PEBB FAQ

Choosing Kaiser Permanente WA

Options, quality, and convenience — it's how Kaiser Permanente makes your health care better. You have the freedom to choose your own doctors, from the more than 1,100 providers at Kaiser Permanente Medical Group1 to the more than 9,000 community doctors2 and 44 hospitals statewide. You also get the quality care you deserve, including more time with your doctor.

Better health care also means making it convenient for you. So nearly all Kaiser Permanente medical offices have lab, X-ray, and pharmacy services all under one roof. Get access anytime, anyplace with our personal online services on your computer or on your smartphone with our new mobile app. Either way, you can make appointments, email your doctors, see your test results, and more whenever you get care at Kaiser Permanente medical offices.

Doctors and Care

You can use our Provider Directory to find available providers in your area or to see if your current primary care provider is available through Kaiser Permanente WA. In addition to the 1,000-plus providers in the Washington Permanente Medical Group, our online Provider Directory also lists the names of over 9,000 contracted doctors.2

To find a provider, check our website for the most current information, refer to our Provider Directory, or call Member Services at 1-888-901-4636. Our Member Services representatives can help you choose a doctor based on his or her location, special interests, gender, or other factors that are important to you. Also remember that each family member may choose a different provider. If for any reason you wish to change doctors, you can at any time.

With your Kaiser Permanente WA health plan, you can choose from 500 specialists in over 60 specialties — most without a referral. These specialists are located at our Kaiser Permanente medical offices. To find out which specialists are available, please call Member Services at 1-888-901-4636 or speak to your primary care provider. If you wish to see a specialist who does not practice at a Kaiser Permanente medical office, talk with your primary care provider about a referral.

The PEBB plans cover a limited number of acupuncture, naturopathy, and chiropractic visits without requiring a referral from your primary care provider. Massage therapy services require a prescription and care plan from your primary care provider if he or she determines the services are medically necessary.

Routine care is available at Kaiser Permanente medical offices or at facilities in our contracted network. Please refer to your Provider Directory on our website for specific phone numbers for the facility of your choice.

Five of our medical centers have Urgent Care Centers, most with evening, weekend, and holiday hours including Bellevue, Olympia, Seattle (Capitol Hill), Silverdale, and the Tacoma Medical Center. Urgent Care Centers at the Bellevue Medical Center, Capitol Hill Campus in Seattle, and Tacoma Medical Center are open 24 hours a day, seven days a week.

For urgent care during business hours, call your provider's office or the Consulting Nurse Service. For urgent care after business hours, on weekends, or on holidays, call the Consulting Nurse at 206-630-2244 for the Seattle area. For all other areas in Washington State, call 1-800-297-6877. The nurse will listen to your concerns and direct you to the most appropriate care.

In a life-threatening emergency, call 911 or your local emergency number. If you are unable to do so, ask someone to call for you or to take you to the nearest emergency care facility. You may go to any hospital in your area for emergency care. Remember that you may save money if you go to an emergency room at any of our contracted hospitals if possible. Refer to Emergency and urgent care for more information. The Consulting Nurse Service can also direct you to the best place near you for your particular emergency.

When you want care advice or need to know if you should get immediate medical attention, Kaiser Permanente WA's Consulting Nurse Service can help 24 hours a day. In the Seattle area, call 206-630-2244. For all other areas in Washington State, call 1-800-297-6877.

Use emergency care for sudden, unexpected medical conditions that, in the reasonable judgment of a prudent lay person, would endanger a person's life or seriously harm the person's health if not treated immediately by a licensed medical professional. Emergency medical conditions include:

  • Suspected heart attack or stroke
  • Sudden or extreme difficulty breathing
  • Bleeding that will not stop or deep cuts
  • Major burns
  • Seizures
  • Sudden and severe headache or abdominal pain
  • Poisoning or suspected poisoning

Kaiser Permanente WA's priority is putting patients first — which always means giving you the best care possible. If you or anyone in your family has a serious illness and needs hospitalization, you can rest assured that Kaiser Permanente WA has amazing partners in care across our service area, including seven hospitals where we have providers on the medical staff. Your primary care provider will help coordinate your care to the place that best suits your needs.

You are covered for emergency and medically necessary urgent care worldwide. In the case of a life-threatening emergency, call 911 or the local emergency number where you are visiting. If you are admitted to the hospital, you or a family member must call the Emergency Notification Line at 1-888-457-9516 within 24 hours, or as soon as reasonably possible. For other care out-of-area, call the Consulting Nurse Service for advice on what to do for your particular health issue.

