FAQs

Kaiser Permanente is a unique, coordinated model of health care founded over 70 years ago. Today, we are recognized as one of America’s leading health care providers and are currently serving over 12 million members in 8 states and the District of Columbia.

With over 300,000 of our Georgia members trusting us with their health care and giving us the highest customer loyalty ranking 11 years in a row*, we feel confident that new Kaiser Permanente TRICARE Prime option members will be very satisfied with their care experiences.

*NICE Satmetrix® 2020 U.S. Consumer NPS Benchmark

This is an additional TRICARE Prime option being offered in the metro Atlanta area. It is now available to eligible military retirees and their family members, and active duty family members.

This option gives you the flexibility to keep your TRICARE benefit and gain access to Kaiser Permanente’s exclusive physician and hospital network.

The Kaiser Permanente TRICARE Prime option provides you with the same benefits and low costs of TRICARE Prime*. In addition, you’ll have access to the medical expertise, coordinated care, and timesaving convenience of Georgia’s top health plan, Kaiser Permanente.** Our over 800 carefully selected providers practice in 25 medical facilities throughout metro Atlanta.

* Some exceptions apply. See our pharmacy section and minimal variations pdf for details.
** NCQA’s Private Health Insurance Plan Ratings/Rankings.

This TRICARE Prime option is available in the metro Atlanta, Georgia area.

When you choose Kaiser Permanente’s TRICARE Prime option, you’ll receive the same plan benefits and low costs of TRICARE Prime* with $0 annual enrollment fee for the 1^st year. (After the 1^st year the annual enrollment fee will be the same as TRICARE Prime.**)

Like with TRICARE Prime, you’ll still be able to receive care at any TRICARE-authorized urgent care provider, military hospital or clinic (if space is available), or the VA (if you are eligible).

In addition, you’ll benefit from the medical expertise, coordinated care, and convenience of getting your care with Kaiser Permanente providers at no extra cost.

You can also take advantage of rewards, discounts & free programs including:

• up to $400 per household each year in wellness rewards – $200 for you and $200 for your enrolled spouse.
• a free virtual wellness & fitness program.
• discounts on chiropractic care, message therapy, fitness products and gym memberships.

As a Kaiser Permanente member, you’ll choose a Primary Care Physician (PCP) who will be your source for basic care, advice and direction. This is similar to a primary care manager (PCM) when you’re enrolled in TRICARE Prime. Care is provided by our network of over 800 top-notch providers at our 25 convenient medical offices in metro Atlanta – most with lab and pharmacy – along with many urgent care centers and hospitals.

For specialty care received within a Kaiser Permanente facility, you won’t need a referral or authorization. If your Kaiser Permanente provider refers you to a doctor within the Kaiser Permanente network, a referral will be submitted on your behalf. For most specialty care, there is no referral required.

*Some exceptions apply. See our pharmacy section and minimal variations pdf for details.
**It’s important to know that all TRICARE beneficiaries, except active duty service members and their families, pay an enrollment fee every year. Congress sets these fees and they’re calculated based on coverage and plan. If you’re not sure what your enrollment fees are, check your military pay for allotments, your bank account for electronic fund transfers, or your debit or credit card statements for recurring charges.

Not for the first year. TRICARE has agreed to waive the annual enrollment fee for the first year to encourage enrollment in this option (as long as you remain enrolled during this period). After the 1^st year, the annual enrollment fee will be the same as TRICARE Prime.

It’s important to know that all TRICARE beneficiaries, except active duty service members and their families, pay an enrollment fee every year. Congress sets these fees and they’re calculated based on coverage and plan. If you’re not sure what your enrollment fees are, check your military pay for allotments, your bank account for electronic fund transfers, or your debit or credit card statements for recurring charges.

This waiver will apply to any new enrollee who enrolls effective 2020, 2021, or 2022.

The Kaiser Permanente, a TRICARE Prime option benefits and copayments are virtually the same as the TRICARE Prime benefits and copayments. See costs and benefits here.

If you have questions just call us at 1-877-904-0015.

You may be eligible to enroll in this option if you are eligible for TRICARE Prime and:

• live in the metro Atlanta area (check ZIP Code below),
• are a retiree, family member of a retiree, or an active duty family member,
• are under the age of 65, and not entitled to Medicare Part A and B,
• do not have other health insurance,
• are not enrolled in TRICARE Reserve Select (TRS), TRICARE Retired Reserve (TRR), TRICARE Young Adult (TYA), or Continued Health Care Benefit Program (CHCBP), AND
• are not receiving services for an autism diagnosis.

