PPO Plan

Glossary

Your Preferred Provider Organization (PPO) Plan with Kaiser Permanente is not just health coverage — it's a partnership in health.

You can choose any licensed physician to provide care nationwide. Online features let you manage most of your care around the clock.

Your benefits include:

  • the choice to see any provider for medical care
  • lower costs when you stay within the network, including preventive care at little or no cost
  • an out-of-pocket maximum that limits how much you'll spend on most covered services each year
  • no paperwork or claims when using in-network providers
  • no referrals needed for specialists
  • convenient pharmacy options: use any Kaiser Permanente pharmacy or choose from nearly 60,000 MedImpact retail pharmacies nationwide

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 CignaHealthcareSM 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/ppo.

Participating provider option

This option gives you:
  • simple copay for most doctor's office visits
  • most preventive care services covered at little or no cost to you
  • simple copays for covered services after meeting your deductible
  • lower out-of-pocket costs

Nonparticipating provider option

This option gives you:
  • choice of any licensed provider, including specialists
  • easy appointments — just call the provider's office
  • most preventive care services covered at little or no cost to you
  • most other services covered at a coinsurance after you reach your calendar-year deductible

Your Certificate of Insurance or Summary Plan Description 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 Network for Shared Administration.

The Kaiser Permanente PPO Plan is underwritten by Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc. 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.