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Point-of-Service (POS) and Preferred Provider Organization (PPO)
Choice Product plans

Point-of-Service (POS) Plan

POS plans offer employees the predictability of an HMO with the flexibility of a PPO.1 Members choose from Kaiser Permanente doctors and facilities, participating providers, or any other licensed provider.

Advantages of a POS Plan

  • Wide selection of plans. Members can choose from a range of deductibles, copays, and coinsurance.

  • Preventive care. Three ways to access care, including Kaiser Permanente’s unique coordinated system of doctors, pharmacies, and labs.

  • Choice of providers. Members can choose from any licensed provider, hospital, or lab that’s convenient, including Kaiser Permanente doctors and facilities; Private Healthcare Systems (PHCS) Network for Kaiser Permanente Insurance Company (KPIC) providers in Kaiser Permanente states (California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, and Washington, D.C.);2 the Cigna PPO Network outside of Kaiser Permanente states;3 or any other licensed provider nationwide.

  • Pharmacy coverage. Low copays for prescriptions filled through Kaiser Permanente pharmacies or MedImpact, with over 57,000 pharmacies nationwide.

  • Disease management. Health screenings and online educational resources help members manage ongoing conditions and encourage a healthy, active lifestyle.

  • Worldwide coverage. Members are covered for urgent and emergency care anywhere in the world.

  • Additional benefits. Supplemental benefit options round out the benefits package for total health and wellness.

Tools and resources

  • Manage health online. Members can email their Kaiser Permanente doctor’s office, view most test results, schedule routine appointments, and more at kp.org or with the Kaiser Permanente app.4

  • Complete Suite. Our Complete Suite portfolio makes it easy to choose the right POS plan for any business. Custom plans are available for large groups. For more information, please contact your sales representative.
Preferred Provider Organization (PPO) Plan

PPO plans give members referral-free access to participating providers or any other licensed provider nationwide.5 PPO plans are a flexible solution for employees living and working outside our service areas, or for employees who’ve already established a relationship with an outside doctor. Offering a PPO plan alongside HMO coverage gives employers a single-carrier solution for smoother, more streamlined benefits management with just one bill and fewer claims to fill out.

Advantages of a PPO Plan

  • Wide selection of plans. Choose from a range of deductibles, copays, and coinsurance.

  • Preventive care. Employees pay copays for doctor office visits and most preventive care services.
  • Choice of providers. Members can choose from the PHCS Network for KPIC providers in Kaiser Permanente states (California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, and Washington, D.C.);6 the Cigna PPO Network outside of Kaiser Permanente states;7 or any other licensed provider nationwide.
  • Specialty care. Employees can visit the specialist of their choice without a referral.
  • Pharmacy coverage. Predictable payments for drug benefits through MedImpact, with over 57,000 pharmacies nationwide.
  • Disease management. Value-added services from Health Dialogue help employees make healthier lifestyle choices.
  • Worldwide coverage. Members are covered for urgent and emergency care anywhere in the world.

Tools and resources

  • Complete Suite. Our Complete Suite portfolio makes it easy to choose the right PPO plan for any business. Custom plans are available for large groups. For more information, please contact your sales representative.


 

Product improvements

You and your employees deserve the best possible customer and member experience, so improvements are continually made to offer more competitive POS and PPO plans.

  1. Finding care is more convenient. As of January 1, 2023, the Cigna PPO Network has replaced members’ PHCS access outside of Kaiser Permanente states (California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, and Washington, D.C.). Members can still get care from their PHCS providers within Kaiser Permanente states. Learn more about our collaboration with Cigna.

  2. Personalized member onboarding. Our expert advisors call new subscribers before their coverage begins to help ensure a smooth transition.

  3. Easier claims. As of January 1, 2023, all claims for KPIC Choice Products will be processed internally, bringing greater control and transparency to the process.

  4. Specialized customer support. Our Employer Broker Services (EBS) team is available to help resolve complex customer questions and concerns.

1The HMO Tier of the POS Plan is underwritten by Kaiser Foundation Health Plan, Inc. (KFHP) while the Participating Provider and Non-Participating Provider Tiers of the POS Plan are underwritten by KPIC. KPIC is a subsidiary of KFHP.
2KPIC has contracted with PHCS Network to provide access to hospitals and physicians with a commitment to keeping out-of-pocket costs low through contracted rates.
3The Cigna PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna PPO for Shared Administration.
4These features are available when you get care from Kaiser Permanente facilities.
5The Kaiser Permanente PPO Plan is underwritten by KPIC, a subsidiary of KFHP.
6See note 2.
7See note 3.

Cigna is an independent company and not affiliated with Kaiser Foundation Health Plan, Inc., and its subsidiary health plans. Access to the Cigna PPO Network is available through Cigna’s contractual relationship with the Kaiser Permanente health plans. The Cigna PPO Network is provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.