Forms and publications

Find information on services and features related to your plan, including coverage information, physician directories, member guidebooks, and authorization of care forms for you or a loved one.


On this page:


Coverage information

Here, you'll find helpful documents related to your plan coverage, such as what to do if you need care while you're traveling, language interpretation services, formulary (covered drugs), student out-of-area benefits, and more.

Getting care
Drug formulary
Creditable coverage
Clinical review

Coverage provided by Kaiser Foundation Health Plan of the Northwest (Oregon and Southwest Washington).

Kaiser Permanente Clinical Review Criteria are developed to assist in administering plan benefits. These criteria neither offer medical advice nor guarantee coverage. For information concerning whether a specific service or benefit is covered, please refer to your Evidence of Coverage, or call Kaiser Permanente Member Services at 503-813-2000 or toll-free at 1-800-813-2000. Kaiser Permanente reserves the exclusive right to modify, revoke, suspend or change any or all of these review criteria, at Kaiser Permanente’s sole discretion, at any time.

By viewing these criteria, you acknowledge that you understand and accept the following:

  • These Kaiser Permanente Clinical Review Criteria are technical and written to assist medical personnel in making coverage determinations. They are not medical advice, nor are they intended to influence the practitioner or alter his/her duty in any way to exercise his/her independent professional judgment in the care of members.
  • The Kaiser Permanente Clinical Review Criteria are developed to identify eligibility for coverage when the patient's coverage contract includes the service/device.
  • It should not be assumed that a patient meeting the criteria has coverage for the service/device. Please check the patient's coverage contract for specific exclusions or limitations.
  • The criteria developed for use by Kaiser Permanente are based on the best available clinical evidence and regionally or nationally accepted standards.
  • All Kaiser Permanente Clinical Review Criteria are reviewed annually. However, they are regularly updated and subject to change without notice. Service requests for a member are reviewed using the most current criteria.
  • Kaiser Permanente has included the results of reviews conducted by the Kaiser Permanente Inter-regional New Technology Committee and the Regional Formulary & Therapeutics Committee. These committees, using evidence-based standards, review new technologies and treatments for medical efficacy. By including these reviews on this site, you will find that not all services are covered, and therefore some do not have approved criteria.
  • Members and practitioners have the right to appeal coverage decisions. If the Kaiser Permanente medical director or his/her designee determines that a service is not covered, a notice will be issued to both the member and the practitioner. In addition to outlining the rationale for the denial, the notice will contain instructions for appealing the decision.

 

PDFs below are available to detail the review process and procedures:

A

B

C

D

E

F

G

H

I

K

M

N

O

P

R

S

N

T


Directories

These directories can help you manage your coverage with Kaiser Permanente. See your Evidence of Coverage for the name of your plan. Each directory is different, so please make sure you use the correct directories for the network associated with your plan.

Oregon Commercial networks (Group and Individual Fully Insured Plans)

Washington Commercial networks (Group and Individual Fully Insured Plans)

Classic (Traditional, Deductible/High Deductible, KP Plus)
Classic Complete (Traditional, Deductible/High Deductible with pediatric dental, KP Plus with pediatric dental, WA Conversion Traditional/Deductible with pediatric dental)
Classic + Dental Choice (Traditional, Deductible/High Deductible with pediatric dental, KP Plus with pediatric dental)
Added Choice (Added Choice POS)
Added Choice + Dental Choice (Added Choice POS with pediatric dental)
PPO Plus (PPO Plus, PPO Plus HSA)
PPO Plus + Dental Choice (PPO Plus with pediatric dental)
Dental (Non-PPO Dental)
Dental Choice (PPO Dental)
Dual Choice (Dual Choice, Dual Choice HSA)


Summary of benefits and coverage

Summary of benefits and coverage (SBC) documents summarize important information about health coverage options in a standard format developed by Health and Human Services. SBCs allow you to check plan benefits and coverage. You can also easily compare Kaiser Permanente plan benefits and coverage with other carriers.


Evidence of coverage

In our effort to assist you in making an informed decision, we are providing plan documents where you can review further details of our plans.


Authorization information and forms

Advance directives
Authorizations
Health information exchange (HIE)
  • 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.


Claim submissions

Visit Billing to submit a claim online.

You may also download and complete a Claim Reimbursement Form (PDF).


Financial assistance forms

 


Member services forms


Prescription information and forms


Request for confidential communications forms

Under Oregon and Washington laws you have the right to submit a Request for Confidential Communications asking Kaiser Permanente to send any communications containing your personal health information to you alone, and not to the insurance subscriber that pays for your health insurance. For example, you can request that explanation of benefits (EOB), notices of adverse benefit determinations, and other visit information only be sent to you.

There are four ways to request confidential communications:

  1. Complete and sign a Confidential Communications Request form, and send it to Attn:
    Membership Administration, 500 NE Multnomah St., Floor 4, Portland, OR 97232.
  2. Complete and sign a Confidential Communications Request form, and Fax it to 855-524-5257.
  3. Complete and sign a Confidential Communications Request form, and email it to NW.Membership.Administration@kp.org.
  4. Contact Member Services at 503-813-2000 and ask for the form.
Note: If you need guidance on how to request or release your medical records, please visit our Records, Forms, & Authorizations page for release of medical information.

For Oregon Residents:
Oregon request for confidential communications (PDF)

For Washington Residents:
Washington request for confidential communications (PDF)

Or:
WA Office of the Insurance Commissioner (OIC) Confidentiality Request Form (PDF)



Related links


1The Medical Directory lists primary care and specialty care participating providers; includes addresses, maps, and telephone numbers for participating medical offices and other participating facilities; and provides general information about getting care at Kaiser Permanente. After you enroll, you will receive a flyer that explains how you may either download an electronic copy of the Medical Directory or request that the Medical Directory be mailed to you.

2Provides information about which physicians are available as part of the Kaiser Permanente dental network.

3Provides information about physicians who are available as part of the Kaiser Permanente network.

4Provides information about physicians who are available to Kaiser Permanente members outside of the traditional provider network.

5Provides information about which physicians are available to Kaiser Permanente members with alternative care needs.

6Provides information about all Kaiser Permanente facilities and explains what makes our approach to your dental care unique.

7Provides Information about which dentists are available as part of the Kaiser Permanente network.

8Provides information about Kaiser Permanente facilities, what makes our Added Choice program and approach to your care unique.

© 2019 Kaiser Permanente