Submit claims for reimbursement

Before you submit a claim for reimbursement, review your coverage, or contact Member Services at 1-888-901-4636.

Reimbursement requests must be received by Kaiser Permanente within 12 months from the date of service.

Pharmacy service claims


Medicare Part D prescriptions

Member reimbursement drug claim form (PDF)

Mail the completed form to:

Date of service after Jan. 1, 2017:
OptumRx
P.O. Box 29044
Hot Springs, AR 71903

Date of service before Jan. 1, 2017:
Pharmacy Help Desk Prescription Claims
Kaiser Permanente (RCA-B2S-01)
2921 Naches Ave SW
Renton, WA. 98057


All other prescriptions: non-Medicare & Medicare without Part D

Prescription claim form (PDF)

Mail the completed form to:

Date of service after Jan. 1, 2016:
OptumRx
P.O. Box 29044
Hot Springs, AR 71903

Date of service before Jan. 1, 2016:
Pharmacy Help Desk Prescription Claims
Kaiser Permanente (RCA-B2S-01)
2921 Naches Ave SW
Renton, WA. 98057


For all pharmacy service claims

Include a brief description of the reason you are making this request for reimbursement and a dispensing list which includes:

  • Member name and ID number
  • Fill date
  • Drug name and strength
  • National Drug Code (NDC) number
  • Quantity (number of pills) and supply (number of days)
  • Prescription number
  • Cost and amount paid

If you make frequent requests for pharmacy reimbursement, submit those on a quarterly basis or more frequently.

After we receive a claim, processing can take four to six weeks. Claims sent to the incorrect address or with missing required information may be returned without reimbursement. Claims processed at pharmacies not in the plan network, including some federal facilities, will be reviewed for a reasonable need to obtain outside of the pharmacy network.

Foreign claims

While traveling outside of the U.S., your plan offers coverage for urgent and emergency care, and an inpatient hospital stay following an emergency admission.

If you are admitted for an emergency, you or a family member must call the Emergency Notification Line at 1-888-457-9516 or 206-630-3413 within 24 hours after admission. Medical providers outside the U.S. usually require you to pay when you receive service and file for reimbursement.

Member reimbursement form for medical claims (PDF)

Mail the completed form to:

Kaiser Foundation Health Plan of Washington
Attn: Claims Administration
P.O. Box 34585
Seattle, WA 98124-1585


For all foreign medical service claims

We require an itemized bill from the provider's office which includes:

  • Member name and ID number
  • Date of service
  • Country where services were provided
  • Place of service (doctor's office, emergency room, urgent care)
  • Description of the medical condition you were seen or treated for and the services provided
  • Practitioner's name
  • Total billed charges
  • Proof of payment
  • Verification of the type of currency used by the country where the services were rendered
  • Translation of all services rendered
  • Translation of medical records required for inpatient claims

For prescription reimbursement following urgent or emergency care

Fill out the appropriate prescription reimbursement form (see Pharmacy Services, above). Prescription reimbursement requires:

  • Member name and ID number
  • Date of service
  • Country where services were provided
  • U.S. equivalent drug name
  • Strength
  • Quantity
  • Days' Supply

Translating documents

To avoid delays in processing your request, provide an English translation of your foreign documents and receipts if they are in another language. We will do our best to translate, but if we are unable to, we will send it back to you for translation. Kaiser Permanente does not cover or reimburse for document translation.

After we receive a claim, processing can take up to 60 days.

Medical service claims


Member reimbursement form (PDF)

Mail the completed form to:

Kaiser Foundation Health Plan of Washington
Attn: Claims Administration
P.O. Box 34585
Seattle, WA 98124-1585


For all medical service claims

Attach an itemized statement from the provider which includes:

  • Member name and ID number
  • Provider name and address
  • Date of service
  • Place of service (doctor's office, emergency room, urgent care)
  • Provider's name
  • Diagnosis (ICD10) and procedure (CPT) codes
  • Itemized charges and proof of payment

Valid proof of payment includes a charge card receipt, a cancelled check, or a statement from the provider showing the services have been paid.

Note: You only have to include a copy of your Explanation of Benefits if Kaiser Permanente is your secondary coverage.

After we receive a claim, processing can take up to 60 days.

Claims with missing required information may be returned without reimbursement.