Stay Covered: Keeping Kaiser Insurance Outside Service Area

If you're a Kaiser Permanente member and are planning to be away from home, there are a few things to keep in mind when it comes to your health care coverage. While Kaiser Permanente provides health coverage and care in a unified experience, being out of your service area may require you to pay upfront for prescriptions at non-Kaiser Permanente pharmacies and file for reimbursement later. Additionally, it's important to note that PPO and POS plans are not eligible for Out-of-Area benefit coverage. Understanding these details can help ensure you maintain access to quality healthcare services even when you're away from your usual Kaiser Permanente service area.

Cigna PPO network: Doctors, hospitals, and specialists contracted as part of Cigna PPO

Cigna's Preferred Provider Organization (PPO) plans offer a large network of participating providers and facilities, giving you a wide range of options when it comes to choosing doctors, hospitals, and specialists. This network includes various Cigna-contracted healthcare providers who have agreed to provide services to Cigna members at a discounted rate.

When you choose a Cigna PPO plan, you gain access to this extensive network, which includes primary care physicians, specialists, and hospitals across the country. This means that you have the flexibility to choose a doctor or specialist that best suits your needs from within the network. It's important to note that your specific plan may determine whether a referral from your primary care physician (PCP) is required to see a specialist.

The Cigna PPO network includes a diverse range of healthcare providers, ensuring that you can find the right type of doctor or specialist for your particular health needs. These contracted doctors and specialists have agreed to provide services to Cigna members at pre-negotiated rates, which helps to keep your out-of-pocket costs lower compared to out-of-network providers.

To find out if a doctor, hospital, or specialist is part of the Cigna PPO network, you can refer to Cigna's provider directory. This directory will allow you to search for in-network providers in your local area, giving you peace of mind and helping you make informed decisions about your healthcare choices. Remember, choosing an in-network provider is generally recommended to keep your healthcare expenses more predictable and affordable.

Additionally, with a Cigna PPO plan, you have the flexibility to seek care outside of the network if needed. However, it's important to note that out-of-network costs can be significantly higher, and you may have to cover the difference between the doctor's bill and what your plan covers. Therefore, it's always advisable to verify that your chosen healthcare providers are part of the Cigna PPO network to maximize the benefits of your plan and minimize unexpected expenses.

Non-Kaiser pharmacies: Members may pay upfront and claim later

If you are a Kaiser Permanente member and you need to fill a prescription while outside of your service area, you have several options. Firstly, you can fill prescriptions written by any licensed provider at MedImpact pharmacies. Kaiser Permanente has a contract with MedImpact to fill outpatient prescription drugs at retail pharmacies across the country. This means you can use any of the retail pharmacies in the MedImpact participating pharmacy network nationwide.

However, if you choose to fill your prescription at a non-participating pharmacy, you will need to pay the full out-of-pocket cost upfront and then submit a claim for reimbursement. This is because non-participating pharmacies are not part of the Kaiser Permanente network and do not have a direct billing arrangement with the insurance company. To submit a claim for reimbursement, you will need to fill out and submit the MedImpact Prescription Drug Claim Form along with the required supporting documentation. You can find the form and the address to submit it to on the Kaiser Permanente website or by contacting Customer Service.

It is important to note that not all medications are eligible for reimbursement. For example, drugs that are time or temperature-sensitive, or those that require professional administration, may not be covered. To find out if your prescription medication is eligible for reimbursement, you can check the Kaiser Permanente Drug Formulary, which provides a list of approved drugs.

Additionally, if your prescription medication is not on the Kaiser Permanente formulary, the pharmacist may check with your prescribing physician to see if a therapeutic equivalent from the formulary can be substituted. This may affect the reimbursement process, so it is important to review the formulary and understand the coverage guidelines before submitting your claim.

