Medical Kaiser Member

Health coverage through Kaiser offers access to an extensive network of providers for all your medical, prescription drug and mental health care needs.

Review the list of Kaiser eligible expenses to see what procedures are covered, may be covered with specific documentation or are not covered.

Use the glossary of technical terms to better understand your health care plan benefits.

Using your medical benefits

You shouldn’t have to pay anything up front when you visit your Kaiser doctor. After your visit, Kaiser will automatically process your claim, send you an Explanation of Benefits (EOB), and then debit your Health Account (or Health Care FSA first, if you elected it) to pay any charges you owe. If you don’t have enough in your account(s) to cover the charges, Kaiser will bill you.

FREE SERVICES AND COSTS

PG&E pays most of the cost of your medical coverage. You pay for your portion of the cost with before-tax contributions deducted from your pay.

Click here to review your 2018 cost of coverage.

Click here for a list of free services.

Click here for the Kaiser free mail-order drug list.

Your health care cards

When you visit a Kaiser pharmacy, you'll need two cards:

  • Kaiser ID card tells your Kaiser provider you’re eligible for prescription benefits
  • Kaiser Visa Health Payment Card Visa Debit Card is loaded with your Health Account credits and — if you elected the Health Care FSA — your annual FSA contribution
KAISER ID CARDKAISER VISA CARD

Paying for your HAP expenses

See the Kaiser Health Account guide to see how you can manage your health account online.

Reimbursements

Using your Kaiser Visa card

You can only use your Visa Health Payment Card to pay for prescriptions from Kaiser pharmacies. You’ll need to file claims for any dental and vision expenses you owe to get reimbursed.

Ways to get reimbursed

If you elected to participate in the Health Care Flexible Spending Account (FSA), the money in your FSA will be used first to reimburse you for any out-of-pocket health care expenses—since the FSA has a “use it or lose it” rule. Kaiser will automatically debit your FSA first to pay for any out-of-pocket medical expenses, and then will debit your Health Account if you don’t have enough in your FSA to cover the expenses. For additional information, view Kaiser's HRA plan FAQs.

Kaiser will automatically pay your Kaiser provider; you do not have to file any claims or deposit any checks when you get care from Kaiser.

IMPORTANT: You can’t use your Kaiser Visa Health Payment card to pay for dental and vision expenses.

When you get care outside Kaiser—for example, dental and vision care—there are two ways to file claims for reimbursement from your Health Account or Health Care FSA:

Be sure to keep a copy of all your receipts before you submit them to Kaiser.

Watch the Reimbursements with Kaiser video to learn more about filing a claim.

For medical expenses

You don’t have to file a claim if you use a Kaiser provider. After you receive care, Kaiser will process your claim, send you an Explanation of Benefits (EOB,) and then automatically debit your Health Account or Health Care FSA to pay any charges you owe for services. If you don’t have enough funds in your account(s), Kaiser will bill you, and you’ll be responsible for paying Kaiser what you owe with your own money.

For prescriptions

Your Kaiser Visa Health Payment Card is loaded with your Health Account credits and — if you elected the Health Care FSA — your annual FSA contribution.

For mental health and preventive substance abuse expenses

Beacon Health Options will file a claim for reimbursement for you with Kaiser. If you have enough in your Health Account or Health Care FSA to cover what you owe, you’ll be reimbursed. Otherwise, you’re responsible for paying your provider amounts you owe.

For dental and vision expenses

If you have to pay your provider at the time of service, you’ll need to spend your own money and then file a claim with Kaiser to be reimbursed from your Health Care FSA or Health Account.

If you don’t have to pay your provider at the time of service, you’ll need to wait for your EOB and then — once you know how much you owe — you’ll need to pay your provider and file a claim with Kaiser to be reimbursed from your Health Care FSA or Health Account.

Prescription drug coverage

You will pay the entire cost of prescriptions if you haven't met your annual deductible. Amounts paid for prescriptions apply to the annual deductible and out-of-pocket maximum.

Some prescriptions are free

You may use Kaiser pharmacies or mail order for free drugs.

