Preferred Provider Organization (PPO) plan - California Region
The PPO plan is an employer group plan that gives you referral-free access to Private Healthcare Systems (PHCS) Network of participating providers or any other licensed provider nationwide.
Preventive care—preventive benefits, as defined under the Patient Protection Affordable Care Act (PPACA), are covered at little or no cost to you when you see a Participating Provider.
Choice of providers—you can choose from more than 658,000 PHCS Network providers, our contracted participating network of providers or any licensed non-participating provider, hospital, or laboratory that’s convenient.
Specialty care—you can access most specialists without a referral when using participating or licensed non-participating providers.
Pharmacy—Kaiser Permanente Insurance Company contracts with MedImpact to fill your outpatient prescription drugs at retail pharmacies across the country. You can use any of the nearly 60,000 retail pharmacies nationwide in the MedImpact participating pharmacy network.
For more information about the drugs covered under your plan, select the drug formulary below that applies to your plan:
Care management—Permanente Advantage (PA) brings the values and experience of Permanente medicine to our PPO members. PA provides care coordination designed to assure the delivery of medically necessary, quality patient care through appropriate utilization of resources in a cost-effective and timely manner. PA is accredited by URAC, previously known as the Utilization Review Accreditation Commission. URAC ensures that health programs meet national quality standards.
Case Management—the Permanente Advantage Case Management program is committed to assisting with serious, complex or high cost illness. Permanente Advantage Case Management will provide care advice customized for your situation, and our team will help you assess your options and arrange the services you need to meet your treatment goals.
If you have any questions about Permanente Advantage Case Management, please call directly at 1-888-251-7052 x1047.
Worldwide coverage—you have coverage for emergency care anywhere in the world.
NOTE: Under California Law, Kaiser Permanente is required to post information about recent rate changes we have made for our small group customers. Our submitted rate filing descriptions are available here.
The information provided on this Web site is drafted in compliance with applicable California legislation and regulations and is intended solely for use by California residents. As such, this information neither purports nor should be construed to purport to sell, solicit, offer or advertise to any entity or individual who is not a resident of California.