Understanding Your Plan and Benefits
Kaiser Permanente Added Choice is a point-of-service health plan that gives you and your family the freedom to choose any of the following coverage options each time you seek care: 1) Kaiser Permanent’s full-service care delivery system 2) Contracted Providers and 3) Any licensed non-Contracted Provider.*
Kaiser Permanente provider option
Features and benefits of covered care from Kaiser Permanente providers.
Lowest out-of-pocket costs. With this option, you’ll generally pay a lower out-of-pocket, with no deductible.
Coordinated care. Your Kaiser Permanente primary care physician works closely with specialists, pharmacists, lab technicians, therapists, and many other professionals. And because your Kaiser Permanente care team is all connected through your electronic medical record, they get up-to-the-minute information on your health for a better care experience.
Referrals from your doctor. Your Kaiser Permanente primary care physician can coordinate your referral to a specialist.
State-of-the-art medical centers. Kaiser Permanente’s State-of-The Art Medical Facilities are located throughout the region, with doctors, specialists, labs, imaging, and pharmacy, all in one place in most locations.
Urgent care. There are 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. If you need urgent care in a state without Kaiser Permanente providers, go to the nearest MinuteClinic or urgent care facility. We recommend that you contact your Kaiser Permanente facility or call the 24/7 advice line before you go to an urgent care center.
Lab services. With a kp.org account, you can review most results online from tests done in Kaiser Permanente medical facilities as soon as they’re available, sometimes the same day
Manage your health online. With a kp.org account, you can view most lab results, refill most prescriptions, email your doctor’s office, schedule routine appointments, and more at kp.org.
Medical advice. If you aren’t feeling well and our offices are closed, call our 24/7 advice at no additional cost. Licensed clinicians can provide advice when medically appropriate or direct you to the appropriate place for care. If you believe you’re having a medical or mental health emergency, call 911 or go to the nearest hospital.
No-cost preventive care. With your plan, you pay $0 for preventive care. That includes routine physicals, well-child visits, and certain screenings and tests (such as mammograms).
Emergency care. You are covered for emergency and urgent care from qualified providers worldwide. The emergency care copay will be waived if you are directly admitted to a hospital as a result of an emergency. If you believe you’re having a medical or mental health emergency, call 911 or go to the nearest hospital.
Hospital care. Kaiser Permanente Hawaii’s Moanalua Medical Center is a full-service hospital. Integrated and comprehensive quality care is what sets us apart. Our specially-trained clinicians and state-of-the-art facility provide medical, surgical, perinatal, neonatal, pediatric, and intensive care for acute illness and injury.
Pharmacy services. Learn about your pharmacy benefits.
To find out more about what is covered under the Kaiser Permanente provider option:
- See your Evidence of Coverage (EOC) or your KPIC Certificate of Insurance (COI).
- Contact the benefits officer where you work, if your employer provides your coverage.
- 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.
The terms of your Group Agreement and Evidence of Coverage govern the Kaiser Permanente provider option.
*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.
Contracted provider option
Features and benefits of covered care from contracted providers.
You have access to contracted providers based upon location of services. With Contracted Providers, you don’t have to select a personal doctor. You can see any Contracted Provider without a referral.* 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.
In Non-Kaiser Permanente States (States other than CA, CO, GA, HI, MD, OR, VA, WA, and DC): The CignaPPONetwork* only provides access to care in non-Kaiser Permanente states
*Disclaimer: The Cigna PPO Network refers to providers (doctors, hospitals, specialists) contracted as part of the Cigna PPO for Shared Administration.
Out-of-pocket costs. Although you will generally have higher out-of-pocket costs than under the Kaiser Permanente provider option (such as a deductible, coinsurance, or a copay), providers’ fees are subject to negotiated rates and providers are not allowed to balance bill you for covered services. Your contracted provider generally completes and submits claim forms.
No-cost preventive care. Preventive care services are offered at no charge whether or not you have met the deductible.
Specialty care. You don’t need a referral for specialty appointments with Contracted Providers. Please note that all inpatient care and certain outpatient care and certain outpatient services are subject to precertification.
Behavioral health. You can receive care for mental illness, emotional disorders, and drug or alcohol abuse from Contracted Providers. Please note that all inpatient care and certain outpatient care and certain outpatient services are subject to precertification.
