Understanding Your Plan and Benefits
Your plan empowers you to make the best health care choice for you – wherever you are, and whenever you need care. Here are the networks for each of the three options: HMO (Option 1), PHCS & MultiPlan Networks within MAS and other Kaiser Permanente states or Cigna PPO Network when travelling outside Kaiser Permanente states (Option 2) and Out-of-Network (Option 3).
You have access to over 1,500 physicians in the Mid-Atlantic Permanente Medical Group, P.C., who practice in Kaiser Permanente medical centers. 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.
Lowest out-of-pocket costs. With this option, you’ll generally pay the least out of pocket, with no deductible.
Coordinated care. Your primary care physician works closely with specialists, pharmacists, lab technicians, therapists, and many other professionals. And because 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.
Referrals from your doctor. Your primary care physician can coordinate your referral to a specialist and can even schedule your appointment.
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.
Urgent care. Urgent care is available 24/7 at six medical centers and on evenings and weekends at five others.
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.
Manage your health online. With My Health Manager, you can view most lab results, refill most prescriptions, email your doctor’s office, schedule routine appointments, and more at kp.org/experience.
Medical advice and video visits. When you call for medical advice, you could also have a video visit with a doctor who is connected to your personal care team.**
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).
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.
Hospital care. Kaiser Permanente carefully selects premier hospitals to team with us in taking great care of you.†
Dental care. Your medical coverage includes dental care you might need after an accident.
Pharmacy services. Learn about your pharmacy benefits.
To find out more about what is covered under Option 1:
- See your Flexible Choice member guide.
- Contact the benefits officer where you work, if your employer provides your coverage.
- Call Customer Service at 888-225-7202 or refer to your ID card.
The terms of your Evidence of Coverage govern Option 1.
*Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (KFHP-MAS) underwrites the in-network HMO tier (Option 1).
** Video visits are available to Kaiser Permanente members who have a camera-equipped computer or mobile device and are registered at kp.org. You must be present in Maryland, Virginia, or Washington, DC, for visits with your primary care physician or mental health provider. For urgent video visits with an emergency doctor, you may be also be present in West Virginia, Florida, North Carolina, or Pennsylvania. For certain medical or mental health conditions. For video visits with a mental health provider, appointments can be scheduled for follow up care.
†The premier hospitals are independently owned and operated hospitals, and they contract with Kaiser Foundation Hospitals.
A wide network of contracted participating providers. To find up-to-date Participating Providers or confirm if your current provider is part of the Network, you can search for Providers by Location, or call Customer Service at 1-888-225-7202 (TTY 711), Monday through Friday 8:00 a.m. to 6 p.m., Eastern time.
Kaiser Permanente States: Within CA, CO, GA, HI, MD, OR, VA, WA and DC you have access to Flexible Choice Provider Directory**
Non-Kaiser Permanente States: The Cigna Healthcare PPO Network* only provides access to care in non-Kaiser Permanente states.
*Disclaimer: The Cigna Healthcare PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna Healthcare PPO for Shared Administration.
Out-of-pocket costs. Although you will generally have higher out-of-pocket costs than in Option 1 (such as a deductible, coinsurance, or a copay), providers’ fees are subject to negotiated rates and providers are not allowed to balance bill you for covered services. Your participating provider also completes and submits claim forms.
No-cost preventive care. Preventive care services are offered at no charge whether or not you have met the deductible.
Specialty care. You don’t need a referral for specialty appointments with Option 2 providers. Please note that all inpatient care and certain outpatient services are subject to precertification.
Behavioral health. You can receive care for mental illness, emotional disorders, and drug or alcohol abuse from a provider in the participating provider networks. Please note that all inpatient care and certain outpatient services are subject to precertification.
Hospital care. You can receive inpatient hospitalization services from Option 2 participating hospitals and facilities. Your Option 2 participating physician may make arrangements for your hospital admission.**
Emergency care. All emergency care is covered as an Option 1 benefit.
Urgent care. You can visit any licensed out-of-network urgent care facility.
Vision Care. You can receive vision care from an Option 2 provider within the participating provider networks.
Maternity care. You can choose any Option 2 provider for your obstetric care from a provider in the participating provider networks. Your copay will be $0 for physician office visits while you are pregnant. Be sure to call for precertification during your first trimester.
