How to Access Covered Care
Choose your doctor and change any time.
Getting in-depth information on how your plan works and getting connected with a provider who suits your individual needs is the first priority. Choose from a wide range of great providers or stay with your current provider. And, remember—you can change at any time. Your plan provides you with that flexibility.
Here’s an overview of getting care with Choice Products. There are two options to choose from with the Plus plan: Kaiser Permanente Network or Out-of-Network (Plus Benefit).
Kaiser Permanente Network
Many ways to access care through Kaiser Permanente.
- Your care in the Kaiser Permanente Network starts with your own personal doctor—your primary care physician—who will coordinate your care. You choose your own doctor and you can change your doctor at any time.
- You can also see most specialists without a referral.
- You can manage your care at kp.org. Visit anytime from anywhere to make an appointment, refill most prescriptions, see most lab results, and much more.
- You could also have a video or telephone visit with a doctor at no extra cost.
- Urgent care is available at select Kaiser Permanente medical offices.
Out-of-Network (Plus Benefit)
Call any licensed provider’s office directly.
- Your Plus Benefit covers care you receive from any licensed provider (who’s not in the Kaiser Permanente Network) for up to a set number of visits or covered outpatient medical services each year.
- No prior authorization or referrals are required to use the Plus Benefit.
- You will pay a copay or coinsurance to see your non-Plan Provider. If you pay a copay, you may also pay coinsurance for procedures performed in the provider’s office. You are responsible for any amount billed that is above the allowed amount for a given service. You may be asked to pay the full cost of the visit upfront and you will need to submit itemized bills and receipts for reimbursement.
Helpful Tips
- When making an appointment. Make sure the provider understands that your plan allows you to see any licensed provider (who is not in the Kaiser Permanente Network) for certain covered outpatient services as long as you don’t exceed the annual visit limit.
- When checking in for your visit. Bring your ID card with you. If your provider has any questions, have them call the customer service phone number on the back of your ID card.
- After your visit. When you receive services from a non-Plan Provider, you will submit a claim and will be responsible for paying the difference.
You’ll generally pay the most out-of-pocket when you receive services from a non-Plan Provider or facility.
To make the most of your Plus visits:
- To make the most of your Plus visits, you may want to save them for office visits with your favorite non-Plan Provider. You can do this by using the Kaiser Permanente network for labs, diagnostic X-rays, and other procedures. That way, they’re covered by your traditional plan benefit, rather than Plus. We can send results to your non-Plan Provider.
To find out more:
- Refer to your Evidence of Coverage (EOC).
- Contact the human resources/benefits officer where you work, if your employer provides your coverage.
- Refer to your ID card or call Customer Service, Monday through Friday, 8 a.m. to 6 p.m., Mountain time at 1-855-364-3184 (TTY 711).
*The Kaiser Permanente Network is underwritten by Kaiser Permanente Foundation Health Plan of Colorado, Inc. (KFHP). Kaiser Foundation Health Plan of Colorado, Inc. underwrites the Plus Benefit.