Hospital care. You can receive inpatient hospitalization services from Contracted hospitals and facilities. Your Contracted Provider may make arrangements for your hospital admission. Please note that all inpatient care and certain outpatient care and certain outpatient services are subject to precertification.
Emergency care. All emergency care is covered at the Kaiser Permanente provider option benefit level. If admitted to a non–Kaiser Permanente facility, you or a family member must notify us within 48 hours after care begins (or as soon as reasonably possible) by calling the phone number on the back of your Kaiser Permanente member ID card or your claim for payment may be denied.
Urgent care. You can visit any licensed urgent care facility.
Maternity care. You can choose from any Contracted Provider for your obstetric care. Your copay will be $0 for routine physician office visits while you are pregnant. Be sure to call for precertification during your first trimester.
Lab tests and X-rays. You can contact facilities directly. Check first to be sure the facility is Contracted. You can request your Contracted Provider to send labs, X-rays, and special procedure orders (MRIs, CT scans, PET scans, nuclear medicine), to a Kaiser Permanente facility any time you choose, and you will likely pay less.
Pharmacy services. Learn about your pharmacy benefits.
To find out more about what is covered under the contracted provider option:
- See your Evidence of Coverage (EOC) or your KPIC Certificate of Insurance (COI).
- Contact the benefits officer where you work, if your employer provides your coverage.
- 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.
The terms of your KPIC’s Group Policy and Certificate of Insurance govern the contracted provider option.
Inpatient and certain outpatient services are subject to precertification. Your Contracted Provider in Hawaii must call 1-888-529-1553 (TTY 711), Monday through Friday 6 a.m. to 4.30 p.m. HST for precertification. If using the Cigna PPO Network for care in non-Kaiser Permanente states (outside of CA, CO, GA, HI, MD, OR, VA, WA and DC), the Cigna PPO providers are responsible for obtaining precertification on your behalf when precertification is required. You won’t be financially responsible if a Cigna PPO provider fails to obtain precertification for covered services.
*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.
**Contracted providers, hospitals and care facilities in Hawaii as of 2022.
Non-contracted provider option
Features and benefits of receiving covered care from any licensed provider.
You have access to any licensed provider who is not within the Kaiser Permanente provider option or contracted option. Coverage under the non-contracted provider option is considered pure fee for service indemnity coverage; however, these non-contracted providers have not agreed to negotiated rates.
Out-of-pocket costs. Using the non-contracted provider option generally means higher out-of-pocket costs. Your out-of-pocket costs will generally be the highest when you choose to receive care from a non-contracted provider. Most services are subject to a deductible, then coinsurance. Depending on your non-contracted provider, you may be required to pay the full cost of the service and submit a claim to KPIC for reimbursement. Only covered charges count toward meeting the deductible and out-of-pocket maximum. In addition, non-contracted providers may also bill you for the difference, if any, between actual billed charges and the maximum allowable charge. Charges that exceed the determined maximum allowable charge are not covered charges, do not satisfy the deductible, and do not accumulate to the out-of-pocket maximum.
Behavioral health. You can receive care from any licensed behavioral health or chemical dependency professional for mental illness, emotional disorders, and drug or alcohol abuse. Please note that all inpatient care and certain outpatient services are subject to precertification.
Hospital care. You can receive inpatient hospitalization services from licensed or accredited hospitals and facilities not in the Kaiser Permanente provider option or the contracted provider option. Please note that all inpatient care and certain outpatient services are subject to precertification.
Emergency care. All emergency care is covered at the Kaiser Permanente provider option benefit level.
Urgent care. You can visit any licensed urgent care facility.
Maternity care. You can choose any licensed provider for obstetric care.
Lab tests and X-rays. You can receive lab, X-ray, and other imaging services at any facility.
Pharmacy services. Learn about your pharmacy benefits.
To find out more about what is covered under the non-contracted provider option:
- See your Added Choice member handbook or your KPIC Certificate of Insurance (COI).
- Contact the benefits officer where you work, if your employer provides your coverage.
- 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.
The terms of KPIC’s Group Policy and Certificate of Insurance govern the non-contracted provider option.
Inpatient and certain outpatient services are subject to precertification. You must call 1-888-529-1553 (TTY 711), Monday through Friday 6 a.m. to 4:30 p.m. HST for precertification.
*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.