How the Kaiser HMO Works

Human Resources

Kaiser Permanente HMO

This is a health maintenance organization (HMO) offered through Kaiser Permanente. The HMO offers a high level of benefits - medical, vision and prescription drugs - in exchange for using Kaiser Permanente health care providers, hospitals, ophthalmologists/optometrists and pharmacies.  Instead of the typical claim forms and annual deductibles, you pay flat-fee copayments for office visits to the Kaiser Permanente physician at the time of the visit.

Please visit the 2018 Colorado Benefits Guide / 2018 Outside Colorado Benefits Guide to view additional information regarding the Kaiser Permanente plan.

Kaiser Permanente Service Area

The HMO option is available only to eligible current and former UCAR employees and their dependents who live in a Kaiser Permanente HMO service area. Currently the Kaiser service areas available are the metro Denver/Boulder area, Northern Colorado (Loveland, Greeley, Fort Collins), Mid-Atlantic Region, Hawaii and parts of California. If you or your covered dependents live in locations outside of the service area, you will not be able to choose this option.

Another health care option may be best for you if:

  • You anticipate moving to a location not included in a Kaiser Permanente service area,
  • You have a dependent you wish to cover who is or will be located outside a Kaiser Permanente service area, or
  • You anticipate traveling for an extended period of time outside a Kaiser Permanente service area.

 

The Primary Care Physician

The HMO has certain doctors, other health care providers and facilities to furnish care to its members. A high level of benefit coverage is maintained since the Primary Care Physician manages the care of each individual using only Kaiser Permanente HMO hospitals, specialists and pharmacies, and by encouraging preventive health care.

Your information kit contains a Provider Directory, which lists participating Kaiser Permanente Primary Care Physicians/facilities, hospitals and pharmacies, and includes a map of the Kaiser Permanente service area. You and your family members may each choose a care provider listed in the Provider Directory for personalized care.

The Primary Care Physician will arrange and coordinate all health care needs, such as specialty care, outpatient surgery, x-rays, etc. These services must be authorized by your Primary Care Physician to be covered by the plan.

In cases of life- or limb-threatening or medical emergencies or medical emergencies that occur while you are out of the service area, you or a covered family member may go to any doctor or medical facility for care of the initial treatment. Follow-up care is not covered, unless included as part of the original treatment billing. (You will be reimbursed by Kaiser Permanente for the covered expenses you pay, minus applicable copayments.)

You may change your Primary Care Physician at any time. Although it is not required, it is suggested you call the New Member Health Coordinator for assistance (upon receipt of your new ID card, please refer to the back of the card for a contact number). Kaiser Permanente does not limit the number of times you can change Primary Care Physicians.

Vision Care

You do not need a referral from your Primary Care Physician to see a Kaiser Permanente ophthalmologist or optometrist. You may contact the Kaiser Permanente vision care center directly for your appointments.

Mail Order Prescription Service

Kaiser Permanente’s mail order prescription service is available through Direct Rx. You may purchase a 90-day supply of maintenance medications and pay a two month copayment. Certain drugs are limited to a 30-day supply. You can order prescriptions by telephone, mail or online on the Kaiser Web site. Your physician or pharmacist can fax the prescription directly to Direct Rx. Contact Direct Rx at:

Kaiser Permanente Direct Rx
P.O. Box 471060
Aurora, CO 80047-1060
(303) 326-6777
(303) 326-6775 fax


Which Plan is Best for You?  View comparison matrices.

For additional information in regards to the Kaiser Permanente plan, please see the Summary of Benefits below:

Colorado SBC / Colorado Evidence of Coverage

Hawaii

Mid-Atlantic States (MD, DC, VA)

Northern California

Southern California

2018 Colorado Benefits Guide / 2018 Outside Colorado Benefits Guide

View the Kaiser Permanente Plan Limitations and Exclusions

2018 Insurance Premiums

Best Doctors -- Expert Second Opinion / Best Doctors Guide



Last updated by irena on October 29, 2017 - 7:29pm.
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