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Point-of-Service (POS) plan - California Region


      The Kaiser Permanente POS Plan is a three-tier employer group plan allowing you to receive care within Kaiser Permanente’s integrated care delivery system or obtain covered medical services through our participating network of providers or any licensed non-participating provider of your choice. The POS Plan is jointly underwritten by Kaiser Foundation Health Plan, Inc. (KFHP) and  Kaiser Permanente Insurance Company (KPIC). The HMO tier of the POS Plan is underwritten by Kaiser Foundation Health Plan, Inc. (KFHP). The participating and non-participating tiers of the POS Plan are underwritten by Kaiser Permanente Insurance Company (KPIC). 

      Here are some highlights:

      Preventive care—preventive benefits, as defined under the Patient Protection Affordable Care Act (PPACA), are covered at little or no cost to you when you see a Kaiser Permanente Provider or Participating Provider.  

      Choice of providers—you can see a Kaiser Permanente physician for a full spectrum of services and specialty care. By seeing a Kaiser Permanente physician, your out-of-pocket costs are lowerYou may also seek provider services through the Private Healthcare Systems (PHCS) Network, our participating network of providers or any licensed, non-participating provider, hospital, or laboratory that’s convenient.

      Specialty care—specialty care is available through Kaiser Permanente as referred by your doctor. You can see most specialists without a referral when using participating network or any licensed non-participating providers.

      Pharmacy coverage—you can access on-site pharmacies at most Kaiser Permanente locations. Additionally, Kaiser Permanente Insurance Company contracts with MedImpact to fill your outpatient prescription drugs at retail pharmacies across the country. You can use any of the nearly 60,000 retail pharmacies nationwide in the MedImpact participating pharmacy network.

      More information about the drugs covered under your plan when accessing a Kaiser Permanente pharmacy is available here.

      For more information about the drugs covered under your plan when accessing a MedImpact pharmacy, select the drug formulary below that applies to your plan:

      Standard Formulary
      Formulary with Specialty Drug Tier

      Care management—Permanente Advantage (PA) brings the values and experience of Permanente medicine to our POS members. PA provides care coordination designed to assure the delivery of medically necessary, quality patient care through appropriate utilization of resources in a cost effective and timely manner. PA is accredited by URAC, previously known as the Utilization Review Accreditation Commission. URAC ensures that health programs meet national quality standards.

      Case Management—the Permanente Advantage Case Management program is committed to assisting with serious, complex or high cost illness. Permanente Advantage Case Management will provide care advice customized for your situation, and our team will help you assess your options and arrange the services you need to meet your treatment goals.

      If you have any questions about Permanente Advantage Case Management, please call directly at 1-888-251-7052 x1047.

      Worldwide coverage—you have coverage for emergency care anywhere in the world.

       

      NOTE: Under California Law, Kaiser Permanente is required to post information about recent rate changes we have made for our small group customers. Our submitted rate filing descriptions are available here.

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      The information provided on this web site is drafted in compliance with applicable California legislation and regulations and is intended solely for use by California residents. As such, this information neither purports nor should be construed to purport to sell, solicit, offer or advertise to any entity or individual who is not a resident of California.