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2023 Kaiser Permanente Medicare Advantage (HMO)
Reference Guide for Employer Group and Federal Members
Welcome to
Kaiser Permanente
Medicare Advantage
Get started in 3 easy steps
kp.org
H2172_EG_22_132
Greetings
Welcome to Kaiser Permanente Medicare Advantage. We’re glad to be your partner
on this journey, and we look forward to a long and healthy relationship with you.
This reference guide will help you make the most of your Kaiser Permanente Medicare
Advantage membership. It puts important information at your fingertips, including how
Stay in the know with all things
to get care, important phone numbers, and information about Urgent Care centers.
You will also find information about pharmacies and getting care away from home. Kaiser Permanente—check
If you are new to Kaiser Permanente, this reference guide will walk you through the most out kp.org/insider for valuable
important steps to accessing your membership. You can also call the New Member
Activation Desk at 1-855-392-4851 (TTY 711), Monday through Friday, 7 a.m. to 7 p.m. health information, facility
or visit kp.org/newmember to learn more. The sooner you choose a doctor and sign up updates, and member discounts.
for an account on our website, the more you’ll get out of your new health plan.
We encourage you to take a few minutes to read through this brochure and keep it
nearby for quick reference.
If you have any questions about your Kaiser Permanente Medicare Advantage plan, call
us at 1-888-777-5536 (TTY 711). Take advantage of all that life has to offer by being as
healthy as you can be.
Ruth Williams-Brinkley
Regional President, Kaiser Permanente
Your plan is governed by an agreement called an Evidence of Coverage (EOC). In the event of ambiguity or conflict between this reference
guide and the EOC, the EOC shall prevail.
1Important contacts
Services Contact Contact hours
New Member Activation Desk 1-855-392-4851 (TTY 711) Monday through Friday,
Our onboarding agents can help you with 7 a.m. to 7 p.m.
choosing a doctor, registering on kp.org,
transferring your prescriptions, and making your
first doctor’s appointment by phone or video.
Member Services 1-888-777-5536 (TTY 711) 8 a.m. to 8 p.m.,
To ask questions about your benefits and 7 days a week
coverage or to request a copy of your
Evidence of Coverage.
No-cost transportation to medical appointments 1-855-932-5412 24 hours a day,
Kaiser Permanente Medicare Advantage includes To ensure availability, schedule your ride as soon as possible, 7 days a week
24 rides1 for nonurgent medical appointments but no later than 2 hours prior to your appointment. Rides
at Kaiser Permanente medical centers and that are canceled within 3 hours of the scheduled pickup
contracted facilities. time will be deducted from your ride allowance.
You can also call this number to check your ride balance.
Prescription refills by phone 1-800-700-1479 (TTY 711) 24 hours a day,
Follow the instructions to request refills for most 7 days a week
prescriptions.
Twenty-four one-way rides per contract year. For nonemergency transportation only.
1
2Services Contact Contact hours
Centers for Medicare & Medicaid Services 1-800-MEDICARE (1-800-633-4227) 24 hours a day,
(TTY 1-877-486-2048) 7 days a week
Medicare.gov
Social Security 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday,
7 a.m. to 7 p.m.
State Medicaid offices Maryland Monday through Friday,
Maryland Medical Assistance Program/HealthChoice 8 a.m. to 5 p.m.
1-410-767-5800 or 1-800-492-5231 (TTY 1-800-735-2258)
Virginia Monday through Friday,
Virginia Department of Medical Assistance Services 8 a.m. to 5 p.m.
1-804-786-6145 (TTY 1-800-828-1120)
Washington, DC Monday through Friday,
DC Department of Health Medical Assistance Administration 8:15 a.m. to 4:45 p.m.
1-202-442-5955 (TTY 711) (closed on DC holidays)
Maryland Senior Prescription Drug Assistance The State of Maryland provides assistance through SPDAP Monday through Friday,
Program (SPDAP) to Medicare beneficiaries with income below certain levels 8 a.m. to 5 p.m.
who enroll in a Part D prescription drug plan. Subsidies
from the Maryland SPDAP can reduce out-of-pocket Part D
premiums for eligible individuals. Interested individuals can
apply by calling 1-800-551-5995 (TTY 1-800-877-5156).
3State County/City/Area Kaiser Permanente medical facilities
Kaiser Permanente medical facilities Anne Arundel County
Baltimore City
• Annapolis Medical Center
• North Arundel Medical Center
Kaiser Permanente Baltimore Harbor Medical Center
Baltimore County • Lutherville-Timonium Medical Center
Maryland Virginia » This center offers 24/7 Advanced Urgent Care, lab, and radiology
01 Abingdon Medical Center 23 Alexandria Medical Center
• South Baltimore County Medical Center
» This center offers 24/7 Advanced Urgent Care, lab, and radiology
02 Annapolis Medical Center 24 Ashburn Medical Center
• White Marsh Medical Center
03 FUTURE OPENING 25 Burke Medical Center
• Woodlawn Medical Center
Carroll Harford
83
Medical Center in Aspen Hill Charles County FUTURE OPENING: Medical Center in Waldorf
26 Caton Hill Medical Center
Kaiser Permanente Frederick Medical Center
MD Baltimore 12
Frederick County
04 Kaiser Permanente Baltimore 27 Colonial Forge Medical Center 1
Harford County Abingdon Medical Center
Harbor Medical Center
Maryland
28 Fair Oaks Medical Center Frederick 95
Howard County Columbia Gateway Medical Center
5 Bowie Fairwood Medical Center 21
29 Falls Church
Montgomery County • Medical Center
FUTURE OPENING: Medical Center in Aspen Hill
8
40
06 Camp Springs Medical Center 22 Balt. City
30 Fredericksburg » This center offers 24/7 Advanced Urgent Care, lab, and radiology
• Gaithersburg Medical Center 270 70
07 Columbia Gateway 4 695
Medical Center • Kensington Medical Center Howard 17
Medical Center
31 Haymarket Crossroads
• Shady Grove Medical Center
9
7
08 Kaiser Permanente Frederick Medical Center • Silver Spring Medical Center
Montgomery 97 14
Medical Center • Well Friendship Heights by Kaiser Permanente TM
15
295
32 Manassas Medical Center 3
95
09 Gaithersburg Medical Center Prince George’s • Bowie Fairwood Medical Center Loudoun 267 Anne Arundel
24 16
33 Reston Medical Center
County • Camp Springs Medical Center 10
2
10 Kensington Medical Center • Largo Medical Center 33
34 OPENING 2022 » This center offers 24/7 Advanced Urgent Care, lab, and radiology
495
19 20 5
11 Largo Medical Center Springfield Medical Center 50 DC
50
• Marlow Heights Medical Center 35 37 11
12 Lutherville-Timonium (adjacent to• current facility)
West Hyattsville Medical Center 28
36
29
Medical Center 35 Tysons Corner Medical Center
Arlington County Alexandria Medical Center 66 31 Fairfax 23
13
13 Marlow Heights Medical Center City of Fredricksburg Fredericksburg Medical Center 25 6
32 34
Fairfax County • Burke Medical Center Prince George’s
14 North Arundel Medical Center Prince William
15 Shady Grove Medical Center Washington, ••DC
Fair Oaks Medical Center
16 Silver Spring Medical Center
Falls Church Medical Center
36 Kaiser Permanente Capitol
• Reston Medical Center VA 26
18 Calvert
