Choice Products Northwest
Kaiser Permanente Northwest Choice Products
Added Choice

Member Information

Understanding Your Plan and Benefits

Added Choice® empowers you to make the best health care choice for you — wherever you are, and whenever you need care.

With Added Choice®, there are 3 tiers, or levels of benefit, to choose from: select provider, preferred provider organization (PPO) provider, and non-participating provider.

Select Provider Tier

Kaiser Permanente Providers

Choose a provider from Kaiser Permanente or The Portland Clinic, conveniently located throughout our service area.1

Features and benefits of our plan:

  • Out-of-pocket costs. With this tier, you’ll pay the least out of pocket, with a lower or no deductible.
  • Coordinated care. Your primary care physician works closely with specialists, pharmacists, lab technicians, therapists, and many other professionals. They are all connected through your electronic medical record for a coordinated care experience.
  • NW medical offices. Kaiser Permanente’s medical offices are located throughout the Northwest region with doctors, specialists, imaging, and in most locations, pharmacy and lab, all in one place.
  • Emergency care. You are covered for emergency care anywhere, worldwide.
  • Urgent care. Urgent care is available at Kaiser Permanente medical offices. Call the number on the back of your ID card to confirm locations and hours of operations.
  • Hospital care. Kaiser Permanente has 2 hospitals in the Portland area and carefully selects contracted hospitals to partner with us in taking care of you.2
  • Medical advice. When you call for medical advice, you will be connected with a professional who can help advise you and make appointments with one of our providers. You can get advice by calling the number on the back of your ID card.
  • Lab services. Your results from tests done in Kaiser Permanente medical offices can be read (for most results) online soon after the lab completes your tests, sometimes the same day.
  • No-cost preventive care. In this tier, you pay $0 for preventive care. That includes routine physicals, well-child visits, and certain screenings and tests (such as mammograms).
  • Choose from telehealth options that fit into your schedule. Chat with a Kaiser Permanente doctor, email, or schedule a phone or video visit. Members with a health savings account (HSA)–qualified high-deductible health plan (HDHP) will pay a fee for scheduled phone and video visits subject to your plan’s deductible. Non-HDHP Added Choice members will pay $0 for telehealth visits.3
  • Manage your health online. Use the convenient features of kp.org to manage your health.
    • Email your doctor’s office with routine, nonurgent questions
    • View most test results
    • Schedule or cancel routine appointments
    • Refill most prescriptions
    • View past visits
    • Find care options and urgent care locations near you
    • Register at kp.org/registernow (Make sure to select your region.)

Your username and password can also be used on our mobile app.

To find out more about what is covered under the select provider tier, see your Evidence of Coverage (EOC) or call the Added Choice Contact Center at 1-866-616-0047 (TTY 711).

1A referral may be required for participating providers.

2These contracted hospitals are independently owned and operated and are not affiliated entities of Kaiser Permanente.

3Video visits are available for members who receive care at Kaiser Permanente medical offices. You must be 18 or older to schedule a video visit. Check with your doctor’s office to find out if video visits are available to you.

PPO provider tier

First Choice Health Network or First Health Network

Choose a preferred provider (PPO) from First Choice Health Network or First Health Network. This option is for members that wish to keep their current PPO provider or who live outside our service area.

To find a participating provider or confirm if your current provider is part of the network, please visit our customized network locators.

First Choice Health Network

First Health Network
(Members receive care in all states EXCEPT OR, WA, ID, MT, WY, ND, SD, and AK.)

If you have any questions or need help with any of the PPO providers, you may contact their customer support at:

