-8221 for additional information. (TTY users should call 711.) Hours are 8 a.m. to 8 p.m., 7 days a week. This call is free. This plan, Kaiser Permanente Senior Advantage, is offered by Kaiser Foundation Health Plan of the Northwest (Health Plan). When this Evidence of Coverage says "we," "us," or "our," it means Health Plan. When it says "plan" or "our plan," it means Kaiser Permanente Senior Advantage (Senior Advantage). This document is available in large print if you need it by calling Member Services (phone numbers are printed on the back cover of this document). Benefits, premiums, deductibles, and/or copayments/coinsurance may change on January 1, 2025. The provider network may change at any time. You will receive notice when necessary. We will notify affected enrollees about changes at least 30 days in advance. This document explains your benefits and rights. Use this document to understand about: • Your plan premium and cost-sharing; • Your medical benefits; • How to file a complaint if you are not satisfied with a service or treatment; • How to contact us if you need further assistance; and, • Other protections required by Medicare law. WAPEBBEC0124