Maintenance prescriptions

You may use Kaiser pharmacies or mail order for maintenance drugs.

Filling prescriptions

Filling a prescription at the pharmacy

You can use your Kaiser Visa health Payment Card to pay for prescriptions. The pharmacy will charge exactly how much you owe for a particular drug under the Kaiser HAP. You'll get an Explanation of Benefits (EOB) statement in the mail, and you can track how much is left in your Health Account (and HealthCare FSA, if you elected it). You can also go to the Kaiser website to view your statement and your Heath Account or Health Care FSA balance.

Filling a prescription for maintenance medications

You can order refills from a Kaiser pharmacy, through Kaiser Permanente's mail-order service or through Kaiser’s website. You don’t have to use mail order for maintenance/chronic condition medication from Kaiser.

Filling a prescription by mail

Go to the Kaiser website to order prescriptions through Kaiser’s mail-order program. You can also get your prescriptions at Kaiser pharmacies; you don’t have to use mail order.

FLEXIBLE SPENDING ACCOUNTS (FSAs)

The Health Care and Dependent Care Flexible Spending Accounts (FSAs) let you set aside before-tax pay to reimburse eligible health and dependent care expenses.

Health and Dependent Care FSA reimbursements

There are two different Flexible Spending Accounts (FSAs). You can elect one or both during Open Enrollment.

You fund the accounts with your own money. Your contributions are deducted from your pay before taxes are calculated—reducing your taxable income and saving you money.

Health Care FSA

This account is for eligible health care expenses—medical, dental, vision, mental health and substance abuse expenses the IRS considers eligible for reimbursement.

You can use the account for yourself—and for your dependents’ health care expenses—even if they’re not enrolled in your plan.

You can’t use this account to pay for dependent day care, gym memberships or for most cosmetic procedures. It’s only for eligible health care expenses.

Dependent Care FSA

This account is for eligible dependent care services for your dependent family members so you can work.

The IRS allows you to use the account for child and elder care while you work—such as day care or adult care, babysitters, at-home caregivers, preschool, before- or after-school programs and summer day camp.

You can’t use this account for your dependents’ health care expenses. It’s only for dependent care services that allow you to work.

The IRS determines how much you can contribute to these spending accounts. For additional details view Publication 502 for medical and dental expenses and Publication 503 for dependent and child care expenses.

How your Health Care FSA coordinates with your Health Account

Your Health Account—100% funded by PG&E—gives you health care credits to spend that can roll over from year-to-year if you don’t use them.

Your Health Care Flexible Spending Account (FSA)—if you’ve elected to contribute your before-tax dollars to help you pay for out-of-pocket medical expenses. Your FSA accounts have a "use it or lose it" rule. However, you can carry over unused balances up to $500 to the next year as long as you're eligible to participate in the Health Care FSA as of January 1 of the next year. To help you avoid forfeiting unused FSA dollars at the end of the year, your Health Care FSA will always pay your Health Account pays claims. When your Health Care FSA is used up, your Health Account will pay claims. No reimbursements will come out of your Health Account until your Health Care FSA is used up, and it’s all handled by Kaiser. For additional information, see Spending Accounts and Kaiser FSA FAQs.

To check your FSA or Health Account balance, log on to kp.org/healthpayment.

Seeing your primary care doctor

You and your family members each get four free visits a year to a primary care doctor:

  • General or family practitioners
  • Doctors of internal medicine
  • Pediatricians
  • Family nurse practitioners
  • OB/GYNs
  • Non-hospital urgent care facilities
TELEMEDICINE – VIRTUAL DOCTOR’S VISIT

With Kaiser Permanente’s telemedicine feature, Video Visits, along with ongoing features like telephone and call-back appointments, you have more flexibility to meet virtually with a doctor anytime, anywhere—including home and work—for consultation when you’re sick, have a rash or even to receive a prescription.

Easily accessible and convenient, all you need is a computer or mobile device to connect—saving you time and the hassle of driving to a doctor’s office, helping you get the right care at the right time. There are no long lines to see your doctor, and it’s already part of the Kaiser Health Account Plan (HAP).

