Understanding Your Plan and Benefits
Choice Products empower you to make the best health care choice for you—wherever you are, and whenever you need care.
Here’s an overview of getting care with Choice Products. In the 3 Tier Point-of-Service (POS) plan, there are three Tiers to choose from: HMO In-Network Provider Tier, Participating Provider Tier, and Non-Participating Provider Tier.
You can also view a short video on the features of our MultiChoice, 3 Tier Point-of-Service (POS) plan, by clicking here.
HMO In-Network Provider Tier
Kaiser Permanente Providers
Features and benefits of our plan.
- Lowest out-of-pocket costs. With this Tier, you’ll usually pay the least out of pocket, with no or a lower deductible.
- Coordinated care. Your primary care physician works closely with specialists, pharmacists, lab technicians, therapists, and many other professionals. And because they are all connected through your electronic medical record, everyone in the network gets up-to-the-minute information on your health for a better care experience.
- Referrals from your doctor. Your primary care physician can coordinate your referral to a specialist, and can even schedule your appointment.
- State-of-the-art medical offices. Kaiser Permanente’s state-of-the-art medical offices are located throughout the region, with doctors, specialists, imaging, pharmacy and many times, labs, all in one place.
- Emergency care. You are covered for emergency care worldwide. The emergency care copay will be waived if you are directly admitted to a hospital as a result of an emergency.
- Urgent care. Urgent care is available at Kaiser Permanente medical offices. To find doctors, locations, and urgent care facilities, please click here.
- Hospital care. Kaiser Permanente carefully selects hospitals to partner with us in taking great care of you.*
- Medical advice. When you call for medical advice you will be connected with a professional that can help advise and make appointments with one of our providers. You can get advice by calling the number on the back your ID card. 24/7.
- Lab services. Your results from tests done in Kaiser Permanente medical offices can be read (for most results) online soon after the lab completes your tests, sometimes the same day.
- No-cost preventive care. With your plan, you pay $0 for preventive care. That includes routine physicals, well-child visits, and certain screenings and tests (such as mammograms).
- Choose from telehealth options that fit into your schedule. Chat with a Kaiser Permanente doctor, email, or schedule a phone or video visit. Be aware that costs may apply for some visits.**
- Manage your health online. Use the convenient features of kp.org to manage your health.**
- Email your doctor’s office
- View most test results
- Schedule or cancel routine appointments
- Refill most prescriptions
- View past visits
- Find care options and urgent care locations near you
- Register at kp.org/registernow
- Select your region
- Your user name and password can also be used on our mobile app
To find out more about what is covered under the HMO In-Network Provider Tier, see your Evidence of Coverage (EOC) or call Customer Service at 1-855-364-3184 (TTY 711).
*These contracted hospitals are independently owned and operated and are not affiliated entities of Kaiser Permanente.
**Video visits are available for members who receive care at Kaiser Permanente medical offices. You must be 18 or older to schedule a video visit. Check with your doctor’s office to find out if video visits are available to you.
Participating Provider Tier
You have two network options within the Participating Provider Tier.
Provider Directory Options by Location:
In Kaiser Permanente States: The 3T POS, PPO, and OOA’s First Health Network provides access to care in the Kaiser Permanente states of CA, CO, GA, HI, MD, OR, VA, WA, and DC.
Non-Kaiser Permanente States: The Cigna HealthcareSM PPO Network* only provides access to care in non-Kaiser Permanente states.
*Disclaimer: The Cigna PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna PPO for Shared Administration.
To find a Participating Provider or confirm if your current provider is part of the Participating Provider Tier, you can search for Providers by location (Kaiser Permanente and non-Kaiser Permanente states) or call Customer Service at 1-855-364-3184 (TTY 711), Monday through Friday 8 a.m.-6 p.m., Mountain time.
Features and benefits of covered care from our participating provider networks.
Your choice of participating provider is determined by location of services. Please see “Providers by Location”, above, to ensure that your provider is part of the Participating Provider Network. You may also call Customer Service at 1-855-364-3184 (TTY 711), Monday through Friday 8 a.m.-6 p.m., Mountain time.
In the Participating Provider Tier, you don’t have to select a personal doctor. You can see First Health or Cigna PPO Network health providers without a referral.
- Out-of-pocket costs. Although you will probably have higher out-of-pocket costs than in the HMO In-Network Provider Tier (such as a deductible, coinsurance, and a copay), you will not be responsible for amount you are billed above the maximum allowable charge set out in your Certificate of Insurance (COI).
