The Plus Benefit gives you more choices. You can continue to see your favorite non-Plan Provider while still getting all the benefits of the Kaiser Permanente Network.
Kaiser Permanente Network:
Fully coordinated, high-quality care, lowest cost of the two options.
- In this option, choose physicians, specialists, and some affiliated providers.
- Kaiser Permanente Providers are connected to your electronic health record, so they’re up-to-date on your care.
- Lowest out-of-pocket costs compared to the non-Plan Provider option.
- Most medical offices across the region offer many services conveniently under one roof, including pharmacy, imaging, lab, primary care physicians and specialists, and urgent care services.
- Your primary care physician coordinates your care. When you need specialty care, you and your doctor will find the specialist right for you and coordinate the referral.
- No claims paperwork is required.
Keep seeing your favorite non-Plan Provider:
- You can receive care from any licensed care provider in the U.S., up to a set number of visits or covered outpatient medical services each year.
- If you have a provider you love, you don’t have to switch. Your visits will still be covered, as long as you don’t exceed the annual visit limit.
You can use your visits for these types of items/services under the Plus Benefit:
- Routine office visits, including primary, preventive and specialty care, as well as mental health and chemical dependency visits
- Diagnostic lab tests, diagnostic X-rays, and selected articles of durable medical equipment provided during the office visit (each test, piece of equipment, and diagnostic X-ray counts separately toward your limit)
- Physical, occupational, and speech therapy office visits
- Allergy injections received at an office
What’s the cost?:
- 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 plan, costs under the Plus Benefit may not be subject to your deductible and may not apply to your out-of-pocket maximum for the year.
What’s Not Covered with the Plus Benefit:
- Inpatient services
- Outpatient surgery
- Prenatal and maternity care
- Chiropractic services
- Genetic testing
- See your Evidence of Coverage (EOC) for details on other excluded benefits.
- Services not covered under your base medical plan will not be covered under the Plus benefit.
View Kaiser Permanente’s Sample Coverage Documents:
FOR future members – To view our SAMPLE plan documents, click here and choose the line of business and state from the dropdown menu and review items to assist in your plan choice.
FOR current members – The sample documents may vary from your actual benefits. To view a copy of your specific plan documents, please log into kp.org or contact Customer Service at:
- 1-855-364-3184 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Mountain time.
- Keep your doctor. The Plus Benefit allows you to keep your favorite non-Plan Provider, while still getting all the great benefits of Kaiser Permanente.
- Pharmacy services. Prescriptions from non-Plan Providers are covered at all Kaiser Permanente and network pharmacies if you have the Plus Benefit. If your Plus Benefit includes out-of-network pharmacy, you have the additional option of filling prescriptions at pharmacies outside of the Kaiser Permanente network.
Check here for more about pharmacy services, finding doctors and facilities, and the benefits of Choice Products.
Is the Plus Benefit right for you?
Here are some examples of how people use the Plus Benefit to get the care they want:
For employers, Choice Products are a great all-in-one solution:
- Give your valuable employees full choice in their providers and allow them to determine and manage their health care costs.
- Having more options gives your valued employees what they need to be healthier and more productive every day.
- The versatility and benefits of Choice Products can help attract and retain employees.
- Your company has the convenience of one health care provider for all your employee benefits administration.
How the Choice Products plan works for your company and employees.
With Choice Products, you can offer your participating employees two options when they receive care:
- Kaiser Permanente Network: Members can receive in-network care from Kaiser Permanente’s highly rated integrated healthcare delivery system through our Kaiser Permanente Providers practicing exclusively at our medical offices. This option provides the most coordinated care with the lowest out-of-pocket costs, with no or lower deductible. Preventive care is at no cost. Members can also use kp.org and our mobile app to schedule certain appointments, email their doctors, view lab results, and refill prescriptions online.
- Out-of-Network (Plus Benefit): Members can receive services from any licensed provider or facility they choose outside those included in the Kaiser Permanente Network. Members pay deductibles (depending on member’s traditional plan), coinsurance, and any difference between the cost of the service and payment provided. So out-of-pocket costs are generally the highest with this option.
- Learn more about what’s included in the Kaiser Permanente Network and Out-of-Network (Plus Benefit), and how they work.
- Choice Products also includes: preventive care, coverage from providers not in the Kaiser Permanente network, and customized case management services for serious, complicated, or high-cost illnesses.
Employers’ frequently asked questions
What are the pharmacy choices under Choice Products?
Members have several choices for having their prescriptions filled.
- Most Kaiser Permanente medical offices have on-site pharmacies. Members can fill prescriptions written by providers in the Kaiser Permanente Network and from non-Plan Providers at pharmacies located in Kaiser Permanente medical offices.
- Members can also choose to receive prescriptions by mail at Kaiser Permanente medical offices.*
- Learn more about pharmacy services.
How are new members on-boarded?
- Onboarding includes: Comprehensive New Member Welcome handbooks, an onboarding call from Customer Service agents, and a help line for any questions, from accessing care to transferring prescriptions.
Who do we contact for product pricing or to purchase Choice Products?
Contact Kaiser Permanente at any time through our Business Plans contact page.
Who processes claims?
The plans that underwrite Kaiser Permanente Network and Out-of-Network, process the claims.
*Kaiser Foundation Health Plan (KFHP) of Colorado, Inc., underwrites the Kaiser Permanente Network Tier and the Plus Benefit. For more information, see your Evidence of Coverage (EOC).
*A program operated or arranged by health plan that distributes prescription drugs to members via mail. Some medications are not eligible for the Mail Service Delivery Program. These may include, but are not limited to, drugs that are time or temperature sensitive, drugs that cannot legally be sent by U.S. mail, and drugs that require professional administration or observation. We cannot deliver to an address outside the state of Colorado.