Kaiser Permanente

Kaiser Permanente

2024 EPO

You and your family receive preventive care services at little or no cost and have access to online features that let you manage most of your care.

Your benefits include:

  • Your choice of doctor for each family member for routine medical care
  • Simple copays or coinsurance for most covered services, including office visits and prescription drugs
  • Little or no cost for preventive care like routine physical exams, mammograms, and cholesterol screenings
  • Little to no paperwork or bills for the services you receive
  • No referrals needed for certain specialties, like optometry and routine obstetrics/gynecology
  • Telehealth options that provides convenient access to safe and high-quality virtual care
  • Mental well-being support for anxiety, stress, sleep and more with the help of self-care, evidence based, free apps, including as Calm, Ginger and myStrength. 

Kaiser coverage, care, and locations

 

Availability

Kaiser Permanente offers health care for participants and their families in California, Colorado, Georgia, the Mid-Atlantic (Maryland, Virginia, and Washington, D.C.), Northwest, and Washington.

Urgent care

You and your eligible family members can get urgent care anywhere in the world. If you think you need urgent care, call Kaiser’s Urgent Care or advice nurse phone number, which you can find on kp.org.

And outside Kaiser Permanente service areas, you’ll pay only a copay or coinsurance at the following locations —  no need to file a claim later1:

In 2024

  • The Little Clinics (TLC)
  • MinuteClinic®
  • Concentra

Emergency care

Members can go to the nearest hospital anywhere in the world and file a claim with Kaiser for reimbursement. If it’s a Kaiser Permanente network location, you’ll pay only normal copay or coinsurance — no need to file a claim later2.

Kaiser Permanente can also help you and your eligible family members before you travel. Just call their 24/7 Away from Home Travel Line at 951-268-3900 or visit kp.org/travel. For Washington: Please call Member Services at 888-901-4636. Monday through Friday, 8 am to 5 pm local time, except major holidays.

Medical plans

Summaries of Benefits and Coverage

View the Kaiser Permanente Summaries of Benefits and Coverage (SBC) for the available plans.

Kaiser exclusive provider organization (EPO) plan

Kaiser $2,500 high-deductible health plan (HDHP)

Contact us

2024

Visit Kaiser Permanente

Call 877-356-5092  

 

 

 

  1. 2024 coverage:
    • Urgent care received in a Kaiser Service Area from a non-network provider or emergency department isn’t covered.
    • Follow-up care from a non-network urgent care provider isn’t covered, except prior-authorized durable medical equipment related to urgent care you received outside the Kaiser Service Area.
  2. 2024 coverage:

    Post-stabilization care received from a non–network provider, including inpatient care at a non–network hospital, is covered until:

    • Your attending emergency physician determines you’re able to travel using non-medical/non-emergency medical transportation.
    • There is an available network facility within a reasonable distance considering your medical condition; you have access to/can pay for the non-medical transportation.

To request prior authorization to receive post-stabilization care from a non–network provider, you (or someone on your behalf) must call the number on your Kaiser Permanente ID card before you receive the care if it is reasonably possible to do so (otherwise, call as soon as reasonably possible).

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1For GA, MD, DC and VA: Community Pharmacy $30

2For GA, MD, DC and VA: Community Pharmacy $30

3For CO: Mandated Coverage for children up to 18 years

   For GA: Pediatric hearing aids are mandated for children up to age 19, one hearing aid per ear when medically necessary every 48 months up to $3000     per ear

4For WA: Covered as part of base benefit (mandated);
   Must match Primary OV cost share (regional standard)

5For WA: 20 visits (regional standard)

6For CO and GA: Community Pharmacy 30% coinsurance after deductible

7For WA: Covered as part of the base plan.
   Plan coinsurance after deductible (regional standard)

8For WA: 20 visits

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Information contained within benefits.tihinsurance.com applies to eligible teammates residing in the United States, unless otherwise specified.

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