Understanding Your Plan and Benefits

Deductible Added Choice

In-Network Providers

Depending on the network that your employer chooses, you have access to either the Kaiser Permanente Signature^SM Provider Network or the Kaiser Permanente Select^SM Provider Network. Each provider network offers choice and flexibility in one plan. Each time you go for care, you can choose between in-network providers and out-of-network providers. You have the flexibility to move between the two provider options at any time. It’s important to keep in mind that your benefits will vary in each provider option, and the amount you pay for a particular service will depend on the provider option you choose.

Kaiser Permanente Signature^SM Provider Network

You get quality care from the Kaiser Permanente Signature network. With this network, you receive services from Mid-Atlantic Permanente Medical Group, P.C. (Permanente), physicians. They’re part of a group of over 1,500 physicians who practice in our medical centers located in Maryland, Washington, DC, and Virginia. A list of network physicians is accessible at kp.org/doctor that allows you to choose and change your doctors at any time, for any reason. Referral is required for specialty visits.

• Most plans have deductibles, but many services are covered at a copay only whether or not the deductible has been met. Once the deductible is met, members pay applicable copay or coinsurance on covered services.
• Virtually no claim forms to complete.

Kaiser Permanente Select^SM Provider Network

You get quality care from the Kaiser Permanente Select network, composed of over 1,500 physicians of the Mid-Atlantic Permanente Medical Group, P.C. (Permanente), and thousands of community physicians in private practice.

• Most plans have deductibles, but many services are covered at a copay only whether or not the deductible has been met. Once the deductible is met, members pay applicable copay or coinsurance on covered services.
• Virtually no claim forms to complete.

And when members get care from in-network providers, they get the advantages of:

Lowest out-of-pocket costs. With this option, you’ll generally pay the least out-of-pocket costs. There is a deductible. Some services, such as preventive care and PCP visits, are offered before a deductible is met. Refer to your plan document for a list of services that are subject or not subject to the deductible. When you visit an in-network provider, you will not be charged more than your deductible, copayment, or coinsurance for covered services.

Coordinated care. Your primary care physician works closely with specialists, pharmacists, lab technicians, therapists, and many other professionals. If you use Kaiser Permanente providers, they are all connected through your electronic medical record, everyone in the network gets up-to-the-minute information on your health for a better care experience.

No hassle referrals. Most specialist visits require a referral, but your primary care physician will typically handle this for you.

Behavioral health. You can seek initial consultation without a referral from your doctor for outpatient treatment for mental illness, emotional disorders, drug abuse, and alcohol abuse. If you have a network physician, contact your doctor’s office directly.

State-of-the-art medical centers. Kaiser Permanente’s state-of-the-art medical centers are located throughout the region, with doctors, specialists, labs, imaging, pharmacy and many times, urgent care, all in one place.

Emergency care. You are covered for emergency care worldwide. The emergency care copay will be waived if you are directly admitted to a hospital as a result of an emergency.

Urgent care. Urgent care is available 24/7 at six Kaiser Permanente medical centers. You also may have access to network Urgent Care facilities in the community, and to Urgent Care facilities while outside of the service area.

Away from home. Visit kp.org/travel or call the away from home travel line at 1-951-268- 3900 for all of your options.

Vision care. Vision care is available at Kaiser Permanente facilities. If you have a network physician, contact your doctor’s office directly. Ask your doctor’s office for business hours.

Maternity care. Maternity care is available at Kaiser Permanente facilities. If you have a network physician, contact your doctor’s office directly.

Hospital care. Kaiser Permanente carefully selects premier hospitals to team with us in taking great care of you. *

Medical advice. When you call for medical advice, you will be connected with a professional who can help advise you and make an appointment with one of our providers. You can get advice by calling the appointment number on the back of your ID card 24/7.

Lab services. Your results from tests done in Kaiser Permanente medical centers can be read (for most results) online soon after the lab completes your tests, sometimes the same day.

No-cost preventive care. With your plan, you pay $0 for preventive care. That includes routine physicals, well-child visits, and certain screenings and tests (such as mammograms).

