Why Dual Choice PPO?

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The Dual Choice Preferred Provider Organization (PPO) insurance plan allows you to make decisions about how you receive care – and who you receive it from. You can receive care from Kaiser Permanente Providers, Network Providers, or from any Out-of-Network licensed physician or facility.

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

What does each provider offer?

Kaiser Permanente Providers

Fully coordinated and quality care.

Choose Kaiser Permanente physicians and specialists in Georgia and CA, CO, HI, MD, OR, WA, and DC.
Kaiser Permanente Providers are connected to your electronic health record, so they’re up-to-date on your care.
Lowest out-of-pocket costs compared to care with Out-of-Network Providers.
Most medical offices offer many services conveniently under one roof, including pharmacy, imaging, lab, primary care physicians and specialists.
Your Kaiser Permanente Provider will coordinate your care. You choose your own doctor and you can change your doctor at any time.
No claims paperwork is required.

Network Providers

A wide network of providers with managed out-of-pocket costs.

Choose from an extensive selection of Network Providers across the country.
We’ve contracted with Network Providers to manage provider costs. With Network Providers, you don’t have to select a personal doctor. You can see any Network Provider without a referral.* To find up-to-date Network Providers or confirm if your current provider is part of the Network, you can search for Providers by Location:

In Georgia: Find Network Providers and Locations

In another Kaiser Permanente State: You can access care from Kaiser Permanente and PHCS Network providers in the states of CA, CO, HI, MD, OR, VA, WA, and DC.

Non-Kaiser Permanente States: Get care from the Cigna Healthcare^SM PPO Network

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

Find Kaiser Permanente Pharmacies in Georgia

Hospital Surprise Billing Rating

Find MedImpact Pharmacies

Your physician will complete a claim form.
You can see most specialists without a referral.
Certain services with PHCS Network providers in Georgia and other KP states of CA, CO, HI, MD, OR, VA, WA and DC require precertification. If using the Cigna PPO Network for care in non-Kaiser Permanente states, 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.

Out-of-Network Providers

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 (outside of In-Network Providers).
Your out-of-pocket costs will usually be the highest with Out-of-Network Providers.
You may have to pay the provider directly at the point of service.
A claim form will have to be completed. 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 with PHCS Network providers in Georgia and other KP states of CA, CO, HI, MD, OR, VA, WA and DC require precertification. If using the Cigna PPO Network for care in non-Kaiser Permanente states, 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.

Get the care you need. Dual Choice PPO empowers you to choose how and where you get covered care.
Manage your care and costs. You choose your provider.
Preventive care. It’s covered at no cost to you, when you see In-Network Providers.
Pharmacy services. Most Kaiser Permanente medical offices in Georgia have on-site pharmacies. You can also have prescriptions filled at retail pharmacies across the country.

Check here for more about pharmacy services, finding doctors and facilities, and the benefits of Dual Choice PPO.

Is Dual Choice PPO right for you?

Here are some examples of how people may use Dual Choice PPO 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 office in Georgia. Tracey receives care from her orthopedist, who is a Network Provider. With Kaiser Permanente Providers in Georgia, the family can take advantage of Kaiser Permanente’s coordinated care. Tracy can receive In-Network care with her Network Provider. Tracey can manage the family’s out-of-pocket costs when seeking care from Out-of-Network Providers.

For employers and brokers, Dual Choice PPO is an all-in-one solution.

Give your valuable employees full choice in their providers, and allow them to determine and manage their health care costs.
Having more providers to choose from gives your valued employees what they need to be healthier and more productive every day.
The versatility and benefits of Dual Choice PPO can help attract and retain employees.
Your company has the convenience of one health care provider for all your employee benefits administration.

How the Dual Choice PPO insurance plan works for your company and employees.

With Dual Choice PPO, you can offer your participating employees more provider choices when they receive care:

Kaiser Permanente Providers in Georgia. Members can receive In-Network care from Kaiser Permanente’s highly rated integrated health care delivery system through Kaiser Permanente Providers practicing exclusively at our medical offices in Georgia. Kaiser Permanente Providers in Georgia offer the most coordinated care with the lowest out-of-pocket costs for office visits and pharmacy copayments. Members can also use kp.org and our mobile app to schedule certain appointments, email their doctors, view lab results, and refill prescriptions online. Preventive care is at no cost when provided by a Kaiser Permanente Provider.
Network Providers. Members can access the Private Healthcare Systems (PHCS) Network for Kaiser Permanente Insurance Company (KPIC) within Georgia and other Kaiser Permanente (KP) states of CA, CO, HI, MD, OR, VA, WA and DC. Members can access the Cigna PPO Network when outside of the KP states. We’ve contracted with these Network Providers to manage provider costs. Certain services are subject to deductible, with coinsurance after the deductible has been met. Some services including office visits and urgent care are offered at a copay. Preventive care is at no cost when provided by a Network Provider.
Out-of-Network Providers. Members can receive services from any licensed provider or facility they choose outside of In-Network Providers. Members pay deductibles, coinsurance, and any difference between the cost of the service and payment provided. Out-of-pocket costs are generally the highest with Out-of-Network Providers.
Learn more about In-Network Providers and Out-of-Network Providers, and how they work.
Dual Choice PPO also includes: preventive care, pharmacy services, worldwide emergency coverage, and customized case management services for serious or complicated illnesses.

Employer and broker frequently asked questions.

What are the pharmacy choices under Dual Choice PPO?

Members have several choices for having their prescriptions filled.

Most Kaiser Permanente medical offices in Georgia have on-site pharmacies. Members can fill prescriptions written by any provider at pharmacies located in Kaiser Permanente medical offices in Georgia, at the lowest out-of-pocket cost.
Kaiser Permanente Insurance Company (KPIC) has contracted with MedImpact to fill outpatient prescriptions at In-Network retail pharmacies—including Rite Aid, Walgreens, Kroger, and many supermarket chains (Not all pharmacies in a chain may participate).
Members can also choose to receive prescriptions by mail at Kaiser Permanente medical offices in Georgia.*
Members also can fill prescriptions at any pharmacy outside the Kaiser Permanente medical office and MedImpact network.
Learn more about pharmacy services.

What are the guidelines regarding precertification?

For care with Kaiser Permanente Providers in Georgia, the provider will arrange for precertification, if required, for certain services.
For care with Network Providers, members must obtain precertification for inpatient services, and certain outpatient surgeries, services, and procedures when using the PHCS Network in Georgia or other Kaiser Permanente states of CA, CO, HI, MD, OR, VA, WA and DC. If using the Cigna PPO Network for care in non-Kaiser Permanente states, 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.
For care with Out-of-Network Providers, members must obtain precertification for inpatient services, and certain outpatient surgeries, services, and procedures.
Learn more about precertification.

How are new members on-boarded?

Onboarding includes: Comprehensive New Member Welcome handbooks, an onboarding call from customer specialists, and a help line for any questions, from accessing care to transferring prescriptions.

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

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

Who processes claims?

Claims are processed by our claims team in Denver, Colorado. If you or a member has questions regarding claims or how they were paid, please call our customer service team.

*A program operated or arranged by a health plan 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.