KP Plus plans provide access to high-quality care from Kaiser Permanente and affiliated providers, plus the option to see out-of-network providers for up to 10 physician visits/medical services, and 5 prescription fills per year. And monthly rates and out-of-pocket expenses are generally lower for employers and employees when compared to a typical PPO plan.
Care from Kaiser Permanente
Care from Kaiser Permanente includes fixed out-of-pocket costs with set copay amounts for most covered services, 24/7 virtual care, and prescription fills at Kaiser Permanente pharmacies.
Care out-of-network
Care out-of-network includes 10 doctor visits or other medical services and 5 prescription fills per year. KP Plus members don’t need a referral or prior authorization to receive care.
Billing
Providers aren’t obligated to accept Kaiser Permanente reimbursement rates and may bill members for any difference between their billed rate and the maximum allowable charge.
Payment
Providers aren’t obligated to submit a bill for services directly to Kaiser Permanente. If a provider doesn’t submit a bill for services, members must pay for the visit upfront and submit a claim to Kaiser Permanente for reimbursement. Submit claims online or by filling out and mailing a form.
Maximums
Each out-of-network office visit and medical service counts toward the 10-visit maximum. Multiple services in the same office visit may be counted as multiple visits. Each prescription filled at an out-of-network pharmacy counts toward the 5-prescription maximum.
Learn more about KP Plus benefits and costs, then contact your Kaiser Permanente representative about KP Plus plans and other related resources.
Refer to frequently asked questions about KP Plus plans.