Note: Active duty service members and TRICARE Young Adult Prime beneficiaries are not eligible for Kaiser Permanente, a TRICARE Prime Option.

To verify eligibility, call Humana Military at 1-877-414-9950.

If you are 65 years or older, and have Medicare Parts A & B, and want to keep your TRICARE benefit, you are covered under TRICARE For Life (TFL) and are not eligible for Kaiser Permanente, a TRICARE Prime option. Please see tricare.mil/tfl for detailed information on TFL.

If you prefer to have Kaiser Permanente coverage and you are eligible for Medicare, you may be able to enroll in our Medicare Advantage plan. Please check out our website at www.kp.org/medicare or feel free to give us a call at 404-365-4155.

You can enroll:

• During the TRICARE Open Season which occurs each fall, beginning on the Monday of the second full week in November to the Monday of the second full week in December.
• Up to 90 days after a Qualifying Life Event (QLE). external link such as marriage, the birth of a child, or retirement from active duty, etc. (A QLE for one family member means all family members may make enrollment changes.)

Note: For recent retirees, you and your family members can enroll up to 12 months after your retirement date. However, we recommend enrolling as soon as possible to avoid a lapse in care or claims issues.

You can enroll by calling Humana Military at 1-877-414-9950.

Once you’ve enrolled in Kaiser Permanente, a TRICARE option, you can get started in 3 simple steps:

1. Choose your doctor
2. Get prescriptions
3. Register on kp.org

We have a dedicated team of representatives to walk you through. Just call 770-291-4430 or toll-free at 1-833-642-5973 and we’ll help.

Your PCP (Primary Care Physician) is a doctor who will be your source for basic care, advice and direction. This is similar to a primary care manager (PCM) with TRICARE Prime. Your PCP will coordinate your total care – from preventive checkups and routine medical care to specialized care and hospitalizations.

• You can choose your own PCP from the doctors at our Kaiser Permanente medical offices.
• All of our available PCPs welcome our Kaiser Permanente TRICARE Prime option members.
• You can change your PCP at any time.

No, you can choose a different PCP  for each family member.

However, for convenience, you can choose a Family Medicine physician for your Primary Care Physician for you and your family, including your children.

You can learn more about our doctors in our Top-Notch Doctors section. There you will find a our online provider directory which will allow you to search for providers by location and provider type. Once you become a member you can call us – we’re happy to help you choose a physician – and you can change at any time if you feel the need.

Once you’ve select a PCP, it is important to make an appointment to establish a relationship with your new doctor. This will give your PCP the opportunity to work with you on scheduling preventive services and any ongoing specialty care needed, ensuring a smooth transition and continuity of care.

You don’t need a referral to see most specialists within Kaiser Permanente – you can self-refer directly. For those you can’t, all you have to do is contact your PCP to take care of it for you. Your PCP can also provide recommendations, guidance and follow-up care.

Yes, the Kaiser Permanente, a TRICARE Prime option includes a pharmacy benefit that:

• is part of your care, which makes medications more easily accessible.
• provides access to Kaiser Permanente’s extensive drug formulary.

When you see a Kaiser Permanente doctor, you can usually pick up your prescriptions right in the same building on your way out the door.

Please see our Pharmacies & Medications section for details.

You will have many options. You can continue to fill your prescriptions at:

• any TRICARE-authorized retail pharmacy.
• any military hospital or clinic.
• the VA (if you do so now).

plus:

• on-site at any of our 24 Kaiser Permanente pharmacies – conveniently located at our Kaiser Permanente facilities in metro Atlanta. After receiving care, your prescription can be picked up in the same facility before you leave. And our 3 Comprehensive Medical Centers have extended and weekend hours.
• through home deliver/mail order – Order your prescription refills from Kaiser Permanente online or by phone and have them sent to your door with no cost for shipping. (Including a 90-day supply refilled at a reduced copay.) (Controlled substances and most refrigerated medications, except insulin, are not currently available.)
• at any Kaiser Permanente  retail network pharmacies – including Rite-Aid, Walgreens, Kroger, Walmart and Publix.

Express Scripts mail order is excluded.

With Kaiser Permanente, you can get care from over 800 top-notch doctors, specialists and other providers at our 25 state-of-the-art medical offices conveniently located throughout metro Atlanta. You choose your own Primary Care Physician (PCP), who coordinates all of your care, like a TRICARE Prime PCM. You won’t need a referral for most specialty care. Most Kaiser Permanente medical offices also have lab, X-ray, and pharmacy services all under the same roof.

