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Kaiser Permanente!

Provider and Care Options

Your Plan provides exclusive access to care from Kaiser Permanente Network Providers (In-Network Providers: Kaiser, direct-contracted) and Non-Participating Providers (Out-of-Network) 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 employer’s Summary Plan Description (SPD) and other Plan documents for more information.

Pharmacy Options

• EPO Network Pharmacy: Members have access to Kaiser Permanente Pharmacies. To locate a Kaiser Permanente pharmacy, log into kp.org and select Pharmacy.
• Non-Participating Pharmacy: 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 1-800-813-2000
• Pharmacy information 1-866-427-7701

Provider and Care Options

Participants enrolled with an Oregon Employer have multiple provider options to choose from.

The Added Choice POS plan provides access to care from KP Select Providers and facilities, PPO Providers and facilities, and Non-participating Providers and facilities.

As a 3-Tier Added Choice plan member, you have multiple provider options to choose from:

• KP Select Providers (Tier 1): Kaiser Permanente Providers and facilities
• PPO Participating Provider (Tier 2):
  • First Choice Health network for participating providers and facilities in Oregon and Washington
  • First Health Network for participating providers and facilities in CA, CO, GA, HI, MD, VA, and Washington D.C.
  • Cigna Healthcare PPO Network for participating providers and facilities in all other states
• Non-Participating Provider (Tier 3): Any other licensed provider outside the networks listed above.

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:

To find a provider refer to the information below:

• Tier 1 – KP Select Providers and facilities: Find Doctors and Locations in OR/SW WA | Kaiser Permanente
• Tier 2 – PPO Participating provider networks:
  • First Choice Health network (for care in Oregon and Washington) https://www.fchn.com/providersearch/kpnw
  • First Health Network (for care in CA, CO, GA, HI, MD, VA, and D.C.) https://providerlocator.firsthealth.com/KPNW
  • Cigna Healthcare^sm PPO Net work (for care in all other states) http://kp.org/CignaPPONetworkDirectory
• Tier 3 – Non-participating providers: contact the licensed provider directly for services.

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

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.

To better understand your plan and benefits, please visit the following links depending on the state of your Employer:

• Oregon Employers: Understanding Your Plan and Benefits

Pharmacy Options

• Network Pharmacies: Kaiser Permanente owned and operated pharmacies and Optum Rx network pharmacies.
  • Visit https://healthy.kaiserpermanente.org/oregon-washington/front-door for Kaiser Permanente pharmacy hours and locations.
  • Visit https://www.optumrx.com/ for Optum Rx network pharmacy hours and locations.
• Non-Participating Pharmacy: There is no coverage for out-of-network pharmacies. You will have to pay full price for medications and will not be reimbursed.

To see a list of your plan’s covered drugs, go to Drug Formulary (Covered Drugs), select the Self-Funded Formulary 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 1-800-813-2000
• Pharmacy information 1-866-427-7701

Provider and Care Options

Participants enrolled with an Oregon employer:
You have multiple options for providers:

• In Network: Providers and facilities under Kaiser Permanente, First Choice Health network, First Health Network, and Cigna Healthcare PPO Network¹

• • • Kaiser Permanente and direct-contracted providers and facilities located in Oregon and Washington
      • Dual Choice PPO Provider Directory
        
    • First Choice Health network providers and facilities located in Oregon and Washington
      • Dual Choice PPO Provider Directory
    • First Health Network providers and facilities located in CA, CO, GA, HI, MD, VA, and Washington D.C.
      • First Health Network
        
    • Cigna Healthcare PPO Network¹ for providers and facilities in all other states states.
      • Cigna Health Care Provider Directory

Out-of-Network: Licensed providers and facilities not part of the networks listed above.

¹ The Cigna Healthcare PPO Network refers to providers (doctors, hospitals, specialists) contracted as part of the Cigna Healthcare PPO Network for Shared Administration.

To find a provider you may reach out to the desired provider directly for covered services. Plan coverage and cost shares vary based on benefit and provider selection. In-Network providers typically have the lowest cost share, Out-of-Network providers typically have the highest cost share. Please refer to your employer’s Summary Plan Description (SPD) for more information. ​

​For questions regarding your plan, please contact Customer Service using the phone number listed on the back of your Physical ID Card, Digital ID Card, or Plan Documents. ​

​To better understand your plan and benefits, please visit the following link: 

• • Oregon Employers: Understanding Your Plan and Benefits

Pharmacy Options

• Network Pharmacies: Kaiser Permanente owned and operated pharmacies and Optum Rx network pharmacies.
  • Visit https://healthy.kaiserpermanente.org/oregon-washington/front-door for Kaiser Permanente pharmacy hours and locations.
  • Visit https://www.optumrx.com/ for Optum Rx network pharmacy hours and locations.
• Non-Participating Pharmacy: There is no coverage for out-of-network pharmacies. You will have to pay full price for medications and will not be reimbursed.

To locate a pharmacy, log on to kp.org.

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

To learn about pharmacy costs when using a Kaiser Pharmacy 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 1-800-813-2000
• Pharmacy information 1-866-427-7701

Provider and Care Options

Participants enrolled with an Oregon employer:
You can receive care from Kaiser Permanente providers, First Choice Health providers in Oregon and Washington, First Health Network providers in CA, CO, GA, HI, MD, VA, DC, or authorized care from Non-Participating Providers.

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

• PPO Providers: Providers and facilities under Kaiser Permanente, First Choice Health network, First Health Network, and Cigna Healthcare PPO Network¹.
  • Kaiser Permanente and direct contracted providers and facilities located in Oregon and Washington: https://healthy.kaiserpermanente.org/oregon-washington/front-door
  • First Choice Health network for providers and facilities located in Oregon and Washington: https://www.fchn.com/providersearch/kpnw
  • First Health Network for providers and facilities located in CA, CO, GA, HI, MD, VA, and Washington D.C.: First Health Network
  • Cigna Healthcare PPO Network¹for providers and facilities in non-Kaiser states:Cigna Health Care Provider Directory
• Nonparticipating Providers: Licensed providers and facilities not part of the networks listed above

¹The Cigna Healthcare PPO Network refers to providers (doctors, hospitals, specialists) contracted as part of the Cigna Healthcare PPO Network for Shared Administration.

Plan coverage and cost shares vary based upon benefit and provider selection. Please refer to your employer’s Summary Plan Description (SPD) and other Plan documents for more information.

To better understand your plan and benefits, please visit the following link:

• • Oregon Employers: Understanding Your Plan and Benefits

Pharmacy Options

• Network Pharmacies: Kaiser Permanente owned and operated pharmacies and Optum Rx network pharmacies.
  • Visit https://healthy.kaiserpermanente.org/oregon-washington/front-door for Kaiser Permanente pharmacy hours and locations.
  • Visit https://www.optumrx.com/ for Optum Rx network pharmacy hours and locations.
• Non-Participating Pharmacy: There is no coverage for out-of-network pharmacies. You will have to pay full price for medications and will not be reimbursed.

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

Contact Information

• Customer Service 1-800-401-8405 (TTY 711)
• Appointments and medical advice 1-800-813-2000
• Pharmacy information 1-866-427-7701