Lab tests and X-rays. You can contact facilities directly. Check first to be sure the facilities are part of the PHCS or MultiPlan network when in Kaiser Permanente states or the Cigna Healthcare PPO Network when in non-Kaiser Permanente states.
Pharmacy services. Learn about your pharmacy benefits.
To find out more about what is covered under Option 2:
- See your Flexible Choice member guide.
- Contact the benefits officer where you work, if your employer provides your coverage.
- Call Member Services at 888-225-7202 or refer to your ID card.
The terms of your KPIC Certificate of Insurance govern Option 2.
Inpatient and certain outpatient services are subject to precertification when in Kaiser Permanente States using PHCS or MultiPlan network providers. If using the Cigna Healthcare PPO Network for care in non-Kaiser Permanente States (outside of CA, CO, GA, HI, MD, OR, VA, WA and DC), the Cigna Healthcare PPO providers are responsible for obtaining precertification on your behalf when precertification is required. You won’t be financially responsible if a Cigna Healthcare PPO provider fails to obtain precertification for covered services.
*Kaiser Foundation Health Plan of the Mid-Atlantic States (KFHP-MAS) underwrites the In-Network HMO Tier (Option 1) and Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP), underwrites the In-Network PPO (Option 2) and Out-of-Network Tier (Option 3).
**The PHCSTM and MultiPlanTM networks include physicians and health care practitioners and facilities that are available to Kaiser Permanente Insurance Company members via a network access agreement. Not all PHCS and MultiPlan network providers are included. For a list of network participants, go to Flexible Choice Provider Directory. Then, select Option 2 providers.
You have access to any licensed provider who is not an Option 1 or Option 2 provider. Coverage under Option 3 is considered fee for service indemnity coverage; however, Option 3 Out-of-Network Providers have not agreed to negotiated rates.
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 Option 3 provider or facility. Most services are subject to a deductible, then coinsurance. Depending on your Option 3 provider, you may be required to pay the full cost of the service and submit a claim to KPIC for reimbursement. Only covered charges count toward meeting the deductible and out-of-pocket maximum. In addition, Option 3 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.
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.
Hospital care. You can receive inpatient hospitalization services from licensed or accredited hospitals and facilities not in Options 1 or 2.
Emergency care. All emergency care is covered as an Option 1 benefit.
Urgent care. You can visit any licensed out-of-network urgent care facility.
Vision care. You can visit any licensed optometrist or vision facility.
Maternity care. You can choose any licensed provider for obstetric care.
Lab tests and X-rays. You can receive lab, X-ray, and other imaging services at any facility.
Pharmacy services. Learn about your pharmacy benefits.
To find out more about what is covered under Option 3:
- See your Flexible Choice member guide.
- Contact the benefits officer where you work, if your employer provides your coverage.
- Call Member Services at 888-225-7202 or refer to your ID card.
The terms of your KPIC Certificate of Insurance govern Option 3.
Inpatient and certain outpatient services are subject to precertification.
*Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP), underwrites the out-of-network tier (Option 3).
You have access to over 1,500 physicians in the Mid-Atlantic Permanente Medical Group, P.C., who practice in Kaiser Permanente medical centers. 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.
Lowest out-of-pocket costs. You’ll generally pay the least out of pocket with this option. A deductible applies to certain services, then a copay or coinsurance. Many services, including office visits and urgent care are offered at a copay before the deductible.
Coordinated care. Your primary care physician works closely with specialists, pharmacists, lab technicians, therapists, and many other professionals. And because 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.
Referrals from your doctor. Your primary care physician can coordinate your referral to a specialist and can even schedule your appointment.
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.
Urgent care. Urgent care is available 24/7 at six medical centers and on evenings and weekends at five others.
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.
Manage your health online. With My Health Manager, you can view most lab results, refill most prescriptions, email your doctor’s office, schedule routine appointments, and more at kp.org/experience.
Medical advice and video visits. When you call for medical advice, you could also have a video visit with a doctor who is connected to your personal care team.**
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).
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.
Hospital care. Kaiser Permanente carefully selects premier hospitals to team with us in taking great care of you.†
Dental care. Your medical coverage includes dental care you might need after an accident.
Pharmacy services. Learn about your pharmacy benefits.
To find out more about what is covered under Option 1:
- See your Deductible Flexible Choice member guide.
- Contact the benefits officer where you work, if your employer provides your coverage.
- Call Customer Service at 888-225-7202 or refer to your ID card.
