Explanation of Benefits are not a bill. They are a summary of services you’ve received. It shows the charges, the date of your visit, and the name of the provider you visited. Use them to:
Be sure to save your EOBs in case you need to validate a claim or for income tax purposes.
HMO Plan Kaiser Foundation Health Plan of Washington (KFHPWA)- Washington only (PDF)
HMO Plan (Kaiser Permanente)- California only (PDF)
If the total costs you have paid for covered services—including copays, deductible, and coinsurance—add up to the out-of-pocket maximum then the plan will pay 100% of the costs for most covered services for the remainder of the year.
You have full access to a broad network of Kaiser Permanente and affiliate providers. For most specialities you can obtain a referral from your primary care physician by email, phone, video, or during an in-person visit. Emergency care is covered worldwide and is always considered in network.
Out of network coverage is generally not included in your plan expect for emergencies and for urgent care when away from home. You are fully covered for emergency care and urgent care worldwide.
Kaiser Permanente combines care and coverage — which makes us different than your other health care options.
Your doctors, hospitals, and health plan work together to make exceptional health care easy to get. That means you’ll have peace of mind knowing care for your total health is there when and where you need it — from your doctor’s office to your living room.
We’re known for catching problems early with preventive care. But if your health needs serious attention, our world-class specialty care has you covered.
In 2020, Kaiser Permanente led the nation as the top performer in 34 effectiveness-of-care measures. The closest national competitor led in only 17.*
The measures include:
*Kaiser Permanente 2020 HEDIS® scores. Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compass® and represent all lines of business. Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality. The source for data contained in this publication is Quality Compass 2020 and is used with the permission of NCQA. Quality Compass 2020 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass® and HEDIS® are registered trademarks of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality.
Choose the right doctor
Start by browsing our online doctor profiles to find a doctor who’s right for you. You can search doctors accepting new patients by gender, location, and languages spoken – and view their photos, education, and credentials.
You can also choose a personal doctor with any of these specialties:
Each covered family member may choose his or her own personal doctor. And if you want to change to another Kaiser Permanente doctor at any time, for any reason, it’s easy to choose a new doctor online or by phone.
Visit kp.org/locations to search for providers and locations.
If you select the Kaiser HMO option during annual enrollment, we’ll be here to help you each step of the way.
Before you enroll
If you enroll in the Kaiser HMO option, you'll need to receive all nonemergency services from Kaiser Permanente doctors, facilities, and affiliated providers as described in the Kaiser Permanente coverage documents when your coverage becomes effective. Except in certain circumstances when continuity of care requirements apply, you may not be able to access routine or ongoing care from your current providers.
If you have questions about how to transition any current courses of care you may be receiving, please call us at 1-800-204-6561 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m. Pacific.
After you enroll
After you enroll and before your membership begins, our dedicated health care transition and onboarding team will contact you to help you:
When your membership begins
We’ll guide you through each step, so you get the care you need without missing a beat. Visit kp.org/newmember to get started on the path to great health.
Kaiser Permanente’s fully integrated pharmacy has the unique ability to keep drug costs low — all while maintaining the safety, efficacy, and outcomes that define our organization.
Clinician-driven formulary
Our doctors and pharmacists select, test, and approve every medication on our formulary, from cost-saving generics to specialty drugs for chronic conditions.
Medication adherence programs
With a shared electronic health record, it’s easier and faster to monitor medication compliance, provide counseling, and stay up to date on prescribing practices.
Convenient prescription services
Whether it’s at a Kaiser Permanente pharmacy, retail location, or straight to their front door, your employees have many ways to order their prescriptions.
Kaiser HMO formulary
A formulary is a list of drugs covered by your health plan. Your doctor and other providers use the formulary to help them choose the safest, most effective drugs for you. Find out what drugs are covered in your area by visiting kp.org/formulary, selecting your area and choosing the California Commercial formulary (3-Tier). Or click below.1
Northern California Formulary (pdf)
Southern California Formulary (pdf)
1. Formularies are regularly updated.
If you get hurt or sick while traveling, you’re covered for emergency and urgent care anywhere in the world.
Outside of Kaiser Permanente States, members can get urgent and emergency care through Cigna’s PPO Network* providers and urgent care at various MinuteClinic (in select CVS and Target stores), Concentra urgent care centers.**
We can also help you before you leave town by checking to see if you need a vaccination, refilling eligible prescriptions, and more.
Just call us or go online:
24/7 Away from Home Travel Line: 951-268-3900***
*The Cigna PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna PPO for Shared Administration.