- Specialty care. You don’t need a referral for specialty appointments with any participating providers. However, your Participating Provider must obtain pre-certification for certain services and treatments* such as:
- Inpatient hospital stay
- Outpatient surgery
- Home health, hospice, and skilled nursing facility services
- Imaging services
- Please review your Certificate of Insurance (COI) for plan detail
- Behavioral health. You can receive care for mental illness, emotional disorders, and drug or alcohol abuse from Participating Providers.
- Hospital care. You can receive inpatient hospitalization services from Participating Provider hospitals and facilities. Your Participating Provider may make arrangements for your hospital admission. (Important! Not all physicians contracted in the Participating Provider Tier have admitting privileges with participating hospitals). Please confirm the facility is contracted with the network or you may pay higher out-of-pocket costs.* To learn more, please click here.
- Maternity care. You can choose a Participating Provider for your obstetric care.*
- Lab tests, X-rays. You can contact facilities directly. Check first to be sure the facilities are part of the Participating Provider network. You can request your Participating Provider to send labs, X-rays, and special procedures (MRIs, CT scans, PET scans, nuclear medicine) to a Kaiser Permanente facility, an HMO In-Network Provider, any time you choose, and you will likely pay less.
- Pharmacy services. Learn about your pharmacy benefits in the Participating Provider Tier.
To find out more about what is covered under the Participating Provider Tier:
- See your Choice Products POS Member Resource Guide.
- Refer to your Certificate of Insurance (COI).
- Contact the human resources/benefits officer where you work, if your employer provides your coverage.
- Call Customer Service at 1-855-364-3184 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Mountain time, or refer to your ID card.
*Inpatient and certain outpatient services are subject to pre-certification. Your Participating Provider must call 1-888-525-1553 (TTY 711) for pre-certification.
This site provides an overview of your benefits and services. If there are any differences between this document and your Certificate of Insurance (COI), your Certificate of Insurance (COI) will prevail.
For its Participating Provider Network, Kaiser Permanente Insurance Company (KPIC) has contracted First Health, a brand name of First Health Group Corp. The list of participating First Health providers is subject to change without notice.
KPIC has also contracted with the Cigna PPO Network outside of Kaiser Permanente states for health care providers (doctors, hospitals, specialists) contracted as part of the Cigna PPO for Shared Administration. Cigna is an independent company and not affiliated with Kaiser Foundation Health Plan, Inc., and its subsidiary health plans. Access to the Cigna PPO Network is available through Cigna’s contractual relationship with the Kaiser Permanente health plans. The Cigna PPO Network is provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
Non-Participating Provider Tier
Features and benefits of receiving covered care from any licensed provider.
- Full provider choice, care anywhere. Your Non-Participating Provider Tier benefits cover care you receive from any licensed provider (who’s not in HMO In-Network Provider Tier or Participating Provider Tier).
- Using Non-Participating Providers generally means higher out-of-pocket costs. Your out-of-pocket costs will generally be the highest when you choose to receive care from a Non-Participating provider or facility.
- Behavioral health. You can receive care from any licensed behavioral health or chemical dependency professional for mental illness, emotional disorders, and drug or alcohol abuse.*
- Hospital care. You can receive inpatient hospitalization services from licensed or accredited hospitals and facilities that are not in the HMO In-Network Provider Tier or Participating Provider Tier.*
- Emergency care. You can visit any licensed Non-Participating emergency care facility. Emergency care is covered at the HMO In-Network Provider Tier benefit level, and you will be responsible only for the HMO In-Network cost share, regardless of where you seek care.
- Urgent care. You can visit any licensed Non-Participating urgent care facility.
- Maternity care. You can choose any licensed provider for obstetric care.*
- Lab tests, X-rays. You can contact facilities directly. Check first to be sure the facilities are part of the First Health® Network or are Direct Contracted Providers. You can request your Non-Participating Provider send labs, X-rays, and special procedures (MRIs, CT scans, PET scans, nuclear medicine) to a Kaiser Permanente facility, a HMO In-Network Provider, any time you choose, and you will likely pay less.
- Pharmacy services. Learn about your pharmacy benefits in the Non-Participating Provider Tier.
To find out more about what is covered under the Non-Participating Provider Tier.
- See your Choice Products POS Member Resource Guide.
- Refer to your Certificate of Insurance (COI).
- Contact the human resources/benefits officer where you work, if your employer provides your coverage.
- Call Customer Service at 1-855-364-3184 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Mountain time, or refer to your ID card.
*Inpatient and certain outpatient services are subject to pre-certification. Call 1-888-525-1553 (TTY 711) for precertification.
This site provides an overview of your benefits and services. If there are any differences between this document and your Certificate of Insurance (COI), your Certificate of Insurance (COI) will prevail.