You can get one-stop services at our 31 Kaiser Permanente medical offices where you'll find that, in addition to seeing your doctor, you usually can get lab tests, X-rays, and pharmacy services. Our Kaiser Permanente medical offices also provide specialty care services. See our Provider Directory for a list of Kaiser Permanente specialists and where they are located.

At Kaiser Permanente, we believe in getting healthy and staying that way. That's why we offer an array of wellness resources and put a priority on preventive care so you can avoid problems before they start. From your annual wellness visit and recommended screenings, to a proactive health risk assessment questionnaire, to access to health coaching 24/7 for additional support, we provide you with a variety of clinical help so that you can be your healthiest self. We also have tobacco cessation programs, classes and support groups, and a whole lot more.

Prescriptions

Your prescriptions can be filled at Kaiser Permanente medical offices or you can find additional contracted pharmacies in your Provider Directory. You can also conveniently refill your prescriptions online and have them delivered to your home with no shipping fees through our Mail Order service.

If you are a new patient and are seeing a Kaiser Permanente WA provider for the first time, you may be taking medicine prescribed by a non-Kaiser Permanente doctor. Please make an appointment to review your medications with your new Kaiser Permanente primary care provider. If you had an authorization for a drug from a previous insurer, you will need to get a new authorization from Kaiser Permanente WA. Call Member Services for assistance.

For information on the drug formulary including the value tier drugs covered at the lowest cost share, please review the drug formularies found here.

Transferring Care and Medical Records

Members with transitional care needs are encouraged to contact a Member Services representative who will help in transitioning and coordinating the care of new members. Please call Member Services at 1-888-901-4636, Monday through Friday, between 8 a.m. and 5 p.m.

You may request your personal medical record from your previous provider. Your previous provider may ask for proof of identification or a signature to release your medical records. You may bring your files to your newly selected provider or you can request that the files be sent directly to the facility of your choice.

Online Services and Mobile App

Kaiser Permanente member website lets you refill prescriptions, create a health risk assessment report, and browse more than 5,000 health care topics. You can also better manage your health care costs by tracking your spending toward deductibles and out-of-pocket expenses. And, when you receive care at Kaiser Permanente medical offices, the secure member website allows you to securely email your doctor, view test results online, view your online medical record, check your child's medical record, and more. See our online tour for more information.

If you are registered with Kaiser Permanente WA member website and receive your care at Kaiser Permanente medical offices, you can now do many things that you can via Kaiser Permanente member website anytime, anywhere — with our smartphone app. For added convenience, this app includes a host of innovative features to easily connect you to the Consulting Nurse, check lab and pharmacy wait times at your nearest Kaiser Permanente medical office, map directions to our medical facilities, or connect to your care team if you get care with Kaiser Permanente WA.

Benefit Changes and Enrollment

Kaiser Permanente WA CDHP

  • Switch the network from Access PPO to Core HMO; Beyond access to 10,000 providers in the Core network, members can call the Consulting Nurse helpline for advice 24/7, use CareClinic at Bartell Drugs at select Seattle-area locations, or get diagnosis and treatment for routine issues with a Kaiser Permanente WA online visit
In 2018, Kaiser Permanente WA Sound Choice will:
  • Reduce out-of-pocket limit of $2000/person, $4000/family
  • Add a $100/person, $300/family prescription drug deductible
  • Waive the prescription drug deductible on value and tier 1 drugs
  • Add $2000/person prescription drug out-of-pocket limit
  • Reduce coinsurance of 15%
In 2018, Kaiser Permanente WA Classic will:
  • Lower medical deductible of $175/person, $525/family
  • Add a $100/person, $300/family prescription drug deductible
  • Waive the prescription drug deductible on value and tier 1 drugs
  • Add $2000/person prescription drug out-of-pocket limit
  • Reduce coinsurance of 15%
In 2018, Kaiser Permanente WA Value will:
  • Add a $100/person, $300 family prescription drug deductible
  • Waive the prescription drug deductible on value and tier 1
  • Add a $2000/person prescription drug out-of-pocket limit

In 2018, Kaiser Permanente WA (KPWA) is offering KPWA SoundChoice, which offers the lowest monthly premium available for Kaiser Permanente WA non-CDHP plans. This plan is available to members living in Snohomish, King, Pierce and Thurston counties. KPWA Value, with its predictable copayments continues to be a cost-effective option for PEBB members. KPWA Classic offers the same services with lower copays. We also offer a consumer-directed health plan (CDHP) with an even lower premium than our other plans, balanced with a higher deductible and out-of-pocket maximum.

