Overview
Flexible Choice, Deductible Flexible Choice and HSA-Qualified Flexible Choice are unique point-of-service (POS) products that combine Kaiser Permanente HMO with Preferred Provider Organization (PPO) and an Out of Network indemnity option.
Like three plans rolled into one, each product in the Kaiser Permanente Flexible Choice family offers three provider options for employees to receive care. Members can move among the three provider options at any time, so they can always make the best decisions for their health and their wallets.
- Option 1 (HMO): In-network care from Kaiser Permanente’s high quality* integrated healthcare delivery system. This option provides the most coordinated care with the lowest out-of-pocket costs.
- Option 2 (PPO): With the Preferred Provider Organization option, members have access within Kaiser Permanente States of CA, CO, GA, HI, MD, OR, VA, WA and DC to Flexible Choice Provider Directory**. Members also have access in non-Kaiser Permanente States to the Cigna Healthcare PPO Network*.
*Disclaimer: The Cigna Healthcare PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna Healthcare PPO for Shared Administration.‡
- Option 3 (Out of Network): Members have access to any licensed provider who is not an Option 1 or Option 2 provider.
*National Committee for Quality Assurance “NCQA’s Private Health Insurance Plan Ratings 2017–2018.”
**The PHCS™ and MultiPlan™ networks include physicians and health care practitioners and facilities that are available to Kaiser Permanente Insurance Company members via a network access agreement. Not all PHCS and MultiPlan network providers are included. For a list of network participants, go to Flexible Choice Provider Directory. Then, select Option 2 providers.
Deductibles, coinsurance and copays for options.
| Plan | Option 1 (HMO) | Option 2 (PPO) | Option 3 (OON) |
|---|---|---|---|
| Flexible Choice | No deductible. Most services are covered at a copay. | Some services are subject to a deductible, then copay or coinsurance.
Certain services are covered before the deductible at a copay. |
Most services are subject to a deductible, and then coinsurance. |
| Deductible Flexible Choice | Some services are subject to a deductible*, then copay or coinsurance.
Certain services are covered before the deductible at a copay. |
Some services are subject to a deductible*, then copay or coinsurance.
Certain services are covered before the deductible at a copay. |
Most services are subject to a deductible*, and then coinsurance. |
| HSA-Qualified Flexible Choice | Most services, including Outpatient Drugs, are subject to a deductible*, then copay or coinsurance. | Most services, including Outpatient Drugs, are subject to a deductible*, then copay or coinsurance. | Most services, including Outpatient Drugs, are subject to a deductible*, and then coinsurance. |
*Each option has a separate deductible. If a member meets the deductible in one option, they will pay only the applicable copay or coinsurance for covered services received in that option. If they receive services in another option, they must meet that option’s deductible amount before only paying the applicable copay or coinsurance for covered services received in that option. Options 2 and 3 deductible and out-of-pocket maximum cross-accumulate. Covered Charges applied to satisfy the Deductible or Out-of-Pocket Maximum in Option 2 will be applied towards satisfaction of the Deductible or Out-of-Pocket Maximums in Option 3. Likewise, Covered Charges applied to satisfy the Deductible or Out-of-Pocket Maximum in Option 3 will be applied towards satisfaction of the Deductible or Out-of-Pocket Maximum in Option 2.