Kaiser access ppo providers

Kaiser access ppo providers DEFAULT

Tips for Choosing a Medical Plan

1. Look beyond the premium.

Sure, the monthly premium is predictable and will remain unchanged for the plan year, but the full cost of the plan to you will depend on a number of factors. This is true whether you’re considering the lowest-premium plan or even the highest-premium plan. Think about how the plan you select will work for you: your access to doctors, the range of benefits and what you pay when you use the services.

2. Identify your needs.

Think about what’s important to you.

  • Do you want to keep your costs for medical services as low as possible?
  • Are you satisfied with being restricted to a specific group of doctors and having your services referred and authorized by a primary care doctor and medical group? Or are you willing to pay a higher premium in order to access specialists directly, without authorizations?
  • Do you or a family member want to see specific doctors, and are those doctors available under the health plan you are considering?
  • Are there specific services or treatments you would like covered?
  • Do you or a family member regularly use prescription drugs, and are the drugs you need on the plan formulary or list of preferred drugs?

3. Understand the basics of how plans work.

UC offers different types of plans and they all work very differently.

  • HMOs (Health Maintenance Organizations) limit covered services to specific doctors and hospitals, and many services, including consultations with specialists, must be authorized in advance by your primary-care doctor, medical group or health plan. With HMOs, you pay set copays for most services. HMOs generally are more restrictive than PPO plans, but they help keep your costs for covered services lower. UC offers two HMOs: Kaiser and UC Blue & Gold.
  • PPO (Preferred Provider Organization) plan allows you to direct your own care and decide where to obtain most services. You are not required to obtain authorization to consult specialists, but the plan should pre-certify some services — surgeries, for example. If you use the plan’s participating providers, you pay less than if you use providers who are not contracted with the plan. Under a PPO, you are subject to annual deductibles and coinsurance for most services. UC Care is a PPO plan. In addition to the usual PPO in-network and out-of-network tiers, it has an extra tier, called UC Select. If you see a provider in UC Select, you pay a copay rather than coinsurance.
  • PPO with Health Savings Account plan is a high-deductible PPO plan with a Health Savings Account (HSA) to help pay eligible expenses. The HSA can be funded by the employer and employee, up to IRS limits, and can be used to help cover the deductible and pay eligible expenses. Until you meet the deductible, you pay, from your own funds or from the HSA, the full cost for services and prescription drugs. After the deductible is met PPO benefits begin, and you pay a coinsurance or percent of the cost of care. You may see any provider you choose, but choosing a plan-contracted provider helps keep your costs lower. The UC Health Savings Plan is UC’s PPO with HSA, and UC funds an initial contribution to the HSA for you.
  • The fee-for-service indemnity plan that UC offers, called CORE, has a very high deductible. You pay all costs until the deductible is met. Then CORE provides coverage for basic medical services, for which you pay a coinsurance. Under the CORE plan, you may choose any provider, but Anthem Blue Cross PPO network providers cost less.

4. Consider out-of-pocket costs.

Your out-of-pocket costs are the amounts you should expect to pay for services under your plan. In general, with HMOs you pay set copayments, and with PPOs you are subject to annual deductibles and coinsurance amounts for most services. There may be services for which you must pay a coinsurance under an HMO (for example, infertility treatment on some plans). As a result of health care reform legislation, certain preventive care services are provided at no charge. You can review a plan’s schedule of benefits to learn what your share of the cost will be for specific services.

Plans also have annual maximum out-of-pocket amounts, which are often overlooked. A plan’s out-of-pocket maximum protects you from paying an unlimited amount for services. Once you reach the maximum out-of-pocket, the plan pays 100 percent of most medical services for the remainder of the calendar year.

5. Determine the plan's covered benefits and exclusions.

Review the range of benefits the plan covers, as well as what is not covered, in light of your specific needs. Some plans offer enhancements, such as coverage for chiropractic care and acupuncture. Infertility coverage differs among UC plans.