Hill Medical Center
• OPENING 2022: Springfield Medical Center (adjacent to current facility)
Virginia
17 South Baltimore County • Tysons Corner Medical Center
Charles
Medical Center 37 Northwest DC Medical 95
» This center offers 24/7 Advanced Urgent Care, lab, and radiology
18 FUTURE OPENING Office
Loudoun CountyBuilding
Ashburn Medical Center
Stafford Arlington
Medical Center in Waldorf Prince William County • Caton Hill Medical Center 27 County
» This center offers 24/7 Advanced Urgent Care, lab, and radiology
• Haymarket Crossroads Medical Center
• Manassas Medical Center 30
Stafford County Colonial Forge Medical Center City of These centers offer 24/7:
19 Capitol Hill Fredericksburg
• Kaiser Permanente Capitol Hill Medical Center • Advanced Urgent Care
Washington, DC
20 West Hyattsville Medical Center
» This center offers 24/7 Advanced Urgent Care, lab, and radiology
Spotsylvania
• Lab
Northwest DC Northwest DC Medical Office Building • Radiology
21 White Marsh Medical Center
22 Woodlawn Medical Center
Please check kp.org/facilities for the most up-to-date listing of services available at Kaiser Permanente medical centers.
4 Please check kp.org/facilities for the most up-to-date listing of services available at Kaiser Permanente medical centers.Let’s get started
Making the most of your membership takes only 3 easy steps. Ready to go?
Step 1 Step 2 Step 3
Create your online Choose your doctor— Get
account on kp.org and change anytime prescriptions
Also inside
Pharmacy phone numbers...............................................................................................................12
Getting care.......................................................................................................................................13
The right care.....................................................................................................................................14 Need help getting started?
Getting virtual care with Kaiser Permanente..................................................................................18
Healthy extras to improve your mental and physical health........................................................19 Call our New Member Activation
Preventive care...................................................................................................................................21 Desk at 1-855-392-4851 (TTY 711),
Specialty care.....................................................................................................................................22 Monday through Friday, 7 a.m. to
Preventive dental ..............................................................................................................................25 7 p.m.
Wellness for the whole you..............................................................................................................26
Thriving After 60................................................................................................................................27 Our onboarding agents can help
Urgent care.........................................................................................................................................28 you with everything from choosing
Kaiser Permanente Urgent Care locations.....................................................................................29 a doctor to registering on kp.org,
Emergency care.................................................................................................................................30 transferring your prescriptions,
Hospital care......................................................................................................................................31 and making your first doctor’s
Extra Help for Medicare Part D prescription drug plan costs......................................................32 appointment.
Additional services............................................................................................................................33
Care away from home.......................................................................................................................36
Claims..................................................................................................................................................37
Moving and disenrollment................................................................................................................40
5Step 1 Create your online account on kp.org
Start using our secure website, kp.org, to manage your health on your time1
Visit kp.org anytime, from anywhere, to: Caregiver access
• Schedule an appointment to see Caregivers can access certain features of
physicians and providers by video visit.2 kp.org for loved ones who are members
• View most lab results. of Kaiser Permanente. Nonmembers can
• Refill most prescriptions. be caregivers on kp.org as long as they are
• Email your doctor’s office with at least 18 years old and have either:
nonurgent questions. • Permission from you, or
• Schedule and cancel routine • Legal rights to make health care decisions
appointments. on your behalf, or Creating an account is easy
• Print vaccination records for school, • Legal rights to access your health care
sports, and camp. Go to kp.org/newmember from a
information
• Manage a family member’s health care. computer or mobile device and follow
To set up an account, go to kp.org/register the sign-on instructions. You’ll need
• Get a personalized cost estimate. and follow the prompts for caregiver access. your medical record number, which
• Use our Chat with KP feature. you can find on your member ID card.
Next, take a few minutes to complete
the Kaiser Permanente Medicare Total
Health Assessment, which provides us
an overview of your medical history
and allows us to provide the best
care for you.
1
These features are available when you get care at Kaiser Permanente facilities.
If you travel out of state, phone appointments and video visits may not be available due to state laws that may prevent doctors and health care providers from
2
providing care across state lines. Laws differ by state.
6Download the Kaiser
Permanente app
Now you can download the Kaiser
Permanente app1 to your smartphone.
1. From your smartphone, go to your
preferred app site: App StoreSM (iOS)
or Google Play® (Android™).2
2. S
earch for the Kaiser Permanente app,
then download it to your smartphone.
se your kp.org user ID and password to
3. U
activate the app, and you’ll be ready to go.
Digital membership card
Access your membership information
anytime, anywhere, with an electronic
version of your membership card to:
• Check in for appointments.
• Pick up prescriptions. Personalize your kp.org experience:
• Access your family’s membership
information.
Use your member ID card and our new Member Photo
To use your digital membership card, Upload feature to add your digital image to kp.org.
tap the card icon at the bottom of the
Kaiser Permanente app dashboard.
To use the Kaiser Permanente app, you must be a Kaiser Permanente member registered on kp.org.
