Understanding Your Plan and Benefits
Choice Products empower you to make the best health care choice for you—wherever you are, and whenever you need care.
Here’s an overview of getting care with Choice Products. In the Added Choice 2 Tier Point-of-Service (POS) plan, there are two Tiers to choose from: In-Network Provider Tier and Out-of-Network Provider Tier.
In-Network Provider Tier
Kaiser Permanente Providers
Features and benefits of our plan.
- Lowest out-of-pocket costs. With this Tier, you’ll usually pay the least out of pocket, with no or a lower deductible.
- Coordinated care. Your primary care physician works closely with specialists, pharmacists, lab technicians, therapists, and many other professionals. And because they are all connected through your electronic medical record, everyone in the network gets up-to-the-minute information on your health for a better care experience.
- Referrals from your doctor. Your primary care physician can coordinate your referral to a specialist, and can even schedule your appointment.
- State-of-the-art medical offices. Kaiser Permanente’s state-of-the-art medical offices are located throughout the region, with doctors, specialists, imaging, and in most locations, pharmacy and lab, all in one place.
- Emergency care. You are covered for emergency care worldwide. The emergency care copay will be waived if you are directly admitted to a hospital as a result of an emergency.
- Urgent care. Urgent care is available at Kaiser Permanente medical offices. Call the number on the back of your ID card to confirm locations and hours of operations.
- Hospital care. Kaiser Permanente carefully selects hospitals to partner with us in taking great care of you.*
- Medical advice. When you call for medical advice you will be connected with a professional that can help advise and make appointments with one of our providers. You can get advice by calling the number on the back of your ID Card. 24/7.
- Lab services. Your results from tests done in Kaiser Permanente medical offices can be read (for most results) online soon after the lab completes your tests, sometimes the same day.
- No-cost preventive care. With your plan, you pay $0 for preventive care. That includes routine physicals, well-child visits, and certain screenings and tests (such as mammograms).
- Choose from telehealth options that fit into your schedule. Chat with a Kaiser Permanente doctor, email, or schedule a phone or video visit. Be aware that costs may apply for some visits.**
- Manage your health online. Use the convenient features of kp.org to manage your health.**
- Email your doctor’s office
- View most test results
- Schedule or cancel routine appointments
- Refill most prescriptions
- View past visits
- Find care options and urgent care locations near you
- Register at kp.org/registernow
- Select your region
- Your user name and password can also be used on our mobile app
To find out more about what is covered under the In-Network Provider Tier, see your Evidence of Coverage (EOC) or call Customer Service at 1-855-364-3185 (TTY 711).
*These contracted hospitals are independently owned and operated and are not affiliated entities of Kaiser Permanente.
**Video visits are available for members who receive care at Kaiser Permanente medical offices. 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.
Out-of-Network Provider Tier
Any other licensed provider or physician
Features and benefits of receiving covered care from any licensed provider.
- Provider choice, care anywhere. Your Out-of-Network Provider Tier benefits cover care you receive from any licensed provider (who’s not in the In-Network Provider Tier).
- Using Out-of-Network Providers generally means higher out-of-pocket costs. Your out-of-pocket costs will generally be the highest when you choose to receive care from an Out-of-Network Provider or facility.
- Behavioral health. You can receive care from any licensed behavioral health or chemical dependency professional for mental illness, emotional disorders, and drug or alcohol abuse.*
- Hospital care. You can receive inpatient hospitalization services from licensed or accredited hospitals and facilities not in the In-Network Provider Tier.*
- Emergency care. You can visit any licensed Out-of-Network emergency care facility. Emergency care is covered at the In-Network Provider Tier benefit level, and you will be responsible only for the In-Network cost share, regardless of where you seek care.
- Urgent care. You can visit any licensed Out-of-Network urgent care facility.
- Maternity care. You can choose any licensed provider for obstetric care.*
- Lab tests, X-rays. You can contact facilities directly. You can request your Out-of-Network Provider send labs, X-rays, and special procedures (MRIs, CT scans, PET scans, nuclear medicine), to a Kaiser Permanente facility, In-Network Provider, any time you choose, and you will likely pay less.
- Pharmacy services. Learn about your pharmacy benefits in the Out-of-Network Provider Tier.
To find out more about what is covered under the Out-of-Network Provider Tier.
- See your Choice Products POS Member Resource Guide.
- Refer to your Certificate of Insurance (COI).
- Contact the human resources/benefits officer where you work, if your employer provides your coverage.
- Call Customer Service at 1-855-364-3185 (TTY 711), Monday through Friday, 7 a.m. to 7 p.m., Eastern time, or refer to your ID card.
*Inpatient and certain outpatient services are subject to prior authorization. You must call 1-800-221-2412 (TTY 711) for prior authorization.
This site provides an overview of your benefits and services. If there are any differences between this document and your Evidence of Coverage (EOC), your Evidence of Coverage (EOC) will prevail.