6. Think about what happens when you travel, or if your child is in college.

If you travel or have a family member who lives out of the area, you may want to select a plan that provides services out of the area. HMO plans cover only emergency and urgently needed services when you are outside of your plan’s service area, with the exception of Kaiser’s Visiting Member Benefits. UC Health Savings Plan, UC Care and CORE provide coverage when you are outside of your area. UC Care and CORE provide the full range of plan benefits when you are outside the US; the UC Health Savings Plan provides coverage for emergency care only when outside the US.

7. Consider whether you expect any life changes in the new year.

If you are anticipating changes to your family, or if you are planning to retire, you should consider what your needs may be after your circumstances change. UC allows you to change plans outside of Open Enrollment when you have a newly eligible family member. A new family member may result in premium increases and a change in the plan services you and your family will be using.

Retirement and coordination with Medicare may affect your plan benefits. You generally cannot change plans at the time of retirement, with a few exceptions, such as moving out of your plan's service area or transitioning to your plan's Medicare plan. After you retire, you can change plans at the next open enrollment. If you are retiring mid-year, anticipating how your plan will work in retirement — with Medicare, if you are eligible — can be important.

8. Consider coverage for prescription drugs.

Copays and coinsurance for prescription drugs vary among plans. With most UC plans, you pay set copays for most covered prescription drugs. UC Health Savings Plan and Core members are responsible for the full cost of prescription drugs until the annual deductible is met. Most plans have formularies or lists of preferred drugs. If your drug is on the plan’s formulary, your copays or coinsurance for the drug are lower than if the drug is a non-formulary medication. Check the plan formulary to see if your drugs are on it to help keep your costs lower.

9. Know what behavioral health benefits are being offered.

All of UC's medical plans include behavioral health benefits for mental health services and substance abuse treatment. Here are a few things you should know:

  • If you select Kaiser and do not have Medicare, you may access care from Optum in-network providers. Kaiser members may access care from Kaiser behavioral health providers or from Optum in-network providers. Kaiser Senior Advantage members must use Kaiser providers. 
  • If you select UC Blue & Gold or Health Net Seniority Plus, you may access care from in-network providers through Managed Health Network (MHN), a Health Net company.
  • If you select a PPO plan, you may access care from Anthem Blue Cross in-network providers. You may also access care from out-of-network providers, but your costs will be higher and you may need to pay your provider directly for services and submit a claim for reimbursement.
  • UC retirees with Medicare and an Anthem plan can select Medicare, Anthem or out-of-network behavioral health providers, but using a Medicare provider, when possible, will result in lower costs to you.
  • Regardless of whether you select an HMO or PPO, you do not need a referral from your primary care provider or health plan to see a behavioral health provider. Some services, such as extended length therapy sessions (beyond 50 minutes) and treatment programs, do require preauthorization.

Congratulations! You're on the road to finding the “best” plan for you and your family.

The UC-sponsored plans are varied and none can be said to be the best one overall. If you review the plan benefits and costs, and consider your personal circumstances, you will be prepared to select the best plan for you.

Special thanks to Bridget Sheehan-Watanabe, UCLA health care facilitator.

Sours: https://ucnet.universityofcalifornia.edu/compensation-and-benefits/health-plans/medical/tips-for-choosing-a-medical-plan.html

Plans That Include Seattle Children’s

Is Seattle Children’s covered by your health insurance plan?

Below is a list of plans that include Seattle Children’s for medical care. For mental health services coverage, see mental health coverage. Make sure you understand your insurance coverage before coming for care.

Check the current status of your plan

This list is updated yearly and may not reflect the current status of your plan. Coverage and authorization requirements can change yearly. Many plans increased cost-sharing requirements for their members.

Check your plan benefits

Review your insurance plan benefits, network status, specialty care copays, annual deductible (both in-network and out-of-network) and coinsurance to understand your cost. See also Consumer Rights Under the Balance Billing Protection Act (PDF).