See rates and benefits.

The annual out-of-pocket maximum is the most you pay in a calendar year. Once you have paid this amount, the plans pay 100 percent of allowed charges for most covered benefits for the rest of the calendar year.

These costs do not apply toward your annual out-of-pocket maximum:

  • Monthly premiums
  • Charges above what the plan pays for a benefit
  • Charges above the plan's allowed amount paid to a provider
  • Charges for noncovered services or treatments
  • Coinsurance for non-network providers
See our website for all of your 2018 plan details.

Visit the PEBB website where you can select the green "My Account" button in the upper right hand corner (under the My PEBB header) to make a plan change online during the PEBB Program's open enrollment period (Nov. 1 – 30, 2018). Or you can download and print a form from PEBB's Forms and Publication link.

Medicare

For retirees, COBRA, and PEBB Continuation of Coverage members only: When you receive your Medicare card, send a copy of it to the Public Employees Benefits Board (PEBB) Program indicating the effective dates of your Medicare Parts A & B coverage. You will also need to send a Medicare Advantage election form (PDF) to Kaiser Permanente WA or the PEBB Program. You won't need to enroll in Medicare Part D, since your PEBB plan provides comparable prescription drug benefits.

Dependent Children and Student Dependents

Dependent students who live outside the Kaiser Permanente WA service area in the Puget Sound and Spokane have the same coverage as any out-of-area member, which is emergency/urgent care only. Other services will be covered when they are obtained within our service area. If your student dependent lives in Kaiser Permanente WA's service area, they can get routine care at Kaiser Permanente medical offices.

Consumer-directed Health Plans (CDHP)and Health Savings Accounts (HSA)

CDHPs offer a low monthly premium, balanced with a higher deductible and out-of-pocket maximum. However, members can use funds in their Health Savings Account (HSA) to pay for many out-of-pocket costs (including deductibles), or allow HSA savings to grow for future medical expenses. When you enroll in a CDHP, your employer or the PEBB Program contributes money into your HSA on a prorated basis. This will add up to $700.08 annually for a single subscriber, or $1400.04 annually for a subscriber and one or more covered dependents. The entire amount is not deposited in the HSA on Jan. 1. If you are a single subscriber, your employer will contribute $58.34 each month in your HSA as long as you remain eligible for enrollment in a consumer-directed health plan and health savings account. If you have a family member enrolled, your employer will contribute $116.67. Members may also choose to make tax-free contributions to their own health savings accounts, up to IRS annual limits. Learn more about the Kaiser Permanente WA's HealthPays HSA (CDHP) plan rates and benefits or call Member Services at HealthEquity, the trustee for your HSA, at 1-877-873-8823.

Yes, similar to an IRA, many HSAs let you choose to invest a portion of your account balance in stocks, bonds, mutual funds, CDs and/or other annuities. With your Kaiser Permanente WA's HSA, you can invest in pre-selected mutual funds after you reach a $2,000 balance in your account.

Yes, you can make a one-time rollover from your IRA into your HSA. You can't however roll money into your IRA from your HSA. Note that a rollover will count against annual contribution limits.

In 2018, the maximum annual contribution limits set by the IRS for an individual account is $3,450 and the maximum contribution for family coverage is $6,850. People ages 55 and older may contribute up to $1,000 more annually in addition to the limits above.

You may take that money with you wherever you go — it's your money and your account. If you're on Medicare or go to another employer that doesn't have a qualified CDHP, you can still use your HSA money to pay for co-pays and qualified medical expenses, but won't be able to make contributions to your HSA.

The money rolls over from year to year. You don't lose the money left in your HSA or the interest it's earned.

Yes, you can take the money out anytime tax-free and without penalty as long as it's to pay for qualified medical expenses. If you take money out for other purposes, however, you'll have to pay income taxes on the withdrawal plus a 20 percent penalty.

Yes, the money in your HSA can be used to pay for qualified medical expenses of any family member who qualifies as a dependent on your tax return. However, if the dependent isn't covered under your plan, his/her expenses won't be applied toward your deductible.

