Employee Benefits | Kaiser - How Your Plan Works


Site Contents	HOW YOUR PLAN WORKS Kaiser Permanente operates a non-profit health care plan that arranges medical care for its members on a prepaid basis. This means that we are a group-practice health maintenance organization (HMO) that provides services directly, and NOT an insurer that pays for services provided by others. The Plan provides health care services in Medical Offices and designated Hospitals. Medical services for our members are provided or arranged by Medical Group Physicians who practice in our Medical Offices and designated Hospitals. They are responsible for your care. Medical services such as surgery, hospital and specialty care are covered. Hospital care is arranged by your Medical Group Physician at designated Hospitals in the Service Area. The providers who contract with Kaiser Permanente to provide authorized covered services to our members shall seek compensation for covered services solely from Kaiser Permanente and not from our members except for Supplemental Charges owed by the members. Your Kaiser Permanente Health Plan coverage requires you to use Kaiser Permanente Physicians, Medical Offices and designated Hospitals whenever possible. As your health care provider, we can assure greater continuity of care through using our own Plan Physicians in our own facilities. Also, when you use Kaiser Permanente facilities, there are no claim forms to fill out, and you pay only the Supplemental Charge, if any, shown on your Benefit Chart. You should choose a Medical Group Physician as your personal physician. Except for emergencies, visits to your Medical Group Physician should be by appointment. Phone the Medical Office of your choice for an appointment. Have your identification card handy to save time. For regularly scheduled appointments with your Plan Physician, we have 15 Medical Offices in the Denver/ Boulder/Longmont metropolitan area. Our Emergency Services section on page 7 will tell you what to do if you have an emergency.
	NAVIGATION Introduction \| Benefit Changes \| How to Use \| Definitions \| How Your Plan Works \| Who Is Eligible \| When Coverage Starts \| Benefits And Services \| Referrals and Restrictions on Choice of Providers \| Emergency Services \| Urgent Care \| Health Plan's Appeals Procedure \| Special Claims Procedures for Medicare Members \| General Provisions \|