The Cigna PPO Network is not available to HMO and EPO members enrolled in coverage issued by Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc.
Cigna is an independent company and not affiliated with Kaiser Foundation Health Plan, Inc., and its subsidiary health plans. Access to the Cigna PPO Network is available through Cigna's contractual relationship with the Kaiser Permanente health plans. The Cigna PPO Network is provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
**Cigna, MinuteClinic, and Concentra coverage varies by plan
***This number can be dialed inside and outside the United States. Before the phone number, dial “001” for landlines and “+1” for mobile lines if you’re outside the United States. Long-distance charges may apply, and we can’t accept collect calls. The phone line is closed on major holidays (New Year’s Day, Easter, Memorial Day, July Fourth, Labor Day, Thanksgiving, and Christmas). It closes early the day before a holiday at 10 p.m. Pacific time (PT), and it reopens the day after a holiday at 4 a.m. PT.
Your doctor will build a care plan based on your needs and work with your care team to deliver high-quality, personalized care.
Get care in your language — with multilingual doctors and phone interpretation in more than 150 languages.
We've helped deliver millions of COVID-19 vaccines to our members, communities and underserved areas. Visit kp.org/covidvaccine to search vaccine appointments.
You have flexible options to get care beyond the doctor’s office — and you can manage your care anytime with the Kaiser Permanente app or at kp.org
Video or phone appointment
Schedule a no-cost, video visit or phone appointment with a Kaiser Permanente care team and any specialists you’ve been referred to.
Appointments
Schedule or cancel routine appointments.1
24/7 advice
Get on-demand support with 24/7 care advice by phone at no cost to you.
Prescription delivery
Fill most prescriptions for home delivery or same-day pickup.
E-visit
Use our online symptom checker for certain conditions and get personalized care advice within a few hours, all at no cost to you.
Message your Kaiser Permanente doctor’s office with nonurgent questions at no cost to you, and get a reply usually within 2 business days.
Visit kp.org/getcare to learn more.
1. Available when you get care from Kaiser Permanente facilities.
Your thoughts and feelings affect your overall well-being.
Personalized support
Get help for a wide range of conditions, like anxiety, depression, substance use disorder, and autism spectrum disorders.
Specialized care teams
Find care with psychiatrists, psychologists, marriage and family therapists, and more.
No referrals needed
Make an appointment for therapy within Kaiser Permanente without a referral.
Learn more at kp.org/mentalhealth
Acupuncture, massage therapy, chiropractic care
Enjoy reduced rates on services to help you stay healthy
Reduced rates on gym memberships
Stay active by joining a local fitness center, plus enjoy thousands of digital workout videos.
Healthy lifestyle programs
Connect to better health with online programs to help you lose weight, quit smoking, reduce stress, and more.
Wellness coaching
Get help reaching your health goals by working one-on-one with a wellness coach by phone.
1. These services aren't covered under your health plan benefits and aren't subject to the terms set forth in your Evidence of Coverage or other plan documents. These services may be discontinued at any time without notice.
The Ginger app offers 1-on-1 support for many common challenges - like anxiety, stress, low mood, relationship issues, and more. Adult members can use the app for 90 days a year at no cost.
What can you do with Ginger?
Text with a coach anytime, anywhere, 24/7 for 90 days
Discuss goals, share challenges and create an action plan with your coach
Get personalized, interactive skill-building tools from a library of more than 200 activities
View recaps from each texting session, track progress and work with your coach to adjust your action plan as needed
*Sarah Kunkle et al., “Association Between Care Utilization and Anxiety Outcomes in an On-Demand Mental Health System: Retrospective Observational Study,” Journal of Medical Internet Research, January 2021. This service isn’t covered under your health plan benefits and isn’t subject to the terms set forth in your Evidence of Coverage or other plan documents. It may be discontinued at any time without notice.
Sign in or register at kp.org or scroll down to contact member services for your area:
California
Call 24 hours a day, 7 days a week (closed holidays)
1-800-464-4000 (TTY 711)
Washington
Monday through Friday, 8 a.m. to 5 p.m. Pacific Time (closed holidays)
1-888-901-4636 (TTY 711)
Choosing a health plan is a big decision — so we’re here to answer any of your questions.Call 1-800-324-9208 (TTY 711), Monday through Friday, 7 a.m. to 6 p.m. Pacific time. Or chat live with one of our online advisors.
Questions for the Microsoft Human Resources team, employees can email askhr@microsoft.com
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