Most Kaiser Permanente plans require members to make copayments directly to the provider. Copayments for office visits, pharmacy services, emergency room care, and inpatient hospital care can be found online if you are registered through One Health Port to access Kaiser Permanente.

Kaiser Permanente. If you elect to participate in the Kaiser Permanente HMO plan, you are limited to using physicians and facilities that are part of Kaiser Permanente’s network of providers. All health care services (except for emergencies) must be coordinated. All Kaiser Permanente health plans cover the medical benefits you and your family need, with an emphasis on preventive care and your overall wellness. Plus, every plan includes access to high-quality virtual care with Kaiser Permanente doctors and clinicians. Choose from online chat, video, phone, and more 1 to get the care and prescriptions.

Kaiser Permanente: TRADITIONAL PLAN. Coverage Period:. Summary of Benefits and Coverage: What this plan covers and what it costs. Coverage for: Individual+Family. This is only a summary. Specialist copayment $50 Hospital (facility) copayment $500 Other (blood work) copayment $10 This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia). On the KP 0/25/Rx plan, you would pay a separate copayment for each of the covered services you receive. In this case, you would pay a $25 copay for the doctor’s ofice visit, a $25 copay for the X-ray, and either a $15 copay or 50 percent coinsurance (whichever is greater) for the generic drug.

For members on Medicare hospice plans or contracts, copayment applies to non-hospice services only.

You should collect copayments from our members at the time service is provided. You may charge interest, a reasonable billing fee, or both on unpaid copayments as stated in your office policy. The exceptions are Medicare and Medicaid enrollees, for whom it is against federal regulation to collect such fees.

Never collect a copayment from approved Medicaid enrollees; it is against federal regulation to collect such fees.

You should collect copayments for office visits only when the member sees a physician, physician's assistant, or nurse practitioner. There is no copay for seeing a lab technician.

Some group plans cover preventive care visits in full. If a member is on such a plan, do not collect a copayment.

Outpatient services requiring copayments

Kaiser Permanente Patient Website

• Audiology/hearing tests
• Family planning, prenatal, post-partum visits, and prenatal tests (but not if the provider bills globally)
• Injectable medications that may be self-administered at home
• Office visits and consultations
• Pharmacy services
• Physical, occupational, and speech therapies
• Radiation therapy and chemotherapy (except PEBB)
• Emergency room visits where there is no hospital admission
• Most mental health and substance use disorder visits

Outpatient services generally not requiring copayments

• Diagnostic radiology, ultrasound, and lab services. Exception: High-end radiology may have a copayment.
• Echocardiograms
• EEG and EKG cardiac tests
• Preventive care visits, depending on the group plan
• Injections and immunizations except injectable medications that may be self-administered at home
• Nursing home services
• Pulmonary function tests
• Tympanometry
• Visiting nurse services
• Psychological tests
• Methadone treatment

Contact the Provider Assistance Unit (PAU) with questions about copayments.

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Kaiser Permanente Copayment Gold

What are automatic refills?

When you enroll qualified prescriptions, Kaiser Permanente will refill your prescriptions automatically at the right time, unless you cancel. We will also contact your doctor to renew a prescription once the last refill is up or the prescription is about to expire.

You can select which prescriptions to include in this service. Before we process a refill, we’ll send you a reminder via text message in case you want to make changes.

What is the cost of enrolling?

There’s no additional cost to enroll in automatic refills. There are also no service, shipping, or handling charges to have qualified prescriptions mailed to you. Unless you cancel, your copay* or coinsurance costs will be charged when an order ships.

*Copayment, copay, or coinsurance is the amount a plan member is required to pay for a prescription in accordance with a plan. The amount may be a deductible, a percentage of the prescription price, a fixed amount, or other charge, with a balance, if any, paid by a plan.

How do I enroll?

1. Sign in at kp.org/wa and select 'access pharmacy services.'
2. Scroll down to click on 'sign up now' under prescription preferences.
3. Complete the steps to enroll in automatic prescription refills.

What are the benefits of having my prescriptions enrolled?

You can save time and energy by not having to refill or renew your prescriptions manually. We'll take care of it for you. This also helps ensure that you won’t miss taking an important medication because of a forgotten refill.

What are the minimum requirements for enrollment?

To provide you with the best service, we ask that you:

1. Register at kp.org/wa.
2. Update your communication preferences to allow text messaging for prescription reminders. Please make sure you have a valid mobile phone number on file.
3. Keep a bank card on file for payment.