The terms of your Evidence of Coverage govern Option 1.
*Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (KFHP-MAS) underwrites the in-network HMO tier (Option 1).
**Video visits are available to Kaiser Permanente members who have a camera-equipped computer or mobile device and are registered at kp.org. You must be present in Maryland, Virginia, or Washington, DC, for visits with your primary care physician or mental health provider. For urgent video visits with an emergency doctor, you may be also be present in West Virginia, Florida, North Carolina, or Pennsylvania. For certain medical or mental health conditions. For video visits with a mental health provider, appointments can be scheduled for follow up care.
†The premier hospitals are independently owned and operated hospitals, and they contract with Kaiser Foundation Hospitals.
A wide network of contracted participating providers. To find up-to-date Participating Providers or confirm if your current provider is part of the Network, you can search for Providers by Location, or call Customer Service at 1-888-225-7202 (TTY 711), Monday through Friday 8:00 a.m. to 6 p.m., Eastern time.
Kaiser Permanente States: Within CA, CO, GA, HI, MD, OR, VA, WA and DC you have access to Flexible Choice Provider Directory**
Non-Kaiser Permanente States: The Cigna Healthcare PPO Network* only provides access to care in non-Kaiser Permanente states.
*Disclaimer: The Cigna Healthcare PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna Healthcare PPO for Shared Administration.
Out-of-pocket costs. Services may be subject to a deductible, then copay or coinsurance; certain services are covered before the deductible at a copay. Although you will generally have higher out-of-pocket costs than in Option 1 (such as a deductible, coinsurance, or a copay), providers’ fees are subject to negotiated rates and providers are not allowed to balance bill you for covered services. Your participating provider also completes and submits claim forms.
No-cost preventive care. Preventive care services are offered at no charge whether or not you have met the deductible.
Specialty care. You don’t need a referral for specialty appointments with Option 2 providers. Please note that all inpatient care and certain outpatient services are subject to precertification.
Behavioral health. You can receive care for mental illness, emotional disorders, and drug or alcohol abuse from a provider in the participating provider networks. Please note that all inpatient care and certain outpatient services are subject to precertification.
Hospital care. You can receive inpatient hospitalization services from Option 2 participating hospitals and facilities. Your Option 2 participating physician may make arrangements for your hospital admission.**
Emergency care. All emergency care is covered as an Option 1 benefit.
Urgent care. You can visit any licensed out-of-network urgent care facility.
Vision Care. You can receive vision care from an Option 2 provider within the participating provider networks.
Maternity care. You can choose any Option 2 provider for your obstetric care from a provider in the participating provider networks. Your copay will be $0 for physician office visits while you are pregnant. Be sure to call for precertification during your first trimester.
Lab tests and X-rays. You can contact facilities directly. Check first to be sure the facilities are part of the PHCS or MultiPlan network when in Kaiser Permanente states or the Cigna Healthcare PPO Network when in non-Kaiser Permanente states.
Pharmacy services. Learn about your pharmacy benefits.
To find out more about what is covered under Option 2:
- See your Flexible Choice member guide.
- Contact the benefits officer where you work, if your employer provides your coverage.
- Call Member Services at 888-225-7202 or refer to your ID card.
The terms of your KPIC Certificate of Insurance govern Option 2.
Inpatient and certain outpatient services are subject to precertification when in Kaiser Permanente States using PHCS or MultiPlan network providers. If using the Cigna Healthcare PPO Network for care in non-Kaiser Permanente States (outside of CA, CO, GA, HI, MD, OR, VA, WA and DC), the Cigna Healthcare PPO providers are responsible for obtaining precertification on your behalf when precertification is required. You won’t be financially responsible if a Cigna Healthcare PPO provider fails to obtain precertification for covered services.
*Kaiser Foundation Health Plan of the Mid-Atlantic States (KFHP-MAS) underwrites the In-Network HMO Tier (Option 1) and Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP), underwrites the In-Network PPO (Option 2) and Out-of-Network Tier (Option 3).
**The PHCSTM and MultiPlanTM networks include physicians and health care practitioners and facilities that are available to Kaiser Permanente Insurance Company members via a network access agreement. Not all PHCS and MultiPlan network providers are included. For a list of network participants, go to Flexible Choice Provider Directory. Then, select Option 2 providers.
You have access to any licensed provider who is not an Option 1 or Option 2 provider. Coverage under Option 3 is considered fee for service indemnity coverage; however, Option 3 Out-of-Network Providers have not agreed to negotiated rates.
