PPO plan overview

Our PPO plans in Washington

Kaiser Permanente Washington has historically provided coverage through HMO products, offering a select network that featured the Washington Permanente Medical Group and 9,000 community providers across our service area. The only coverage outside of the network is for emergencies.

Starting in 2014, we expanded to PPO products to address the market demand for more network choice. A PPO (preferred provider organization) provides more flexibility by essentially offering any licensed provider to plan members. Our PPO product includes our regional Kaiser Permanente providers along with more than 26,000 other providers we contract with directly in our service area. The regional First Choice Health provider network and First Health network in the rest of the country are also in-network. In addition, PPO members are covered to see any additional licensed provider at their out-of-network benefit level, which usually has higher cost shares and requires members to pay up front and then be reimbursed.

Current PPO offerings

Currently, we have three different PPO products that you'll see on member ID cards.

  • Access PPO - This is our most popular PPO product. It is offered to commercial small groups, commercial large groups, and select private exchanges for employers. Access PPO includes an "enhanced benefit," which are lower copays or cost shares for office visits and some drugs with a select group of providers, including physicians and pharmacies at Kaiser Permanente Washington.
  • Options Federal - This product is only offered to federal employees through The Federal Employees Health Benefit Program (FEHB). It does not include the enhanced benefit like Access PPO, so there are no lower copays or cost shares for using the Kaiser Permanente Washington providers or pharmacies. This product also covers preventive dental through contracted providers.
  • Elect PPO - This product is offered through the Aon Active Health Exchange and starting in 2020 will be available to commercial small groups. It does not include an enhanced benefit like the Access PPO and has a considerably smaller network of preferred providers, other than Kaiser Permanente Washington providers. However, in 2020 we expect this PPO network to add an additional network outside of our service area for added choice.

Please see our Identifying members page for samples of these ID cards.

PPO network information

map of First Choice Health network and First Health networkAccess PPO and Options Federal
The Access PPO and Options Federal share the same network which includes Kaiser Permanente Washington providers, First Choice Health network (www.fchn.com) in Oregon, Alaska, Montana, Idaho, and Washington and First Health network (www.firsthealth.com) in the rest of the country, who are all preferred providers. (For a First Health provider locator custom search for Kaiser Permanente Washington members see: https://providerlocator.firsthealth.com/kawa). Out of network coverage is provided for any other licensed U.S provider.

Enhanced benefits for Access PPO are included in these networks:

  • Kaiser Foundation Health Plan of Washington medical facilities and providers
  • Columbia Medical Associates (CMA)
  • Providence Eastern Washington Physicians
  • Family Care Network in the North Sound area
  • Walla Walla Clinic
  • Kadlec Clinics in Tri-Cities
  • Memorial Physicians in Yakima

Elect PPO
This product has an exclusive network of providers as compared to the Access and Options Federal PPO networks. In network coverage includes the Washington Permanente Medical Group and community providers across our service area. Out of network coverage is provided by First Choice Health network in Oregon, Alaska, Montana, Idaho, and Washington and First Health network in the rest of the country.

What pharmacies are included in the PPO?

Access PPO and Options Federal include prescription coverage at all Kaiser Permanente Washington pharmacies and mail order, contracted pharmacies, and the OptumRx national pharmacy network. There is no coverage if a member chooses a pharmacy that is not included in those networks. Access PPO members receive lower cost shares for certain drugs at Kaiser Permanente Washington pharmacies and mail order.

Elect PPO includes in-network prescription coverage at all Kaiser Permanente Washington pharmacies, Kaiser Permanente Washington mail order, and contracted pharmacies. Out of network coverage is provided by the OptumRx national pharmacy network.

Preauthorization and referrals

For PPO products, a primary care physician is not required. This means members may make appointments with specialists without a referral, except as noted under Section IV of the member’s Evidence of Coverage (EOC). These exceptions include non-emergent air transportation, clinical trials, dental services in preparation for treatment, certain drugs, laboratory and radiology (unless associated with Emergency or inpatient services), inpatient rehab, and skilled nursing care and transgender services. The full list of preauthorization and notification requirements for our PPO networks can be found here (PDF) .

In the event specialty services are not available from a preferred provider, preauthorization is required, and out-of-network provider services will be covered at the preferred provider in-network level.

For specialists in the PPO network who don’t practice at Kaiser Permanente, the member will need to ask the recommending physician to submit a referral to get authorization from Kaiser Permanente if needed.

What if a PPO member needs care away from home?

Emergency care
If a member needs emergency care and is admitted to a hospital, the member must notify Kaiser Permanente within 48 hours after care begins, or as soon as is reasonably possible. They can call the notification line listed on the back of the Kaiser Permanente member ID card to help make sure the claim is accepted. The member will need to submit them with any claims for reimbursement when they return.

Access to non-emergency care while traveling
Our PPO members will be able to access other Kaiser Permanente providers in other regions as preferred providers. Members looking for non-emergency care while traveling outside our service area in Washington should call Member Services for assistance in finding the right provider for their needs who also belongs to their plan network.

Where can I find more information about the PPO?

Kaiser Permanente Washington, First Choice Health, and First Health network providers can get more support if needed by calling our Provider Assistance Unit (PAU) at 1-888-767-4670.