Kaiser Permanente Plans and Networks
Kaiser Permanente provides coverage to employer groups, government programs, individuals, and families through two health carriers — Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc.
Kaiser Foundation Health Plan of Washington
Kaiser Foundation Health Plan of Washington is a nonprofit membership organization in Washington state that offers HMO (health maintenance organization) plans. With most of our HMO plans, members select a primary care physician to manage and coordinate their care. The plan pays for covered services when a member receives care from a defined network featuring roughly 16,000 providers across Washington state, including Kaiser Permanente Physicians who practice at Kaiser Permanente medical offices and area hospitals. There is no out of network coverage except for medically necessary urgent and emergency care.
Kaiser Foundation Health Plan of Washington Options, Inc.
Kaiser Foundation Health Plan of Washington Options, Inc. (registered in Washington and Idaho) is a for-profit subsidiary of Kaiser Foundation Health Plan of Washington offering point-of-service (POS) and preferred provider organization (PPO) plans.
- Point-of-service plans: this type of plan pays for services members receive from a subset of providers at the in-network level, and also allows members to receive care from a larger network of providers for, in most cases, higher cost shares.
- Preferred provider organization plans: this type of plan has an extensive network of providers. It does not require a primary care physician to provide referrals.
Kaiser Permanente networks
An overview of the health plans offered by Kaiser Permanente is listed below.
In addition to access within these networks, all Kaiser Permanente members have access to medical care at Kaiser Permanente clinics in other Kaiser Permanente regions.
| HEALTH CARRIER | PROVIDER NETWORKS | PLAN TYPE | |
|---|---|---|---|
| Core | Kaiser Foundation Health Plan of Washington | Broad group of Washington state providers we contract with directly, including Washington Permanente Medical Group. Out-of-network coverage: None except emergency and medically necessary urgent care. | HMO |
| Connect | Kaiser Foundation Health Plan of Washington | Exclusive high performing network that includes Washington Permanente Medical Group with select medical groups and providers to provide coverage in 6 core counties. Out-of-network coverage: None except emergency and medically necessary urgent care. | HMO |
| Medicare Advantage HMO | Kaiser Foundation Health Plan of Washington | Broad group of Washington state providers we contract with directly, including Washington Permanente Medical Group. Out-of-network coverage: None except emergency and medically necessary urgent care. | HMO |
| Summit PPO | Kaiser Foundation Health Plan of Washington Options, Inc. | Tiered network product. Tier 1 is an exclusive high performing network that includes Washington Permanente Medical Group with select medical groups and providers. Tier 2 are the remaining providers in the Access PPO network that include: Directly contracted PPO providers, First Choice Providers in Washington state and Kootenai and Latah counties in Idaho and Aetna Signature Administrators network providers in remaining states. OR Directly contracted PPO providers, First Choice Providers in Washington, Oregon, Alaska, Idaho, and Montana and First Health Network in all other states. Tier 3 is out-of-network coverage by any licensed provider in the U.S. not directly contracted with Kaiser Permanente, First Choice Health, First Health Network, or Aetna Signature Administrators. | PPO |
| Access PPO Options Federal (Formerly GHO Federal or Omni PPO) | Kaiser Foundation Health Plan of Washington Options, Inc. | Extensive network of Washington state providers we contract with directly, including Washington Permanente Medical Group and over 29,000 providers. First Choice Health in Washington state and Kootenai and Latah counties in Idaho and Aetna Signature Administrators network providers in remaining states. OR First Choice Health in Washington, Oregon, Alaska, Idaho, and Montana and First Health Network in all other states. Out-of-network coverage for all PPO Plans: Any licensed provider in the U.S. not directly contracted with Kaiser Permanente, First Choice Health, First Health Network, or Aetna Signature Administrators. Access PPO preauthorization (PDF) | PPO |
| Elect PPO | Kaiser Foundation Health Plan of Washington Options, Inc. | Extensive network of Washington state providers we contract with directly, including Washington Permanente Medical Group and most major medical groups. First Choice Health in Washington state and Kootenai and Latah counties in Idaho and Aetna Signature Administrators network providers in remaining states. OR First Choice Health in Washington, Oregon, Alaska, Idaho, and Montana and First Health Network in all other states. Out-of-network coverage for all PPO Plans: Any licensed provider in the U.S. not directly contracted with Kaiser Permanente, First Choice Health, First Health Network, or Aetna Signature Administrators. Elect PPO preauthorization (PDF) | PPO |
| Options | Kaiser Foundation Health Plan of Washington Options, Inc. | Broad number of Washington state providers we contract with directly, including Washington Permanente Medical Group. Covered at the out-of-network benefit level: Discounted rates from First Choice Health providers in Washington state and Kootenai and Latah counties in Idaho and Aetna Signature Administrators network providers in remaining states OR Discounted rates from First Choice Health providers in Washington, Oregon, Alaska, Idaho, and Montana and First Health Network providers in all other states. Any licensed provider in the U.S. without any discounts. | POS |
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