Choose from telehealth options that fit into your schedule. Chat with a Kaiser Permanente doctor, email, or schedule a phone or video visit. Be aware that costs may apply for some visits.**

Manage your health online. Use the convenient features of kp.org to manage your health.***

• Email your Kaiser Permanente doctor’s office
• View most test results done in Kaiser Permanente facilities
• Schedule or cancel routine appointments with Kaiser Permanente providers
• Refill most prescriptions in Kaiser Permanente pharmacies
• View past visits with Kaiser Permanente providers
• Find care options and Urgent Care locations near you
• Register at kp.org/registernow
• Select your region
• Your username and password can also be used on our mobile app

To find out more about what is covered in-network:

• See your Evidence of Coverage (EOC) or your Added Choice Reference Guide.
• Contact the benefits officer where you work.
• Refer to your ID card or call Customer Service, Monday through Friday, 7:30 a.m. to 9:00 p.m., Eastern time, at 1-888-225-7202 (TTY 711).

*The premier hospitals are independently owned and operated hospitals, and they contract with Kaiser Foundation Hospitals.

**Video visits are available for members who receive care at Kaiser Permanente medical centers. You must be 18 or older to schedule a video visit. Check with your doctor’s office to find out if video visits are available to you.

***These features are available when you get care at Kaiser Permanente facilities.

Deductible Added Choice

Out-of-Network
Any other licensed provider or physician

You have access to any licensed provider, pharmacy, or hospital that is not considered in-network.

Out-of-pocket costs. Using out-of-network providers generally means higher out-of-pocket costs. Your out-of-pocket costs will generally be the highest when you choose to receive care from an out-of-network provider or facility. Most services are subject to a deductible and then coinsurance.  Depending on your out-of-network provider, you may be required to pay the full cost of the service and submit a claim for reimbursement. Only covered charges count toward meeting the deductible and out-of-pocket maximum. In addition, out-of-network providers may also bill you for the difference, if any, between actual billed charges and the maximum allowable charge. Charges that exceed the determined maximum allowable charge are not covered charges, do not satisfy the deductible, and do not accumulate to the out-of-pocket maximum.

Referrals. No referral is needed for office visits to specialists. Most services are subject to a deductible, then coinsurance. Some services require preauthorization.

Behavioral health. You can receive care from any licensed behavioral health or chemical dependency professional for mental illness, emotional disorders, and drug or alcohol abuse. Preauthorization is required before receiving inpatient hospital care. Depending on your plan, it may also be required for certain outpatient procedures.

Hospital care. You can receive inpatient hospitalization services from licensed or accredited hospitals and facilities that are not considered in-network.

Medical advice. You may choose to call your out-of-network provider directly during business hours or call the Kaiser Permanente appointment and advice line at 1-800-777-7904 (TTY 711), 24 hours a day, 7 days a week.

Emergency care. All emergency care is covered as an in-network benefit.

Urgent care. You can visit any licensed out-of-network urgent care facility. Make sure to keep a copy of your bill to submit with your claim for reimbursement.

Vision care. You can visit any licensed optometrist or vision facility. You will pay for services in full and submit a claim for reimbursement.

Maternity care. You can choose any licensed provider for obstetric care. For office visits and other services while you are pregnant, you will pay your applicable copays or coinsurance, and your deductible must be met, unless otherwise indicated.

Lab tests and X-rays. You can receive lab, X-ray, and other imaging services at any facility. You will likely pay in full and submit a claim for reimbursement.

Pharmacy services. Learn about your pharmacy benefits.

To find out more about what is covered out-of-network:

• See your Added Choice Reference Guide.
• Contact the benefits officer where you work, if your employer provides your coverage.
• Refer to your ID card or call Customer Service, Monday through Friday, 7:30 a.m. to 9 p.m., Eastern time, at 1-888-225-7202 (TTY 711).

Kaiser Foundation Health Plan of the Mid-Atlantic States (KFHP-MAS) underwrites the Added Choice Product line.