Understanding Your Plan and Benefits
KP Plus plans combine the benefits of convenient, coordinated care from Kaiser Permanente providers with the flexibility to see out of network providers for certain outpatient care.
Here’s an overview of getting care with KP Plus. There are two options to choose from with your plan for commonly used services: Kaiser Permanente’s care delivery system (in-network) and any other licensed provider in the country (out-of-network).
In-Network Providers1
Kaiser Permanente providers and facilities in California
- To find a Kaiser Permanente provider in California, search the Kaiser Permanente Provider Directory:
Kaiser Permanente Providers and Locations – Northern California
Kaiser Permanente Providers and Locations – Southern California
Benefits of using the Kaiser Permanente care delivery system:
- Lowest out-of-pocket costs. With Kaiser Permanente providers, you’ll usually pay the lowest out-of-pocket costs for office visits, prescriptions, and other services.
- Coordinated care. Your Kaiser Permanente provider 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 Kaiser Permanente care delivery system gets current information on your health for a high-quality care experience.
- Convenient medical offices. Kaiser Permanente’s medical offices are located within Kaiser Permanente’s service area in California, with doctors, pharmacy, lab and X-rays usually all under one roof.
- Emergency care.2 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. You have access to urgent care at designated Kaiser Permanente locations, plus a network of affiliated urgent care centers located outside of Kaiser Permanente’s service area and throughout the country. For advice and locations, call the number on your ID card or visit kp.org/getcare.
- Medical advice. Registered nurses can give you self-care instructions or help you decide how to get care, find a convenient location, and/or schedule an appointment, 24/7. Just call the number on your ID Card or visit kp.org/getcare.
- Lab services. See your results from most tests done in Kaiser Permanente medical facilities online as soon as they’re ready, sometimes the same day.
- No-cost preventive care and screenings. With your insurance plan, you pay $0 for preventive care. That includes routine physicals, well-child services, and certain screenings and tests (such as mammograms).
- Care from home. Choose from telehealth options that fit into your schedule. Chat online with a Kaiser Permanente clinician, email your doctor’s office, complete an e-visit, or schedule a phone or video visit.3
- Manage your health online. Use the convenient features of kp.org to manage your health. 4
- Email your doctor’s office
- View most test results
- Schedule or cancel routine appointments
- Refill most prescriptions
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 with Kaiser Permanente providers in California, refer to your Evidence of Coverage (EOC) or call KP Plus Customer Service at 1-800-788-0710 (TTY 711), Monday through Friday, 7 a.m. to 7 p.m. Pacific time. Contact the human resource/benefits officer where you work for your copy of your EOC.
1 In your plan documents such as your EOC, in-network providers may also be referred to as “Plan Providers.”
2 If you believe you have an emergency medical condition, call 911 or go to the nearest hospital. For the complete definition of an emergency medical condition, please refer to your Evidence of Coverage or other coverage documents.
3 When appropriate and available. These features are available when you get care at Kaiser Permanente facilities. For high deductible health plan members, phone and video appointments are subject to your plan’s annual deductible. If you travel out of state, phone appointments and video visits may not be available due to state laws that may prevent doctors from providing care across state lines. Laws differ by state. To have a video visit, members must be registered on kp.org and have a camera-equipped computer or mobile device. Applicable cost shares will apply for services or items ordered during an e-visit.
4 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.
Out-of-Network Providers1
Any licensed provider or physician in the country
You already have access to the high-quality care at Kaiser Permanente through your traditional in-network coverage—but as a KP Plus member, you get even more. Choose to see any licensed provider outside of the Kaiser Permanente care delivery system, any time, for up to 10 physician visits or covered outpatient medical services each year. You also have up to 5 fills or refills within any licensed out-of-network pharmacy each year.
- You’ll get 10 services with out-of-network providers that you can use for an office visit or certain covered outpatient services, including lab tests and imaging, per year. So, if you have a provider you want to keep seeing, you don’t have to switch. Your visits will still be covered, as long as you don’t exceed the annual service limit. Refer to your Evidence of Coverage (EOC) for a list of covered services, when the benefit limits refresh each year, exclusions, and limitations.
- You’ll also have a Kaiser Permanente primary care physician to coordinate your in-network care, who you can choose or change your Kaiser Permanente doctor any time.
- You don’t need a referral or prior authorization to use your out-of-network benefits.
- Your cost share (copay or coinsurance) will generally be higher for services received out-of-network than for services received in-network.
- Your out-of-network benefits are not subject to a deductible, and these services do not apply to your annual out-of-pocket maximum.
- You can save on service limits and out-of-pocket costs by having an out-of-network provider order prescriptions, labs and radiology performed at Kaiser Permanente locations.
- Emergency care. Emergency services are covered as an in-network benefit at any emergency room.
- Pharmacy services. Learn about your pharmacy services. Learn about your pharmacy benefits with the out-of-network option.
How Are the 10 Services Counted?
- Out-of-network services include covered physician visits or medical services that are received out-of-network.
- Here is a list of key services/items that count as a service covered under the out-of-network benefit:
- Routine office visits, including primary, preventive, and specialty care, as well as mental health and substance use disorder visits
- Each diagnostic lab test and imaging counts toward your service limit
- Physical, occupational, and speech therapy office visits
- Allergy injections received at an office
- Multiple services in the same office setting on the same day may count as multiple services and will accrue towards the annual 10 service limit.
- For example, if you see an out-of-network provider (one service) and they order 2 lab tests done in their office (one service for each test), this will count as 3 services.
Where can KP Plus members find out how many out-of-network visits or medical services they have left?
- Login to kp.org and navigate to the Benefits section where you will find a benefit summary showing the services that are covered in-network vs. out-of-network, cost shares, and how many provider visits or outpatient medical services you have used to date.
- You can also call Customer Service at 1-800-788-0710 (TTY 711), Monday through Friday, 7 a.m. to 7 p.m. Pacific time.
What’s Not Covered with the Out-of-Network Benefit:
- Inpatient services
- Outpatient surgery
- Advanced imaging (MRI, CT and PET)
- Dental care
- Refer to your Evidence of Coverage (EOC) for details on other excluded benefits.
- Services not covered under your plan will not be covered under the out-of-network benefit.
To find out more about what is covered under the out-of-network benefit:
- Refer to your Evidence of Coverage (EOC) or contact the human resources/benefits officer where you work for your copy of your EOC.
- Call Customer Service at 1-800-788-0710 (TTY 711), Monday through Friday, 7 a.m. to 7 p.m., Pacific time, or refer to your ID card.
This site provides an overview of your benefits and services. If there are any differences between this website and your Evidence of Coverage (EOC), your EOC will prevail.
1 In your plan documents such as your EOC, out-of-network providers may also be referred to as “Non-Plan Providers.”