First Choice Health Network
1-800-467-5281

First Health Network
1-888-685-7774

    • First Choice Health Network or First Health Network. You can choose to receive your medical care through a provider contracted within the First Choice Health Network or the First Health Network.
    • A wide network of contracted providers. The First Choice Health Network and First Health Network consist of doctors, hospitals, specialists, laboratories, and physical therapists across the country.
    • Out-of-pocket costs. Although you will have higher out-of-pocket costs than in the select provider tier (such as a deductible, coinsurance, and a copayment), in most cases you will not be responsible for the amount you are billed above the maximum allowable charge set out in your Evidence of Coverage (EOC) — this is referred to as balance billing.
    • Specialty care. Most First Choice Health Network or First Health Network providers do not require a referral for specialty care. However, this is determined by the specialty provider so please inquire with them when scheduling your appointment. Your participating provider must obtain prior authorization for certain services and treatments* such as:
      • Inpatient hospital stay
      • Outpatient surgery
      • Home health, hospice, and skilled nursing facility services
      • Imaging services
      • Please review your Evidence of Coverage (EOC) for plan details
    • Behavioral health. You can receive care for mental health and drug or alcohol dependency from a provider in the First Choice Health Network or First Health Network.*
    • Hospital care. You can receive inpatient hospitalization services from First Choice Health Network or First Health Network hospitals and facilities. Your participating provider may make arrangements for your hospital admission
      • NOTE: Not all providers contracted in the Preferred Provider Organization (PPO) provider tier have admitting privileges with participating hospitals. Please confirm the facility and providers are contracted with the network or you may pay higher out-of-pocket costss
    • Maternity care. You can choose a First Choice Health Network or First Health Network provider for your obstetric care.
    • Lab tests and imaging. You can choose a First Choice Health Network or First Health Network provider for lab tests and imaging.
    • Pharmacy services. Learn about your pharmacy benefits on the Pharmacy page.

     

  • For additional information on what is covered under the Preferred Provider Organization (PPO) provider tier:
      • Refer to your Evidence of Coverage (EOC).
      • Contact the human resources/benefits representative where you work, if your employer provides your coverage.
      • Call the Added Choice Contact Center at 1-866-616-0047 (TTY 711).

     

    *Inpatient and certain outpatient services are subject to prior authorization. Your participating provider must call 1-855-281-1840 (TTY 711) for prior authorization. Failure to get prior authorization will result in greater out-of-pocket cost to you.

    This site provides an overview of your benefits and services. If there are any differences between this document and your Evidence of Coverage (EOC), your Evidence of Coverage (EOC) will prevail.

    For its PPO Provider Network, Kaiser Permanente has contracted with First Choice Health Network or First Health Network. The list of participating First Choice Health Network or First Health Network providers is subject to change without notice.

Non-participating provider tier

Any other licensed provider or physician

Choose a non-participating provider nationwide. Non-participating providers include any licensed providers who are not select providers or PPO providers. This tier has the highest out-of-pocket costs.

Features and benefits of receiving covered care from any licensed provider:

  • Provider choice, care anywhere. Your non-participating provider tier benefits cover care you receive from any licensed provider (who’s not in the select provider tier or the PPO provider tier).
  • Using non-participating providers means higher out-of-pocket costs. Your out-of-pocket costs will be the highest when you choose to receive care from a non-participating provider or facility. When using a non-participating provider or facility, you will be responsible for the amount you are billed above the maximum allowable charge set out in your Evidence of Coverage (EOC) — this is referred to as balance billing. These charges billed directly by your provider do not apply to your deductible or out-of-pocket maximum.
  • Behavioral health. You can receive care from any licensed behavioral health or chemical dependency professional for mental health and drug or alcohol dependency.*
  • Hospital care. You can receive inpatient hospitalization services from licensed or accredited hospitals and facilities that are not in the select provider tier or the PPO provider tier.
  • Emergency care. You can visit any licensed non-participating emergency care facility. Emergency care is covered at the select provider tier benefit level, and you will be responsible only for the select provider cost share, regardless of where you seek emergency care.
  • Urgent care. You can visit any licensed non-participating urgent care facility.
  • Maternity care. You can choose any licensed provider for obstetric care.
  • Lab tests and imaging. You can choose any licensed provider for lab tests and imaging.
  • Pharmacy services. Learn about your pharmacy benefits on the pharmacy page.

For additional information on what is covered under the non-participating provider tier:

  • Refer to your Evidence of Coverage (EOC).
  • Contact the human resources/benefits representative where you work, if your employer provides your coverage.

Call the Added Choice Contact Center at 1-866-616-0047 (TTY 711).

*Inpatient and certain outpatient services are subject to prior authorization. Your non-participating provider must call 1-855-281-1840 (TTY 711) for prior authorization. Failure to get prior authorization will result in greater cost to you.

This site provides an overview of your benefits and services. If there are any differences between this document and your Evidence of Coverage (EOC), your Evidence of Coverage (EOC) will prevail.