Understanding Your Plan and Benefits
In addition to the care included in our traditional HMO plan, Kaiser Permanente offers the HMO Flex benefit to eligible members, subject to their employer’s contract. The HMO Flex benefit provides coverage for primary care office visits to non-Kaiser Permanente providers.
You and your covered dependents can see the following types of licensed providers statewide and on the U.S. mainland*: General Practice, Family Medicine, Internal Medicine, Obstetrics and Gynecology, Pediatrics, Behavioral Health (Mental Health and Chemical Dependency providers).
Kaiser Permanente providers and facilities
Benefits inside the Kaiser Permanente HMO
- Lowest out-of-pocket costs. With the Kaiser Permanente HMO, you’ll usually pay the least out of pocket deductible.
- Coordinated care. Your primary care physician works closely with specialists, pharmacists, lab technicians, therapists, and many other professionals. And because they are all connected through your electronic medical record, everyone in the network gets up-to-the-minute information on your health for a better care experience.
- Referrals. You can self refer to certain specialty providers without a PCP referral.
- State-of-the-art medical centers. Kaiser Permanente’s State-of-The Art Medical Facilities are located throughout the region, with doctors, specialists, imaging, and in most locations, pharmacy and lab, all in one place.
- Emergency care. You are covered for emergency care worldwide. The emergency care copay will be waived if you are directly admitted to a hospital as a result of an emergency.
- Urgent Care. 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. 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.
- 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.
- Medical advice. When you call for medical advice, you will be connected with a professional who can help advise you and make an appointment with one of our providers. You can get advice by calling the appointment number on the back of your ID card 24/7.
- Lab services. Your results from tests done in Kaiser Permanente medical centers can be read (for most results) online soon after the lab completes your tests, sometimes the same day.
- 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).
- Choose from telehealth options that fit into your schedule. Chat with a Kaiser Permanente doctor, email, or schedule a phone or video visit. Be aware that costs may apply for some visits.**
- Manage your health online. Use the convenient features of kp.org to manage your health.***
- Email your doctor’s office
- View most test results
- Schedule or cancel routine appointments
- Refill most prescriptions
- View past visits
- Find care options and Urgent Care locations near you
- Register at kp.org/registernow
- Select your region
- Your username and password can also be used on our mobile app
To find out more about what is covered under the Kaiser Permanente HMO, see your Evidence of Coverage (EOC) or call Member Services at: 1-800-966-5955 (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.
*If you receive care or services within another Kaiser Permanente service area, our Visiting Member policy applies. Visit kp.org/travel and see our Visiting Member brochure (“Getting care in Kaiser Permanente service areas”) for details.
**Video visits are available for members who receive care at Kaiser Permanente medical centers. You must be 18 or older to schedule a video visit. Check with your doctor’s office to find out if video visits are available to you.
***These features are available when you get care at Kaiser Permanente facilities.
Any other licensed provider
- You already have access to the best of Kaiser Permanente through your traditional HMO—but with the HMO Flex rider, you get even more. Choose to see any licensed provider outside of the integrated Kaiser Permanente HMO any time for certain outpatient services such as routine primary care* office visits, basic lab tests, basic imaging, and prescription drugs.
- You’ll get 10 office visits with non-Kaiser Permanente providers for routine primary care*, including Affordable Care Act (ACA) covered immunizations and contraceptives.
- You’ll get 10 combined basic lab, basic imaging, and testing services.
- You’ll get 10 prescriptions for self-administered drugs that you can fill at a non-Kaiser Permanente pharmacy. Each prescription is limited to a 30-day supply.
- Non-Kaiser Permanente primary care office visits, lab tests, X-rays, and prescriptions all count as separate services. For example, if you see your non-Kaiser Permanente provider and he/she orders a lab test done in his/her office, this will count as one office visit and one lab service.
- You do not need a referral or precertification to use your HMO Flex benefits.
- Your cost share (copayment or coinsurance) will generally be higher than the cost share for these services if you choose to go out-of-network.
- Your out-of-network benefit is not subject to a deductible, and it does not apply to your out-of-pocket maximum.
- Emergency care. ER services are covered at any emergency facility but will always be administered as an in-network covered service with the applicable cost shares applied.
- Pharmacy services. Learn about your pharmacy benefits with non-Kaiser Permanente pharmacies.
What’s Not Covered with the Out-of-Network Benefit:
- Office visits that are not from family practitioners, general practitioners, internists, pediatricians, obstetricians, gynecologists or behavioral health providers
- Inpatient services
- Outpatient surgery
- Chiropractic services
- Dental
- Physical therapy, occupational therapy and speech language pathology
- See your Evidence of Coverage (EOC) for details on other excluded benefits
- Services not covered under your base medical plan will not be covered under the out-of-network benefit
- To find out more about what is covered under the out-of-network benefit, refer to your Evidence of Coverage (EOC)
- Contact the human resources/benefits officer where you work
- 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)
*Primary care is limited to services provided by the following types of physicians: family practice, general practice, internal medicine, pediatrics, obstetrics/gynecology, and behavioral health (mental health and chemical dependency).
This site provides an overview of your benefits and services. If there are any differences between this website and your Evidence of Coverage (EOC), your Evidence of Coverage (EOC) will prevail.