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.
Added Choice® lets you choose to receive covered services from KP Select Providers, PPO Providers, or Non-Participating Providers. The services we cover, and what you pay, will differ depending on the provider you choose.
To know if your plan allows for cross-accumulation between these providers for your deductible and out-of-pocket-maximum, see your Evidence of Coverage.
Get more information on managing your deductible plan.
KP Select Providers
Kaiser Permanente Providers
Choose a provider from Kaiser Permanente.
Features and benefits of our plan:
- Out-of-pocket costs. With these providers, 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. 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 with KP Select Providers, see your Evidence of Coverage (EOC) or call Customer Service at 1-866-616-0047 (TTY 711).
2These contracted hospitals are independently owned and operated and are not affiliated entities of Kaiser Permanente.
PPO Providers
First Choice Health or First Health Network
Choose a PPO Provider from First Choice Health or First Health Network. This provider option is for members that wish to keep their current PPO Provider or who live outside our service area.
To find a PPO Provider or confirm if your current provider is part of the First Choice Health or First Health Network, please visit our customized PPO Provider locator.
First Choice Health Network
(Members receiving care in OR, WA, ID, MT, WY, ND, SD, and AK.)
First Health Network
(Members receiving care in all states EXCEPT OR, WA, ID, MT, WY, ND, SD, and AK.)
- First Choice Health or First Health Network. You can choose to receive your medical care through a provider contracted within First Choice Health or the First Health Network.
- Providers Nationwide. First Choice Health 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 with KP Select Providers (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 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 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 substance use concerns from a PPO Network provider.*
- Hospital care. You can receive inpatient hospitalization services from First Choice Health or First Health Network hospitals and facilities. Your provider may make arrangements for your hospital admission
- NOTE: Not all PPO Providers have admitting privileges with participating hospitals. Please confirm the facility and Provider is part of First Choice Health or First Health Network using our customized PPO Provider locators or you may pay higher out-of-pocket costs.
- Maternity care. You can choose a First Choice Health or First Health Network Provider for your obstetric care.
- Lab tests and imaging. You can choose a First Choice Health 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 with PPO Providers:
- Refer to your Evidence of Coverage (EOC).
- Contact the human resources/benefits representative where you work, if your employer provides your coverage.
- Call Customer Service at 1-866-616-0047 (TTY 711).
*Inpatient and certain outpatient services are subject to prior authorization. Your 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 Providers, Kaiser Permanente has contracted with First Choice Health and First Health Network. The list of participating First Choice Health or First Health Network providers is subject to change without notice.
Non-Participating Providers
Any other licensed provider or physician
Choose a Non-Participating Provider nationwide. Non-participating Providers include any licensed providers who are not KP Select Providers or PPO providers. This provider option 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 benefits cover care you receive from any licensed provider (who’s not a KP Select Provider or a PPO Provider).
- 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 for mental health and substance use concerns from a PPO Network provider.*
- Hospital care. You can receive inpatient hospitalization services from licensed or accredited hospitals and facilities that are not a KP Select Provider or a PPO Provider.
- Emergency care. You can visit any licensed Non-Participating emergency care facility. Emergency care is covered at the same cost as if received from a KP Select Provider, and you will be responsible only for the KP 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 with Non-Participating Providers:
- Refer to your Evidence of Coverage (EOC).
- Contact the human resources/benefits representative where you work, if your employer provides your coverage.
Call Customer Service at 1-866-616-0047 (TTY 711).
*Inpatient and certain outpatient services are subject to prior authorization. Your 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.
Balance Billing
If you use a Non-Participating Provider, it is important that you understand balance billing. Balance billing can mean significant out-of-pocket costs for you.
What is balance billing?
Balance billing is the difference between what a Non-Participating Provider charges for a service and what Medicare will reimburse for that service. What Medicare will reimburse for the service is called an “allowed amount.”
For example, if a Non-Participating Provider charges $100 and the allowed amount is $70, the Provider can balance-bill you directly for the difference — in this case, $30. You will be responsible for paying all amounts above the allowed amount in addition to your copay and coinsurance.
This is one reason why it’s generally less expensive to use KP Select and PPO providers. KP Select and PPO providers cannot bill you above the allowed amount.
Other things to know about balance billing:
- Your deductible
- Balance-billed amounts do not accumulate to your deductible.
- Your out-of-pocket maximum
- Although your plan has an out-of-pocket maximum, it does not apply to balance-billed charges from a Non-Participating Provider. This means you could end up paying above your annual out-of-pocket maximum to cover the cost of a service.
- Billing
- You could receive a bill in the mail at any time after your service.
Please contact Customer Service at 1-866-616-0047(TTY 711) for more information.