Why Choice Products?

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Different Provider Options

In-Network Providers:

A wide network of providers with managed out-of-pocket costs.

In Colorado, this plan uniquely features a blend of Kaiser Permanente’s nationally recognized integrated health care and coverage model and an extended open network of providers affiliated with Colorado’s top hospitals and health systems.
Nationally, we’ve contracted with First Health® and the Cigna Healthcare^SM PPO Network to offer choices and flexibility – and help manage provider costs.
Your out-of-pocket costs will be lower when you get care from In-Network Providers.
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 pre-certification with First Health providers within other Kaiser Permanente states (CA, GA, HI, MD, OR, VA, WA, and DC). If using the Cigna Healthcare PPO Network for care in non-Kaiser Permanente states, the Cigna Healthcare 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 Healthcare PPO provider fails to obtain pre-certification for covered services.

Out-of-Network Providers:

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 (excluding In-Network Providers).
Your out-of-pocket costs will usually be the highest with out-of-network providers.
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 an In-Network 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:

Tracey: Gets great care, keeps her specialist, and manages costs.

Tracey lives in South Carolina and is enrolled in the PPO Plan. She has an OB/GYN she has used for years who is an In-Network Provider. Tracey can continue to see her OB/GYN and those services will be processed and paid according to In-Network costs. This plan allows Tracey the choice of providers while managing her health care costs.

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 a variety 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.

How the Choice Products plan works for your company and employees.

With Choice Products, you can offer your In-Network employees a variety of providers when they receive care:

In-Network Providers: With In-Network Providers, members have access to Kaiser Permanente providers, First Health providers, and Cigna Healthcare^SMPPO Network providers based on service location.
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.
Provider Directory Options by Location:
In Colorado: Find Kaiser Permanente providers and statewide network of contracted providers (Coming Soon).
In Other Kaiser Permanente States: The 3T POS, PPO, and OOA’s First Health Network provides access to care in the Kaiser Permanente states of CA, GA, HI, MD, OR, VA, WA, and DC.
In Non-Kaiser Permanente States: The Cigna Healthcare^SMPPO Network* only provides access to care in non-Kaiser Permanente states.
*The Cigna Healthcare PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna Healthcare PPO for Shared Administration. Cigna Healthcare is an independent company and not affiliated with Kaiser Foundation Health Plan, Inc., and its subsidiary health plans. Access to the Cigna Healthcare PPO Network is available through Cigna Healthcare’s contractual relationship with the Kaiser Permanente health plans. The Cigna Healthcare PPO Network is provided exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance Company. The Cigna Healthcare name, logo, and other marks are owned by Cigna Healthcare Intellectual Property, Inc.

Out-of-Network Providers: Members can receive services from any licensed provider or facility they choose, not including In-Network Providers. Members pay deductibles, coinsurance, and any difference between the cost of the service and payment provided. Out-of-pocket costs are generally the highest.
Learn more about what’s included in the In-Network and Out-of-Network, 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.

Members can fill prescriptions (written by any provider) at Kaiser Permanente operated pharmacies.
KPIC has contracted with MedImpact to fill outpatient prescriptions at In-Network retail pharmacies—including Rite Aid, Safeway, Walgreens, and many supermarket chains. (Not all pharmacies in a chain may participate).
Members can also 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 In-Network Providers, In-Network Providers must obtain pre-certification for inpatient services and certain outpatient surgeries, services, and procedures when receiving care from First Health providers in other KP states. If using the Cigna Healthcare PPO Network for care in non-Kaiser Permanente states, the Cigna Healthcare 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 Healthcare PPO provider fails to obtain pre-certification for covered services.
For care with Out-of-Network Providers, members must obtain pre-certification 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?

Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc., underwrites the Choice PPO plan and processes the claims.

*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.