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Kaiser Permanente!

Provider and Care Options

Your Plan provides exclusive access to care from Kaiser Permanente Network Providers and Non-Participating Providers (for a select number of services, see your plan details for more information).

To make an appointment please select a provider according to the appropriate Tier. For questions regarding your plan or Tier type, please contact Customer Service using the phone number listed on the back of your Physical ID Card, Digital ID Card, or Plan Documents:

• In-Network Services: To find a Kaiser Permanente Provider, log into kp.org.
• Out-of-Network Services: Your plan includes a select number of services/visits* with any other licensed provider. For qualified services and details, refer to your Summary of Benefits and Coverage in the Resources and Forms section to the right. Note: Plan name can be found within the Benefit Booklet from your employer.
  • Key services/items that count as services/visits:
    • Routine office visits, including primary, preventive and specialty care, mental health and chemical dependency visits
    • Diagnostic lab tests and X-rays
    • Physical, occupational, and speech therapy office visits
    • Allergy injections received at an office

*Services/Visits – one visit may include multiple services. For Example:  If a member sees an Out-of-Network Provider and the provider orders a lab test done in his/her office, this will count as two Plus visits.

This is just a summary. Plan coverage and cost shares vary based upon benefit and provider selection. Please refer to your Summary Plan Description (SPD) and other Plan documents for more information.

Pharmacy Options

• In-Network: Members have access to Kaiser Permanente Pharmacies. To locate a Kaiser Permanente pharmacy, log into kp.org and select Pharmacy.
• Out-of-Network: Members have access to any other licensed pharmacy for certain prescriptions. Limitations and exclusions will apply. Refer to your SPD or Benefits Booklet for additional details.

You can also see a list of your plan’s Drug Formulary (Covered Drugs). Select the Self-Funded/Level Funded Drug Formulary from the list on kp.org and go to the information you are seeking (formulary drug list, specialty drug list, or preventive drug list).

To learn about pharmacy costs after your Plan’s effective date, please visit Pharmacy Services.

Care While Traveling

Members who are traveling away from home can plan ahead by visiting Health Care Away from Home. 24/7 care is available from Kaiser Permanente health care professionals by phone or video.

Contact Information

• Customer Service 1-800-401-8405 (TTY 711)
• Appointments and medical advice 1-703-359-7878
  • Outside Washington Metro Area 1-800-777-7904 (TTY 711)
• Pharmacy information 1-866-427-7701

This 2-Tier Point-of-Service Added Choice Plan has two in-network provider options, Kaiser Permanente’s Signature™ or Select™. Your Employer will choose one to use for their Level Funded Plan so please ask them which provider network they selected. If you are traveling outside of a Kaiser Permanente state, you also have a network option for Urgent and Emergency care. Lastly, your Plan offers the flexibility of moving between your Plan’s in-network providers and out-of-network providers at any time.

• Tier One: KP Signature™ or Select™ provider network (depending upon your Employer’s choice) for Kaiser Permanente states and Cigna Healthcare PPO Network for Urgent and Emergency care received outside of Kaiser Permanente states.
• Tier Two: Out of Network (OON).

Provider and Care Options

Signature™ Provider Network: With this network, you receive services from Mid-Atlantic Permanente Medical Group, P.C. (Permanente), physicians. They’re part of a group of over 1,500 physicians who practice in our medical centers located in Maryland, Washington, DC, and Virginia.

Select™ Provider Network: With this network, you get quality care from the Kaiser Permanente Select network, composed of over 1,500 physicians of the Mid-Atlantic Permanente Medical Group, P.C. (Permanente), and thousands of community physicians in private practice.

Doctors & Facilities

To locate your Signature™ or Select™ Network provider, please go to kp.org or call the Customer Service number on the back of your ID card for assistance.

Your cost share may vary depending on plan and can be found in your plan’s Summary of Benefits and Coverage document to the right (find your specific plan name on Plan Documents).

Preauthorizations – Some services require preauthorization to be covered, such as inpatient care (such as hospital surgical procedures) and some outpatient procedures.

• In-Network: Some services may require preauthorization. If you have a Kaiser Permanente doctor, he or she will obtain preauthorization for you. If you have a Select™ network physician, you may be responsible for obtaining preauthorization.
• Some services require preauthorization. You will be responsible for obtaining preauthorization.

For services requiring preauthorization, please refer to your Benefit Booklet or call the Customer Services number on the back of your ID card. Prior authorization is not required for Emergency or Urgent care.

Note: Video visits are available for members who receive care at Kaiser Permanente medical centers. 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.

Pharmacy Options

• In-Network Pharmacies: You have access to Kaiser Permanente pharmacies (lowest out-of-pocket costs).
• Participating Pharmacies: You have access to Participating (community network) pharmacies that include Giant, Harris Teeter, Rite Aid, Safeway, Target, Walmart, and others.
• Out-of-Network Pharmacies: You have access to any other pharmacy.

Members may fill a prescription written from any provider, at any pharmacy option listed above. Cost shares and fill quantity may differ by pharmacy option: Check plan for details.