1
Apple is a trademark of Apple, Inc., registered in the U.S. and other countries. App Store is a service mark of Apple, Inc. Google Play and Android are trademarks
2
of Google, Inc.
7Step 2 Choose your doctor—and change anytime
Select an available Kaiser Permanente doctor and change to another available Kaiser Permanente doctor anytime,
for any reason
Choose the right You can choose a personal doctor Your physician network
Kaiser Permanente doctor with any of these specialties: A physician network is a group of doctors
To help you find a personal doctor (also • Adult medicine/internal medicine and other providers who are contracted to
called a primary care physician) who’s right • Family medicine give health care services to plan members.
for you, you can browse our online doctor Your network includes physicians in the
• Ob-gyn
profiles. There, you’ll see information related Mid-Atlantic Permanente Medical Group,
• Pediatrics/adolescent medicine
to their education, credentials, specialties, P.C., who practice in Kaiser Permanente
(for children up to 18)
and interest areas, as well as whether or not medical centers. You may also choose
they’re accepting new patients. Each covered family member may choose network physicians for primary care and
his or her own personal doctor. If you do not obstetrics-gynecology. Network physicians
Women up to age 75 should choose an
choose a primary care physician or ob-gyn are in private practice in the community
ob-gyn in addition to their primary care
within the first 30 days of enrollment, one and do not practice at Kaiser Permanente
physician.
will be assigned to you. medical centers. You must use network
If the doctor you’d like to select isn’t providers except in emergency or urgent
accepting new patients, you can call us at care situations or for out-of-area renal
1-800-777-7904 (TTY 711) for assistance. dialysis. If you obtain routine care from
out-of-network providers, neither Medicare
nor Kaiser Permanente will be responsible
for the costs.
To access our online provider directory,
visit kp.org/directory. To request a copy
of the provider directory, please call
Member Services at 1-888-777-5536
(TTY 711), 7 days a week, 8 a.m. to 8 p.m.
8Change your doctor anytime
You can choose an available
Kaiser Permanente doctor, by visiting
kp.org/doctor, or you can call us
for assistance at 1-800-777-7904
(TTY 711), 24 hours a day, 7 days a week.
You can change to another available
Choose online
Kaiser Permanente doctor at any time.
Go to kp.org/doctor to browse our
Notification of physician changes doctor profiles and find an available
If your doctor leaves our network or changes doctor who matches your needs. You
office locations, we will mail you a letter can also call 1-800-777-7904 (TTY
explaining the change and when the change 711), 24 hours a day, 7 days a week.
is effective. Typically, another physician will
be named to take your doctor’s patients. Choose by phone
However, if you would like to make your own Call us at 1-888-777-5536 (TTY
selection, you may do so at any time. If your 711), 7 days a week, 8 a.m. to 8 p.m.
physician is just moving to another location,
Once you’ve decided on a doctor,
you may choose to continue seeing him or
her at the new location. we can help you schedule your first
appointment.
9Step 3 Get prescriptions1
We make it easy to get your prescriptions
We have two ways to help you transfer your • The prescription number of the Creating a reminder is easy:
prescriptions from your current pharmacy prescribed medication 1. In the Kaiser Permanente app, go to the
to a Kaiser Permanente pharmacy. pharmacy section.
• Go to kp.org/newmember and follow
Mail Order Pharmacy
2. In the medication list, tap the medication
the steps to complete the online form. Get medications in 3 to 5 days and at no
you want to view.
• Simply choose a Kaiser Permanente cost with Mail Order Pharmacy.2 Register
at kp.org to start using this service, or call 3. U
nder prescription details, toggle on
pharmacy at kp.org/facilities and call us.
1-800-700-1479 (TTY 711), 24 hours a day, “Reminders to Take.”
Remember to contact us before you need
7 days a week. Some prescriptions are
a refill, as it can take 2 or more business
available for same-day delivery for a small Using network pharmacies
days to transfer your prescriptions.
fee; members with eligible prescriptions You may also have access to participating
can select this option at checkout. network pharmacies, including Giant,
Here’s what you’ll need Harris Teeter, Rite Aid, Safeway, Walgreens,
To transfer a prescription, please have the Medication reminder service Walmart, and others. You will not be able
following information ready when you call: to use the Kaiser Permanente Mail Order
Remembering to take medication is
• Your Kaiser Permanente medical important for your health care. Our reminder Pharmacy if you fill your prescriptions using
record number service—offered via the Kaiser Permanente network pharmacies. Check your plan
• The name and telephone number app3,4 —can send you alerts about what document to see if your plan gives you
of your current pharmacy dose of your medications to take and when, access to network pharmacies.
• The name, strength, and directions making it easier for you to keep track. For a list of Kaiser Permanente pharmacies
for use of the prescribed medication and phone numbers, see page 12.
1
ot all Kaiser Permanente Medicare Advantage plans include coverage for outpatient prescription drugs. Please see your Evidence of Coverage for more details.
N
2
For certain drugs, you can get prescription refills mailed to you through our Kaiser Permanente Mail Order Pharmacy. You should receive them within 3-5 days. If not,
please call 1-800-700-1479 (TTY 711), 24 hours a day, 7 days a week. Some medications are not eligible for Mail Order Pharmacy. Mail Order Pharmacy can deliver to
addresses in MD, VA, DC, and certain locations outside the service area.
3
Apple is a trademark of Apple, Inc., registered in the U.S. and other countries. App Store is a service mark of Apple, Inc. Google Play and Android are trademarks
of Google, Inc.
4
To use the Kaiser Permanente app, you must be a Kaiser Permanente member registered on kp.org.
10Get prescription refills by phone
Call us at 1-800-700-1479 (TTY 711), 24 hours
a day, and follow the instructions to request refills
P HA R MA C Y
for most prescriptions.
Get prescription refills online
Register on kp.org or the Kaiser Permanente app2
to request refills for most prescriptions online.
What drugs are covered?
Visit kp.org/seniorrx for a list of approved
drugs. You can also call Member Services to
request a printed copy of the formulary. Please
check kp.org/seniorrx regularly for changes to
the list of approved drugs.
Picking up your order
You can fill your prescriptions at the
Kaiser Permanente pharmacies located in our
medical centers. Just visit kp.org/facilities and
select the Kaiser Permanente pharmacy where
you’d like to pick them up.