Members age 13 to 17 are not eligible at this time.

Are all of my prescriptions eligible?

No, not all prescriptions are eligible for automatic refill or renewal. This service is available for many common maintenance medications taken on a long-term basis, such as medications for managing blood pressure, cholesterol, or diabetes. Some medications, such as controlled substances and over-the-counter medications, are not eligible for this service. You will receive a confirmation with medications that have been enrolled.

How does the automatic refill service work?

1. Request enrollment.
2. Kaiser Permanente will enroll all eligible prescriptions.
3. You will receive a secure message from Kaiser Permanente confirming the medications that have been enrolled.
4. Approximately 10 to 14 days before your refill due date, you will receive a text message reminder. At that point, you will have 2 days to request changes, delay, or cancel the refill before we begin processing your prescription through our pharmacy.
5. The Kaiser Permanente mail-order pharmacy will ship your prescriptions to you.
6. Once they’ve been mailed, you’ll receive a text notification with shipment tracking information.

How do I delay or cancel an automatic refill?

The best way to cancel or make changes is when you receive a text message reminder that your refill due date is coming up. To request changes at another time, please text the Kaiser Permanente pharmacy at 452-80, and we’ll respond within one business day. If you do not cancel within 2 days of receiving the reminder, your prescription refill or renewal order will be processed. Your current payment method will be charged for your copay* when the order ships (if applicable).

*Copayment, copay, or coinsurance is the amount a plan member is required to pay for a prescription in accordance with a plan. The amount may be a deductible, a percentage of the prescription price, a fixed amount, or other charge, with a balance, if any, paid by a plan.

When and how will you contact my doctor for a prescription renewal?

If your prescription has expired or run out of refills, we’ll contact your doctor’s office via electronic request, fax, or phone. If your doctor does not respond or declines the renewal, we will not be able to ship that medication automatically. If your doctor approves the renewal, we will process the order and send the medication to you.

What if my doctor changes my prescription or adds a new prescription?

Changes to existing prescriptions, such as how you take the medication, should not impact the automatic refill process. If you start a new medication that’s eligible, it will be enrolled automatically — no action is needed. If you don’t receive a text message confirmation and would like to confirm that your prescription is enrolled, please text our pharmacy at 452-80. We’ll respond within one business day.

How do I pay for prescriptions that are enrolled?

If you have a copay* or coinsurance, we will charge your default payment option when your prescription order is shipped. Prescriptions enrolled in automatic refills and renewals are not eligible for the installment copayment plan.

*Copayment, copay, or coinsurance is the amount a plan member is required to pay for a prescription in accordance with a plan. The amount may be a deductible, a percentage of the prescription price, a fixed amount, or other charge, with a balance, if any, paid by a plan.

How do I add a stored bank card for payment?

To add or update a stored bank card, call our pharmacy at 1-800-245-7979 (TTY 711), Monday through Friday, 7:30 a.m. to 7 p.m.; Saturday and Sunday, 8 a.m. to 4:30 p.m. You can also save your payment method when you pay for a prescription refill ordered through kp.org/wa or the Kaiser Permanente Washington mobile app.

How do I remove a prescription if I no longer want it refilled automatically?

When you receive our text message reminder that your refill due date is coming up, you can contact us within 2 days to request that the prescription be removed from automatic refills (otherwise it will be processed and shipped). To notify us at another time, text the Kaiser Permanente pharmacy at 452-80. We’ll respond within one business day.

How can I track my order once it's been mailed?

When your order ships, you'll receive a text message with tracking details. You can also view your order status at kp.org/wa under 'My Prescriptions.'

Can I return an automatic prescription refill?

We do not accept returns of prescriptions filled through our automatic refill service. You can cancel an order in advance when you receive a text message reminder (approximately 10 to 14 days before your prescription is shipped). You’ll have 2 days after receiving the reminder to notify us of any changes before your prescription is processed. After that, we’ll no longer be able to make changes or cancel your prescription.

If you have additional questions, contact us:

• Send a text to 452-80, and we'll respond within one business day.
• Call us at 1-800-245-7979 (TTY 711), Monday through Friday, 7:30 a.m. to 7 p.m.; Saturday and Sunday, 8 a.m. to 4:30 p.m.
• Sign in at kp.org/wa to chat online with pharmacy staff.