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z

A

Aetna

All plans are accepted, except Medicare. Some plans require an insurance referral for services that are out-of-network.

Alaska Medicaid

Alaska Medicaid is accepted.

Allegiance

Accepted for Seattle Children’s Pediatric Cardiology of Montana location. Services outside of Montana require insurance approval and referral.

Amerigroup

Washington Apple Health plans are accepted.

Apple Health (Medicaid)

Washington Apple Health plans are accepted.

Asuris

All plans are accepted, except Medicare. (Regence Blue Shield affiliate)

B

BDCT Transplant Services

Seattle Children’s is contracted for select transplant services.

Blue Cross Blue Shield of Montana 

Accepted for Seattle Children’s Pediatric Cardiology of Montana location. Services outside of Montana require insurance approval and referral.

BridgeSpan Health

Plans sold on the Washington Health Benefit Exchange are accepted. (Regence Blue Shield Affiliate)

C

Careington Dental

All plans are accepted.

CareOregon

Accepted for services referred from Oregon.

Cigna

All plans are accepted. Some plans require an insurance referral for services that are out-of-network.

Community Health Plan of Washington

Washington Apple Health plans are accepted. We are currently in negotiations with Community Health Plan of Washington to be in-network for their Cascade Select plans offered on the Washington Health Benefit Exchange, but at this time, we are not in-network. 

Coordinated Care

Washington Apple Health and AmBetter plans are accepted, except Cascade Select plans offered on the Washington Health Benefit Exchange.

Coventry/First Health

All plans are accepted, except Medicare.

D

Delta Dental

All plans are accepted.

E

Envolve (formerly OptiCare)

Accepted for eye services. 

EyeQuest

Accepted for eye services.

F

First Choice Health Network

All plans are accepted, except Medicare.

First Health

See Coventry/First Health.

G

Great West Healthcare

See Cigna.

Group Health Cooperative

See Kaiser Health Foundation Plan of Washington.

H

Health Net Federal Services (TriCare)

All plans are accepted. Approved referral and authorization are required from the patient’s primary care provider. Call your plan for a pre-authorization number, then call us to schedule.

HMSO (Highline Medical Services Organization)

Washington Apple Health plans are accepted. HMSO requires a referral and authorization before scheduling services.

I

Idaho Medicaid

Idaho Medicaid is accepted.

Interlink Transplant Services

Seattle Children’s is contracted for select transplant services.

K

Kaiser Health Foundation Plan of Washington (formerly Group Health Cooperative)

Core and Options plans require referral and pre-authorization from Kaiser to access Seattle Children’s at the in-network benefit level. Seattle Children’s is in-network for Access PPO members. Contact Kaiser for more information. Please note: We are not contracted with Kaiser Foundation Health Plan of the Northwest, which offers plans on the Washington Health Benefit Exchange.

Koan Risk Solutions

Seattle Children’s is contracted for select transplant services.

L

LifeSource Transplant Services

Seattle Children’s is contracted for select transplant services.

LifeTrac Transplant Services

Seattle Children’s is contracted for select transplant services.

LifeWise Health Plan of Washington

All plans are accepted, except Medicare. Seattle Children’s accepts LifeWise plans sold on the Washington Health Benefit Exchange (Premera Blue Cross Affiliate).

M

MCNA Dental

Accepted for Idaho Medicaid members.

Medicare

Seattle Children’s is enrolled in the federal Medicare program and accepts assignment.

MetLife Dental

All plans are accepted.

Molina Healthcare

Washington Apple Health and Molina Marketplace plans are accepted.

Montana Health Cooperative

Accepted for Seattle Children’s Pediatric Cardiology of Montana location only.

Montana Medicaid

Montana Medicaid and Montana Healthy Kids are accepted. Services outside of Montana require insurance approval and referral.

Multiplan/PHCS

All products are accepted, except Medicare. Some plans require an insurance referral for services that are out-of-network.

N

NPN

Washington Apple Health plans are accepted. NPN requires authorization before scheduling services.

