Kaiser Permanente Plus™ gives you more choices and flexibility. You can enjoy the benefits of the Kaiser Permanente care delivery system, plus continue to see your favorite out-of-network provider.
Kaiser Permanente Providers in California
Fully coordinated, quality care with the lowest cost of the two options.
You may have to pay the provider directly at the point of service.
- Choose Kaiser Permanente physicians and specialists in California.
- Kaiser Permanente Providers are connected to your electronic health record, so they’re up to date on your care.
- Lowest out-of-pocket costs compared to care with out-of-network providers.
- Most medical facilities offer many services conveniently under one roof, including pharmacy, imaging, lab, and primary care physicians or specialists.
- Your Kaiser Permanente Provider will coordinate your care. You choose your own primary care doctor, and you can change at any time.
- Access quality care from wherever you are. Chat with a Kaiser Permanente clinician online, email your doctor’s office, complete an e-visit, or schedule a phone or video visit.
- No claims paperwork is required.
Keep seeing your favorite out-of-network provider:
- You can receive care from any licensed care provider in the country, up to 10 office visits or covered outpatient medical services each year.
- If you have a provider you’re already familiar with, you don’t have to switch. Your visits will still be covered, as long as you don’t exceed the annual service limit.
- You’ll still also have a Kaiser Permanente primary care physician, who you can choose or change any time, to coordinate your in-network care.
You can use your visits for these types of items/services under the out-of-network benefit:
- Routine office visits, including primary, preventive and specialty care, as well as mental health and chemical dependency services.
- Diagnostic lab tests, X-rays, and special procedures. (Each office service, test, X-ray, and procedure may count separately toward your limit.)
- Physical, occupational, and speech therapy services.
- Allergy injections received at an office.
- Note that emergency care is covered at any emergency department and will always be administered as an in-network covered service with the applicable cost shares applied.*
* 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.
What’s the cost?
- Your cost share (copay or coinsurance) will be higher if you choose to go out-of-network.
- Your costs under the out-of-network benefit are not subject to your deductible (if applicable), and they do not apply to your out-of-pocket maximum for the year.
What’s not covered out-of-network
- Inpatient services
- Outpatient surgery
- Advanced imaging (MRI, CT)
- Non-formulary drugs
- Fertility drugs
- Weight loss drugs, sometimes called “GLP-1 drugs”
- Drugs on Tier 4 in our drug formulary, sometimes called “specialty drugs”
- Anticancer drugs and certain critical adjuncts following a diagnosis of cancer
- Home infusion drugs
- Mail order delivery of prescription drugs
- Dental care
- Refer to your Evidence of Coverage (EOC) for details on other excluded benefits.
- Services not covered under your medical plan will not be covered out-of-network.
- Keep your doctor. The out-of-network benefit allows you to keep your provider if they are out of network, while still being able to access all the great benefits of Kaiser Permanente. You have access to any licensed provider outside of the Kaiser Permanente care delivery system, any time, for up to 10 physician or covered outpatient medical services each year.
- Pharmacy services. Prescriptions from out-of-network providers are covered at all Kaiser Permanente and affiliated pharmacies. You also have the option of filling prescriptions at pharmacies outside of the Kaiser Permanente care delivery system. Members can have 5 fills or refills within any licensed out-of-network pharmacy each year.
- Check here for more about pharmacy services, finding doctors and facilities, and the benefits of KP Plus.
Is KP Plus right for you?
Here are some examples of how people use the out-of-network benefit to get the care they want:
For employers, these plans are a great all-in-one solution:
- Give your employees expanded choice in their providers, while allowing them to get coordinated, convenient Kaiser Permanente care.
- Helps you and your employees manage health care costs.
- Having more options makes it easier for employees to get the care they need to be healthier and more productive.
- The versatility and benefits of KP Plus can help attract and retain employees.
- Your company has the convenience of one health care provider for all your employee benefits administration
How KP Plus plans work for your company and employees.
With KP Plus, you can offer your participating employees two options when they receive care:
- Kaiser Permanente care delivery system: Members can receive in-network care from Kaiser Permanente’s highly rated integrated medical care program. This option provides the most coordinated care with the lowest out-of-pocket costs. Preventive care is at no cost. Members have many telehealth options to get care from home, and can use kp.org and our mobile app to schedule appointments, email their doctor’s office, view lab results, refill most prescriptions, and more. 1
- Out-of-network: Members can receive services from any licensed out-of-network provider or pharmacy in the country. Members generally pay higher cost shares and the difference (if any) between the cost of the service and the amount your plan pays. You have access to any licensed provider outside of the Kaiser Permanente care delivery system, any time, for up to 10 provider or covered outpatient medical services each year. Members can have 5 fills or refills within any licensed out-of-network pharmacy each year.
- Learn more about what’s included in the Kaiser Permanente care delivery system and out-of-network, and how they work.
- KP Plus plans also include: Preventive care, pharmacy services, worldwide coverage, and customized case management services for serious, complicated, or high-cost illnesses.
Employers’ frequently asked questions
What are the pharmacy choices?
Members have several choices for having their prescriptions filled.
- Most Kaiser Permanente medical offices in California have on-site pharmacies. Members can fill prescriptions written by any provider at pharmacies located in Kaiser Permanente California, at the lowest out-of-pocket cost.
- Members can choose to receive prescriptions by mail, with no cost for shipping. 2
- Members also can fill prescriptions at any out-of-network pharmacy up to 5 fills or refills per contract year.
- Learn more about pharmacy services.
How are new members onboarded?
Members receive help getting started through a comprehensive new member welcome program. It includes an insert with their ID Cards, a mailed new member guide, a help line for any questions, and more. We can help members choose a doctor, transition prescriptions, create their online account, and more.
Who do we contact for product pricing or to purchase KP Plus?
Contact Kaiser Permanente at any time through our business plans contact page.
1. 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.
2. A program operated or arranged by a health plan distributes prescription drugs to members via mail. Some medications are not eligible for the Mail Service Delivery Program. These may include, but are not limited to, drugs that are time or temperature sensitive, drugs that cannot legally be sent by U.S. mail, and drugs that require professional administration or observation.