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Kaiser Permanente Plus™ plans

Help employees get more choices for their health care needs

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 up to 10 physician visits or medical services and 5 prescription fills or refills per year. Monthly rates are generally lower for employers and employees when compared to a typical PPO plan.

Flexible options in and out of network

Care from Kaiser Permanente

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

Care out of network includes 10 doctor visits or other medical services and 5 prescription fills or refills per year. KP Plus members don’t need a referral or prior authorization to receive care.

Important information employees need to know

Billing

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.

Payment

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.

Maximums

Each out-of-network office visit and medical service counts toward the 10-visit maximum. 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 5-prescription maximum.

Learn more about KP Plus benefits and costs

For more information, contact your Kaiser Permanente representative or explore the resources below.

Download the Kaiser Permanente Plus Overview

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All plans offered and underwritten by Kaiser Foundation Health Plan of Washington

© 2024 Kaiser Foundation Health Plan of Washington