11Pharmacy phone numbers
There is a pharmacy in each Kaiser Permanente medical center. See page 4 for locations on a map.
Maryland Kensington Medical Center White Marsh Medical Center Fredericksburg Medical Center
1-301-929-7175 1-410-933-7626 1-540-368-3800
Abingdon Medical Center
1-410-515-5450 Largo Medical Center Woodlawn Medical Center Haymarket Crossroads
1-301-618-5552 1-443-663-6116 Medical Center
Annapolis Medical Center
Lutherville-Timonium 1-571-445-7300
1-410-571-7360
Medical Center Virginia Manassas Medical Center
Kaiser Permanente Baltimore
1-410-847-3029 Alexandria Medical Center 1-703-257-3030
Harbor Medical Center
Marlow Heights Medical Center 1-703-721-6310 Reston Medical Center
1-410-637-5750
1-301-702-5190 Ashburn Medical Center 1-703-709-1560
Bowie Fairwood Medical Center
North Arundel Medical Center 1-571-252-6005 Springfield Medical Center
1-301-867-1330
1-410-508-7675 Burke Medical Center 1-703-922-1234
Camp Springs Medical Center
Shady Grove Medical Center 1-703-249-7750 Tysons Corner Medical Center
1-301-702-6175
1-301-548-5755 Caton Hill Medical Center 1-703-287-4650
Columbia Gateway
Silver Spring Medical Center 1-703-986-2500
Medical Center
1-410-309-7500 1-301-572-1055 Colonial Forge Medical Center Washington, DC
South Baltimore County 1-540-602-6300 Kaiser Permanente
Kaiser Permanente
Medical Center Fair Oaks Medical Center Capitol Hill Medical Center
Frederick Medical Center
1-410-737-5200 1-703-934-5800 1-202-346-3300
1-240-529-1800
West Hyattsville Medical Center Falls Church Medical Center Northwest DC
Gaithersburg Medical Center
1-240-906-6600 1-703-237-4430 Medical Office Building
1-240-632-4150
1-202-419-6900
You also have access to network pharmacies. In general, you will pay more for prescriptions you fill at network pharmacies. Please check
your Evidence of Coverage for your benefits. For information about network pharmacies, please refer to the Pharmacy Directory by visiting
kp.org/directory or call Member Services at 1-888-777-5536 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.
12Getting care
Member ID card Digital membership ID card2 Transportation to medical
You will receive your member ID card in You can access a digital version of appointments
the mail. You’ll need this card to make your membership ID card on the Never miss an important medical
appointments, fill prescriptions, and receive Kaiser Permanente app.3 appointment with no-cost transportation.
medical services. Your member ID card is To access your Kaiser Permanente mobile Kaiser Permanente Medicare Advantage
issued to you, and only you may use it.1 membership ID card, register at kp.org includes 24 rides4 for nonemergency
Keep your ID card with you at all times. If and then download the Kaiser Permanente medical appointments at Kaiser Permanente
you lose your ID card, call Member Services app from your favorite app store. medical centers and contracted facilities. To
at 1-888-777-5536 (TTY 711) or go to My schedule a ride or request your ride balance,
To use your digital membership card,
Health Manager on kp.org to request a call 1-855-932-5412 24 hours a day, 7 days
tap the card icon at the bottom of the
replacement. You’ll be asked to show a valid, a week. To ensure availability, schedule your
Kaiser Permanente app dashboard.
government-issued photo ID in addition to ride as soon as possible, but no later than
your member ID card when you check in two hours prior to your appointment. Rides
for an appointment at a Kaiser Permanente that are canceled within 3 hours of the
facility. If you have not received your member scheduled pickup time will be deducted
ID card, your valid, government-issued ID from your ride allowance.
can serve as a temporary ID card.
NEW for 2023: Schedule rides online
If your ID card is lost or stolen, go to kp.org You can now schedule your rides online by
to request a replacement, or call Member visiting kpmas.member.saferidehealth.com.
Services. Your Kaiser Permanente ID card is Call 1-855-932-5412 to activate your account.
the only card you should use to get covered
medical services. Please keep your red,
white, and blue Medicare card in a safe
place in case you need it later.
1
Letting another person use your ID card for care is considered fraud, and can result in your coverage being terminated.
2
The digital membership ID card is not available with all Kaiser Permanente Medicare health plans.
3
To use the Kaiser Permanente app, you must be a Kaiser Permanente member registered on kp.org.
4
Twenty-four one-way rides per contract year. For nonemergency transportation only.
13The right care
Services Contact Availability
Seeing your doctor To make appointments with doctors at Call or go online 24 hours a day, 7 days
For an expected care need, such Kaiser Permanente facilities, visit a week, to schedule appointments with
as a recommended preventive kp.org/appointments or call 1-800-777-7904 Kaiser Permanente doctors.
screening or a visit for a health (TTY 711). If you have a network physican, call the
issue currently being treated. If you have a network physician, contact your doctor’s office for business hours.
Or, for a new health concern doctor’s office directly.
or change in an existing health
condition that is not an urgent
care need.
Video visits1 For doctors who practice at Kaiser Permanente Call or go online 24 hours a day, 7 days
ee physicians and providers by
S medical centers, visit kp.org or call 1-800-777-7904 a week, to schedule video visits with
video visit—wherever you need. (TTY 711). Kaiser Permanente doctors.
You can also meet a physician
on demand with Get Care Now.
Short wait times may apply.
If you travel out of state, phone appointments and video visits may not be available due to state laws that may prevent doctors and health care providers from
1
providing care across state lines. Laws differ by state.
14Services Contact Availability
E-visits1 Get started at kp.org. E-visits are available 7 days a week,
se our online symptom
U from 8 a.m. to midnight.
checker for certain
conditions and get
personalized care advice
within 2 hours.
Medical advice by phone 1-800-777-7904 (TTY 711) Call for medical advice 24 hours a day,
Whenever you need 7 days a week.
medical advice or are
unsure whether you need
urgent care.
Urgent care 1-800-777-7904 (TTY 711) 15 locations; 7 open 24 hours a day,
ou are covered at any
Y Unsure if you need urgent or emergency care? 7 days a week
Kaiser Permanente Urgent Call 1-800-677-1112 (TTY 711). Members are welcome to walk in
Care or Advanced Urgent without an appointment.