Cigna's relationship: Access to Cigna PPO via their relationship with Kaiser health plans

Kaiser Permanente has entered a new collaboration with Cigna to deliver more convenient access to care for its members while travelling outside of Kaiser's service areas. This agreement will give Kaiser's commercial members access to Cigna's national network of providers for urgent or emergency care. This means that members will not have to pay out-of-network rates for visiting Cigna providers outside of the eight states covered by Kaiser.

Cigna Healthcare and Kaiser Permanente are two of the top insurance companies in the US that offer Medicare plans. Cigna offers a wider variety of supplemental insurance policies, such as Medicare Supplement Insurance (Medigap) plans. Cigna also offers Medicare Advantage plans, including PPO (Preferred Provider Organisation) plans, which are less common with Kaiser.

Kaiser Permanente owns its own healthcare facilities and employs its own doctors in some areas, whereas Cigna does not. Cigna's plans are accepted by a wide range of hospitals, doctor's offices, clinics, and pharmacies.

This new agreement with Cigna will improve convenience and access for Kaiser members travelling out of areas where Kaiser provides care. Members can access an extensive provider directory to find convenient care while away from home. This agreement demonstrates Kaiser Permanente's commitment to serving its members regardless of their physical location.

Cigna PPO exclusivity: The network is provided by Cigna Corporation subsidiaries

Cigna Preferred Provider Organization (PPO) plans offer a large network of participating providers and facilities, giving customers a wide range of doctors and hospitals to choose from. This means that you are not required to select a primary care provider (PCP) to coordinate your healthcare.

Cigna PPO plans are provided exclusively by or through operating subsidiaries of The Cigna Group Corporation, including:

• Cigna Health and Life Insurance Company (Bloomfield, CT) (CHLIC)
• Loyal American Life Insurance Company (Cleveland, OH)
• Cigna HealthCare of Arizona, Inc.
• Cigna HealthCare of Georgia, Inc.
• Cigna HealthCare of Illinois, Inc.
• Cigna HealthCare of North Carolina, Inc.
• Cigna HealthCare of South Carolina, Inc.
• Cigna HealthCare of Texas, Inc.

In Utah, all products and services are provided by Cigna Health and Life Insurance Company (Bloomfield, CT).

Cigna PPO plans offer flexibility, allowing customers to choose their physician and healthcare options without needing referrals to see a specialist. However, this means that out-of-pocket costs are usually higher compared to Health Maintenance Organization (HMO) or Exclusive Provider Organization (EPO) plans. Out-of-network services will also be covered at a higher cost to the customer and will require separate claims and deductible processes.

Ineligible plans: PPO and POS plans are not eligible for Out-of-Area coverage

When it comes to health insurance plans, there are several options available, each with its own unique features and benefits. Two common types of plans are PPO (Preferred Provider Organization) and POS (Point of Service) plans, which offer flexibility and choice to their members.

PPO plans are characterized by their network of contracted providers, who offer services at lower out-of-pocket costs compared to out-of-network providers. With a PPO plan, members have the freedom to choose their own doctors without requiring referrals, and they receive coverage for both in-network and out-of-network providers. However, PPO plans typically come with higher costs and may require copays, coinsurance, and deductibles.

On the other hand, POS plans are more restrictive in terms of choice but offer lower costs. With a POS plan, members must choose a Primary Care Provider (PCP) within the plan's network and obtain referrals for other providers, except for OB-GYNs. POS plans often have lower premiums and may not have deductibles, but copays and coinsurance costs may still apply, especially for out-of-network care.

Despite their benefits, PPO and POS plans offered by Kaiser Permanente are not eligible for Out-of-Area coverage. This means that members with these plans cannot access the same benefits and services when they are outside of their designated service area. This restriction is important to consider when choosing a health insurance plan, as it may impact an individual's access to healthcare services while travelling or living in a different region.

It is crucial for individuals to carefully review the details of their health insurance plans, including any restrictions on out-of-area coverage, to ensure they understand the extent of their coverage and make informed decisions about their healthcare options.

Frequently asked questions