How to Access Covered Care
Choose your doctor and change any time.
Getting in-depth information on how your plan works and getting connected with a provider who suits your individual needs is the first priority. Choose from a wide range of great providers or stay with your current provider. And remember—you can change at any time. Your plan provides you with that flexibility.
Here’s an overview of getting care with Kaiser Permanente Plus and Deductible Kaiser Permanente Plus. There are two options to choose from with the plan: Kaiser Permanente In-Network or Out-of-Network (any other licensed provider).
Kaiser Permanente Network
Many ways to access care through Kaiser Permanente
- Your care in the Kaiser Permanente Signature network starts with your own personal doctor—your primary care physician—who will coordinate your care. You choose your own doctor and you can change your doctor at any time.
- Most specialist visits require a referral, but your primary care physician will typically handle this for you.
- You can manage your care at kp.org. Visit any time from anywhere to make an appointment, refill most prescriptions, see most lab results, and much more.
- You could also have a video or telephone visit with a doctor at no extra cost.
- Urgent care is available at select Kaiser Permanente medical centers, with some open 24 hours a day, seven days a week.
Out-of-Network
Call any licensed provider’s office directly
- Your out-of-network benefit covers care you receive from any licensed provider (who’s not in the Kaiser Permanente Signature network) for up to 10 visits or covered outpatient medical services each year.
- No pre-certifications or referrals are required to use the out-of-network benefit.
- You will pay a higher copay to see your out-of-network provider. You may also pay a higher coinsurance for procedures performed in the provider’s office (such as drugs administered during an office visit) than if you were seeing an in-network provider.
- You are responsible for any amount billed that is above the allowed amount for a given service. You may be asked to pay the full cost of the visit upfront and you will need to submit itemized bills and receipts for reimbursement.
Helpful Tips
- When making an appointment. Make sure the provider understands that your plan allows you to see any licensed provider for certain covered outpatient services as long as you don’t exceed the annual visit limit.
- When checking in for your visit. Bring your ID card with you. If your provider has any questions, have them call the customer service center phone number on the back of your ID card.
- After your visit. When you receive services from an out-of-network provider, you may need to submit a claim and will be responsible for paying the difference, if any, over the billed amount.
You’ll generally pay the most out-of-pocket when you receive services from an out-of-network provider or facility.
To make the most of your visits:
- To make the most of your out-of-network visits, you may want to save them for office visits with your favorite out-of-network provider. You can do this by using the Kaiser Permanente network for labs, X-rays, and other procedures. That way, they’re covered by your Kaiser Permanente Plus or Deductible Kaiser Permanente Plus in-network benefit, rather than your out-of-network benefit. We can send results to your out-of-network provider.
To find out more:
- Refer to your Evidence of Coverage (EOC).
- Contact the human resources/benefits officer where you work, if your employer provides your coverage.
- Refer to your ID card or call the Customer Service Center, Monday through Friday, 8 a.m. to 6 p.m. Eastern Time at 888-225-7202 (TTY 711).
*This product is underwritten by Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (KFHP-MAS).