You're responsible to pay the amount your insurance has contracted to pay your doctor, typically a discounted rate, until your deductible is met. You can use your HSA for this expense. It's best to have your doctor's office put the charge through to your insurance so that you can receive credit toward your deductible and know exactly what to pay. Some doctors may require that you pay up front, but most bill your insurance and then bill you only once the claim has been processed.

Yes, but if you do (and you are under age 65) you'll be taxed on the money you use and assessed a 20 percent penalty. Once you are 65, you'll be taxed for moneys used for nonmedical expenses, but won't pay the penalty.

Contacting Kaiser Permanente WA

CDHPs offer a low monthly premium, balanced with a higher deductible and out-of-pocket maximum. However, members can use funds in their Health Savings Account (HSA) to pay for many out-of-pocket costs (including deductibles), or allow HSA savings to grow for future medical expenses. When you enroll in a CDHP, your employer or the PEBB Program contributes money into your HSA on a prorated basis. This will add up to $700.08 annually for a single subscriber, or $1400.04 annually for a subscriber and one or more covered dependents. The entire amount is not deposited in the HSA on Jan. 1. If you are a single subscriber, your employer will contribute $58.34 each month in your HSA as long as you remain eligible for enrollment in a consumer-directed health plan and health savings account. If you have a family member enrolled, your employer will contribute $116.67. Members may also choose to make tax-free contributions to their own health savings accounts, up to IRS annual limits. Learn more about the Kaiser Permanente WA's HealthPays HSA (CDHP) plan rates and benefits or call Member Services at HealthEquity, the trustee for your HSA, at 1-877-873-8823.

Yes, similar to an IRA, many HSAs let you choose to invest a portion of your account balance in stocks, bonds, mutual funds, CDs and/or other annuities. With your Kaiser Permanente WA's HSA, you can invest in pre-selected mutual funds after you reach a $2,000 balance in your account.

Yes, you can make a one-time rollover from your IRA into your HSA. You can't however roll money into your IRA from your HSA. Note that a rollover will count against annual contribution limits.

In 2018, the maximum annual contribution limits set by the IRS for an individual account is $3,450 and the maximum contribution for family coverage is $6,850. People ages 55 and older may contribute up to $1,000 more annually in addition to the limits above.

You may take that money with you wherever you go — it's your money and your account. If you're on Medicare or go to another employer that doesn't have a qualified CDHP, you can still use your HSA money to pay for co-pays and qualified medical expenses, but won't be able to make contributions to your HSA.

The money rolls over from year to year. You don't lose the money left in your HSA or the interest it's earned.

Yes, you can take the money out anytime tax-free and without penalty as long as it's to pay for qualified medical expenses. If you take money out for other purposes, however, you'll have to pay income taxes on the withdrawal plus a 20 percent penalty.

Yes, the money in your HSA can be used to pay for qualified medical expenses of any family member who qualifies as a dependent on your tax return. However, if the dependent isn't covered under your plan, his/her expenses won't be applied toward your deductible.

You're responsible to pay the amount your insurance has contracted to pay your doctor, typically a discounted rate, until your deductible is met. You can use your HSA for this expense. It's best to have your doctor's office put the charge through to your insurance so that you can receive credit toward your deductible and know exactly what to pay. Some doctors may require that you pay up front, but most bill your insurance and then bill you only once the claim has been processed.

Yes, but if you do (and you are under age 65) you'll be taxed on the money you use and assessed a 20 percent penalty. Once you are 65, you'll be taxed for moneys used for nonmedical expenses, but won't pay the penalty.

1Washington Permanente Medical Group personnel records, January 2018
2OIC Provider Form A
3Prescriptions from online visits must be filled at Kaiser Permanente Washington medical offices or mail order service.

STATE EMPLOYEES AND RETIREES INDEX

Questions?

Kaiser Permanente has set up a special Customer Service line just for active PEBB employees.

Speak with a representative Mon. – Fri. 8 a.m. – 6 p.m.

Call 1-866-648-1928

For Medicare questions

Medicare members call to speak with a licensed Kaiser Permanente WA representative:

1-800-581-8252 (TTY 711)

Provider Directories

Find a Provider For SoundChoice Subscribers

Find a Provider For Classic, CDDHP, and Value Subscribers)

Find a Provider Medicare Advantage Retirees

Frequently Asked Questions

Find answers to frequently asked questions about our online services to manage your care, including paying premiums or bills, refilling prescriptions, emailing your doctor, and more.