HMO with HMO Flex
How to Access Covered Care
Choose your doctor and change any time.
Getting in-depth information on how your plan works and getting connected with a provider who suits your individual needs is the first priority. Choose from a wide range of great providers or stay with your current provider. And remember—you can change at any time. Your plan provides you with that flexibility.
Here’s an overview of getting care with HMO with HMO Flex:
Kaiser Permanente HMO
Many ways to access care through Kaiser Permanente
- Your care in the Kaiser Permanente HMO starts with your own personal doctor—your primary care physician—who will coordinate your care. You choose your own doctor and you can change your doctor at any time.
- Most specialist visits require a referral, but your primary care physician will typically handle this for you.
- You can manage your care at kp.org. Visit anytime from anywhere to make an appointment, refill most prescriptions, see most lab results, and much more.
- You could also have a video or telephone visit with a doctor at no extra cost.
- There are several urgent care centers available to you on Maui and Hawaii Island that have contracted with Kaiser Permanente after our Kaiser Permanente facilities are closed.
Call any licensed primary care provider’s office directly
- Your out-of-network benefit covers care you receive from any licensed primary care provider (who’s not a Kaiser Permanente provider) for a set number of covered outpatient medical services each year.
- No precertification or referrals are required to use the out-of-network benefit.
- You will generally pay a higher copay to see your non-Kaiser Permanente provider. You may also pay a higher coinsurance for procedures performed in the provider’s office (such as drugs administered during an office visit) than if you were seeing an in-network provider.
- You will pay a copay or coinsurance to see your non-Plan Provider. If you pay a copay, you may also pay coinsurance for services performed in the provider’s office. You may be asked to pay the full cost of the visit upfront and you will need to submit itemized bills and receipts for reimbursement.
Helpful Tips
- When making an appointment. Make sure the provider understands that your plan allows you to see any licensed primary care provider for certain covered outpatient services as long as you don’t exceed the annual visit limit.
- When checking in for your visit. Bring your ID card and the HMO Flex flyer with you. If your provider has any questions, have them call the member services phone number on the back of your ID card.
- After your visit. When you receive services from a non-Kaiser Permanente provider, your provider may file a claim for you. If your provider does not agree to file a claim for you, you will need to submit claim forms and itemized bills for reimbursement.
You’ll generally pay the most out-of-pocket when you receive services from a non-Kaiser Permanente provider.
To make the most of your visits:
- To make the most of your non-Kaiser Permanente visits, you may want to save them for office visits with your favorite non-Kaiser Permanente provider. You can do this by using Kaiser Permanente for labs, X-rays, and other procedures. That way, they’re covered by your HMO in-network benefit, rather than your out-of-network benefit.
To find out more:
- Refer to your Evidence of Coverage (EOC).
- Contact the human resources/benefits officer where you work, if your employer provides your coverage.
- Refer to your ID card or call Member Services, Monday through Friday, 8 a.m. to 5 p.m., Saturday, 8 a.m. to 12 p.m. HST at 1-800-966-5955 (TTY 711).
- Download the KP app for iOS or Android
This product is underwritten by Kaiser Foundation Health Plan, Inc. (KFHP).