Footnotes
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One Pass® is a registered trademark of Optum, Inc. in the U.S. and other jurisdictions and is a voluntary program.
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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.
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When receiving care at a Kaiser Permanente facility. Some prescriptions are not available through the mail-order pharmacy.
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May vary by plan type. Check your plan benefits for more information.
Kaiser Permanente is an HMO and HMO-POS plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.
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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