Additional providers and pharmacies

 

Some of our plans include regional and national networks whose providers are not listed in the online provider and facility directory.

Click your plan name below to learn more about your network coverage. If you don’t see your plan, all of your provider options are included in the online directory.

PPO and POS provider and pharmacy network options and coverage

Access PPO

With Access PPO you can choose from an extensive network of preferred, in-network primary or specialty care providers, including our exclusive medical group at Kaiser Permanente facilities. These providers are available to you at an enhanced benefit: lower costs for office visits and some prescription medications.

You also have the option to get in-network care through our regional and national networks, and out-of-network care with any licensed provider in the United States.

In-network care with Kaiser Permanente clinicians

  • More than 1,400 Kaiser Permanente doctors and other clinicians1
  • Over 25 Kaiser Permanente medical facilities and pharmacies2
  • Visit kp.org/wa/find-a-doctor

In-network care from other network providers

  • Care from thousands of additional network providers
  • Includes most major and designated pharmacies in the Kaiser Permanente Washington service area
  • Visit kp.org/wa/find-a-doctor

In-network care from First Choice Health network

  • Regional care in Washington state and in Kootenai and Latah counties in Idaho, when outside of the Kaiser Permanente service area. (Care from these providers within the Kaiser Permanente service area is provided at your out-of-network benefit level).
  • Find providers on the First Choice Health website

In-network care from Aetna PPO network providers; access through Aetna Signature Administrators®3

  • For care across the country when outside Washington state and outside Kootenai and Latah counties in Idaho
  • Access to 1.9 million participating physicians and ancillary providers, including over 10,000 hospitals
  • Find providers on the Aetna Signature Administrators website
  • When accessing care through the Aetna Signature Administrators®3, Kaiser Foundation Health Plan of Washington utilizes Aetna medical clinical policies to determine medical necessity. Visit Aetna’s Clinical Policy Bulletins website. 

Out-of-network care from nonparticipating providers

  • Care from any licensed provider in the United States
  • Balance billing may apply

Pharmacy access

Elect PPO

Elect PPO plans provide you the choice and flexibility of getting in-network care from the high-quality Kaiser Permanente provider network within our Washington service area and care through our regional and national networks.

In-network care with Kaiser Permanente clinicians

  • More than 1,400 Kaiser Permanente doctors and other clinicians1
  • Over 25 Kaiser Permanente medical facilities and pharmacies2
  • Visit kp.org/wa/find-a-doctor

In-network care from other network providers

  • Care from thousands of additional network providers
  • Includes most major providers and designated pharmacies in the Kaiser Permanente Washington service area
  • Visit kp.org/wa/find-a-doctor

In-network care from First Choice Health network

  • Regional care in Washington state and in Kootenai and Latah counties in Idaho, when outside of the Kaiser Permanente service area. (Care from these providers within the Kaiser Permanente service area is provided at your out-of-network benefit level.).
  • Find providers on the First Choice Health website

In-network care from Aetna PPO network providers; access through Aetna Signature Administrators®

  • For care across the country when outside Washington state and outside Kootenai and Latah counties in Idaho
  • Access to 1.9 million participating physicians and ancillary providers, including over 10,000 hospitals
  • Find providers on the Aetna Signature Administrators website
  • When accessing care through the Aetna Signature Administrators®3, Kaiser Foundation Health Plan of Washington utilizes Aetna medical clinical policies to determine medical necessity. Visit Aetna’s Clinical Policy Bulletins website. 

Out-of-network care from nonparticipating providers

  • Care from any licensed provider in the United States
  • Balance billing may apply

Pharmacy access

Summit PPO

Summit PPO has 3 tiers of coverage for different groups of clinicians, and you get the best value when you choose high-quality care from Kaiser Permanente clinicians. And when choice is most important, you have access to more than 1 million in-network health professionals anywhere in the United States.

Tier 1: Preferred in-network care with Kaiser Permanente clinicians and contracted clinicians

  • Care from more than 1,400 Kaiser Permanente doctors and other clinicians1
  • Includes access to preferred contracted clinicians
  • More than 25 Kaiser Permanente medical facilities and pharmacies2
  • Visit kp.org/wa/find-a-doctor

Tier 2: In-network care from other network providers

Tier 2: In-network care from First Choice Health network

Tier 2: In-network care from Aetna PPO network providers; access through Aetna Signature Administrators®

  • For care across the country when outside Washington state and outside Kootenai and Latah counties in Idaho
  • Access to 1.9 million participating physicians and ancillary providers, including over 10,000 hospitals
  • Find providers on the Aetna Signature Administrators website
  • When accessing care through the Aetna Signature Administrators®3, Kaiser Foundation Health Plan of Washington utilizes Aetna medical clinical policies to determine medical necessity. Visit Aetna’s Clinical Policy Bulletins website. 

