Forms

Permanente Advantage

Resources

Please Note: Permanente Advantage IS NOT AVAILABLE to members who have KP HMO, Medicare (Senior Advantage) or Self-funded products/plans.

Permanente Advantage IS ONLY available to the regions for members in the following regions with the following KPIC product plans:

California (Northern & Southern)

Preferred Provider PPO
“Added Choice” Point-of-Service (POS) (3-tier)
School of Medicine (Self-Funded)

Colorado

2 Tier Point-of-Service (POS)
3 Tier Point-of-Service (POS)
PPO – Preferred Provider
Level Funded (Self-Funded)

Georgia

“Added Choice” Point-of-Service (POS)
“Dual Choice” PPO
“Multi Choice” POS (3-tier)
Out-of-area PPO
AON Hewitt Private Exchange (2-tier) (POS)
Level Funded (Self-Funded)

Hawaii

“Added Choice” POS

Mid-Atlantic States (Maryland, Virginia, and Washington D.C.)

“Added Choice” Point-of-Service (POS) (3-tier)
Out-of-Area PPO
AON Hewitt Private Exchange (2-tier) (POS)

*Kaiser Permanente's Added Choice Plan is underwritten by Kaiser Foundation Health Plan, Inc. (KFHP) and Kaiser Permanente Insurance Company (KPIC). The HMO tier is underwritten by KFHP, and the Out of Network tier is underwritten by KPIC, a subsidiary of KFHP.

**Kaiser Permanente's PPO and Out-of-Area Indemnity Plans are underwritten by KPIC, a subsidiary of KFHP.

To learn about the pre-certification process for routine, urgent and hospital admissions requests, and turnaround times, please visit our Pre-certification Requests link.

Listed below are forms frequently used by Kaiser Permanente Insurance Company (KPIC) members, staff, and representatives for certain requested services. All forms are fillable and downloadable in PDF format.

If you would like further information or have any questions regarding how our plans work and/or our process, please feel free to contact us by phone. Email is ONLY available for submission of pre-certification requests.