Care center. Learn more at kp.org/urgentcare/mas.
Available when you register and log in to kp.org or the Kaiser Permanente app.
1
15The right care (continued)
Services Contact Availability
Emergency care1 If you think you’re experiencing a medical 24 hours a day, 7 days a week
You are covered for urgent emergency, immediately call 911 or go to the
and emergency illness or nearest emergency facility anytime, day or night.
injury anywhere in the world. Unsure if you’re experiencing an emergency?
Call 1-866-677-1112 (TTY 711).
Behavioral health You can seek initial consultation without Monday through Friday, 8:30 a.m. to 5 p.m.
a referral from your doctor for outpatient (closed holidays)
treatment for behavioral health or substance use
conditions.
Call 1-866-530-8778 (TTY 711)
Vision care Visit kp.org or call 1-800-777-7904 (TTY 711) Hours vary by location. Learn more at
You don’t need a referral from your doctor kp2020.org.
to make an appointment.
Dental care Call Dominion Member Services at 1-855-733-7524 Monday through Friday, 7:30 a.m. to 6 p.m.
For details, see page 25. (TTY 711).
If you reasonably believe you have an emergency medical condition, call 911 or go to the nearest emergency department. An emergency medical condition is
1
one that, in the absence of immediate medical attention, may result in 1) placing the health of the individual (or, with respect to a pregnant woman, the health of
the woman or her unborn child) in serious jeopardy, 2) serious impairment to bodily functions, or 3) serious dysfunction of any bodily organ or part. Refer to your
Evidence of Coverage for the complete definition of emergency medical conditions.
16Services Contact Availability
Seeing specialty doctors You need a referral from your primary care physician Call or go online 24 hours a day,
for specialty care. In most cases, an appointment will 7 days a week, to schedule appointments
be coordinated for you by your care team. Otherwise, with Kaiser Permanente doctors.
call Kaiser Permanente at 1-800-777-7904 (TTY 711).
If you have a network physician, call the
You do not need a referral for obstetrics-gynecology, doctor’s office directly for business hours.
optometry, dental, and some behavioral health
services.
If you have a network physician, contact your doctor’s
office directly.
If you are a new member who hasn’t seen your Kaiser Permanente doctor yet and if you have a chronic condition, were recently
hospitalized, or are or think you might be pregnant, please make an appointment as soon as possible. Call 1-800-777-7904 (TTY 711).
17Getting virtual care with Kaiser Permanente
Virtual care allows members to see their personal doctor—as well as any
specialists they’ve been referred to—by video, phone, or email, usually for
no copay.1 When you need medical attention, you can start your journey
using any of our virtual care options after registering and logging on to
kp.org and downloading the Kaiser Permanente app.2
Get Care Now 24/7 on-demand service During a virtual visit, your doctor can access your electronic health record
with the next available clinician—no and consult with other physicians, so your care is seamless, convenient,
appointment is needed for Urgent Care and connected. All of your post-visit information, prescriptions, lab results,
that can be addressed virtually immunization status, emails, and more are available and secure with kp.org
and the Kaiser Permanente app.
E-visits for personalized advice in
2 hours or less
Are you ready for your video visit?
Please make sure your computer is working prior to your appointment.
To check, visit kp.org/tipsvideovisits and click Tech Check.
Email consultations with your doctor
24/7 advice line and online chat For more information on your telehealth options and how to join
a video visit, go to kp.org/getcare.
If you travel out of state, phone appointments and video visits may not be available due to state laws that may prevent doctors and health care providers from
1
providing care across state lines. Laws differ by state.
2
To use the Kaiser Permanente app, you must be a Kaiser Permanente member registered on kp.org.
18Healthy extras to improve your mental and physical health
Enjoy access to our healthy extras1—online • Calm. Reduce stress, improve sleep, and • Online wellness programs. Learn more
resources to help manage your well-being: enhance mood with meditation. at kp.org/healthylifestyles.
• Ginger. Get immediate one-on-one • ChooseHealthy® offer discounts on
Virtual classes at no extra cost emotional support for coping with many alternative care and fitness services. The
• Managing prediabetes common challenges—from stress and low program is available to you in addition to
• Nutrition for cholesterol control mood to work or relationship issues. any benefits for these services that may
• Nutrition for weight control Learn more and download these apps at be covered under your plan. Learn more
• Stress management kp.org/selfcareapps. at kp.org/choosehealthy.
• Cataract class Refer to your plan document for more
Other resources to help keep information.
Fitness classes at no extra cost you informed and inspired
• ClassPass on-demand fitness classes • Health education classes at our facilities. Member discounts for products
• Silver&Fit® Healthy Aging and Exercise Registration is required. Browse courses and services
Program.2 See page 27 for details. at kp.org/classes, and to register, call Kaiser Permanente partners with leading
1-800-777-7904 (TTY 711). companies to support your health, safety
Self-care apps3 • Partners in Health. This monthly newsletter and well-being—and offer substantial
• myStrength®. Boost your overall well-being brings you health tips, member stories, savings and discounts.
and resilience with this easy-to-use app. and facility or service updates.
1
he products and services described are provided by entities other than Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., and are neither offered
T
nor guaranteed under your Kaiser Permanente contract. Kaiser Permanente does not endorse or make any representations regarding the quality or medical
effectiveness of such products and services, nor the financial integrity of these entities. Kaiser Permanente disclaims any liability for these products and services.
Some Kaiser Permanente members may have coverage through their health plan for some of the same services available through ChooseHealthy®. The value-added
services available under the ChooseHealthy program are separate and apart from any chiropractic, acupuncture, or massage services available under your contract.
Please see your coverage documents for information regarding those services covered under your Kaiser Permanente contract. The ChooseHealthy program
is administered by American Specialty Health Administrators, Inc., a subsidiary of American Specialty Health Incorporated (ASH). ChooseHealthy is a federally
registered trademark of ASH and used with permission herein.
2
The Silver&Fit program is provided by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH).
Silver&Fit is a trademark of ASH and used with permission herein. All programs and services are not available in all areas. Participating fitness centers and fitness
chains may vary by location and are subject to change.
3
The apps described above are not covered under your health plan benefits and are not subject to the terms set forth in your Evidence of Coverage or other plan
documents. These services may be discontinued at any time without notice. myStrength® is a wholly owned subsidiary of Livongo Health, Inc.
