Added Choice® Point-of-Service Plan

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Glossary

Good news! We now have a new site for Added Choice members. Click here or go to kp.org/addedchoice/nw to find more information about your plan.

Your Kaiser Permanente Added Choice® Point-of-Service (POS) Plan is not just health coverage — it's a partnership in health.

You can choose any licensed physician to provide care nationwide, and receive preventive care at little or no cost from in-network providers. Online features let you manage most of your care around the clock.

Your benefits include:

  • a personal doctor for in-network medical care
  • freedom to visit any preferred provider or any licensed nonparticipating provider in the United States
  • no or lower deductible to satisfy when care is in-network
  • coinsurance for most covered services after meeting your deductible, when receiving care from a nonparticipating provider
  • an out-of-pocket maximum that limits how much you'll spend on most covered services each year
  • no additional coinsurance needed for most covered services after the annual out-of-pocket maximum is met

As an Added Choice® member, you have access to all that Kaiser Permanente offers, plus the option to seek care from providers outside of our network.

The Added Choice Point of Service® plans let you choose among three benefit "tiers" when you receive covered services:

Tier 1—Select providers
Tier 2—PPO providers
Tier 3—Non-participating providers

Download the Added Choice quick reference guide (PDF)

Tier 1 plan—Select providers

  • For a list of select facilities and providers to choose from, please visit our medical staff directory.
  • To make an appointment with a select provider, log in to kp.org and go to the Appointment Center.

Kaiser Permanente Northwest members with an Added Choice plan living in the Seattle, Olympia, and Spokane areas can visit Kaiser Permanente Washington providers, facilities and pharmacies under Tier 1 benefits using a Kaiser Permanente Washington member record number. To start using Kaiser Permanente Washington services, call our visiting member line at 1-800-446-4296.

If you have any questions or need help, call Membership Services. We're available from 8 a.m. to 6 p.m., Monday through Friday.

Membership Services
1-866-616-0047

Toll-free TTY for the hearing/speech impaired
1-800-735-2900

For language interpretation services
1-800-324-8010

Tier 2 plan—PPO providers

For a list of PPO facilities and providers to choose from, please select from the following list of preferred providers:

If you have any questions or need help with any of the PPO providers, you can also call them at the following numbers:

First Choice Health Network
800-467-5281

First Health Network
1-888-685-7774

Tier 3 plan—Non-participating providers

If the provider you want to see is not a select provider (Tier 1 plan) or a PPO provider (Tier 2 plan), he or she falls into what we call the non-participating provider (Tier 3 plan) category.

If you are unsure whether or not your provider falls under the non-participating provider (Tier 3 plan) category, please contact Membership Services, Monday through Friday, 8 a.m. to 6 p.m.

Membership Services
1-866-616-0047

Toll-free TTY for the hearing/speech impaired
1-800-735-2900

For language interpretation services
1-800-324-8010

Pharmacy

Fill a prescription

  • To get your prescription filled by a select pharmacy, the medication must be listed in our formulary. If the medication is listed on our formulary, then you will pay the select pharmacy copayment or coinsurance listed in your benefit summary.

The prescription can be filled at any of these locations or you can sign up for our mail-order pharmacy.

  • To get your prescription filled by a network pharmacy, the medication will either be generic/brand 2-tier pharmacy plan or generic/preferred brand (see formulary)/Non Preferred Brand 3-tier pharmacy plan. Based on which type of plan you have, you will then pay the corresponding copayment or coinsurance listed in your benefit summary. Not all plans have a network pharmacy benefit. Please see your summary of benefits for more details.
  • To Find a MedImpact pharmacy, see the Pharmacy LocatorKaiser Permanente is not responsible for the content or policies of external Internet sites, or mobile apps. page provided by MedImpact and select the “General Pharmacy Locator” link on the page bypassing the member login request.

Step therapy and prior authorization

Beginning in 2012 certain drugs filled at MedImpact pharmacies may be subject to prior authorization or step therapy restrictions. For a list of restricted drugs and the criteria used, see below. For further information on these restrictions please see your Evidence of Coverage.

Drugs requiring pre-authorization:
Actemra – Criteria (PDF)
Aranesp – Criteria (PDF)
Auvi-Q – Criteria (PDF)
Avonex – Criteria (PDF)
Berinert – Criteria (PDF)
Betaseron – Criteria (PDF)
Cimzia – Criteria (PDF)
Cinryze – Criteria (PDF)
Copaxone – Criteria (PDF)
Cystaran – Criteria (PDF)
Daklinza – Criteria (PDF)
Dupixent – Criteria (PDF)
Emflaza – Criteria (PDF)
Enbrel – Criteria (PDF)
Epclusa – Criteria (PDF)
Epogen – Criteria (PDF)
Esbriet – Criteria (PDF)
Evzio – Criteria (PDF)
Extavia – Criteria (PDF)
Firazyr – Criteria (PDF)
Fortamet – Criteria (PDF)
Genotropin – Criteria (PDF)
Gilenya - Criteria (PDF)
Glatopa – Criteria (PDF)
Glumetza – Criteria (PDF)
Granix – Criteria (PDF)
Harvoni – Criteria (PDF)
HP Acthar – Criteria (PDF)
Humatrope – Criteria (PDF)
Humira – Criteria (PDF)
Juxtapid – Criteria (PDF)
Kalydeco – Criteria (PDF)
Kineret – Criteria (PDF)
Kuvan – Criteria (PDF)
Kynamro – Criteria (PDF)
Mircera – Criteria (PDF)
Neulasta – Criteria (PDF)
Neupogen – Criteria (PDF)
Norditropin – Criteria (PDF)
Nutropin – Criteria (PDF)
Ofev – Criteria (PDF)
Omnitrope – Criteria (PDF)
Orencia – Criteria (PDF)
Orenitram – Criteria (PDF)
Orfadin – Criteria (PDF)
Orkambi – Criteria (PDF)
Oxycontin – Criteria (PDF)
Plegridy – Criteria (PDF)
Praluent – Criteria (PDF)
Procrit – Criteria (PDF)
Pulmozyme – Criteria (PDF)
Rebif – Criteria (PDF)
Remodulin – Criteria (PDF)
Repatha – Criteria (PDF)
Ruconest – Criteria (PDF)
Saizen – Criteria (PDF)
Serostim – Criteria (PDF)
Simponi – Criteria (PDF)
Sovaldi/Olysio - Criteria (PDF)
Stelara – Criteria (PDF)
Tecfidera – Criteria (PDF)
Technivie – Criteria (PDF)
Tyvaso – Criteria (PDF)
Viekira – Criteria (PDF)
Xeljanz – Criteria (PDF)
Xyrem – Criteria (PDF)
Zarxio – Criteria (PDF)
Zepatier – Criteria (PDF)
Zomacton – Criteria (PDF)
Zorbtive – Criteria (PDF)

Drugs requiring step therapy:
Currently no drugs require step therapy.

Reminder: If you are an existing Added Choice member, you can find all necessary provider contact information on the back of your ID card.

For more information about our Added Choice plans, check out our brochure (PDF). If you are an existing Added Choice member, you can visit our health plan documents section to view your EOC.

Your Certificate of Insurance contains a complete explanation of benefits, exclusions, and limitations. The information provided here is not intended nor designed to serve as your Certificate of Insurance.

Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Portland, OR 97232