Plus Plan
Understanding Your Plan and Benefits
Choice Products empower you to make the best health care choice for you—wherever you are, and whenever you need care. You can choose which provider to use each time you receive care.
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).
You can also view a short video on the features of our Plus plan by clicking here.
Kaiser Permanente Providers and contracted hospitals
Benefits inside the Kaiser Permanente Network
- Lowest out-of-pocket costs. With this option, you’ll usually pay the least in out-of-pocket expenses.
- Coordinated care. Your primary care physician works closely with specialists, pharmacists, lab technicians, therapists, and many other professionals. And because they are all connected through your electronic medical record, everyone in the network gets up-to-the-minute information on your health for a better care experience.
- Referrals. You can self refer to certain specialty providers without a PCP referral.
- State-of-the-art medical offices. Kaiser Permanente’s state-of-the-art medical offices are located throughout the region, with doctors, specialists, imaging, and in most locations, pharmacy and lab, all in one place.
- Emergency care. You are covered for emergency care worldwide. The emergency care copay will be waived if you are directly admitted to a hospital as a result of an emergency.
- Urgent care. Urgent care is available at Kaiser Permanente medical centers. To find doctors, locations and urgent care facilities, please click here.
- Hospital care. Kaiser Permanente carefully selects hospitals to partner with us in taking great care of you.*
- Medical advice. When you call for medical advice you will be connected with a professional that can help advise and make appointments with one of our providers. You can get advice by calling the number on the back of your ID Card. 24/7.
- Lab services. Your results from tests done in Kaiser Permanente medical offices can be read (for most results) online soon after the lab completes your tests, sometimes the same day.
- No-cost preventive care. With your plan, you pay $0 for preventive care. That includes routine physicals, well-child visits, and certain screenings and tests (such as mammograms).
- Choose from telehealth options that fit into your schedule. Chat with a Kaiser Permanente doctor, email, or schedule a phone or video visit. Be aware that costs may apply for some visits.**
- Manage your health online. Use the convenient features of kp.org to find manage your health.**
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- Email you doctor’s office
- View most test results
- Schedule or cancel routine appointments
- Refill most prescriptions
- View past visits
- Find care options and urgent care locations near you
- Register at kp.org/registernow
- Select your region
- Your user name and password can also be used on our mobile app
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To find out more about what is covered under the Kaiser Permanente Network, see your Evidence of Coverage (EOC) or call Customer Service at 1-855-364-3184 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Mountain time.
*These contracted hospitals are independently owned and operated and are not affiliated entities of Kaiser Permanente.
**Video visits are available for members who receive care at Kaiser Permanente medical offices. You must be 18 or older to schedule a video visit. Check with your doctor’s office to find out if video visits are available to you.
Out-of-Network (Plus Benefit)
Any other licensed provider
Plus Benefits outside the Kaiser Permanente Network
- You already have access to the best of Kaiser Permanente through your traditional plan—but as a Plus member, you get even more. With Plus, choose to see any licensed provider not associated with Kaiser Permanente, any time, up to a set number of visits or covered outpatient medical services each year—and depending on your plan, you may also have some coverage when you fill your prescriptions at out-of-network pharmacies.
- You’ll get a set number of visits to see a doctor who isn’t associated with Kaiser Permanente (we refer to them as non-Plan Providers) for certain covered outpatient services. So, if you have a provider you love, you do not have to switch. Your visits will still be covered, as long as you don’t exceed the annual visit limit.
- Out-of-network lab tests, diagnostic radiology, select durable medical equipment (DME), allergy injections, physical, occupational, and speech therapy visits all count as separate Plus visits. For example, if you see your non-Plan provider and he/she orders a lab test done in his/her office, this will count as two Plus visits.
- Here is a list of key services/items that count as a visit covered under the Plus benefit:
- Routine office visits, including primary, preventive and specialty care, as well a mental health and chemical dependency visits
- Diagnostic lab tests, diagnostic X-rays, and selected articles of durable medical equipment (walking boot, sling) count separately toward your visit limit
- Physical, occupational, and speech therapy office visits
- Allergy injections received at an office
- Your cost share (copayment or coinsurance) may be the same as, or similar to, the cost share for these services in your traditional plan.
- Depending on your traditional plan, your Plus Benefit may be subject to a deductible, and may apply to your out-of-pocket maximum.
- Consider having prescriptions, labs and diagnostic radiology performed at Kaiser Permanente to save on visit limits.
- Pharmacy services. Learn about your pharmacy benefits in the out-of-network option.
What’s Not Covered with Plus Benefit:
- Inpatient services
- Outpatient surgery
- Radiation therapy
- Screening colonoscopies
- Infertility
- Prenatal and maternity care
- Chiropractic, acupuncture, or massage services
- Genetic testing
- Contact lens fitting
- Dental care
- Special procedures
- Many other medical benefits that are not described as covered under the Plus benefit
To find out more about what is covered under the Plus Benefit:
- 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 at 1-855-364-3184 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Mountain time.
This site provides an overview of your benefits and services. If there are any differences between this document and your Evidence of Coverage (EOC), your Evidence of Coverage (EOC) will prevail.