Forms & publications

Can't find what you need? Visit UMP Forms and publications for more documents.

Kaiser Permanente WA Original Medicare Certificate of Coverage (COC) 2019

This booklet gives you the details about your Kaiser Permanente WA Medicare Advantage plan for 2018. It explains how to get coverage for the health care services you need. This is an important legal document.

Publication

Kaiser Permanente WA preauthorization requirements

Preauthorization requirements for Kaiser Permanente WA plans. Preauthorization is when you seek approval from your health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.

Publication

Kaiser Permanente WA SoundChoice Certificate of Coverage (COC) 2019

This benefits book describes what is covered under Kaiser Permanente WA SoundChoice, including medical services and prescription drugs, as well as specific services not covered by the plan. Finding preferred providers and how much you’ll pay, including deductibles, coinsurance, and copays. It also includes how to request an appeal, submit a claim, and how Medicare works with your plan.

Publication

Kaiser Permanente WA SoundChoice Summary of Benefits and Coverage (SBC) 2019

A summary of what the Kaiser Permanente WA SoundChoice plan covers and what it costs.

Publication

Kaiser Permanente WA Value Certificate of Coverage (COC) 2019

This benefits book describes what is covered under Kaiser Permanente WA Value, including medical services and prescription drugs, as well as specific services not covered by the plan. Finding preferred providers and how much you’ll pay, including deductibles, coinsurance, and copays. It also includes how to request an appeal, submit a claim, and how Medicare works with your plan.

Publication

Kaiser Permanente WA Value Summary of Benefits and Coverage (SBC) 2019

A summary of what the Kaiser Permanente WA Value plan covers and what it costs.

Publication

List of prescription drugs subject to emergency fill

This is a partial list of prescription drugs for which you may request an emergency fill during the preauthorization process, and a description of how it works.

Publication

Long-Term Disability (LTD) Program Certificate of Coverage (COC) 2019

This is the Long-term Disability (LTD) Program book. It includes information on eligibility, enrollment, exclusions, and premiums.

Publication

Medical benefits comparison 2019

This chart briefly compares the per-visit costs of some in-network benefits for PEBB plans. Some copays and coinsurance do not apply until after you have paid your annual deductible.

Publication

Medical Claim Form

This form is for sending in a claim for medical services for all Uniform Medical Plans.

Form

Pages