How to Access Covered Care
You can choose coordinated care with your Kaiser Permanente physician or call any provider’s office directly. Here’s a quick view of getting care with Added Choice’s three options: 1) Kaiser Permanent’s full-service care delivery system 2) Contracted Providers 3) Any licensed non-Contracted Provider.*
For members who have a POS, Out-of-Area PPO, or PPO plan – For Information about Kaiser Permanente Insurance Company’s (KPIC’s) Network Adequacy Policy, please review our Frequently Asked Questions Documentation
Kaiser Permanente providers
Many ways to access care through Kaiser Permanente providers.
You have many ways to get care when it works for you — online, by phone, or in-person. This includes 24/7 virtual care (by video or phone), no appointment necessary. Plus, there are also other virtual care options available, including scheduled video visits and e-visits, phone appointments and refills for most prescriptions online. Explore Convenient Ways to Get Care at Kaiser Permanente Hawaii facilities.
- Your care in the Kaiser Permanente network 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.
- You can also see some specialists without a referral such as obstetrics/gynecology, optometry, and some kinds of behavioral health.
- 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.
- Kaiser Permanente has urgent care locations on Oahu and Maui. Explore Convenient Ways to Get Care at Kaiser Permanente Hawaii facilities
- There are also several urgent care centers available to you on Maui and Hawaii Island that have contracted with Kaiser Permanente and KPIC after our Kaiser Permanente facilities are closed. With Kaiser Permanente providers, you’ll usually pay lower out-of-pocket costs with no deductible.
With Kaiser Permanente providers, you’ll usually pay the lowest out-of-pocket costs with no deductible.
Contracted providers
Call your contracted provider’s office directly.
- You can call or make an appointment directly with contracted providers.
- You don’t need a referral for appointments with Contracted Providers. Please note that all inpatient care and certain outpatient care and certain outpatient services are subject to precertification.
- At your appointment, show your member ID card. The first time you visit, you will have to let the office staff know you’re using the Point-of-Service (POS) features of your plan.
- To find up-to-date Contracted Providers or confirm if your current provider is part of the Network, you can search for Providers by Location, or call Customer Service at 1-800-238-5742 (TTY 711), Monday through Friday 8a.m. to 5 p.m., Saturday, 8 a.m. to 12 p.m. HST.
In Hawaii: Contracted Providers provide access to care. You have access to more than 3,000 Kaiser Permanente Insurance company (KPIC) contracted providers and more than 160 contracted hospitals and care facilities in Hawaii. ** Be sure to check if your provider is a contracted provider prior to receiving services.
Non-Kaiser Permanente States outside of CA, CO, GA, HI, MD, OR, VA, WA and DC the CignaPPONetwork provides access to care.
*Disclaimer: The Cigna PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as of the Cigna PPO for Shared Administration.
- With contracted providers and Cigna PPO Network providers, you’ll probably have to pay copays, coinsurance and meet a deductible. Please refer to KPIC’s Group Policy and Certificate of Insurance for details about your plan and benefits.
You’ll generally pay more out of pocket when you receive services from contracted providers compared to Kaiser Permanente providers.
Non-contracted provider option
Call any licensed provider’s office directly.
- You can call any non-contracted provider for care or to make an appointment, you can call their office directly.
- You don’t need a referral for appointments with non-contracted specialists. However, you will need precertification for some services and procedures.
- At your appointment, show your member ID card. The first time you visit, you will have to let the office staff know you’re using the POS features of your plan.
- Your doctor may require you to pay the full cost of the visit. If so, you will need to submit claim forms and itemized bills for reimbursement.
- You’ll have to pay coinsurance and meet a deductible. You’ll also be responsible for any difference between what your provider charges for service and the payment KPIC provides.
You’ll generally pay the most out of pocket when you receive services from non-contracted providers and facilities.
It’s important to keep in mind:
- Your cost-shares will vary in each provider option.
- The amount you pay for a particular service will depend on the provider option you choose and—in some cases—where you choose to receive care.
To find out more:
- Your member handbook has details about accessing covered care using the different options.
- Call Customer Service at 1-800-238-5742 (TTY 711), Monday through Friday, 8 a.m. to 5 p.m., Saturday, 8 a.m. to 12 p.m. HST or refer to your ID card.
- Download the KP app for iOS or Android
The terms of your Group Agreement and Evidence of Coverage govern the scope of covered benefits in the Kaiser Permanente provider option. The terms of your KPIC’s Group Policy and Certificate of Insurance govern the scope of covered benefits in the contracted and non-contracted provider options. Certain exclusions and limitations apply.
*Kaiser Foundation Health Plan, Inc. (KFHP) underwrites the Kaiser Permanente provider option. The contracted and non-contracted provider options of this plan are underwritten by Kaiser Permanente Insurance Company (KPIC), a subsidiary of KFHP.