Understanding Your Plan and Benefits
KP Plus plans combine the benefits of convenient, coordinated care from Kaiser Permanente providers with the flexibility to see out-of-network providers.
Here’s an overview of getting care with KP Plus. There are two options to choose from with your plan: Kaiser Permanente’s care delivery system (or in-network) and any other licensed provider in the country (or out-of-network).
In-Network Providers1
Kaiser Permanente providers and facilities in Georgia
Benefits of using the Kaiser Permanente care delivery system
- Lowest out-of-pocket costs. With Kaiser Permanente providers in Georgia, you’ll usually pay the lowest out-of-pocket costs for office visits and prescriptions.
- Coordinated care. Your Kaiser Permanente provider 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 Kaiser Permanente care delivery system gets up-to-the-minute information on your health for a better care experience.
- Convenient medical offices. Kaiser Permanente’s medical offices are located throughout metro Atlanta with doctors, pharmacy, lab and X-rays usually all under one roof.
- Emergency care.2 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. You have access to 24/7 urgent care at three Kaiser Permanente locations, plus a network of affiliated urgent care centers. For advice and locations, call the number on your ID card.
- Medical advice. Registered nurses can give you self-care instructions or help you decide how to get care, find a convenient location, and/or schedule an appointment, 24/7. Just call the number on your ID Card.
- Lab services. See your results from most tests done in Kaiser Permanente medical offices online as soon as they’re ready, sometimes the same day.
- No-cost preventive care. With your insurance plan, you pay $0 for preventive care. That includes routine physicals, well-child visits, and certain screenings and tests (such as mammograms).
- Care from home. Choose from telehealth options that fit into your schedule. Chat online with a Kaiser Permanente doctor, email your doctor, complete an e-visit, or schedule a phone or video visit.
- Manage your health online. Use the convenient features of kp.org to manage your health. 3
- Email your doctor’s office
- View most test results
- Schedule or cancel routine appointments
- Refill most prescriptions
Register at kp.org/register
- Select your region
- Your username and password can also be used on our mobile app
To find out more about what is covered with Kaiser Permanente providers in Georgia, see your Explanation of Coverage (EOC) or call Customer Service at 1-855-364-3185 (TTY 711), Monday through Friday, 8a.m. to 6 p.m. Eastern time.
1 In your plan documents such as your EOC, in-network providers may also be referred to as “In-Plan Providers.”
2 In an emergency — a condition that requires immediate attention to prevent serious jeopardy to your health — call 911 or go to the nearest hospital emergency room. If you’re admitted to a non-Kaiser Permanente hospital, we ask that you or the hospital contact us within 24 hours of admission to enable the coordination of your care.
3 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.
Out-of-Network Providers1
Any other licensed provider or physician in the country
You already have access to the best of Kaiser Permanente through your traditional in-network coverage—but as a KP Plus member, you get even more. Choose to see any licensed provider outside of the Kaiser Permanente care delivery system, any time, for up to 10 physician office visits or covered outpatient medical services each year. You can also have 5 fills within any licensed out-of-network pharmacy each contract year, up to a 30-day supply per fill.
- You’ll get 10 visits with out-of-network providers that you can use for an office visit or certain covered outpatient services, including lab tests and X-rays, per contract year. So, if you have a provider you want to keep seeing, you don’t have to switch. Your visits will still be covered, as long as you don’t exceed the annual visit limit.
- You’ll also have a Kaiser Permanente primary care physician to coordinate your in-network care, who you can choose or change any time.
- You don’t need a referral or prior authorization to use your out-of-network benefits.
- Your cost share (copay or coinsurance) will be higher for services received out-of-network than for services received in-network.
- Your out-of-network benefit is not subject to a deductible, and it does not apply to your out-of-pocket maximum.
- You can save on visit limits and out-of-pocket costs by having prescriptions, labs and radiology performed at Kaiser Permanente locations.
- Emergency care. ER services are covered as an in-network benefit at any emergency facility.
- Pharmacy services. Learn about your pharmacy services. Learn about your pharmacy benefits with the out-of-network option.
How Are the Ten Visits Counted?
- An out-of-network visit is any physician encounter or individual medical service that is received out-of-network.
- Here is a list of key services/items that count as a visit covered under the out-of-network benefit:
- Routine office visits, including primary, preventive, and specialty care, as well as mental health and chemical dependency visits
- Each diagnostic lab test and X-ray count toward your visit limit
- Physical, occupational, and speech therapy office visits
- Allergy injections received at an office
- Multiple services in the same office setting on the same day may count as multiple visits and will accrue towards the annual 10 visit limit.
- For example, if you see an out-of-network provider (one visit) and they order 2 lab tests done in their office (one visit for each test), this will count as 3 visits.
What’s Not Covered with the Out-of-Network Benefit:
- Inpatient services
- Outpatient surgery
- Prenatal and maternity care
- Advanced imaging (MRI and CT)
- Dental
- Vision
- See your Evidence of Coverage (EOC) for details on other excluded benefits.
- Services not covered under your 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, if your employer provides your coverage.
- Call Customer Service at 1-855-364-3185 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Eastern time, or refer to your ID card.
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.
1 In your plan documents such as your EOC, out-of-network providers may also be referred to as “KP Plus Providers.”