19Healthy extras to improve your mental and physical health (continued)
Lively™ Mobile Plus Comfort Keepers in-home care Mom’s Meals healthy meal
Get a personal emergency response and assistance delivery
system that provides 24/7 help with the Uplifting in-home care services to help Getting the right nutrition is essential to
push of a button. Receive a reduced you maintain independence at home with achieving and maintaining good health. And
one-time device for a discounted fee everything from 24-hour care, respite, with Mom’s Meals, you can get refrigerated,
and choice of two monthly service meal preparation, and light housekeeping. ready-to-heat-and-eat meals delivered to
plans (coverage limits may apply). Visit Receive a discount on all services and get your home. Crafted by chefs and registered
greatcall.com/KP or call 1-800-205-6548 a free in-home safety assessment. Visit dietitians, the meals are tailored to support
(TTY 711) for more information. comfortkeepers.com/kaiser-permanente most major chronic conditions and overall
or call 1-800-611-9689 (TTY 711) for more wellness. Kaiser Permanente members enjoy
information. discounted pricing and free shipping from
Mom’s Meals. Visit momsmealsnc.com
or call 1-866-224-9483 (TTY 711) for
more information.
Kaiser Permanente members may continue to use or select these products or services from any company of their choice, but Kaiser
Permanente discounts are only available with the partners listed above. The products and services described above are neither offered nor
guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes
regarding these products and services may be subject to the Kaiser Permanente Senior Advantage grievance process. BEST BUY HEALTH,
GREATCALL, LIVELY and LINK are trademarks of Best Buy and its affiliated companies. ©2022 Best Buy. All rights reserved.
20Preventive care
Preventive care is key to how we practice Copays for preventive care
medicine at Kaiser Permanente. It can
With Medicare Advantage, you pay $0 copay
help you avoid some health issues and
for most preventive care. This includes
catch others before they become serious.
routine physicals and certain screenings and
Your health care team is here to help you
tests (such as mammograms). So there’s no
make the right choices at the right times.
need to delay making your first appointment
Preventive care needs depend on:
with your doctor.
• Age
Sometimes during an appointment for a
• Gender preventive care visit, the doctor will want
• Health habits to do something that is not considered
• Personal health history preventive care. For example, during your
Find out what screenings you need at every routine appointment, the doctor may find a
stage of life online at kp.org/prevention. We mole that needs to be removed for testing.
also recommend that you sign up for kp.org Because that’s not covered as preventive
and, once registered, that you complete the care, you’ll be asked to pay a copay for the
Kaiser Permanente Medicare Total Health service. In most cases, you’ll get a bill in the
Assessment. This will give you a prevention mail for such additional, non-preventive
plan that meets your needs and addresses services.
what matters to you. You’ll also find other
tools and resources there.
21Specialty care
Referrals to specialists
Kaiser Permanente doctors and other from network providers. You must have an • Skilled nursing and acute rehabilitation
network providers offer primary care, authorized referral to the out-of-network facilities.
pediatric services, ob-gyn services, provider in order for us to cover the • Nonemergency medical transportation.
and specialty care—including but not services and/or supplies. If the referral to • Care received from a practitioner or
limited to orthopedics, general surgery, an out-of-network provider is appropriately
• facility that does not have a contract with
dermatology, neurology, cardiology, and authorized, you pay only the copayments
Kaiser Permanente.
gastroenterology. If your primary care you would have paid if a network provider
• Nonemergency care received outside
physician decides, in consultation with had provided the service and/or supplies.
of the Kaiser Permanente service area.
you, that you require medically necessary Examples of services requiring authorization Emergency services (inside and outside
and appropriate services, you may be or notification include but are not limited to our service area) do not require a referral
referred to a Kaiser Permanente doctor or the following: from a primary care physician. You do
other network provider for that service.
• Inpatient admissions, including those for not need to obtain care from a network
The referral that has been entered by your
childbirth, behavioral health, and chemical provider.
primary care provider or attending specialist
dependency (inpatient admissions are If you have any questions regarding the
must be authorized before you receive
those hospital visits for which members status of your referral or denied services or
nonemergency specialty care services.
are admitted to a facility for 24 hours or would like to request a copy of any guideline
Your primary care physician or specialist more). or other criteria (provided at no charge)
may refer you to an out-of-network provider.
• Specialized services, such as home health, used in any decision regarding your care,
Services from out-of-network providers
medical equipment and associated please contact Member Services at
will be authorized only if not available
supplies, and hospice care. 1-888-777-5536 (TTY 711).
Out-of-network/non-contracted providers are under no obligation to treat Kaiser Permanente members, except in emergency situations.
Please call our customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to
out-of-network services.
22See certain specialists without a referral
You don’t need a referral for the following specialties—just call for an appointment.
Specialty Contact Availability
Obstetrics-gynecology 1-800-777-7904 (TTY 711) 24 hours a day, 7 days a week
Behavioral health
Initial consultation for outpatient treatment for mental Monday through Friday, 8:30 a.m.
1-800-777-7904 (TTY 711)
illness, emotional disorders, chemical dependency, to 5 p.m. (closed holidays)
and addiction medicine.
Vision care
o referral is needed for routine eye exams, glaucoma
N 1-800-777-7904 (TTY 711) 24 hours a day, 7 days a week
screenings, and cataract screenings.
Dental Dominion Member Services, Monday through Friday, 7:30 a.m.
For details, see page 25. 1-855-733-7524 (TTY 711) to 6 p.m.
For other types of specialty care, your doctor will refer you.
23Specialty care (continued)
Getting a second opinion
If you need a second opinion, your primary
care physician or specialist will help
coordinate this for you. Kaiser Permanente
Medicare Advantage will cover it, as long
as you visit another Kaiser Permanente
Medicare Advantage provider with an
authorized referral from your primary
care physician. If you get services from
any doctor, hospital, or other health care
provider without getting an authorized
referral in advance (except for emergency
care or urgently needed care received
outside the service area), you may have to
pay for these services yourself, even if you
get the services from a network provider.