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 Option 3 provider or facility. Most services are subject to a deductible, then coinsurance. Depending on your Option 3 provider, you may be required to pay the full cost of the service and submit a claim to KPIC for reimbursement. Only covered charges count toward meeting the deductible and out-of-pocket maximum. In addition, Option 3 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.
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.
Hospital care. You can receive inpatient hospitalization services from licensed or accredited hospitals and facilities not in Options 1 or 2.
Emergency care. All emergency care is covered as an Option 1 benefit.
Urgent care. You can visit any licensed out-of-network urgent care facility.
Vision care. You can visit any licensed optometrist or vision facility.
Maternity care. You can choose any licensed provider for obstetric care.
Lab tests and X-rays. You can receive lab, X-ray, and other imaging services at any facility.
Pharmacy services. Learn about your pharmacy benefits.
To find out more about what is covered under Option 3:
- See your Flexible Choice member guide.
- Contact the benefits officer where you work, if your employer provides your coverage.
- Call Member Services at 888-225-7202 or refer to your ID card.
The terms of your KPIC Certificate of Insurance govern Option 3.
Inpatient and certain outpatient services are subject to precertification.
*Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP), underwrites the out-of-network tier (Option 3).
If you have an HSA-Qualified Flexible Choice plan, you have the option of opening a health savings account (HSA). An HSA allows the use of pre-tax dollars to pay for qualified medical expenses. Once an HSA is opened, money can be deposited into the account. Keep in mind that the IRS sets a limit on how much money can be put in an HSA each year. Employers can contribute money to their employees’ accounts. Check with your human resources manager to see if you have an HSA with your plan.
You have access to over 1,500 physicians in the Mid-Atlantic Permanente Medical Group, P.C., who practice in Kaiser Permanente medical centers. 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.
Lowest out-of-pocket costs. You’ll generally pay the least out of pocket with this option, Most services, including pharmacy are subject to deductible, then a copay or coinsurance.
Coordinated care. Your primary care physician works closely with specialists, pharmacists, lab technicians, therapists, and many other professionals. And because 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.
Referrals from your doctor. Your primary care physician can coordinate your referral to a specialist and can even schedule your appointment.
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.
Urgent care. Urgent care is available 24/7 at six medical centers and on evenings and weekends at five others.
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.
Manage your health online. With My Health Manager, you can view most lab results, refill most prescriptions, email your doctor’s office, schedule routine appointments, and more at kp.org/experience.
Medical advice and video visits. When you call for medical advice, you could also have a video visit with a doctor who is connected to your personal care team.**
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).
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.
Hospital care. Kaiser Permanente carefully selects premier hospitals to team with us in taking great care of you.†
Dental care. Your medical coverage includes dental care you might need after an accident.
Pharmacy services. Learn about your pharmacy benefits.
To find out more about what is covered under Option 1:
- See your Flexible Choice member guide.
- Contact the benefits officer where you work, if your employer provides your coverage.
- Call Member Services at 888-225-7202 or refer to your ID card.
The terms of your Evidence of Coverage govern Option 1.
*Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (KFHP-MAS) underwrites the in-network HMO tier (Option 1).
** If you have an HSA-qualified deductible plan, you will need to pay the full charges for scheduled phone and video visits until you reach your deductible. Once you reach your deductible, your copay is $0 for scheduled phone and video visits. Video visits are available to Kaiser Permanente members who have a camera-equipped computer or mobile device and are registered at kp.org. You must be present in Maryland, Virginia, or Washington, DC, for visits with your primary care physician or mental health provider. For urgent video visits with an emergency doctor, you may be also be present in West Virginia, Florida, North Carolina, or Pennsylvania. For certain medical or mental health conditions. For video visits with a mental health provider, appointments can be scheduled for follow up care.
†The premier hospitals are independently owned and operated hospitals, and they contract with Kaiser Foundation Hospitals.
A wide network of contracted participating providers. To find up-to-date Participating Providers or confirm if your current provider is part of the Network, you can search for Providers by Location, or call Customer Service at 1-888-225-7202 (TTY 711), Monday through Friday 8:00 a.m. to 6 p.m., Eastern time.
Kaiser Permanente States: Within CA, CO, GA, HI, MD, OR, VA, WA and DC you have access to Flexible Choice Provider Directory**
Non-Kaiser Permanente States: The Cigna Healthcare PPO Network* only provides access to care in non-Kaiser Permanente states.
