Overview
The Out-of-Area (OOA) Preferred Provider Organization (PPO) plan combines an in-network provider option and an out-of-network option in one plan. Members can move among the two provider options at any time. (Only available for mid-size and large group employees and their families who work and live outside the Kaiser Permanente Mid-Atlantic States coverage area).
In-Network
PHCS, MultiPlan and Cigna Healthcare PPO Networks
- With the in-network provider options, members have access nationwide to medical care through Kaiser Permanente Insurance Company’s (KPIC) network access agreements with PHCS, MultiPlan and the Cigna Healthcare PPO Networks. To find up-to-date participating physicians, facilities or health care practitioners you can search by Location or call Customer Service at 1-888-225-7202 (TTY 711), Monday through Friday 8:00 a.m. to 6 p.m., Eastern time.
Kaiser Permanente States: Within CA, CO, GA, HI, MD, OR, VA, WA and DC you have access to PHCS and Multiplan Networks**
Non-Kaiser Permanente States: The Cigna Healthcare PPO Network* only provides access to care in non-Kaiser Permanente states.
*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
Out-of-Network
Any other licensed provider or physician
- Members can receive services from any other licensed provider or facility they choose.
Deductibles, coinsurance and copays for options.
| Plan | In-Network
PHCS, MultiPlan and Cigna PPO Networks |
Out-of-Network
Any other licensed provider or physician |
|---|---|---|
| Out-of-Area PPO | 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. |
KPIC has contracted with PHCS and Multiplan Networks, national preferred provider organization networks that contract with physicians, hospitals, and other health care providers, to provide access to the PHCS network for KPIC in Kaiser Permanente States of CA, CO, GA, HI, MD, OR, VA, WA and DC. KPIC has contracted with the Cigna Healthcare PPO Network to provide access in non-Kaiser Permanente States to their providers (doctors, hospitals, specialists) that are contracted as part of the Cigna Healthcare PPO Network for Shared Administration.
*The PHCSTM and MultiPlanTM networks include physicians and health care practitioners and facilities that are available to Kaiser Permanente Insurance Company members via a network access agreement.
**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.
Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP), underwrites the In-Network PPO Tier and Out-of-Network Tier.