24Preventive dental
Your Kaiser Permanente Medicare health Choosing a dentist Dominion Member Services
plan includes dental coverage through
You may select any of our participating Quality service is an important part of any
Dominion National (Dominion). You pay $30
dental providers as your general dentist, dental plan. Knowledgeable Dominion
for preventive care office visits. This includes:
and each eligible family member may use Member Services specialists are available
• Oral exams (up to two per year) a different participating dentist. For a list Monday through Friday, 7:30 a.m. to 6 p.m.,
• Cleanings (up to two per year) of participating dentists or information to answer questions about coverage or
about a dentist, including office hours, to help you find a participating dentist.
• Bitewing X-rays (up to two per year)
directions, languages spoken, etc., visit Dominion’s voice response system is
Other covered dental services are provided DominionNational.com/kaiserdentists available 24 hours a day for information
at a reduced fee. or call Dominion Member Services at about participating dental providers in your
Your dental and health plan providers— 1-855-733-7524 (TTY 711), Monday through area or to help you select a dental provider.
Dominion and Kaiser Permanente—are Friday, 7:30 a.m. to 6 p.m. The most up-to-date list of participating
working together to help you stay healthy. dental providers can be found online.
Specialty care
Phone: 1-855-733-7524 (TTY 711)
Save on restorative care Specialty care is also available in many
Mailing address:
More extensive care (fillings, crowns, locations. To receive treatment from
Dominion National
dentures, root canals, periodontal a participating specialist, ask your
P.O. Box 21522
treatment, oral surgery, etc.) is provided at participating general dentist to arrange
Eagan, MN 55121-0522
fees lower than the usual and customary a referral. Your costs may be higher for
charges for these services. When covered, care you receive from a network specialist. Web: DominionNational.com/kaiserdentists
specialty care services are performed by Services received from non-participating
Dental benefits are underwritten by
plan specialists and a different fee will apply. dentists are not covered.
Kaiser Foundation Health Plan of the
Mid-Atlantic States, Inc., and administered
Making an appointment by Dominion National.
Make an appointment by calling
your chosen dental office. Bring your
Kaiser Permanente ID card to your
appointment. There is no separate
dental ID card.
25Wellness for the whole you
At Kaiser Permanente, we believe in caring • Progress reports to give you insight into • Digital fitness and well-being choices
for the whole you—mind and body. That’s how you’re doing Members may select one2 home fitness kit
why we’ve included a fitness membership1 • Flexible training that fits your schedule per calendar year. Choose from wearable
and online brain health exercises with your • A monthly newsletter with brain health fitness tracker, Pilates, strength, swim, and
membership at no cost. news, tips, and recipes yoga kit options. This benefit also includes
access to on-demand workout videos,
To set up your no-cost account, please visit
BrainHQ workout plans, the Well-Being Club,
kp.brainhq.com. If you have questions,
Brain training that works newsletters, and other helpful features.
please contact the BrainHQ help line via
Your brain defines who you are. It’s the center email at support@brainhq.com or call For more information about the Silver&Fit
of everything you think, do, and feel. So 1-877-573-3067, Monday through Friday, program, visit SilverandFit.com.
it’s no surprise that Kaiser Permanente has 1:30 p.m. to 10:30 p.m.
included BrainHQ with your membership.
BrainHQ’s online exercises, which you can Silver&Fit® Healthy Aging and
do on a computer or mobile device, improve Exercise Program1
cognitive function (including memory, The Silver&Fit fitness program helps you
attention, and processing speed), as well as get and stay active. We’ve included the
daily life (including safer driving, improved following with your Kaiser Permanente
balance, and better mood). People who use Medicare health plan:
it notice the difference.
• Fitness center membership
What’s more, BrainHQ supports you every Reshape your life with membership at a
step of the way, with great features such as: local participating Silver&Fit fitness center.
• Weekly challenges to inspire you to Visit SilverandFit.com to find a fitness
improve center near you.
• A personalized trainer that tailors the
training to you
1
he Silver&Fit program is provided by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH).
T
Silver&Fit is a trademark of ASH and used with permission herein. All programs and services are not available in all areas. Participating fitness centers and fitness
chains may vary by location and are subject to change.
2
Kits are subject to change and once selected cannot be exchanged.
26Thriving After 60
Connect with other members
at workshops and outings
The Thriving After 60 community is
dedicated to keeping its members mentally
and physically healthy—and having a
good time in the process. You’ll have the
opportunity to meet like-minded friends at
our interesting virtual and in-person1 events
and workshops, which focus on supporting
the changing health and wellness needs of
those over 60. Our activities are designed to
help you maintain your health and energy,
and stay connected with the community well
into retirement.
To learn more and register for our events,
please visit kp.org/ta60mas and follow
our Facebook page at facebook.com/
ThrivingAfter60.
In-person event schedule based on necessary COVID-19 response.
1
27Urgent care
You are covered worldwide for urgent and emergency care. Go to the nearest urgent or emergency care facility.
Kaiser Permanente These are examples of conditions that are Get Care Now
Urgent Care centers treated in Urgent Care or Advanced Urgent
With our Get Care Now on-demand service,
Care. If you think you are experiencing an
Open evenings, weekends, and holidays, no appointment is needed for Urgent Care
emergency medical condition,1 call 911. that can be addressed virtually—you can see
our Urgent Care centers are located in
Maryland, Virginia, and Washington, DC. the next available clinician today.
24/7 Kaiser Permanente
Call 1-800-777-5536 (TTY 711) to get • Connect to this virtual care service 24/7,
Advanced Urgent Care centers and a physician will reach out to you,
the care you need, or come in if you are
experiencing any of the following: At our medical centers that have 24/7 usually within 2 hours
Advanced Urgent Care, you get: • Offered at no charge
• Abdominal pain
• Physicians trained in emergency medicine • Available via phone, video, kp.org, or the
• Breathing trouble
• Lower cost shares2 than those for a typical Kaiser Permanente app3,4
• Broken bones
hospital ER visit
• Deep cuts
• 24/7 laboratory services
• Flu- or cold-like symptoms
• Extended pharmacy hours, with most
• Rash or skin infection
open 24/7
• Sprains and strains
• 24/7 advanced imaging services,
• Urinary tract infections including CT, MRI, and ultrasound
• Vomiting, diarrhea, or nausea • An observation unit where patients can
be monitored for up to 24 hours
1
n emergency medical condition is one that, in the absence of immediate medical attention, may result in 1) placing the health of the individual (or, with respect
A
to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, 2) serious impairment to bodily functions, or 3) serious dysfunction of any
bodily organ or part. Refer to your plan document for the complete definition of emergency medical conditions.
