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