Level Funded Added Choice members can fill a prescription written by any licensed provider at a Kaiser Permanente Pharmacy, Participating (community network) Pharmacies, or any licensed pharmacy depending on what plan your employer selected. Please note cost shares differ per selection.

Pharmacy locator: Kaiser Permanente and OptumRx pharmacy locations can be found by logging into kp.org.

To see a list of your plan’s covered drugs, go to Drug Formulary (Covered Drugs) and select Self-Funded/Level Funded.

To learn about pharmacy costs when using a Kaiser Pharmacy after your plan’s effective date, please visit Pharmacy Services: Track & Fill Prescriptions.

Contact Information

• Customer Service 1-800-401-8405 (TTY 711)
• Appointments and medical advice 1-703-359-7878
  • Outside Washington Metro Area 1-800-777-7904 (TTY 711)
• Pharmacy information 1-866-427-7701

This plan provides you with access to Kaiser Permanente’s Signature™ provider network, a contracted network, or any other licensed provider you choose.

Provider and Care Options

In-network (Option 1): You have access to Kaiser Permanente providers and, generally, pay the least out-of-pocket costs. Kaiser Permanente’s state-of-the-art medical centers are located throughout the region.

Contracted Networks (Option 2): You have access to a wide network of contracted participating providers.

• For care received in Kaiser Permanente states (CA, CO, GA, HI, NW, WA, and MAS): You can access Physicians that are part of the KP-contracted PCHS/MultiPlan network, and
• For care received outside of Kaiser Permanente states: You can access the Cigna PPO Network.

To find up-to-date Participating Providers or confirm if your current provider is part of the Network, you can search for Providers by Location or call Customer Service at 1-888-225-7202 (TTY 711), Monday through Friday 8:00 a.m. to 6 p.m., Eastern time.

• To find a PHCS/MultiPlan network provider, go to: https://www.multiplan.com/kpmas.
• To find a Cigna Healthcare PPO Provider, go to: https://www.kp.org/CignaPPONetworkDirectory.

Out-of-pocket costs. Although you will generally have higher out-of-pocket costs than in Option 1 (such as a deductible, coinsurance, or a copay), providers’ fees are subject to negotiated rates and providers are not allowed to balance bill you for covered services. Your participating provider also completes and submits claim forms.

Out-of-Network (Option 3): You have access to any licensed provider who is not an Option 1 or Option 2 provider. Coverage under Option 3 is considered fee for service indemnity coverage; however, Option 3 Out-of-Network Providers have not agreed to negotiated rates.

Inpatient and certain outpatient services are subject to precertification.

Pharmacy Options

• In-Network Kaiser Permanente and Participating Pharmacies (Option 1): You have access to Kaiser Permanente pharmacies (lowest out-of-pocket costs).
• OptumRx Pharmacies (Option 2): You have access to Participating (community network) pharmacies that include Costco, Rite Aid, Target, CVS, Walgreens, Safeway, Kmart, Farm Fresh, Giant, Harris Teeter, Walmart, and Shoppers Food Warehouse.
  • Not all locations in a chain participate, some are independently contracted. To check on a specific pharmacy or for more information, call the OptumRx Customer Service number found on the back of your ID Card.
• Out-of-Network Pharmacies (Option 3): You have access to any other pharmacy. You will pay full out-of-pocket costs for prescriptions filled at out-of-network pharmacies and then submit a OptumRx Claim Form for reimbursement.

For HSA-Qualified plans, prescription drugs are subject to medical deductible in all three options.

Pharmacy locator: Kaiser Permanente and OptumRx pharmacy locations can be found by logging into kp.org.

To see a list of your plan’s covered drugs, go to Drug Formulary (Covered Drugs) and select Self-Funded/Level Funded.

Contact Information

• Customer Service 1-800-401-8405 (TTY 711)
• Appointments and medical advice 1-703-359-7878
  • Outside Washington Metro Area 1-800-777-7904 (TTY 711)
• Pharmacy information 1-866-427-7701

Provider and Care Options

Your Out-of-Area PPO* plan empowers you to choose how and where you get care.

Provider Options by Location:

• Kaiser Permanente States: The PHCS and MultiPlan Provider 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 Healthcare PPO Network* only provides access to care in non-Kaiser Permanente states.

You can also choose to see any other licensed provider. You have flexibility to move between in-network providers and out-of-network providers at any time.

*Disclaimer: The Cigna Healthcare PPO Network refers to providers (doctors, hospitals, specialists) contracted as part of the Cigna Healthcare PPO Network for Shared Administration.

Pharmacy Options

You can fill a prescription (written by any provider) at any Kaiser Permanente pharmacy, participating OptumRx pharmacy, and non-participating pharmacies (please note cost shares may differ per selection).

Pharmacy locator: Kaiser Permanente and OptumRx pharmacy locations can be found by logging into kp.org.

To see a list of your plan’s covered drugs, go to Drug Formulary (Covered Drugs) and select Self-Funded/Level Funded.

Contact Information

• Customer Service 1-800-401-8405 (TTY 711)
• Appointments and medical advice 1-703-359-7878
  • Outside Washington Metro Area 1-800-777-7904 (TTY 711)
• Pharmacy information 1-866-427-7701