Why Flexible Choice Products?

Home > Flexible Choice > Why Flexible Choice Products?

Flexible Choice family of products is the best of all worlds. Flexible Choice, Deductible Flexible Choice and HSA-Qualified Flexible Choice each offer three options that empower you to make decisions about how you receive care.

You’re free to choose whatever option you prefer, whenever you receive care.

What does each option offer?

Option 1:

Kaiser Permanente Care (HMO): Fully coordinated, high-quality care, lowest cost of the three options.

Choose from over 1,500 carefully selected physicians and specialists in the Mid-Atlantic Permanente Medical Group (our HMO network) and some affiliated providers.
Every care provider in the network is connected to your electronic health record, so they’re up-to-date on your care, and can coordinate your care for better outcomes.
Lowest out-of-pocket costs compared to options 2 and 3.
Our medical centers across the region offer dozens of services conveniently under one roof, including pharmacy, imaging, lab, primary care physicians and specialists, and six centers offer 24/7 urgent care.
Your primary care physician coordinates your care. When you need specialty care, you and your doctor will find the specialist right for you and coordinate the referral. Specialists can often be seen within a few days or even sooner.
No claims paperwork is required.

Option 2:

Preferred Provider Organization (PPO): A wide network of providers with managed out-of-pocket costs.

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 PHCS and MultiPlan networks. Members also have access in non-Kaiser Permanente States to the CignaPPONetwork*.*Disclaimer: The Cigna PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna PPO for Shared Administration.
We’ve contracted with three networks: Private Healthcare Systems Network (PHCS) and MultiPlan to manage provider costs within the Kaiser Permanente States and we’ve contracted with the Cigna PPO Network to manage provider costs outside the Kaiser Permanente states.
Your out-of-pocket costs will be higher than in Option 1 and usually less than Option 3.
Your physician will complete a claims form, just as with most traditional health plans.
You can see most specialists in this network without a referral.
Certain services require precertification if receiving care within the Kaiser Permanente States with PHCS or MultiPlan Network providers. If using the Cigna PPO Network for care in non-Kaiser Permanente States (outside of CA, CO, GA, HI, MD, OR, VA, WA and DC), the Cigna PPO providers are responsible for obtaining precertification on your behalf when precertification is required. You won’t be financially responsible if a Cigna PPO provider fails to obtain precertification for covered services.

Option 3:

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 Option 1 or 2).
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 precertification.

Get the care you need. Flexible Choice, Deductible Flexible Choice, and HSA-Qualified Flexible 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 a Kaiser Permanente provider (Option 1) or participating provider (Option 2).
Pharmacy services: All Kaiser Permanente medical centers have onsite pharmacies. You can also have prescriptions filled at over 70,000 retail pharmacies across the country.

Check here for more about pharmacy services, finding doctors and facilities and the benefits of Flexible Choice, Deductible Flexible Choice and HSA-Qualified Flexible Choice.

Is the Flexible Choice Family of Products right for you?

Here’s are some examples of how people use the Flexible Choice family of products to get the care they want:

Tracey: Gets great family care, keeps her specialist, and manages costs.

Tracey’s young family appreciates all the services, convenience, and urgent care at their nearby Kaiser Permanente medical center. Tracey’s orthopedist is part of the Multiplan/PHCS network. With Option 1, the family can take advantage of Kaiser Permanente’s coordinated care. With Option 2, Tracey can manage her out-of-pocket costs for her specialist.

Offering a product in the Flexible Choice family of products at your company

For employers, a product in the Flexible Choice family of products (Flexible Choice, Deductible Flexible Choice, and HSA-Qualified Flexible Choice) is a great all-in-one solution:

It gives your valuable employees full choice in their providers and allows them to determine and manage their health care costs.
Having options gives your valued employees what they need to be healthier.
The versatility and benefits of Flexible Choice make it an excellent recruitment and retention tool.
Offer it side-by-side with HMO, HMO Plus, Deductible HMO, or HSA-Qualified Deductible plans to decrease your company’s overall health care costs, and still offer your employees plan choice.

How the Flexible Choice family of products work for your company and employees.

