Forms and publications

Find information on services and features related to your plan, including coverage information, service 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, how to get emergency care, and more.

Emergency care information
Completion of covered services
Students
Visiting members
How providers are paid


Directories

Find directories and more to help you make the most of your plan.

Medicare provider directories

2024

Temporary facility closures and changes

We're gradually reopening facilities that were temporarily closed due to the coronavirus/COVID-19 pandemic. We have safety measures in place, including requiring masks at all Kaiser Permanente locations.

See updates about your local facilities in Northern California.

See updates about your local facilities in Southern California.


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.


Member resource guide

The Member Resource Guide provides information on how to get care, your rights and responsibilities, guide for members with disabilities, and policies and procedures. The Guide is available for viewing or downloading here. If you would like to request a hard copy, please call the Member Service Contact Center at 1-800-464-4000.

Member Resource Guide:


Preventive services


Help in your language

Learn about our interpreter services.

Interpreter services, including sign language, are available during all hours of operation at no cost to you. We can also provide you, your family, and friends with any special assistance needed to access our facilities and services. In addition, you may request health plan materials translated in your language, and may also request these materials in large text or in other formats to accommodate your needs. For more information, call our Member Service Contact Center 24 hours a day, seven days a week (except closed holidays, and closed after 5 p.m. the day after Thanksgiving, after 5 p.m. on Christmas Eve, and after 5 p.m. on New Year's Eve) at 1-800-464-4000 (TTY users call 711).

以您的語言提供協助
我們在辦公時間內免費為您提供口譯服務，包括手語在內。我們也可以向您本人、您的家人和朋友提供使用我們設施和服務所需的任何特別協助。此外，您可以要求將會員資料翻譯成您的語言，並且要求這些資料以大字版或其他格式來滿足您的需求。如需更多資訊，請致電我們的會員服務電話中心，我們每週7天，每天24小時為您服務（節假日全天以及感恩節翌日、聖誕節前夕和新年前夕下午 5 時後休息），電話號碼是
1-800-757-7585（免費電話）（TTY使用者請撥711）。

Ayuda en su idioma
Se ofrecen servicios de intérprete sin costo alguno para usted durante todo el horario de atención, incluida la lengua de señas (sign language). También podemos ofrecerles a usted y a sus familiares y amigos todo tipo de ayuda especial que necesiten para tener acceso a nuestros centros y servicios. Además, puede solicitar que los materiales del plan de salud se traduzcan a su idioma, y que estos materiales sean con letra grande o en otros formatos que se acomoden a sus necesidades. Para obtener más información llame a la Central de Llamadas de Servicio a los Miembros las 24 horas del día, los siete días de la semana (excepto los días festivos y después de las 5 p. m. el día después de Thanksgiving [Día de Acción de Gracias], y las vísperas de Navidad y Año Nuevo) al 1-800-788-0616 (usuarios de TTY llamen al 711).
 


Authorization information and forms

Advance directives
Forms for Kaiser Permanente's addiction medicine department
Confidential communication request form

Note: Print, fill out, sign and mail the Confidential Communication Form to the address shown on the bottom of the form.

Confidential communication revocation form
Disclosure authorization
Statement of authorized representative (AOR)
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). Available in Spanish (PDF) | Chinese (PDF)


Prescription information and forms

Patients can submit a request online for their pharmacy records. 

Notes:

  • A $15 processing fee applies.
  • Requests may be fulfilled electronically using a secure portal if an email address is provided. Records will not be faxed.
  • Pharmacy records will include all prescriptions dispensed from Southern California pharmacies.
     


Grievance forms


California rate review forms

Under California law, Kaiser Permanente is required to post information about recent rate changes we have made for our Individual and Family and Group customers.

Our rate filing descriptions are available below.

For help in any language, please call the phone number on your membership card.

Individual and Family Plans
Large Group Plans
Small Group Plans



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