Dual Choice PPO

Plan overview

In-network providers

Kaiser Permanente providers

Get care from top physicians in Kaiser Permanente medical offices.

  • Enjoy the lowest out-of-pocket costs.
  • At most locations, see your doctor plus get labs, X-rays, and prescriptions all under one roof.
  • Schedule certain appointments, email your doctor’s office, refill most prescriptions, and more – online or with the Kaiser Permanente app.

Network providers

You have many ways to access care through network providers across the state and nationwide.

  • When using these providers, you don’t have to select a personal doctor and you don’t need a referral. 
  • Some services require prior approval (precertification).
     

Out-of-network providers

Any other licensed provider

You can see any licensed provider using your out-of-network provider benefits.

  • You may pay more.
  • You may be asked to pay at the time of service and file a claim for reimbursement.
  • Some services require prior approval (precertification).

The provider you choose affects your copays, coinsurance, and deductibles. You’ll generally have the lowest costs when you get care from Kaiser Permanente providers, higher costs when you get care from network providers, and the highest costs when you get care from out-of-network providers.


Precertification

You may need prior approval to ensure that the medical services ordered are medically necessary and cost-effective. This is known as precertification.

  • For care with network providers – you’ll need precertification for some services and procedures. Call 1-800-221-2412 (TTY 711) to get precertification.
  • For care with out-of-network providers – you must get precertification by calling 1-800-221-2412 (TTY 711). If you don’t get precertification for services from out-of-network providers, you may have to pay the entire expense.

To learn more, review the precertification section in your Certificate of insurance.