Forms and publications

Diabetic supplies are covered under your health plan at $0 copayment/coinsurance and are not subject to your deductible.

Covered under the Medical benefit:

• Continuous glucose monitors (Dexcom CCM and FreeStyle Libre), when clinical guidelines are met and when obtained from sources designated by your health plan
  

Covered under the Prescription drug benefit:
The following diabetic supplies, when obtained at health plan pharmacies or from sources designated by your health plan:

• Acetone test tablets
• Disposable syringes and needles for the administration of insulin
• Glucose monitors
• Glucose monitoring supplies (glucose test strips, calibration solution and lancets)
• Nitrate screening test strips for pediatric patient home use

• Emergency and urgent care away from home (PDF)
• Getting care away from home (PDF)

The provider directory for CHP+ members directory is updated monthly:

• Denver/Boulder CHP+ plan provider directory (PDF)
• Denver/Boulder CHP+ plan evidence of coverage (PDF)
• Denver/Boulder CHP+ Formulary (PDF)
• Denver/Boulder CHP+ plan new member guidebook (English) (PDF)
• Denver/Boulder CHP+ plan new member guidebook (Spanish) (PDF)
   

• Kaiser Permanente ambulatory surgery center (KASC) patient rights (English) (PDF)
• Kaiser Permanente ambulatory surgery center (KASC) patient rights (Spanish) (PDF)

• View our Preventive Services page to learn more

• Out-of-area benefit flyer (PDF)

• Nondiscrimination notice and help in your language (PDF)

At Kaiser Permanente, we make it easy to manage your health care costs. Depending on your health plan and the care you receive, your costs may vary. We’re here to help with any questions. Simply contact Member Services.

• Common Health Care Costs (PDF)

• Advance directives
  

• Authorization to disclose health information (Chinese) (PDF)
• Authorization to disclose health information (English) (PDF)
• Authorization to disclose health information (Spanish) (PDF)

Options to request these records:

• Download, complete, and email the Authorization to disclose health information (above) to KPCOReleaseofInfo@kp.org
• Fax the completed form to 303-404-4750
• Mail the completed form to:

Northfield Support Services
Attn: Release of Information
11000 E. 45th Avenue
Denver, CO 80239-3004

If you have any questions, please call our Release of Information office at 303-404-4700.

• Request for an accounting of disclosures of protected health information (English) (PDF)
• Request for an accounting of disclosures of protected health information (Spanish) (PDF)
• Request for an amendment of protected health information (English) (PDF)
• Request for an amendment of protected health information (Spanish) (PDF)

• Find out how Kaiser Permanente shares important medical information
  
  Learn how Kaiser Permanente shares important medical information as part of Health Information Exchange.
  
  At Kaiser Permanente, knowing your medical history, such as your active medications and allergies, is critical to help ensure that you receive high-quality care. Advancements in technology support safe and secure electronic exchange of important clinical information from one health care provider to another, through Health Information Exchange (HIE) networks.
  
  Kaiser Permanente operates an HIE network among its regions and participates in several HIE networks with trusted outside health care providers who have electronic medical record systems.
  
  HIE participants like Kaiser Permanente are required to comply with specific federal and state laws that protect the privacy and security of your health and personal information. For example, we cannot share sensitive health information, including psychotherapy notes and records of substance abuse, through the HIE without first obtaining your written authorization.
  
  Under the Health Insurance Portability and Accountability Act (HIPAA), Kaiser Permanente can legally share your health information with your other care providers for the purposes of treatment and care coordination. It is important for your care providers to have timely access to this information so that they have a complete picture of your medical history, reducing the likelihood of conflicting diagnoses, prescriptions, and treatment plans as well as repeated tests or procedures.
  
  For more information, visit the HIE Frequently Asked Questions (FAQ) document available below or contact the Member or Customer Services number on the back of your ID card with any questions.
  
  
• Frequently asked questions about Health Information Exchange (PDF)

• Member Relations Authorization of Representation (PDF)
• Medicare AOR (English) (PDF)
• Medicare AOR (Spanish) (PDF)
• Medicare AOR Large Print (English) (PDF)
• Medicare AOR Large Print (Spanish) (PDF)