Understanding Your Plan and Benefits
KP Plus plans combine the benefits of convenient, coordinated care from Kaiser Permanente providers with the flexibility to see out of network providers.
Here’s an overview of getting care with KP Plus. There are two options to choose from with your plan: Kaiser Permanente’s care delivery system (in-network) and any other licensed provider in the country (out-of-network).
In-Network Providers1
Kaiser Permanente providers and facilities in Oregon and SW Washington
Benefits of using the Kaiser Permanente care delivery system
- Lowest out-of-pocket costs. With Kaiser Permanente providers in Oregon and SW Washington, you’ll usually pay the lowest out-of-pocket costs for office visits, prescriptions, and other services.
- Coordinated care. Your Kaiser Permanente provider 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 Kaiser Permanente care delivery system gets up-to-the-minute information on your health for a better care experience.
- Convenient medical offices. Kaiser Permanente’s medical offices are located throughout Oregon and Southwest Washington with doctors, pharmacy, lab and X-rays usually all under one roof.
- Emergency care.2 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. You have access to 24/7 urgent care at three Kaiser Permanente locations, plus a network of affiliated urgent care centers. For advice and locations, call the number on your ID card.
- Medical advice. Registered nurses can give you self-care instructions or help you decide how to get care, find a convenient location, and/or schedule an appointment, 24/7. Just call the number on your ID Card or visit kp.org/getcare.
- Lab services. See your results from most tests done in Kaiser Permanente medical offices online as soon as they’re ready, sometimes the same day.
- No-cost preventive care. With your insurance plan, you pay $0 for preventive care. That includes routine physicals, well-child services, and certain screenings and tests (such as mammograms).
- Care from home. Choose from telehealth options that fit into your schedule. Chat online with a Kaiser Permanente doctor, email your doctor, complete an e-visit, or schedule a phone or video visit.3
- Manage your health online. Use the convenient features of kp.org to manage your health. 4
- Email your doctor’s office
- View most test results
- Schedule or cancel routine appointments
- Refill most prescriptions
Register at kp.org/registernow
- Select your region
- Your username and password can also be used on our mobile app
To find out more about what is covered with Kaiser Permanente providers in Oregon and SW Washington see your Explanation of Coverage (EOC) or call Customer Service at 1-866-616-0047 (TTY 711), Monday through Friday, 8a.m. to 6 p.m. Pacific time.
1 In your plan documents such as your EOC, in-network providers may also be referred to as “In-Plan Providers.”
2 In an emergency — a condition that requires immediate attention to prevent serious jeopardy to your health — call 911 or go to the nearest hospital emergency room. If you’re admitted to a non-Kaiser Permanente hospital, we ask that you or the hospital contact us within 24 hours of admission to enable the coordination of your care.
3 When appropriate and available. These features are available when you get care at Kaiser Permanente facilities. For high deductible health plan members, phone and video appointments are subject to your plan’s annual deductible. If you travel out of state, phone appointments and video visits may not be available due to state laws that may prevent doctors from providing care across state lines. Laws differ by state. To have a video visit, members must be registered on kp.org and have a camera-equipped computer or mobile device. Applicable cost shares will apply for services or items ordered during an e-visit.
4 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 Providers1
Any other licensed provider or physician in the country
You already have access to the best of Kaiser Permanente through your traditional in-network coverage—but as a KP Plus member, you get even more. Choose to see any licensed provider outside of the Kaiser Permanente care delivery system, any time, for up to 10 physician visits or covered outpatient medical services each year. You also have 5 fills within any licensed out-of-network pharmacy each contract year.
- You’ll get 10 services with out-of-network providers that you can use for an office visit or certain covered outpatient services, including lab tests and imaging, per contract year. So, if you have a provider you want to keep seeing, you don’t have to switch. Your visits will still be covered, as long as you don’t exceed the annual service limit.
- You’ll also have a Kaiser Permanente primary care physician to coordinate your in-network care, who you can choose or change any time.
- You don’t need a referral or prior authorization to use your out-of-network benefits.
- Your cost share (copay or coinsurance) will be higher for services received out-of-network than for services received in-network.
- Your out-of-network benefit is not subject to a deductible, and it does not apply to your out-of-pocket maximum.
- You can save on service limits and out-of-pocket costs by having prescriptions, labs and radiology performed at Kaiser Permanente locations.
- You may be responsible for the amount you are billed above the maximum allowable charge by your plan.
- Emergency care. ER services are covered as an in-network benefit at any emergency facility.
- Pharmacy services. Learn about your pharmacy services. Learn about your pharmacy benefits with the out-of-network option.
How Are the 10 Services Counted?
- Out-of-network services include covered physician visits or medical services that are received out-of-network.
- Here is a list of key services/items that count as a service covered under the out-of-network benefit:
- Routine office visits, including primary, preventive, and specialty care, as well as mental health and substance use disorder visits
- Each diagnostic lab test and imaging counts toward your service limit
- Physical, occupational, and speech therapy office visits
- Allergy injections received at an office
- Multiple services in the same office setting on the same day may count as multiple services and will accrue towards the annual 10 service limit.
- For example, if you see an out-of-network provider (one service) and they order 2 lab tests done in their office (one service for each test), this will count as 3 services.
Where can Plus members find out how many out-of-network visits or medical services they have left?
- Login to kp.org/benefits where you will find a benefit summary showing the services that are covered in-network vs. out-of-network, cost shares, and how many provider visits or outpatient medical services you have used to date.
- You can also call Customer Service at 1-866-616-0047 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Pacific time.
What’s Not Covered with the Out-of-Network Benefit:
- Inpatient services
- Outpatient surgery
- Maternity care
- Advanced imaging (MRI and CT)
- Dental
- Vision
- See your Evidence of Coverage (EOC) for details on other excluded benefits.
- Services not covered under your plan will not be covered under the out-of-network benefit.
To find out more about what is covered under the out-of-network benefit:
- Refer to your Evidence of Coverage (EOC).
- Contact the human resources/benefits officer where you work, if your employer provides your coverage.
- Call Customer Service at 1-866-616-0047 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Pacific time, or refer to your ID card.
This site provides an overview of your benefits and services. If there are any differences between this website and your Evidence of Coverage (EOC), your Evidence of Coverage (EOC) will prevail.
1 In your plan documents such as your EOC, out-of-network providers may also be referred to as “KP Plus Providers.”