Understanding Your Plan and Benefits
Dual Choice PPO allows you to make the best health care choice for you—wherever you are, and whenever you need care.
Here’s an overview of getting care with Dual Choice PPO. You have the option to see Kaiser Permanente Providers in Oregon and Washington, In-Network Providers, or any licensed provider.
In-Network
Kaiser Permanente:
You have access to more than 1,200 Kaiser Permanente doctors and specialists in Oregon and Southwest Washington.
To find providers, locations, and pharmacies, visit the Dual Choice PPO Provider Directory.
Features and benefits of your insurance plan.
Lowest out-of-pocket costs. You will have lower cost shares for certain covered services, including primary care, urgent care, and prescriptions when you get care from Kaiser Permanente, The Portland Clinic, and PeaceHealth providers or fill prescriptions at Kaiser Permanente pharmacies.
Coordinated care. Kaiser Permanente doctors, nurses, and other specialists all work together to help keep you healthy. They’re connected to each other, through our electronic health record. So they know important things about your health — like when you’re due for a screening and what medications you’re taking. That way, you get personalized care that’s right for you. Coordinated care is with Kaiser Permanente Providers in Oregon and Washington with doctors, specialists, imaging, and in most locations, pharmacy and lab, all in one place.
Emergency care. You are covered for emergency care worldwide.
Urgent care. Urgent care is available at Kaiser Permanente medical offices in Oregon and Washington. For the latest hours, go to kp.org/locations or call 1-800-813-2000 (TTY 711).
Medical advice. When you call for medical advice, you will be connected with a professional that can help advise and make appointments with one of our providers. You can get advice by calling the number on the back of your ID Card, 24/7.
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. With your insurance plan, you pay $0 for preventive care. That includes routine physicals, well-child visits, and certain screenings and tests (such as mammograms).
Get care your way, in a way that fits into your schedule. Chat with a Kaiser Permanente doctor in Oregon or Washington, email, or schedule a phone or video visit – all for a $0 copay for most members.*
Manage your health online. Use the convenient features of kp.org to manage your health.*
- Email your doctor’s office
- View most test results
- Schedule or cancel routine appointments
- Refill most prescriptions
Register at kp.org/registernow
To find out more about what is covered with Kaiser Permanente Providers in Oregon and Washington, see your Evidence of Coverage or call Customer Service at 1-866-616-0047 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Pacific time.
*These features apply to care you get at Kaiser Permanente facilities. When appropriate and available. If you have an HSA-qualified deductible plan, you will need to pay the full charges for scheduled phone and video visits until you reach your deductible. Once you reach your deductible, your copay is $0 for scheduled phone and video visits.
First Choice Health and First Health Network:
Features and benefits of receiving covered care from our First Choice Health and First Health Network.
With Dual Choice PPO, you can also choose to see any First Choice Health Network or First Health® Network providers without a referral.*
First Choice Health or First Health Network. You can choose to receive your medical care through a network of providers nationwide, including First Choice Health, First Health Network, and other providers.
A wide network of contracted providers. First Choice Health and First Health Network consists of more than 800,000 doctors, hospitals, specialists, and physical therapists across the country.
No-cost preventive care. With your insurance plan, you pay $0 for preventive care. That includes routine physicals, well-child visits, and certain screenings and tests (such as mammograms).
Specialty care. You don’t need a referral for specialty appointments with First Choice Health and First Health Network. However, you must obtain prior authorization for certain services and treatments such as:
- Inpatient hospital stays
- Outpatient surgery
- Home health, hospice, and skilled nursing facility services
- Imaging services
Please review your Evidence of Coverage for details
Behavioral health. You can receive care from any licensed behavioral health or chemical dependency professional for mental health or substance use concerns.*
Hospital care. You can get inpatient hospitalization services from First Choice Health and First Health Network hospitals and facilities. (Important! Not all physicians contracted as First Choice Health and First Health Network have admitting privileges with First Choice Health and First Health Network hospitals). Please confirm the hospital is contracted with the First Choice Health and First Health Network or you may pay higher out-of-pocket costs.*
Emergency care. You are covered for emergency care worldwide. The emergency care copay will be waived if you are directly admitted to a hospital as a result of an emergency.
Urgent care. You can visit any licensed In-Network urgent care facility.
Maternity care. You can choose within the First Choice Health and First Health Network for your obstetric care.*
Lab tests and X-rays. You can contact facilities directly.
Pharmacy services. Learn about your pharmacy benefits with MedImpact Providers.
To find out more about what is covered with First Choice Health and First Health Network:
Refer to your Evidence of Coverage.
Contact the human resources/benefits officer where you work, if your employer provides your coverage.
Call Customer Service at 1-866-616-0047 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Pacific time, or refer to your ID card.
*Some services are accessed through referral and prior authorization. You must call 1-855-281-1840 (TTY 711) for prior authorization. This site provides an overview of your benefits and services. If there are any differences between this document and your Evidence of Coverage, your Evidence of Coverage will prevail.
For its In-Network Providers, Kaiser Permanente has contracted with First Choice Health and First Health Network. The list of participating First Choice Health and First Health Network providers is subject to change without notice.
Lower cost shares with enhanced benefits
Some in-network providers, including Kaiser Permanente, have lower cost shares for certain covered services, including primary care, urgent care, specialty care, routine eye exam visits, and mental health and chemical dependency outpatient services. This is referred to as an enhanced benefit.
In-network providers who offer Enhanced Benefits are identified with an asterisk (*) in the provider directoy. Visit the Dual Choice PPO Provider Directory for a searchable provider directory.
Out-of-Network
Any other licensed provider or physicians
Features and benefits of receiving covered care from any licensed provider
Provider choice, care anywhere. You can see any other licensed provider nationwide and get care at a wide range of medical facilities using your out-of-network provider benefits.
Using your Out-of-Network benefit generally means higher out-of-pocket costs. Your out-of-pocket costs will generally be the highest when you choose to receive care from an Out-of-Network Provider or facility.
Behavioral health. You can receive care from any licensed behavioral health or chemical dependency professional for mental health or substance use concerns.*
Hospital care. You can receive inpatient hospitalization services from licensed or accredited hospitals and facilities that are not associated with In-Network Providers.*
Emergency care. You can visit any licensed Out-of-Network emergency care facility. Emergency care is covered at the In-Network provider benefit level, and you will be responsible only for the In-Network provider cost share, regardless of where you seek care.
Urgent care. You can visit any licensed Out-of-Network urgent care facility.
Maternity care. You can choose any licensed provider for obstetric care.*
Lab tests, X-rays. You can contact facilities directly. You can request your Out-of-Network Provider send labs, X-rays, and special procedures (MRIs, CT scans, PET scans, nuclear medicine) to a Kaiser Permanente facility or a Kaiser Permanente Provider, any time you choose, and you will likely pay less.
Pharmacy services. Learn about your pharmacy benefits with Out-of-Network Providers.
To find out more about what is covered with Out-of-Network Providers:
Refer to your Evidence of Coverage.
Contact the human resources/benefits officer where you work, if your employer provides your coverage.
Call Customer Service at 1-866-616-0047 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m., Pacific time, or refer to your ID card
*Some services are accessed through referral and prior authorization.
You must call 1-855-281-1840 (TTY 711) for prior authorization.
This site provides an overview of your benefits and services. If there are any differences between this document and your Evidence of Coverage, your Evidence of Coverage will prevail.