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.

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 2023 cost of coverage.

Click here for a list of free services.

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

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

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

Using your Kaiser Visa card

Effective January 1, 2023, you can use your Kaiser Permanente Visa Health Payment card outside of the Kaiser Permanente pharmacy. In addition to using your health payment card at the Kaiser pharmacy, you can now also use it at the dentist, eye doctor and for other eligible health expenses and eligible over-the-counter items at big-box retailers.

TIP: If you use your health payment card at a big-box retailer, pay at the pharmacy register.
Pharmacy registers are typically set up to recognize eligible items and will accept the card. Front registers might reject the card.

Ways to get reimbursed

If you pay for a service or for an eligible health expense using your own money and you need to be reimbursed, there are two ways to file claims for reimbursement from your Health Account or Health Care FSA:

• By logging on to Kaiser’s website and uploading, faxing, or mailing your supporting documents to Kaiser
• Through Kaiser’s smartphone app—KP HRA/HSA/FSA Balance Tracker—available through the iPhone/iPad app store and the Google Play Android Store

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.

You’ll have up to 180 days to verify expenses. If you haven’t verified your expense after 180 days, Kaiser Permanente will suspend your card.

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.

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

Generally, you won't need to file a claim for reimbursement to pay for prescriptions. You may use your Kaiser Visa Health Payment Card at the Kaiser pharmacy. Your prescription will be paid for 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

Carelon Behavioral Health (formerly 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

Effective January 1, 2023, you may use your Kaiser Visa Health Payment card when you check in for a visit at the dentist or eye doctor, or when you get a bill.

For health care services outside of Kaiser Permanente facilities, such as dental visits, you’ll need to provide an Explanation of Benefits (EOB), bill or itemized receipt to validate your health care expenses.

Kaiser Permanente will send reminders if you need to verify your expenses. You’ll need to log in to your account at kp.org/healthexpense and click File a Claim. Then follow the required steps. To verify your expenses were eligible, you’ll need to provide an Explanation of Benefits (EOB), bill or itemized receipt.

You’ll have up to 180 days to verify expenses. If you haven’t verified your expense after 180 days, Kaiser Permanente will suspend your card.

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 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 Health Care 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.

Filling a prescription for an opioid

If your doctor or dentist prescribes you an opioid, here’s what you should know.

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.

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 $570 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.

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

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 Care 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.

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.

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

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.

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).

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

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.

Kaiser provides all mental health and substance use disorder care for its members except inpatient and residential substance use disorder treatment which is covered by Carelon Behavioral Health (formerly Beacon Health Options). To preauthorize care, contact Kaiser at 1-877-750-3399 or Carelon at 1-888-445-4436.

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

Visit kp.org/mentalhealth for resources on the following:

• How to connect to care
• What to expect
• Understanding your health plan benefits (need KP member number to access)

Finding a Counselor

When seeking assistance from a counselor, it’s important to find someone who is trained to treat your problem, makes you feel comfortable, and is someone you can trust. Click here for helpful hints on finding someone who is a good fit for you.

Inpatient and Residential Substance Use Disorder Treatment

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

• A Carelon care manager at 1-888-445-4436
• 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 Carelon.

Applied Behavior Analysis

Applied Behavior Analysis services can be provided through Kaiser or Carelon (at no charge, with no deductible). To obtain prior authorization or pre-certification from Carelon, 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).

To file a claim for reimbursement for coverage through Carelon, go to Carelon's MemberConnect website, download a claim form and submit using the online form. You may also create an account on MemberConnect to access benefits information, claims and other resources. Alternatively, you can access the claim form here.

Mental Health and Wellness Tools

Take a moment. Take a breath. Take time for self-care. Explore Kaiser’s broad range of self-care resources designed to help you thrive in mind, body, and spirit, including:

• The myStrength app which can help with depression, anxiety, sleep, stress, substance use, and chronic pain
• The Calm app for meditation and sleep
• 24/7 access to emotional support coaches through the Ginger app
• Classes and support groups
• Audio activities and articles
• Depression Awareness and Help
• And more

Visit Kaiser’s mental health and wellness tools website to get started.