Benefits

Kaiser WA (formerly Group Health) plans

Kaiser Permanente acquired Group Health Cooperative and its subsidiaries in February, 2017. The Group Health name has changed to Kaiser Permanente. Becoming part of Kaiser Permanente does not change the 2017 PEBB plan benefits, cost sharing or premiums for Group Health members. Group Health Cooperative health plans are now Kaiser WA. Another division of Kaiser Permanente also offers a PEBB health plan available only in SW Washington and northern Oregon, which is now called Kaiser Permanente NW to distinguish it from the Puget Sound Kaiser WA plans. Four plans continue to be available in the Puget Sound area: Kaiser WA Classic, Kaiser WA Value, Kasier WA SoundChoice, and Kaiser WA CDHP.

Enroll

You’re eligible to enroll in a Kaiser WA plan if you’re eligible for PEBB benefits and live within the service area for the plan. The SoundChoice plan, however, is only available to employees who live in King, Pierce, Snohomish, or Thurston counties.

If you already know which Kaiser WA plan you want, see enroll in a medical and dental plan to enroll. Use the information on this page for help choosing the plan that’s best for you and your family.

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Provider networks

In general, when you have a Kaiser WA plan, you’ll visit Kaiser Permanente Medical Centers to receive care and get prescriptions. Kaiser Permanente has locations throughout Puget Sound and encompasses a wide array of doctors and other professionals. However, you don’t receive coverage if you use a provider outside the plan’s network.

The exception is the consumer-directed health plan (CDHP), which has a large network that includes providers nationwide. The other plans have smaller, regional networks: the Classic and Value plans share the same network while the SoundChoice has its own, slightly smaller network.

To browse each plan’s network or to find a specific provider, either call the plan directly or use the plan’s web search tool.

Plan Network Find a provider online
Kaiser WA CDHP Access PPO CDHP network search
Kaiser WA Classic Core/Group Health Classic plan network search
Kaiser WA SoundChoice PEBB SoundChoice SoundChoice network search
Kaiser WA Value Core/Group Health Value plan network search

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Cost overview

The four Kaiser WA plans offer you a range of cost options. As is always the case with health insurance, it’s best to consider not only the premium but also the costs for using services, such as the deductible, coinsurance, and copayments.

Premiums and deductibles

Premium and deductible costs are the primary difference between the Classic plan and the Value plan.

While the Value plan has cheaper premiums, its medical out-of-pocket-limit are higher than the Classic plan. Otherwise, they have identical networks and similar coverage costs. For example, a visit to your primary care doctor costs $15 with the Classic plan and $30 with the Value plan.

The SoundChoice plan and CDHP both offer premiums that are considerably cheaper than the Classic and Value plans.

The CDHP is a high-deductible style plan, which means that in return for taking on the financial risk of a high deductible, you pay a significantly lower premium. You also get a Health Savings Account to help pay for medical costs. Learn more about how CDHPs and HSAs work.

Copayments or coinsurance?

With coinsurance, the costs you pay for services are calculated as a percentage (for example, 20 percent). Insurance pays the remaining percentage of the cost. With copayments, on the other hand, you pay a fixed amount (for example, $20).

Generally, you’ll pay coinsurance after your visit the doctor, when the bill arrives in the mail. Copayments are usually made at the doctor’s office, when you get the service.

While plans using coinsurance are more common, some people prefer plans with copayments because costs are more predictable.

This predictability is why some people prefer the Classic and Value plans, which use copayments for services. Unlike coinsurance, where you may not know your exact cost until your bill arrives, copayments allow you to know your cost before you visit the doctor.

In contrast, the SoundChoice plan and CDHP both use coinsurance for most services. However, both offer premiums that are noticeably cheaper than both Classic and Value.

Compare costs

The table shows a sample of costs to help you quickly compare plans. For a full list of costs, refer to the Certificate of Coverage.

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2017

Plan Employee premium
(per month)
Employee
Deductible
(per year)
Primary care visit
(your cost)
Kaiser WA Classic $147 $250 $15 copayment
Kaiser WA Value $69 $250 $30 copayment
Kaiser WA SoundChoice $46 $250 20% coinsurance*
Kaiser WA CDHP $25 $1,400 10% coinsurance

*With Kaiser WA SoundChoice, your first primary care visit each year is free, then the cost is 20%
Complete table of Employee monthly medical premiums 2017

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Coverage overview

While all plans cover the same basic health care services, you may want to know whether or not a certain service is covered by the plan. The most direct way to find out is to call the plan and ask. Alternatively, you can read the plan’s Certificate of Coverage (also called the benefits booklet), which describes the plan in detail. These booklets are long, but they can be helpful if you need to know something specific.

If you simply want an overview of a plan’s coverage and costs, take a look at the plan Summary of Benefits and Coverage, an easy-to-read summary that lets you quickly review health plans. You can compare options based on price, benefits, and other features that may be important to you.

To view plan details side by side and directly compare coverage and costs, use the state’s medical benefit comparison tool.

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2017

Plan Certificate of Coverage (2017) Summary of Benefits
and Coverage (2017)
Kaiser WA CDHP – Individual View PDF View PDF
Kaiser WA CDHP – Family View PDF View PDF
Kaiser WA Classic View PDF View PDF
Kaiser WA SoundChoice View PDF View PDF
Kaiser WA Value View PDF View PDF
Prescription drug coverage

With Kaiser Permanente, you’re required to use network pharmacies for prescription drugs; otherwise you’ll pay full price for prescriptions. There isn’t a deductible for prescriptions, and mail-order drugs are available in all plans.

All the plans use copayments, rather than coinsurance, for prescription coverage. Coverage is tiered: the amount you pay increases as you move up the tiers from the least expensive, generic drugs to the more expensive, specialty drugs.

You can find complete details about prescription drug coverage by reviewing the plan’s Certificate of Coverage.

Vision coverage

Generally, vision benefits are part of your medical plan. Providers can be found in the provider directory, or by contacting the medical plan.

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