Choice Products empower you to make decisions about how you receive care—and who you receive it from. You can receive care from providers in the Participating Provider Tier, or from any licensed physician or facility you choose in the Non-Participating Provider Tier.
You’re free to choose whatever provider you prefer, whenever you receive care.
What does each Tier offer?
Participating Provider Tier:
A wide network of providers with managed out-of-pocket costs.
- Choose from an extensive network of Participating Providers across the country.
- We’ve contracted with First Health® and the Cigna PPO Network to manage provider costs.
- Your out-of-pocket costs will be lower than in the Non-Participating Provider Tier.
- Your physician will complete a claim form, just as with most traditional health plans.
- You can see most specialists in this network without a referral.
- Certain services require prior authorization/pre-certification with First Health providers within Colorado and other Kaiser Permanente states (CA, GA, HI, MD, OR, VA, WA and DC). If using the Cigna PPO Network for care in non-Kaiser Permanente states, the Cigna PPO providers are responsible for obtaining pre-certification on your behalf when pre-certification is required. You won’t be financially responsible if a Cigna PPO provider fails to obtain pre-certification for covered services
Non-Participating Provider Tier:
Care from any licensed provider in the U.S., highest out-of-pocket costs.
- You can receive care from any licensed care provider in the U.S., including physicians, specialists, hospital, or laboratory (outside of the Participating Provider Tier).
- Your out-of-pocket costs will usually be the highest with this Tier.
- You may have to pay the provider directly at the point of service.
- A claim form will have to be completed, just as with most traditional health plans. If you are required to pay out-of-pocket at the point of service, you can complete a medical claim form and submit it for reimbursement from your insurance carrier.
- You can see any specialist you choose without a referral.
- Certain services require pre-certification.
View Kaiser Permanente’s Sample Coverage Documents:
FOR future members – To view our SAMPLE plan documents, click here and choose the line of business and state from the dropdown menu and review items to assist in your plan choice.
FOR current members – The sample documents may vary from your actual benefits. To view a copy of your specific plan documents, please log into kp.org or contact Customer Service at 1-855-364-3184 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Mountain time.
- Get the care you need. Choice Products empower you to choose how and where you get covered care.
- Manage your care and costs. You choose your provider.
- Preventive care. It’s covered at no cost to you, when you see a Participating Provider.
- Pharmacy services. You can have prescriptions filled at retail pharmacies across the country.
Check here for more about pharmacy services, finding doctors and facilities, and the benefits of Choice Products.
Are Choice Products right for you?
Here are some examples of how people use Choice Products to get the care they want:
For employers, Choice Products are a great all-in-one solution:
- Give your valuable employees full choice in their providers, and allow them to determine and manage their health care costs.
- Having two Tiers of providers to choose from gives your valued employees what they need to be healthier and more productive every day.
- The versatility and benefits of Choice Products can help attract and retain employees.
- Your company has the convenience of one health care provider for all your employee benefits administration.
- Offer it side-by-side with HMO, DHMO, or HDHP plans to decrease your company’s overall health care costs, and still offer your employees plan choice.
How the Choice Products plan works for your company and employees.
With Choice Products, you can offer your participating employees two Tiers of providers when they receive care:
- Participating Provider Tier. With the Participating Provider Tier, members can select their providers based on location to manage provider costs. Certain services are subject to deductible, with coinsurance after the deductible has been met. Some services including office visits and urgent care are offered at a copay.
Starting 1/1/2023 Provider Directory Options by Location:
In Kaiser Permanente States: The 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 CignaPPONetwork* 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.
- Non-Participating Provider Tier: Members can receive services from any licensed provider or facility they choose outside the Participating Provider Tier. Members pay deductibles, coinsurance, and any difference between the cost of the service and payment provided. Out-of-pocket costs are generally the highest under this Tier.
- Learn more about what’s included in the Participating Provider Tier and Non-Participating Provider Tier, and how they work.
- Choice Products also includes: preventive care, pharmacy services, worldwide coverage, and customized case management services for serious, complicated, or high-cost illnesses.
Employers’ frequently asked questions
What are the pharmacy choices under Choice Products?
Members have several choices for having their prescriptions filled.
- KPIC has contracted with MedImpact to fill outpatient prescriptions at participating retail pharmacies—including Rite Aid, Safeway, Walgreens, and many supermarket chains. (Not all pharmacies in a chain may participate).
- Members also can fill prescriptions at any pharmacy outside the Kaiser Permanente medical office and MedImpact network.
- Learn more about pharmacy services.
What are guidelines regarding prior approval?
- For care with Participating Providers, Participating Providers must obtain pre-certification for inpatient services and certain outpatient surgeries, services and procedures when with First Health providers in Colorado and other KP states. If using the Cigna PPO Network for care in non-Kaiser Permanente states, the Cigna PPO providers are responsible for obtaining pre-certification on your behalf when pre-certification is required. You won’t be financially responsible if a Cigna PPO provider fails to obtain pre-certification for covered services.
- For care with Non-Participating Providers, members must obtain precertification for inpatient services, and certain outpatient surgeries, services, and procedures.
- Learn more about pre-certification.
How are new members on-boarded?
- Onboarding includes: Comprehensive New Member Welcome handbooks, an onboarding call from Customer Service agents, and a help line for any questions, from accessing care to transferring prescriptions.
Who do we contact for product pricing or to purchase Choice Products?
Contact Kaiser Permanente at any time through our Business Plans contact page.
Who processes claims?
The plans that underwrite the Participating Provider Tier and Non-Participating Provider Tier process the claims:
Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc., underwrites the Participating Provider Tier – First Health and Direct Contracted Providers and Non-Participating Provider Tier.
*A program operated or arranged by health plan that distributes prescription drugs to members via mail. Some medications are not eligible for the Mail Service Delivery Program. These may include, but are not limited to, drugs that are time or temperature sensitive, drugs that cannot legally be sent by U.S. mail, and drugs that require professional administration or observation.