Documents and Forms

Links to important forms and documents:

Member Resources:

Network Access Plan

HMO Colorado Access Plan

HMO KP Select Access Plan

Provider Directories

HMO In-Network Tier: You have access to any Kaiser Permanente provider, affiliated hospital, or pharmacy, all within the integrated delivery system. To find a provider, visit kp.org

Non-participating Provider Network Tier: Through the Non-Participating Provider Tier, you can work directly with any licensed provider or facility anywhere. No referral is needed for office visits to Non-Participating Providers or specialists.

Your Rights and Protection Against Surprise Medical Bills

Formularies

HMO Drug Formulary

KPIC Colorado POS and PPO Formulary

KPIC Colorado POS and PPO Formulary en espanol

Prior Approval forms

Medical: Permanente Advantage Pre-Certification Form

Pharmacy: Pharmacy Prior Authorization Request Form (KPIC MRF)

MedImpact Standard Commercial Guidelines

Oncology Step Regulation PA Guidelines

Claim forms

Medical: Choice Products Medical Claim Form

Pharmacy: Drug Reimbursement Form

Other documents and forms

Point-of-Service (POS) New Member Guidebook

Member Care Transition Form

Information for Physicians POS Plan