Point-of-Service Plan

Glossary

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

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

Your benefits include:

  • three provider options to choose from
  • no deductible to satisfy when care is in-network
  • an out-of-pocket maximum that limits how much you'll spend on most covered services each year
  • no additional coinsurance needed for eligible services after the annual out-of-pocket maximum is met
  • convenient pharmacy options:
    • use any of the nearly 60,000 MedImpact retail pharmacies nationwide including Walgreens, CVS, Rite Aid, Safeway, Costco, and many others
    • use of Walgreens Home Delivery service (100-day supply for the price of two 30-day supply copays)

Three provider options for you

Choose the provider that's best for your needs.

Tier 1: Kaiser Permanente provider

With this choice, you'll get:

  • more than 9,100 Kaiser Permanente physicians
  • more than 160 locations in California, most with multiple services under one roof
  • simple copays for most services, such as office visits, X-rays, and prescription drugs
  • lower out-of-pocket costs and virtually no paperwork
  • no deductibles or claims
  • choose your own personal care physician

Tier 2: Participating Network Provider

The choice is yours

This plan gives you two convenient options for choosing a doctor. You can choose to receive your medical care through the PHCS Network for KPIC1 in California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, and the District of Columbia (Kaiser Permanente states) or through the Cigna HealthcareSM PPO Network2 in all non-Kaiser Permanente states.

KPIC contracts with these strong networks of providers at competitive contracted rates. These networks consist of doctors, hospitals, specialists, laboratories, and more. To find a provider or check if your current provider is part of the PHCS Network for KPIC or Cigna Healthcare PPO Network, visit kp.org/kpic/pos.

With this choice, you'll get:

  • after reaching your calendar-year deductible, pay only a copayment or coinsurance for most covered services
  • usually no claims or paperwork to file

Tier 3: Nonparticipating provider

With this choice you'll get:

  • choice of any licensed provider in the country, including specialists
  • easy appointments by calling the provider's office directly
  • after reaching your calendar-year deductible, pay a coinsurance rate for most covered services
  • may need to pay charges up front and submit a claim for reimbursement

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.

1 KPIC has contracted with the PHCS Network to provide access to hospitals and physicians with a commitment to keeping out-of-pocket costs low through contracted rates.

2 The Cigna Healthcare PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna Healthcare PPO for Shared Administration.

The HMO Tier of the Point-of-Service (POS) plan is underwritten by Kaiser Foundation Health Plan, Inc. (KFHP) while the Participating Provider and Non-Participating Provider Tiers of the POS plan are underwritten by Kaiser Permanente Insurance Company (KPIC). KPIC is a subsidiary of KFHP. Cigna Healthcare is an independent company and not affiliated with Kaiser Permanente. Access to the Cigna Healthcare PPO Network is available through Cigna Healthcare's contractual relationship with Kaiser Permanente. The Cigna Healthcare PPO Network is provided exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance Company. The Cigna Healthcare name, logo, and other marks are owned by Cigna Intellectual Property, Inc.