O

OptumHealth Transplant Services

Seattle Children’s is contracted for select transplant services.

Oregon Health Plan Transplant Services Program

Seattle Children’s is contracted for select transplant services.

Oregon Medicaid

Accepted for services referred from Oregon.

P

PacifiCare

See United Healthcare.

PacMed US Family Health Plan (USFHP)

All plans accepted. Approved referral and authorization are required from the patient’s primary care provider. Call USFHP for a pre-authorization number, then call us to schedule.

Premera Blue Cross

All plans are accepted, including Premera Blue Cross of Alaska, except Medicare. Seattle Children’s accepts Premera’s plans sold on the Washington Health Benefit Exchange. For MultiCare Connected Care, Everett Clinic Integrated Network and EvergreenHealth Partners PersonalCare plans, a provider referral is required before scheduling services.

Principal Dental

All plans are accepted.

R

Regence BlueShield

All plans are accepted, except Medicare and MultiCare Accountable Health Network. Some plans require an insurance referral for services that are out-of-network.

T

TriCare

All plans are accepted. Approved referrals and authorization are required from the patient’s primary care physician. Call TriCare for a pre-authorization number, then call us to schedule.

U

Uniform Medical Plan

All plans are accepted.

UnitedHealthcare

All plans are accepted, except Secure Horizons (Medicare).

UnitedHealthcare Community & State

Washington Apple Health plans are accepted.

UW Medicine Accountable Care Network (Boeing Employees)

Seattle Children’s participates in the UW Medicine Accountable Care Network offered to Boeing employees and their covered dependents.

W

Washington Medicaid (Apple Health)

Washington Apple Health plans are accepted.

Sours: https://www.seattlechildrens.org/clinics/paying-for-care/insurance/insurance-plans/
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How do you get your coverage? Choose from the list below to see providers in our networks.

Individual plans purchased through Kaiser Permanente or through Washington Healthplanfinder

Medicare plans

State, schools, and federal employee plans

Select to start your search.

Arrow to select core Core (federal, schools, and state employees)
Includes the providers and pharmacies at Kaiser Permanente medical offices as well as thousands of community providers and dozens of contracted hospitals and facilities.

Arrow to select core Access PPO (schools employees)
Over a million in-network providers and facilities in Washington state and the rest of the country. The provider directory will show you most of your options in Washington. Learn about additional searches for Access PPO, including First Choice Health and First Health.

Arrow to select SoundChoice (state employees) SoundChoice (state and schools employees)
Includes the providers and pharmacies at Kaiser Permanente medical offices as well as thousands of community providers and dozens of contracted hospitals and facilities.

Arrow to select Options Federal (federal employees) Options Federal (federal employees)
Over a million in-network providers and facilities in Washington state and the rest of the country. The provider directory will show you most of your options in Washington. Learn about additional searches for Options Federal.

Employer plans

Select to start your search.

Arrow to select Core Core
Includes the providers and pharmacies at Kaiser Permanente medical offices as well as thousands of community providers and dozens of contracted hospitals and facilities.

Arrow to select Elect PPO Elect PPO
Offers the choice and flexibility of in-network care from the high-performing Kaiser Permanente provider network within our Washington service area, and from the broad provider networks of First Choice Health and First Health outside our Washington service area.

Arrow to select Access PPO Access PPO
Over a million in-network providers and facilities in Washington state and the rest of the country. The provider directory will show you most of your options in Washington. Learn about additional searches for Access PPO.

Arrow to select Virtual Plus - Connect Virtual Plus — Connect Network (Plan Year 2021)
Supports our Virtual Plus plans by providing quality care from the high-performing physicians at Kaiser Permanente medical facilities.

Arrow to select Summit Summit PPO (Plan Year 2021)
Value and choice are highlights of our 3-tier Summit PPO plans. When choice is most important, you have access to more than 1 million in-network health professionals anywhere in the United States.