Just go to kp.org/mydoctor/videovisits for additional information about Video Visits or to get started. When meeting with a doctor at work, you must use cell service to connect. Virtual doctor consultations cannot be accessed through PG&E’s Wi-Fi.

As a reminder, if you have a work-related discomfort or injury, call the 24/7 Nurse Report Line at 1-888-449-7787.

Kaiser Permanente currently offers Video Visits only to members who live in Northern California. Employees who live in Southern California counties, including but not limited to: Kern, Orange, San Bernardino, San Diego and San Joaquin will have access to Video Visits at a later date. You can still access care remotely by calling your local Kaiser Permanente call center for a telephone or call-back appointment with a doctor.

Onsite Telemedicine

Kaiser members are also invited to use Anthem’s telemedicine program, LiveHealth Online, as an alternative option to access healthcare. You may use an onsite kiosk located at select PG&E office locations to virtually meet with a doctor for consultation of minor acute health conditions.

The cost for a virtual doctor appointment is $49. This service is considered out-of-network. You can use your Health Account to pay this cost; however, you will need to pay using your own debit or credit card, then file a claim for reimbursement as you cannot use your Kaiser Visa® card for payment of services.

Onsite Locations

The onsite kiosk is first-come, first-served and gives you a quiet place to virtually meet with a doctor through built-in internet and video camera tools.

  • Bishop Ranch, 6121 Bollinger Canyon Road, Building Z, Room 2201B
  • Concord RMC, 1850 Gateway Blvd, 5th floor, Room 5010
  • Fresno Contact Center, 650 O Street, Room 304
  • San Jose Contact Center, 111 Almaden Blvd, Room 205B
  • Sacramento Contact Center, 2740 Gateway Oaks Drive, Room 135
  • San Ramon Valley Conference Center, 3301 Crow Canyon Road, A-Wing 2nd Floor Break Area
  • Stockton Contact Center, 3136 Boeing Way, 1st floor, Room 1441
  • Winters Training Center, 1 PG&E Way, Wellness Room 144

For more information about PG&E’s Telemedicine program email Wellness@pge.com or refer to the LiveHealth Online FAQs. As a reminder, if you have a work-related discomfort or injury, call the 24/7 Nurse Report Line at 1-888-449-7787.

Seeing a specialist

You pay 20% of the cost for all specialist office visits after you meet the annual deductible. Your specialist may charge you up to the full amount of your deductible at the time of service, and you may need to file a claim to get reimbursed (see "Getting Reimbursed" further down on this page). Your primary care doctor must preauthorize your specialist care.

CANCER RESOURCES

When you hear the word “cancer,” it can be a frightening, confusing experience. What happens next? What are your options? What’s covered under your Kaiser Permanente plan?

As a Kaiser Permanente member, your care and coverage is coordinated for you. With specialized cancer centers across Northern California, you can get high-quality care closer to the comfort and support of your home and family. Kaiser provides you with access to the care and doctors you need quickly, and at times that fit your schedule and lifestyle. And your treatment goes beyond medical care to include comprehensive support from social workers to dietitians to care clinics, giving you the help you need, every step of the way. Kaiser can even help you make travel arrangements to and from cancer centers.

Your cancer center: Specialized care for your specific cancer
Cancer is a complex disease that requires intricate knowledge of the various types of treatments available — and Kaiser Permanente has the experience to provide you with the best outcome possible. Kaiser has specialized cancer physicians and providers available throughout Northern California. Their medical centers include fellowship-trained staff who specialize in your specific type of cancer. That means you’ll be referred quickly to the right care center in Kaiser Permanente’s network. And with so many locations throughout Northern California, you can stay closer to home, so you’ll have the support of your community, friends, and family throughout your treatment journey.

