Welcome to
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). We work together to create a personalized wellness plan that makes it easier for you to stay healthy — in mind and body.

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 specific plan in the Resources and Forms section to the right. Note: Plan name can be found within your 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.

To see a list of your plan’s covered drugs, go to Drug Formulary (Covered Drugs) and select the Five Tier Plan formulary.

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 (when appropriate and available).

Provider and Care Options

As a Level Funded Dual Choice PPO Member, you have multiple options for providers:

• Option 1: Kaiser Permanente Network of Providers
• Option 2: Participating Providers from the PHCS Network*
• Option 3: Any Other Licensed Provider in the U.S.

Provider Options by Location:

• You may select a provider from the PHCS Network for service in Kaiser Permanente states of CA, CO, GA, HI, MD, OR, VA, WA, and DC.
• In all other states to find network providers and facilities, visit the Cigna Healthcare PPO Network* provider directory.  You will receive a bill later for your regular copay or coinsurance.
• You can also visit the following urgent care clinics and pay your normal copay or coinsurance.  That includes any prescription you receive during your visit.**
• • Minute Clinic in Arizona, Connecticut, Florida, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas and Wisconsin.
  • Concentra in Arizona, Arkansas, Connecticut, Delaware, Florida, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, and Wisconsin.
  • The Little Clinic in Arizona, Indiana, Kansas, Kentucky, Ohio, Tennessee

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

**Only commonly prescribed acute care medications made during an urgent or emergency visit outside of Kaiser Permanente states are covered at non–Kaiser Permanente pharmacies. Maintenance medications — like for blood pressure, diabetes, or cholesterol — and high-cost or specialty medications aren’t included, so you’ll have to pay for them upfront and file a claim for reimbursement.

To find a provider with Options 1 and 2, log into kp.org (*our PHCS network is customized so use kp.org for providers). For Option 3, you may reach out to providers directly for services (view Plan Documents for covered services).

Your cost share will vary depending on each (with Options 1 and 2 having lower cost shares), as can be found in your plan’s Summary of Benefits and Coverage document to the right (find your specific plan name on your provided Plan Documents).

Pharmacy Options

Level Funded Dual Choice PPO members can fill a prescription written by any licensed provider at a Kaiser Permanente Pharmacy, select OptumRx Pharmacies, or any licensed pharmacy (please note cost shares differ per selection).

To locate a pharmacy, log into kp.org.

To see a list of your plan’s covered drugs go to Drug Formulary (Covered Drugs) and select the Georgia Level Funded PPO Formulary.

To learn about pharmacy costs when using a Kaiser Permanente Pharmacy after your plan’s effective date, please visit Pharmacy Services.