Why Dual Choice PPO?

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What does each provider offer?

The provider you choose affects your copays, coinsurance and deductibles. You’ll generally have the lowest costs when you get care from a select group of in-network providers, higher costs when you get care from First Choice Health and First Health Network providers, and the highest costs when you get care from out-of-network providers.

Kaiser Permanente Providers in Oregon and Washington

Fully coordinated and quality care.

Kaiser Permanente doctors, nurses, and other specialists all work together to keep our members healthy. They’re connected to each other, through our electronic health record. So they know important things about each member’s health — like when they’re due for a screening and what medications they’re taking. That way, each member gets personalized care that’s right for them.
Most medical offices across the Northwest region offer many services conveniently under one roof, including pharmacy, imaging, lab, primary care physicians and specialists, and urgent care services.
Kaiser Permanente Provider will coordinate each member’s care. The entire care team has a shared stake and personal investment in keeping our members healthy, and takes the time to listen, explain, and care.
No claims paperwork is required.

First Choice or First Health Network Providers

A wide network of providers with managed out-of-pocket costs.

Members can choose from an extensive list of First Choice Health or First Health Network providers across the country, making Dual Choice PPO a simple solution for employees who live and work out of the Kaiser Permanente service area.
We’ve contracted with First Choice Health or First Health Network to manage provider costs.
First Choice Health or First Health Network providers will complete claims forms.
Members can see most specialists without a referral.
Certain services require prior authorization.

Out-of-Network Providers

Care from any licensed provider in the U.S., highest out-of-pocket costs.

Members can receive care from any other licensed provider in the U.S., including physicians, specialists, hospital, or laboratory.
Members’ out-of-pocket costs will usually be the highest with Out-of-Network Providers.
Members may have to pay the provider directly at the point of service.
A claim form will have to be completed. If members are required to pay out-of-pocket at the point of service, they can complete a medical claim form and submit it for reimbursement from Kaiser Permanente.
Members can see any licensed specialist they choose without a referral.
Certain services require prior authorization.

Get the care you need. Dual Choice PPO empowers you to choose how and where you get covered care.
Manage your care and costs. You can choose your provider, opting for Kaiser Permanente providers, First Choice Health or First Health Network, or out-of-network providers.
Preventive care. It’s covered at no cost to you, when you see In-Network Providers.
Pharmacy services. Most Kaiser Permanente medical offices have on-site pharmacies. You can also have prescriptions filled at MedImpact retail pharmacies across the country

Check here for more about pharmacy services, finding doctors and facilities, and the benefits of Dual Choice PPO.

Is Dual Choice PPO right for you?

Here are some examples of how people may use Dual Choice PPO to get the care they want:

Katherine: Wants to experience Kaiser Permanente’s care before committing to transitioning her care.

Katherine has always had a PPO plan, but is interested in Kaiser Permanente’s integrated care and coverage model. Having never had Kaiser Permanente before, Katherine is interested in seeing a primary care doctor and experiencing it for herself before switching. She wants to see how it goes, and the Dual Choice PPO allows her to do that while still having the option for First Choice Health or First Health Network providers.

For employers and producers, Dual Choice PPO is an all-in-one solution.

Give your valuable employees full choice in their providers and allow them to determine and manage their health care costs, with the benefit of working with a single carrier.
Having more providers to choose from helps give your valued employees what they need to be healthier and more productive every day.
A simple plan design enhances efficiencies and helps provide a simpler user experience for both the employer group and the member.
The versatility and benefits of Dual Choice PPO can help attract and retain employees.
Your company has the convenience of one health care provider for all your employee benefits administration.
We’ve built Dual Choice PPO from the ground up to be a competitively priced product offering, rooted Kaiser Permanente’s long-standing efforts that help keep premiums predictable and sustainable.

How the Dual Choice PPO insurance plan works for your company and employees.

With Dual Choice PPO, you can offer your participating employees more provider choices when they receive care:

Kaiser Permanente Providers in Oregon and Washington. Members can receive In-Network care from Kaiser Permanente’s highly rated integrated health care delivery system through Kaiser Permanente Providers practicing exclusively at our medical offices in Oregon and Washington. Kaiser Permanente Providers in Oregon and Washington offer the most coordinated care with the lowest out-of-pocket costs for office visits and pharmacy copayments. Members can also use kp.org and our to schedule certain appointments, email their doctors, view lab results, and refill prescriptions online.
First Choice Health or First Health Network providers. Members can access the First Choice Health and the First Health Network. We’ve contracted with First Choice Health and First Health Network to manage provider costs. Certain services are subject to deductible, with coinsurance after the deductible has been met. Some services including office visits and urgent care are offered at a copay. Preventive care is at no cost.
Out-of-Network Providers. Members can receive services from any licensed provider or facility they choose outside of In-Network Providers. Members pay deductibles, coinsurance, and any difference between the cost of the service and payment provided. Out-of-pocket costs are generally the highest with Out-of-Network Providers.
Learn more about In-Network Providers and Out-of-Network Providers, and how they work.

Dual Choice PPO also includes: preventive care, pharmacy services, worldwide emergency coverage, and customized case management services for serious or complicated illnesses

Employer and producer frequently asked questions.

What are the pharmacy choices under Dual Choice PPO?

Members have several choices for having their prescriptions filled.

Most Kaiser Permanente medical offices have on-site pharmacies. Members can fill prescriptions written by any provider at pharmacies located in Kaiser Permanente medical offices at the lowest out-of-pocket cost.
Kaiser Permanente has contracted with MedImpact to fill outpatient prescriptions at MedImpact retail pharmacies.
Members can also choose to receive prescriptions by mail from Kaiser Permanente.**
Learn more about pharmacy services.

What are the guidelines regarding prior authorization?

For care with Kaiser Permanente Providers in Oregon and Washington, the provider will arrange for prior authorization, if required, for certain services.
For care with First Choice Health or First Health Network providers, members must obtain prior authorization for inpatient services, and certain outpatient surgeries, services, and procedures.
For care with Out-of-Network Providers, members must obtain prior authorization for inpatient services, and certain outpatient surgeries, services, and procedures.
Learn more about prior authorization.

How are new members on-boarded?

Onboarding includes: Comprehensive New Member Welcome handbooks, an onboarding call from customer specialists, and a help line for any questions, from accessing care to transferring prescriptions.

Who do we contact for product pricing or to purchase Dual Choice PPO?

Contact Kaiser Permanente at any time through our Business Plans contact page.

Who processes claims?

Claims are processed by our claims team in Denver, Colorado. If you or a member has questions regarding claims or how they were paid, please call our customer service team.

*To use the Kaiser Permanente app, you must be a member registered on kp.org.

**A program operated or arranged by a health plan distributes prescription drugs via mail to members with addresses in Oregon or Washington. Some medications are not eligible for the Mail Service Delivery Program. These may include, but are not limited to, drugs that are time or temperature sensitive, drugs that cannot legally be sent by U.S. mail, and drugs that require professional administration or observation.