  • bladder cancer – 2 centers, 4 surgeons, 3 specialized oncologists
  • acute leukemia – 3 centers
  • brain cancer – 3 centers, 28 neurosurgeons
  • pediatric brain cancer – 3 centers, 4 neurosurgeons
  • esophageal cancer – 5 centers, 20 surgeons
  • gynecologic cancer – 5 centers, 13 surgeons
  • head & neck cancer – 5 centers, 6 surgeons
  • liver cancer – 5 centers, 6 surgeons
  • ocular melanoma – 2 facilities, 1 specialized ocular oncologist
  • pancreatic cancer – 5 centers, 15 surgeons
  • thyroid cancer – 4 centers, 6 surgeons
  • radiation oncology – 5 centers, 31 radiation oncologists
  • pediatric oncology – 3 centers, 9 pediatric oncologists

All of Kaiser’s centers are or are in the process of being accredited by the Commission on Cancer, meeting rigorous standards in quality, prevention, treatment, and lifelong follow-up care.

For more information about Kaiser’s cancer resources, contact your doctor.

Additional Kaiser Cancer Support Resources

Leading-edge cancer treatment flyer

Urgent care

An urgent care need is one that requires prompt medical attention, but is not an emergency medical condition.* If you have an illness or injury that’s not life- or limb-threatening, but also can’t wait, Kaiser’s urgent care departments can help.

Urgent care is covered as primary care, so you won’t have to pay a deductible. After you’ve used your four free primary care visits for the year, you pay 10% of the cost.

For Kaiser members, urgent care is located in many of Kaiser’s Northern California facilities. Note: If you go to a Kaiser medical office without a hospital, it’s likely to be billed as an emergency, not as urgent care.

If you’re not sure what kind of care you need, Kaiser’s advice nurses can direct you to the most appropriate place for treatment and provide advice, when medically necessary. Call Kaiser Member Services at 1-800-663-1771 for more information.

*If you reasonably believe you have an emergency medical condition, which is a medical or psychiatric condition that requires immediate medical attention, call 911.

Emergency care

You pay 20% of the cost, subject to the annual deductible. After you visit the emergency room, your HAP plan administrator — Kaiser — will process the claim and then send you an Explanation of Benefits (EOB).

Benefits while traveling

In general, you must use doctors and facilities in the Kaiser Permanente California region to get benefits. However, emergencies can happen anywhere. As a Kaiser Permanente member, you’re covered for an emergency and urgent care anywhere in the world. Whether you’re traveling in the U.S. or a foreign country, the Emergency and Urgent Care Away from Home brochure explains what to do if you need emergency or urgent care during your trip.

Whether you’re planning a trip or already away from home, our travel line can help you:

  • Find out how to fill an eligible prescription before you leave or while away from home.
  • Find care in a Kaiser Permanente region.
  • File a claim for reimbursement when you’re back.

Call the Kaiser Travel Line at 951-268-3900* for additional information.

*This number can be dialed from inside and outside the United States. Outside, you must dial the U.S. country code “001” for landlines and “+1” for mobile lines before the phone number. Long-distance charges may apply. This phone line is closed on major holidays

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Benefits for family members living away from home

Coverage outside Kaiser’s service area is extremely limited. Only emergency services and urgent care related to emergency care are covered. No other services are covered, even if those services are related to an emergency condition.

Mental health and substance use disorder care

Kaiser provides all mental health and substance use disorder care for its members except inpatient and residential substance use disorder treatment. To preauthorize care, contact Kaiser at 1-877-750-3399.

Beacon Health Options provides Kaiser members with inpatient and residential substance use disorder treatment. To preauthorize Beacon Health Options care, contact:

  • A Beacon Health Options care manager at 1-800-562-3588
  • An on-site Employee Assistance Program Counselor during Normal Business hours, or contact the Employee Assistance Program (EAP) 24 hours a day, 7 days a week at 1-888-445-4436

Detoxification services can be provided through Kaiser or Beacon Health Options.

Here's what you pay for services:

  • Outpatient services: You pay 10% of the cost with no deductible
  • Inpatient services: You pay 20% of the cost after you meet the annual deductible

Applied Behavior Analysis services can be provided through Kaiser or Beacon Health Options (at no charge, with no deductible). To obtain prior authorization or pre-certification from Beacon Health Options, please call 1-888-445-4436. During this call, a care manager will request basic information — including, but not limited to — a child's diagnosis, who made the diagnosis, and what the presenting symptoms are (e.g., developmentally delayed skills, problem behaviors).