Kaiser Permanete Medical Plan Benefits

Preventive care includes covered well-adult and well-child physicals, immunizations, flu shots and appropriate preventive screening tests like mammograms, colonoscopies, and prostate exams. Covered eligible in-network preventive care is paid in full by the Trust — with no deductibles, co-insurance or co-pays. In some cases, if you already have a diagnosed medical condition, these types of services may be considered diagnostic rather than preventive and subject to annual deductible, copays, and coinsurance.

With Kaiser Online Visit, plan participants can receive quick online care for many common conditions, a treatment plan and, if needed, a prescription — without a trip to the doctor’s office.

You may use an online visit for the following common conditions:

You may start an online visit anytime. You will get a treatment plan in your message inbox when you submit the questionnaire during these hours: 9 a.m. – 9 p.m., 7 days a week, including holidays. If you submit a questionnaire outside of the above hours, you will get a response near the start of the next session. Responses are sent in the order received.

Sometimes it’s not convenient, or even possible, to talk to your doctor when you need information or answers to your questions. It’s nice to know that, even in the middle of the night or on weekends, you can call the 24-hour Nurse Line to talk with a registered nurse about health concerns, and get guidance on next steps, and whether to use home treatments or visit your doctor, urgent care, or the ER.

If you receive care at Kaiser Permanente Medical Centers, the Consulting Nurse Service staff has access to portions of your medical history and prescriptions, so they can better advise you on what is best for your personal situation.

The Nurse Line is available 24/7, confidential and provided at no cost to you. Call (800) 297-6877.

A nurse can help you:

Kaiser Permanente’s Behavioral Health Services pre-authorizes and coordinates non-emergency mental health and chemical dependency care. You do not need a referral from your personal physician to get these services and you can call if you have:

Call (888) 287-2680 or search “Behavioral Health Services” on the Kaiser Permanente website.

Kaiser Permanente’s Case Management is a free service to help you access the medical care and services you need, and that are most appropriate for you. Case Managers help you stay informed about specific diseases and specific care settings and ensure that you receive access to timely, appropriate medical care.

Case Management teams are made up of trained nurses and other certified health care specialists. Case Managers help with trauma, emergencies, and the following chronic conditions:

Your Case Manager will coordinate access to care, assess chronic conditions, monitor your progress, assist with discharge planning and follow-up, and help ensure you are using your benefits effectively. Most importantly your Case Manager will be there to support you and your entire family through a potentially difficult time.

Complex Case Management, a service targeting recently discharged patients with significant needs, is available to you if you have complex conditions such as diabetes, depression, or conditions that are more severe than the ones mentioned above.

Case Management is a voluntary program. If you or a covered family member is facing a complex medical condition that may require inpatient, outpatient or at-home care you may be eligible. Call Kaiser Permanente at (866) 656-4183 to find out more.

Precertification is the process of determining if services, equipment or supplies are medically necessary and will be covered by your Plan prior to your obtaining them. This process protects you from unexpected costs. With precertification you will have the assurance that the services you receive are medically necessary and eligible to be covered by the Plan prior to incurring the expense.