Out-of-Area Plan
Experience care your way. The Choice Out-of-Area plan empowers you to choose how and where you get care.
Quick Documents and Links
Drug Formulary
Claims Forms
- Medical: Choice Products Medical Claim Form
- Pharmacy: Drug Reimbursement Form
Prior Approval and Pre-certification Forms
- Medical: Pre-Certification Request Form (Coming Soon)
- Pharmacy: Pharmacy Prior Authorization Request Form (KPIC MRF)
- Step Therapy: Step Therapy Process
Selected prescription drugs require step therapy. Step therapy is the protocol that requires you to use a particular outpatient prescription drug or sequence of prescription drugs, other than the drug that your provider recommends for your treatment before we provide coverage for the recommended prescription drug. - Oncology Step Regulation PA Guidelines
- Exception Requests for Prior Authorization and Step Therapy
- You or your authorized representative or the prescribing provider may request an exception or a waiver to the Outpatient Prescription Drug Prior Authorization Request and Step Therapy process described above if you are already being treated for a medical condition and currently under medication of a drug subject to prior authorization or step therapy, provided the drug is appropriately prescribed and is considered safe and effective for your condition. To request an exception or waiver to the Outpatient Prescription Drug Prior Authorization or Step Therapy process please call 1-800-788-2949 (Pharmacy Help Desk).
Other Documents and Forms
- Choice Out-of-Area New Member Guidebook (Coming Soon)
- Walgreens Home Delivery Prescription Services (Coming Soon)
- Filling Prescriptions at MedImpact Retail Pharmacies (Coming Soon)
- Permanente Advantage – Pre-certification and Care Management (Coming Soon)
- Member Care Transition Form (Coming Soon)
- Your Rights and Protection Against Surprise Medical Bills
- KPIC Notice of Language Assistance and Non-Discrimination
Understanding Your Plan and Benefits
Learn about the features and benefits of the Choice Out-of-Area plan.
How to Access Covered Care
Learn how to get care with providers.
Finding Doctors and Facilities
You can choose your provider and where to get care.
Pharmacy
Where and how to fill prescriptions.
Pre-certification
An overview of pre-certification and how to obtain it.
Member Support
Where and how to get member support.
Claims
When you need to file a claim and how to submit one to Kaiser Permanente Insurance Company.
Coverage Documents
Need a coverage document?
Documents and Forms
View, download, or print commonly used forms, FAQs, and other documents here.