Tier 3: Out-of-network care from nonparticipating providers

  • Care from any licensed provider in the United States
  • Balance billing may apply

Pharmacy access

Options Federal PPO

With Options Federal PPO you can choose from an extensive network of preferred, in-network primary or specialty care providers, including our exclusive medical group at Kaiser Permanente facilities. You also have the option to get in-network care through our regional and national networks, and out-of-network care with any licensed provider in the United States.

In-network care with Kaiser Permanente clinicians

  • More than 1,400 Kaiser Permanente doctors and other clinicians1
  • Over 25 Kaiser Permanente medical facilities and pharmacies2
  • Visit kp.org/wa/find-a-doctor

In-network care from other network providers

  • Thousands of additional network providers
  • Includes most major providers and designated pharmacies in our service area
  • Visit kp.org/wa/find-a-doctor

In-network care from First Choice Health network

In-network care from Aetna PPO network providers; access through Aetna Signature Administrators®

  • For care across the country when outside Washington state and outside Kootenai and Latah counties in Idaho
  • Access to 1.9 million participating physicians and ancillary providers, including over 10,000 hospitals
  • Find providers on the Aetna Signature Administrators website
  • When accessing care through the Aetna Signature Administrators®3, Kaiser Foundation Health Plan of Washington utilizes Aetna medical clinical policies to determine medical necessity. Visit Aetna’s Clinical Policy Bulletins website. 

Out-of-network care from nonparticipating providers

  • Care from any licensed provider in the United States
  • Balance billing may apply

Pharmacy access

Options

Options provides you access to high-quality in-network care from Kaiser Permanente clinicians and thousands of other additional network providers. For greater choice and convenience, Options provides you discounted out-of-network access to regional and national networks. You can also get care out-of-network, at higher costs, from any licensed provider in the United States.

In-network care with Kaiser Permanente clinicians

  • More than 1,400 Kaiser Permanente doctors and other clinicians1
  • Over 25  Kaiser Permanente medical facilities and pharmacies2
  • Visit kp.org/wa/find-a-doctor

In-network care from other network providers

  • Care from  thousands of additional network providers
  • Includes most major providers and designated pharmacies in our service area
  • Visit kp.org/wa/find-a-doctor

Care from First Choice Health network providers

  • For care in Washington state and in Kootenai and Latah counties in Idaho
  • Covered at the out-of-network benefit level
  • Find providers on the First Choice Health website

Care from Aetna PPO network providers; access through Aetna Signature Administrators®

  • For care across the country when outside Washington state and outside Kootenai and Latah counties in Idaho
  • Access to 1.9 million participating physicians and ancillary providers, including over 10,000 hospitals
  • Covered at the out-of-network benefit level
  • Find providers on the Aetna Signature Administrators website
  • When accessing care through the Aetna Signature Administrators®3, Kaiser Foundation Health Plan of Washington utilizes Aetna medical clinical policies to determine medical necessity. Visit Aetna’s Clinical Policy Bulletins website. 

Out-of-network care from nonparticipating providers

  • Care from any licensed provider in the United States
  • Balance billing may apply

Pharmacy access

First Fill Pharmacy Network Limitations 

Select plans require members to fill maintenance medications at a Kaiser Foundation Health Plan of Washington (KFHPWA) clinic pharmacy or mail order pharmacy. Members will be allowed one fill at any network pharmacies before requiring refills to be filled at a KFHPWA pharmacy. This does not affect prescriptions for acute medications and can be filled and refilled at any network pharmacy without restrictions. Members can call 1-800-245-7979 to transfer prescriptions to KFHPWA. If you have questions regarding your plan, please call Member Services at 1-888-901-4636.

Core Small and Large Group

The pharmacies listed here have limitations on the select plans regarding maintenance medications.

Access and Summit PPO

The pharmacies listed here have limitations on the select plans regarding maintenance medications.

 

1Washington Permanente Medical Group personnel records
2OIC Provider Network Form A
3 Self-funded groups must opt in to offer the Aetna PPO network through Aetna Signature Administrators. Please contact your employer for more information.