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Footnotes:

1: Dental benefits are underwritten by Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., and administered by LIBERTY Dental Plan. Continue at [1] comprehensive dental plan

2: With a 50% coinsurance. $500 allowance for Kaiser Permanente Medicare Advantage High Plans (HMO-POS) and Liberty Plan (HMO). Continue at [2] annual allowance

3: The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Silver&Fit is a trademark of ASH and used with permission herein. Continue at [3] Silver&Fit® Exercise and Healthy Aging Program

4: Please refer to your Evidence of Coverage for details. OTC benefits may change each year on January 1. Each order must be at least $20. Any unused portion of the quarterly benefit limit will not carry forward to the next quarter. Your order may not exceed your quarterly benefit limit. Limitations and restrictions may apply. Cash, check, credits cards, or money orders are not accepted. Continue at [4] Monday through Friday

5: Hearing aid allowance can only be used for hearing aids purchased at Kaiser Permanente audiology centers. Continue at [5] hearing aid allowance

6: Twenty-four one-way rides per contract year. For nonemergency transportation only. Transportation benefits are not available with the following plans: Kaiser Permanente Medicare Advantage Value Balt (HMO), Kaiser Permanente Medicare Advantage Value MD (HMO), and Kaiser Permanente Medicare Advantage DC (HMO-POS). Continue at [6] rides you have left for the year

7: The ChooseHealthy program is provided by ChooseHealthy, Inc. The Active&Fit Direct program is provided by American Specialty Health Fitness Inc., (ASH Fitness). ChooseHealthy, Inc., and ASH Fitness are subsidiaries of American Specialty Health, Inc. (ASH). Active&Fit Direct and ChooseHealthy are trademarks of ASH and used with permission herein. Please note: The ChooseHealthy program is a discount program; it is not insurance. You can access services from any ChooseHealthy participating provider; referral from a primary care physician is not required. You’re responsible for paying the discounted fee directly to the contracted provider. The ChooseHealthy products and services are provided by entities other than Kaiser Permanente, and Kaiser Permanente disclaims any liability for them. Some Kaiser Permanente members may have coverage through their health plan for some of the same services available through ChooseHealthy. Check your Kaiser Permanente Evidence of Coverage or Membership Agreement for details or call our Member Service Contact Center before accessing the discounted services. If a problem arises with the discounted services, you may take advantage of the Kaiser Permanente grievance process by calling the Member Service Contact Center. The products and services described above are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the Medicare Advantage grievance process. Continue at [7] Special discounts with ChooseHealthy®

8: Not available with Kaiser Permanente Medicare Advantage Care Plus (HMO-POS), Kaiser Permanente Medicare Advantage Value Baltimore (HMO), Kaiser Permanente Medicare Advantage Value MD (HMO), and Kaiser Permanente Medicare Advantage Liberty (HMO) plans. Members are responsible for any charged amounts for covered services that exceed the annual allowance maximum of $1,200. Coverage limited to inside the United States and its territories. See your Evidence of Coverage for details. Continue at [8] plans include Medicare Explorer®

9: If you get care at a MinuteClinic® or Concentra Urgent Care in states without Kaiser Permanente, you’ll be charged your standard copay or coinsurance. If you get urgent care at a MinuteClinic®, Concentra Urgent Care, or any other urgent care facility in a state with Kaiser Permanente providers, you’ll be asked to pay up front for services you receive and will need to file a claim for reimbursement. Continue at [9] hours of operation here

10: When receiving care at a Kaiser Permanente facility. Some prescriptions are not available through the mail-order pharmacy. Continue at [10] most prescriptions delivered to you

11: May vary by plan type. Check your plan benefits for more information. For certain drugs, you can get prescription refills mailed to you through our Kaiser Permanente mail-order pharmacy. You should receive them within 3–5 days. If not, please call 1-800-733-6345. Continue at [11] preferred mail-order pharmacy for $0

Kaiser Permanente is an HMO and HMO-POS plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.

Hearing aid allowance can only be used for hearing aids purchased at Kaiser Permanente audiology centers.

The products and services described above are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the grievance process.

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This page was last updated: January 2, 2024 at 12 a.m. PT