*Disclaimer: The Cigna PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna PPO for Shared Administration.
Out-of-pocket costs. Most services, including pharmacy, are subject to a deductible, then copay or coinsurance. Although you will generally have higher out-of-pocket costs than in Option 1 (such as a deductible, coinsurance, or a copay), providers’ fees are subject to negotiated rates and providers are not allowed to balance bill you for covered services. Your participating provider also completes and submits claim forms.
No-cost preventive care. Preventive care services are offered at no charge whether or not you have met the deductible.
Specialty care. You don’t need a referral for specialty appointments with Option 2 providers. Please note that all inpatient care and certain outpatient services are subject to precertification.
Behavioral health. You can receive care for mental illness, emotional disorders, and drug or alcohol abuse from a provider in the participating provider networks. Please note that all inpatient care and certain outpatient services are subject to precertification.
Hospital care. You can receive inpatient hospitalization services from Option 2 participating hospitals and facilities. Your Option 2 participating physician may make arrangements for your hospital admission.**
Emergency care. All emergency care is covered as an Option 1 benefit.
Maternity care. You can choose any Option 2 provider for your obstetric care from a provider in the participating provider networks. Your copay will be $0 for physician office visits while you are pregnant. Be sure to call for precertification during your first trimester.
Lab tests and X-rays. You can contact facilities directly. Check first to be sure the facilities are part of the PHCS or MultiPlan network when in Kaiser Permanente states or the Cigna PPO Network when in non-Kaiser Permanente states.
Pharmacy services. Learn about your pharmacy benefits.
To find out more about what is covered under Option 2:
- See your Flexible Choice member guide.
- Contact the benefits officer where you work, if your employer provides your coverage.
- Call Member Services at 888-225-7202 or refer to your ID card.
The terms of your KPIC Certificate of Insurance govern Option 2.
Inpatient and certain outpatient services are subject to precertification when in Kaiser Permanente States using PHCS or MultiPlan network providers. If using the Cigna PPO Network for care in non-Kaiser Permanente States (outside of CA, CO, GA, HI, MD, OR, VA, WA and DC), the Cigna PPO providers are responsible for obtaining precertification on your behalf when precertification is required. You won’t be financially responsible if a Cigna PPO provider fails to obtain precertification for covered services.
*Kaiser Foundation Health Plan of the Mid-Atlantic States (KFHP-MAS) underwrites the In-Network HMO Tier (Option 1) and Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP), underwrites the In-Network PPO (Option 2) and Out-of-Network Tier (Option 3).
**The PHCSTM and MultiPlanTM networks include physicians and health care practitioners and facilities that are available to Kaiser Permanente Insurance Company members via a network access agreement. Not all PHCS and MultiPlan network providers are included. For a list of network participants, go to Flexible Choice Provider Directory. Then, select Option 2 providers.
You have access to any licensed provider who is not an Option 1 or Option 2 provider. Coverage under Option 3 is considered fee for service indemnity coverage; however, Option 3 Out-of-Network Providers have not agreed to negotiated rates.
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 Option 3 provider or facility. Most services are subject to a deductible, then coinsurance. Depending on your Option 3 provider, you may be required to pay the full cost of the service and submit a claim to KPIC for reimbursement. Only covered charges count toward meeting the deductible and out-of-pocket maximum. In addition, Option 3 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.
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.
Hospital care. You can receive inpatient hospitalization services from licensed or accredited hospitals and facilities not in Options 1 or 2.
Emergency care. All emergency care is covered as an Option 1 benefit.
Urgent care. You can visit any licensed out-of-network urgent care facility.
Vision care. You can visit any licensed optometrist or vision facility.
Maternity care. You can choose any licensed provider for obstetric care.
Lab tests and X-rays. You can receive lab, X-ray, and other imaging services at any facility.
Pharmacy services. Learn about your pharmacy benefits.
To find out more about what is covered under Option 3:
- See your HSA-Qualified Flexible Choice member guide.
- Contact the benefits officer where you work, if your employer provides your coverage.
- Call Member Services at 888-225-7202 or refer to your ID card.
The terms of your KPIC Certificate of Insurance govern Option 3.
Inpatient and certain outpatient services are subject to precertification.
*Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP), underwrites the out-of-network tier (Option 3).