You’ll also have access to:

• a broad network of urgent care centers including 3 locations open 24/7.
• hospital care at Emory Midtown, Emory Saint Joseph’s, Children’s HealthCare of Atlanta and others.
• any ER for emergency care.

Plus, you’ll still be able to receive care at any TRICARE-authorized urgent care provider, any military hospital or clinic (if space is available), and the VA (if you are eligible).

If you need urgent care* including after hours while home or traveling, you can still access the TRICARE-authorized network providers PLUS you can access any Kaiser Permanente urgent care location.

In metro Atlanta, you’ll have access to a broad network of urgent care locations including 3 Kaiser Permanente facilities that offer urgent care 24/7.

• Gwinnett Comprehensive Medical Center. external link
  3650 Steve Reynolds Blvd.
  Duluth, GA 30096
• Southwood Comprehensive Medical Center. external link
  2470 Mt. Zion Parkway
  Jonesboro, GA 30236
• TownPark Comprehensive Medical Center. external link
  750 Townpark Lane
  Kennesaw, GA 30144

You can also call us 24/7 to get nurse advice on the best way, and best location, to get the care you need.

*Non-emergency medical conditions requiring prompt attention-such as an ear infection or a sprained ankle

You’ll have access to any hospital emergency room, anywhere in the world. Just call 911 or just go to the nearest hospital emergency room.

If you need hospital care such as a scheduled procedure or maternity care, Emory University Hospital Midtown and Emory Saint Joseph’s Hospital are the primary hospitals for Kaiser Permanente physicians and members. Children’s Healthcare of Atlanta is also an option. Northside Hospital is available for maternity care.

If you’re still within the metro Atlanta Kaiser Permanente TRICARE Prime option service area, if you choose to, you can change your Primary Care Physician (PCP) at Kaiser Permanente by selecting a new PCP online or calling us. You will need to contact Humana Military to update your address.

If you move outside the service area, Humana Military can help you transition your care to TRICARE Prime or TRICARE Select.

You’ll have coverage for emergency or urgent care anywhere you travel.

Medical Emergency

If you have a medical emergency¹, call 911 or go to the nearest hospital. If you’re admitted to a non-Kaiser Permanente hospital, we ask that you or the hospital contact us within 24 hours of admission to enable the coordination of your care.

Urgent Care

You have many options to get urgent care² without a referral while traveling outside of Georgia. You can get care at:

• any TRICARE-authorized urgent care provider.
• any military hospital or clinic (if space is available).
• the VA if you are eligible.

Plus you can visit:

• any Kaiser Permanente facility that has urgent care or after-hours services.
  • Kaiser Permanente provides care in many states across the country including all or parts of California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, and Washington, D.C.
  • You can call us 24/7, toll-free to get nurse advice on the best way, and best location to get the care you need.
  • Please note that when you’re outside of Georgia, Kaiser Permanente contracted providers (those which are not inside a Kaiser Permanente facility) will be out of network unless they’re also TRICARE-authorized.

To learn more, please see our Care Away from Home section.

¹An emergency medical condition is a medical or psychiatric condition that requires immediate medical attention to prevent serious jeopardy to your health.

²An urgent care need is one that requires prompt medical attention, usually within 24 or 48 hours, but is not an emergency medical condition. Examples include minor injuries, cuts, backaches, earaches, upper-respiratory symptoms, sore throats, frequent or severe coughs, frequent urination or a burning sensation when urinating.

 

For non-urgent care while outside of Georgia, you can:

• email your Kaiser Permanente’s doctor’s office with non-urgent questions.
• have a phone/video visit with a Kaiser Permanente physician.
• connect with a Kaiser Permanente care provider 24/7 for medical advice.
• see a Kaiser Permanente doctor when you’re in another Kaiser Permanente service area for a non-urgent visit. Just call us toll-free and we can help you get the care you need.

In addition, you can continue to:

• go to any TRICARE-authorized network provider.
• visit a military hospital or clinic (if space is available).
• go to the VA if you are eligible.

Please see our Care Away from Home section to learn about your many care options.

Yes. You always have the option to receive care at a military hospital or clinic (if space is available) or the VA (if your are eligible). The Kaiser Permanente TRICARE Prime option is an additional provider in the Military Health System network.