MMC Benefits Handbook
How the Kaiser Medical Plan Options Work
This Plan helps you and your family to pay for medical care. Generally, the Plan's reimbursement is 80% for most services (70% under the $3,000 Deductible Plan). You select a primary care physician (PCP) who will manage your care and refer you to a specialist or other provider in the network if necessary. Except in an emergency or for services authorized by Kaiser you do not receive benefits if you receive care outside the network. Note: For emergency care outside the network, you will be responsible to pay the billed charges subject to deductible, coinsurance and out-of-pocket if Kaiser cannot have the charges re-priced through their relationship with the vendors who re-price claims via their network.
For more information, including coverage criteria, other limitations of covered services, and excluded services, see the Kaiser Permanente Evidence of Coverage (EOC) available on Colleague Connect (https://mmcglobal.sharepoint.com/sites/home). Select Pay & Benefits, under Find a document, select Search all documents.
Some services have specific limits or restrictions; as described in the Kaiser EOC.
Benefits are only paid for medically necessary charges or for specified wellness care expenses.
Preauthorization may be required in order to receive coverage for certain services.