Added Choice and Deductible Added Choice each offer two options that empower employees to make decisions about how they receive care and who they receive it from.
Employees are free to choose whatever provider they prefer, whenever they receive care.
What does each option offer?
In-Network
Kaiser Permanente Care: Fully coordinated, high-quality care, lowest cost of the two options.
Kaiser Permanente SignatureSM Provider Network
With the Kaiser Permanente Signature provider network, you receive quality care from the award-winning physicians of the Mid-Atlantic Permanente Medical Group, P.C.,* These care teams practice exclusively in our medical centers, which are conveniently located throughout the covered Maryland, Virginia, and Washington, DC, service areas.
You have access to over 1,500 physicians in the Mid-Atlantic Permanente Medical Group, P.C., who practice in Kaiser Permanente medical centers. A list of network physicians is accessible at kp.org/doctor that allows you to choose and change your doctors at any time, for any reason. Referral is required for specialty visits.
Kaiser Permanente SelectSM Provider Network
Building on our Signature provider network, Select adds access to contracted community physicians in private practice. Members may choose a physician in the Mid-Atlantic Permanente Medical Group, P.C., or a community physician, and also have access to contracted hospitals located throughout the service area.
Out-of-Network
Out-of-Network Care: Care from any licensed provider in the U.S., highest out-of-pocket costs.
- You can receive care from any licensed care provider in the U.S., including physicians, specialists, hospital or laboratory (who are not in considered in-network.
- Your out-of-pocket costs will usually be the highest with this option.
- You may have to pay the treating provider directly at the point of service, based on the provider’s charges.
- A claim form will have to be completed, just as with most traditional health plans. If you are required to pay out-of-pocket at the point of service, you can complete a medical claim form and submit it for reimbursement from your insurance carrier.
- You can see any specialist you choose without a referral.
- Certain services require preauthorization. You will be responsible for obtaining preauthorization.
- Get the care you need.Added Choice and Deductible Added Choice empower you to choose how and where you get covered care.
- Manage your care and costs. You choose your provider. You determine how to manage out-of-pocket costs. You decide which provider network option you want to use any time you access care.
- Preventive care. It’s covered at no cost to you, when you see in-network providers.
- Pharmacy services. All Kaiser Permanente medical centers have onsite pharmacies. You can also have prescriptions filled at many retail pharmacies.
Check here for more about pharmacy services, finding doctors and facilities and the benefits of Added Choice and Deductible Added Choice.
Is Added Choice right for you?
Here’s are some examples of how people use Added Choice to get the care they want:
Offering Added Choice products at your company
For employers and brokers, Added Choice products are a great all-in-one solution:
- It gives your valuable employees choice in their providers and allows them to determine and manage their health care costs.
- Having two provider options to choose from gives your valued employees what they need to be healthier and more productive every day.
- The versatility and benefits of Added Choice can help attract and retain employees.
- Your company has the convenience of one health care provider for all your employee benefits administration.
- Offer it side-by-side with HMO, HMO/DHMO Plus, and Deductible HMO plans to decrease your company’s overall health care costs, and still offer your employees plan choice.
How Added Choice products work for your company and employees.
With each of these plans, you can offer your participating employees two options when they receive care:
In-Network
Members have access to the Kaiser Permanente SignatureSM Provider Network or Kaiser Permanente SelectSM Provider Network for the in-network option.
- Members have access to nearly 1,500 physicians in the Mid-Atlantic Permanente Medical Group, P.C., who practice in Kaiser Permanente medical centers.
- Some plans have deductibles, but many services are covered at a copay only. Once the deductible is met, members pay applicable copay or coinsurance on covered services.
- Virtually no claim forms to complete.
- A list of network physicians is accessible at kp.org.doctor that allows members to choose and change their doctors at any time, for any reason.
- Referral is required for specialty visits.
If the Select network is chosen, members can also access many community physicians in private practice.
- Some plans have deductibles, but many services are covered at a copay only. Once the deductible is met, members pay applicable copay or coinsurance on covered services.
- Virtually no claim forms to complete.
And when members get care from Kaiser Permanente facilities, they get the advantages of:
- Convenient access to contracted hospitals located throughout the service area.
- Coordinated care and around-the-clock access to the features on kp.org, including the ability to email their doctor, check lab and radiology test results, schedule appointments with their Permanente physician, and so much more.
- Receiving their diagnosis and treatment at one-stop medical centers, most with after-hours and 24/7 Urgent Care accessibility.
Out-of-Network
- Members can receive services from any licensed provider or facility they choose outside those considered in-network.
Learn more about what’s included in the in-network and out-of-network options and how they work.
Why choose Deductible Added Choice?
- By adding deductible requirements for in-network services, premium prices can be reduced below those of similar Added Choice plans. Employers have the flexibility of choosing the plan design that best meet their needs, whether the overall goal is to keep employee costs down or reduce premiums.
- Deductible Added Choice can be paired with price competitive Deductible HMO plans for selection by employees, enabling employers to control costs and employees to choose the plan that best fits their health care needs and budget. Both plans can be paired with certain kinds of Kaiser Permanente health reimbursement arrangements (HRA) for additional savings. (HRA accounts can also be opened with other financial vendors.)
- Deductible Added Choice can also be paired with traditional HMO, HMO Plus, and certain Deductible HMO Plus plans.
Employers’ frequently asked questions
What are the pharmacy choices under Added Choice and Deductible Added Choice?
Members can fill prescriptions from any provider at any pharmacy.
Kaiser Permanente pharmacies:
- All Kaiser Permanente medical centers have onsite pharmacies. There are more than 30 centers across the Mid-Atlantic region. Members can fill prescriptions written by any provider at pharmacies located in Kaiser Permanente medical centers, at the lowest out-of-pocket costs among the three options.
- Members can also choose to receive their prescriptions by mail only if they fill it at a Kaiser Permanente pharmacy.*
Participating (community network) pharmacies:
- Fill prescriptions at participating pharmacies that include Giant, Harris Teeter, Rite Aid, Safeway, Target, Walmart, and others.
- There is no mail-order service with this pharmacy option.
- Members may have higher copayments than they would if they go to a Kaiser Permanente pharmacy, and a deductible may apply, depending on your plan’s benefits.
Out-of-network pharmacies:
Depending on what your plan an employer selects, employees may or may not have out-of-network pharmacy coverage.
- Fill prescriptions at other licensed pharmacies.
- There is no mail-order service with this pharmacy option.
- Members may have higher copayments than they would if they go to a participating (community network) pharmacy or a Kaiser Permanente pharmacy, and a deductible may apply, depending on their plan’s benefits.
- Members may need to pay full out-of-pocket costs for prescriptions filled at out-of-network pharmacies and submit claims for reimbursement.
- Learn more about pharmacy services.
What are guidelines regarding preauthorization?
- For in-network, some services may require preauthorization. Your physician, hospital, or authorized representative may obtain preauthorization for you. If you have a Select network physician, you may be responsible for obtaining preauthorization.
- For out-of-network providers, some services require preauthorization. You will be responsible for obtaining preauthorization.
- Learn more about preauthorization.
How are new members on-boarded?
- Onboarding includes: Comprehensive New Member Reference Guides, an onboarding call from Customer Service agents, and a help line with extended hours for any questions, from accessing care to transferring prescriptions.
Who processes claims?
The plans that underwrite the in-network and out-of-network options processes the claims.
- Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (KFHP-MAS) underwrites the Added Choice Product lines.
Who do we contact for product pricing or to purchase Added Choice?
Contact Kaiser Permanente at any time through our Business Plans contact page.