2
Cost share depends upon your plan. For specific information, please check your Evidence of Coverage.
3
To use the Kaiser Permanente app, you must be a Kaiser Permanente member registered on kp.org.
4
If you travel out of state, phone appointments and video visits may not be available due to state laws that may prevent doctors and health care providers from
providing care across state lines. Laws differ by state.
28Kaiser Permanente Urgent Care locations
Maryland South Baltimore County Reston Urgent Care
Advanced Urgent Care 24/7 1890 Metro Center Drive
Kaiser Permanente Baltimore
1701 Twin Springs Road Reston, VA 20190
Harbor Urgent Care
Halethorpe, MD 21227 Mon–Fri: 3–11 p.m.
Temporarily closed
Sat, Sun, holidays: 9 a.m.–9 p.m.
815 E. Pratt St. White Marsh Urgent Care
Baltimore, MD 21202 4920 Campbell Blvd. Tysons Corner Advanced Urgent Care 24/7
Nottingham, MD 21236 8008 Westpark Drive
Camp Springs Urgent Care
Mon–Fri: 3–11 p.m. McLean, VA 22102
Temporarily closed
Sat, Sun, holidays: 9 a.m.–5 p.m.
6104 Old Branch Ave. Washington, DC
Temple Hills, MD 20748 Woodlawn Urgent Care
Temporarily closed Kaiser Permanente Capitol Hill
Gaithersburg Advanced Urgent Care 24/7 Advanced Urgent Care 24/7
7141 Security Blvd.
655 Watkins Mill Road 700 2nd St. NE
Baltimore, MD 21244
Gaithersburg, MD 20879 Washington, DC 20002
Kensington Urgent Care Virginia
Temporarily closed Caton Hill Advanced Urgent Care 24/7
10810 Connecticut Ave. 13285 Minnieville Road
Kensington, MD 20895 Woodbridge, VA 22192 The continued availability and/or
participation of any facility cannot be
Largo Advanced Urgent Care 24/7 Fredericksburg Urgent Care guaranteed.
1221 Mercantile Lane 1201 Hospital Drive
Largo, MD 20774 Kaiser Permanente reserves the right
Fredericksburg, VA 22401
to relocate, modify, or terminate the
Lutherville-Timonium Advanced Mon–Fri: 3–11 p.m.
location and hours of services for
Urgent Care 24/7 Sat, Sun, holidays: 9 a.m.–5 p.m.
Urgent Care. For the most up-to-date
2391 Greenspring Drive Manassas Urgent Care information, visit kp.org/urgentcare/mas.
Lutherville-Timonium, MD 21093 Temporarily closed
10701 Rosemary Drive
Manassas, VA 20109
29Emergency care
If you think you are experiencing an emergency, immediately call 911 or go to the nearest emergency room.
You are covered worldwide for urgent and emergency care.
Not sure if your medical problem requires loss of function of a limb. The medical What is covered if you have
an emergency room visit? Call 1-800-677- symptoms may be an illness, injury, a medical emergency?
1112 (TTY 711), 24 hours a day, 7 days severe pain, or a medical condition that
You may get emergency medical care
a week, and we’ll direct you to the most is quickly getting worse.
(including ambulance) whenever you need
appropriate place to receive care. For more information about what it, anywhere in the world (claim forms
constitutes an emergency, read your required). For more information, refer to
If you visit an emergency room Evidence of Coverage. your Evidence of Coverage.
Report your emergency room visit to
Kaiser Permanente within 48 hours, or as
soon as reasonably possible. Call the
24-hour medical advice line at 1-800-777-
7904 (TTY 711) to report your visit.
What is an emergency?
A medical emergency is when you, or
any other prudent layperson with an
average knowledge of health or medicine,
believe that you have medical symptoms
that require immediate medical attention
to prevent loss of life, loss of a limb, or
30Hospital care
Kaiser Permanente carefully selects hospitals1 to team with us in taking great care of you.
Visit kp.org/directory to view the hospitals HOSPITAL
we team with in coordinating your care
HOSPITAL
when you need inpatient or outpatient HOSPITAL
hospital care. These hospitals are located
throughout Maryland, Virginia, and
Washington, DC.
If you’re admitted to a
hospital that does not have
Kaiser Permanente doctors
Once your condition has stabilized,
we may move you to a hospital where
Kaiser Permanente doctors are on
duty. By doing so, we can provide you
seamless and coordinated care, both
during your hospitalization and in your
transition out of the hospital.
he hospitals we team with are independently owned and operated hospitals and are not affiliated entities of Kaiser Permanente. Visit kp.org/directory for the
T
1
most current information.
31Extra Help for Medicare Part D prescription drug plan costs
People with limited incomes may qualify Permanente Medicare Advantage plan with
for the Extra Help program, which can help Medicare Part D prescription drug coverage,
pay for their prescription drug costs. If you Medicare will tell us how much Extra Help
qualify, you can get help paying for your you’re receiving, and we’ll let you know the
drug costs, including monthly prescription amount you’ll pay.
drug premiums, annual deductibles, and The State of Maryland also provides
coinsurance. Additionally, those who qualify prescription drug assistance through
will not be subject to the coverage gap or the Senior Prescription Drug Assistance
a late enrollment penalty. Program (SPDAP) to Medicare beneficiaries
Many people are eligible for these with income below certain levels who
savings and don’t even know it. For enroll in a Part D prescription drug plan.
more information about Extra Help, call Subsidies from the Maryland SPDAP can
1-800-MEDICARE (1-800-633-4227), reduce out-of-pocket Part D premiums for
24 hours a day, 7 days a week. TTY users eligible individuals. Interested individuals
should call 1-877-486-2048. can apply by calling 1-800-551-5995 toll
If you qualify for Extra Help for your free, Monday through Friday, 8 a.m. to
Medicare Part D prescription drug plan 5 p.m. (TTY 1-800-877-5156).
costs, the amount of your monthly premium
may be lower. Your cost at the pharmacy will
be lower. Once you have enrolled in a Kaiser
32You can also read
