Choosing a group health plan often means balancing your budget with employees’ preferences. Some employees appreciate Kaiser Permanente’s coordinated care, while others hesitate because they have relationships with doctors outside its network.
Kaiser Permanente Plus, also called KP Plus, offers an option worth exploring. It combines access to Kaiser Permanente and affiliated providers with limited benefits for certain out-of-network services.
How does KP Plus work?
Employees can receive care through Kaiser Permanente while having an annual allowance for out-of-network physician visits, outpatient medical services, and prescription fills or refills.
The number of services available varies by plan, region, and group size. This makes reviewing the specific coverage important before deciding whether it fits your workforce.
KP Plus is available to eligible small and large businesses in Kaiser Permanente service areas, including California. Members must live or work within the applicable service area.
Who might appreciate this option?
Consider an employee who likes Kaiser Permanente’s approach but wants occasional visits with an established outside physician. Another employee might value limited access to non-Kaiser providers while traveling within the United States.
KP Plus may offer flexibility for these situations. However, it is not unlimited out-of-network coverage, and it should not be evaluated as though it were a traditional PPO.
Understand how the limits apply
One appointment does not necessarily equal one visit toward the annual allowance. An outside specialist appointment that includes laboratory work and an X-ray may count as three services.
Once members exceed their annual out-of-network limits, they must pay for additional outside services themselves. They still retain access to covered in-network care.
Each covered family member receives their own applicable allowance. Members can check remaining benefits through kp.org or by calling the number on their ID card.
Review billing and service restrictions
Out-of-network providers may require payment upfront, leaving employees to request reimbursement. Members may also owe charges above the amount the plan covers.
Although referrals and prior authorization are not required for the plan’s out-of-network benefits, some services must be provided through Kaiser Permanente or affiliated providers. These include inpatient care, outpatient surgery, maternity, and prenatal care, according to the FAQ.
KP Plus is also not HSA-compatible, an important consideration when designing your benefits package.
Let’s compare your group plan choices
The right coverage depends on your employees, budget, and priorities. Contact Bay Area Health Insurance for more information on group plans. We can explain KP Plus, review its limitations, and help you compare available options for your business.