With each of these plans, you can offer your participating employees three options when they receive care:

Option 1 (HMO): Members can receive in-network care from Kaiser Permanente’s high quality* integrated healthcare delivery system through our Kaiser Permanente providers practicing exclusively at our medical centers. This option provides the most coordinated care with the lowest out-of-pocket costs. A deductible may apply, depending on the selected plan. Preventive care is at no cost, before the deductible (when applicable).
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 PHCS and MultiPlan networks. Members also have access in non-Kaiser Permanente States to the CignaPPONetwork*.

*Disclaimer: The Cigna PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna PPO for Shared Administration

Within Option 2 there is a deductible to be met, with copay or coinsurance for certain covered services after the deductible has been met. Depending on the plan selected, some services may be offered before the deductible at a copay. Preventive care is covered at no cost, before the deductible.

Option 3 (Out of Network): Members can receive services from any licensed provider or facility they choose outside those included in Option 1 or 2. Members pay deductibles, coinsurance, and may be balance billed. Out-of-pocket costs are generally the highest with this option.

Learn more about what’s included in Option 1, Option 2, and Option 3 and how they work.

Why choose HSA-Qualified Flexible Choice?

Because this type of plan meets U.S. Treasury guidelines, it can be paired with a health savings account (HSA). An HSA allows the use of pretax dollars to pay for qualified medical expenses. Once an HSA is opened, money can be deposited into the account. Keep in mind that the IRS sets a limit on how much money can be put in an HSA each year. Employers can contribute money to their employees’ accounts.
HSA-Qualified Flexible Choice generally offers lower premiums than traditional and Deductible Flexible Choice plans. Pairing HSA-Qualified Flexible Choice with our competitively priced HSA-Qualified Deductible HMO plan creates the most cost-effective Flexible Choice solution and both plans can be paired with a Health Savings Account (HSA) for tax saving benefits. (HSA can be opened with any financial vendor.)
HSA-Qualified Flexible Choice can also be paired with traditional HMO, Deductible HMO, HMO Plus, and Deductible HMO Plus plans.

Why choose Deductible Flexible Choice?

By adding deductible requirements for Option 1, premium prices can be reduced below those of similar Flexible 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 Flexible 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 Flexible Choice can also be paired with traditional HMO, HMO Plus, and certain Deductible HMO Plus plans.

*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 multiplan.com/kpmas.

Employers’ frequently asked questions

What are the pharmacy choices under Flexible Choice, Deductible Flexible Choice and HSA-Qualified Flexible Choice?

Members have several choices for having their prescriptions filled.

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 providers in Options 1, 2 and 3 at pharmacies located in Kaiser Permanente medical centers, at the lowest out-of-pocket costs among the three options. You can also choose to receive your prescriptions by mail only if you fill it at a Kaiser Permanente pharmacy.*
Kaiser Permanente has also contracted with MedImpact to fill outpatient prescriptions at over 70,000 participating retail pharmacies—including Costco, Rite Aid, CVS and many supermarket chains. (Not all pharmacies in a chain may participate.)
Members also can fill prescriptions at any licensed pharmacy outside the Kaiser Permanente medical centers and MedImpact network.
Members also can fill prescriptions at any pharmacy outside the Kaiser Permanente medical centers and MedImpact network.

For HSA-Qualified Flexible Choice plans, prescription drug benefits are subject to the medical deductible in each option.
Learn more about pharmacy services.

What are guidelines regarding precertification?

Members using Options 2 and 3 do need precertification for all inpatient services and certain outpatient surgeries, services and procedures. The exception is if using the Cigna PPO Network for care in non-Kaiser Permanente States (outside of CA, CO, GA, HI, MD, OR, VA, WA and DC), the Cigna PPO providers are responsible for obtaining precertification on your behalf when precertification is required. You won’t be financially responsible if a Cigna PPO provider fails to obtain precertification for covered services.
Our Permanente Advantage office with its extended hours is the administrator for precertification.
Learn more about precertification.

How are new members on-boarded?

Onboarding includes: Comprehensive New Member Welcome handbooks, an onboarding call from Member 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 Options 1, 2, and 3 process the claims.

Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (KFHP-MAS) underwrites the in-network HMO Tier (Option 1).
Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP), underwrites the in-network PPO Tier (Option 2) and out-of-network Tier (Option 3).

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

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

HSA-Qualified Flexible Choice and Deductible Flexible Choice Frequently Asked Questions
*A program operated or arranged by Health Plan that distributes prescription drugs to Members via mail. 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. The Mail Service Delivery Program can mail to addresses in MD, VA, D.C., and certain locations outside the service area.