KP Plus plans provide access to high-quality care from Kaiser Permanente and affiliated providers, plus the option to see out-of-network providers for a set number of physician visits or medical services and 12 prescription fills or refills per year. Monthly rates are generally lower for employers and employees when compared to a typical PPO plan.
Care from Kaiser Permanente includes fixed out-of-pocket costs, 24/7 virtual care, and prescription fills and refills at Kaiser Permanente pharmacies.
Care out of network includes up to a set number of doctor visits or other medical services and 12 prescription fills or refills per year. KP Plus members don’t need a referral or prior authorization to receive care.
Out-of-network providers aren’t obligated to accept Kaiser Permanente reimbursement rates and may bill members for any difference between their billed rate and the maximum allowable charge.
Out-of-network providers aren’t obligated to submit a bill for services directly to Kaiser Permanente. If a provider doesn’t submit a bill for services, members must pay for the visit upfront and submit a claim to Kaiser Permanente for reimbursement. Members can submit claims online or by filling out and mailing a form.
Each out-of-network office visit and medical service counts toward the maximum number of visits. Multiple services in the same office visit may be counted as multiple visits. Each prescription filled or refilled at an out-of-network pharmacy counts toward the 12-prescription maximum.
For more information, contact your Kaiser Permanente representative or explore the resources below.