Or pick your employer to start a custom search:

Arrow to select Boeing Boeing

Arrow to select Microsoft Microsoft

Arrow to select Overlake Overlake

Arrow to select Providence/St. Joseph Health Caregivers Providence/St. Joseph Health Caregivers

Arrow to select Swedish CaregiversSwedish Caregivers

Sours: https://wa.kaiserpermanente.org/html/public/fad

Access PPO

Note: Kaiser Permanente WA Options Access PPO plans are available in the following counties: Island, King, Kitsap, Lewis, Mason, Pierce, Skagit, Snohomish, Spokane, Thurston, and Whatcom.

Central to all our plans is care from Kaiser Permanente Access PPO providers, but our Kaiser Permanente WA Options Access PPO plans offer the broadest choice, with in-network care from high-quality providers through First Choice Health and First Health networks.

The First Choice Health network gives you even more Access PPO in-network providers in Washington state, plus Oregon, Idaho, Montana, and Alaska. You can find First Choice Health network providers at fchn.com.

You can use the providers with the First Health network for states outside the Pacific Northwest. To find these providers, go to myfirsthealth.com, click on "Start now," and fill out type of provider and location information. Click on "Search now" to view results.

Here are some plan highlights:

  • No copays for primary care office visits for kids up to age 18.
  • No referrals required for most specialty care.
  • No deductibles applied for office visits, including primary and specialty care, outpatient mental health, and urgent care.
  • Reduced copays when services are received at a Kaiser Permanente Washington medical facility.
  • No deductible for prescription drugs and enhanced benefits apply when prescriptions are filled at Kaiser Permanente Washington pharmacies or through our mail-order service.

Kaiser Permanente WA Access PPO 3

The Access PPO 3 plan is ideal for members looking for the most robust coverage and broadest provider network. Of the 3 Access PPO plans, this plan features the lowest out-of-pocket maximum and lowest deductible for medical services – which doesn’t apply to most office visits. Primary care office visits are covered at $20, or $10 when services are received at a Kaiser Permanente Washington medical facility. As with all the Access PPO plans, preventive care is covered at 100%.

Kaiser Permanente WA Access PPO 2

The Access PPO 2 plan has a lower monthly employee contribution than Access PPO 3, but with a higher out-of-pocket maximum and a higher annual deductible for medical services. Primary care office visits are covered at $25, or $15 when services are received at a Kaiser Permanente Washington medical facility. In addition, preventive care is covered at 100% and the first $500 in labs/X-rays is covered in full.

Kaiser Permanente WA Access PPO 1

Access PPO 1 has the lowest monthly premium of the Kaiser Permanente Access PPO plans and may be an attractive option for people who want greater provider choice, but don’t expect to need a lot of care in the coming year. The basic coverage this plan provides is great for the average user as the deductible does not apply to most office visits and prescription drugs. In addition, preventive care is covered at 100% and the first $500 in labs/x-rays is covered in full.

E = Enhanced benefit when services are received or prescriptions filled at a Kaiser Permanente Washington medical facility.

Premium surcharges

You (the subscriber) may be charged a premium surcharge in addition to your monthly medical premium:

Tobacco use premium surcharge

If you or a dependent age 13 or older enrolled on your SEBB medical coverage uses a tobacco product. To avoid the premium surcharge, you and your dependents — ages 18 and older — who use tobacco products can enroll in the Quit for Life Program. Dependents ages 13 to 17 can use the resources at teen.smokefree.gov/.

Spouse or state-registered domestic partner coverage premium surcharge

If your spouse or state-registered domestic partner is enrolled on your SEBB medical coverage and they have elected not to enroll in their employer-based group medical insurance.

*Source: School Employees Benefits Board (SEBB) Program

Note: Monthly premiums are for school employees. If you are a SEBB Continuation Coverage subscriber, visit HCA's website to see your premiums.

Sours: https://wa-my.kp.org/sebb/plan-information/health-plans/access-ppo/

Providers ppo kaiser access

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PPO Vs. HMO: What's the Difference and Which is Better?

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