A Preferred Provider Organization (PPO) plan through Kaiser Permanente offers a flexible and comprehensive approach to healthcare. It is designed to provide members with broad access to medical providers across the country, along with the convenience of managing your health care online. With a PPO, you have the freedom to select any licensed healthcare professional, whether in-network or out-of-network, making it an attractive choice for those seeking flexibility and cost savings.
Your PPO benefits are structured to promote both preventive care and specialist access, all while helping you control healthcare expenses. Staying within the network typically results in lower costs, including for preventive services that are often covered at little or no out-of-pocket expense. Additionally, the plan features an annual out-of-pocket maximum, which caps your total spending on covered services, providing financial protection in case of serious health issues. In-network services eliminate the need for paperwork or claims submissions, simplifying your experience. Plus, you can see specialists without requiring referrals, streamlining your care process. For pharmacy needs, you can use any Kaiser Permanente pharmacy or choose from nearly 60,000 retail pharmacies nationwide, such as those in the MedImpact network.
The Choice Is Yours
Kaiser Permanente’s PPO plan offers two primary options for selecting healthcare providers. The first is via the PHCS Network, available for KPIC members in California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, and the District of Columbia. The second option is through the Cigna Healthcare SM PPO Network, which covers all states outside of the Kaiser Permanente service areas.
KPIC collaborates with these extensive networks of healthcare providers, including doctors, hospitals, specialists, and laboratories, offering services at negotiated rates. To verify if your current provider participates or to find a new one, visit kp.org/kpic/ppo.
Participating Provider Option
This plan provides straightforward benefits:
- Fixed copays for most doctor visits, simplifying your billing process
- Coverage for most preventive services at little or no cost
- Reduced copays for other covered services after meeting your deductible
- Lower overall out-of-pocket expenses
Nonparticipating Provider Option
This alternative grants you:
- The freedom to choose any licensed provider, including specialists
- Easy scheduling — just call the provider’s office directly
- Coverage for preventive services at minimal or no cost
- Coverage for most other services at coinsurance after reaching your annual deductible
Your detailed benefits, exclusions, and limitations are outlined in your Certificate of Insurance or Summary Plan Description. The information provided here is a summary and does not replace official policy documents.
The Kaiser Permanente PPO plan is underwritten by Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc. The Cigna Healthcare PPO Network, which is part of the Cigna Group, operates independently and is not affiliated with Kaiser Permanente. Access to this network is made possible through contractual arrangements with Cigna Healthcare. For a broader understanding of the challenges facing the U.S. healthcare system and how reforms are evolving, you can explore this resource.
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