Benefits

Kaiser WA plans

Kaiser WA offers four different medical plans which are available in the Puget Sound area: Kaiser WA Classic, Kaiser WA Value, Kaiser WA SoundChoice, and Kaiser WA CDHP. Another division of Kaiser Permanente also offers PEBB health plans which are only available in SW Washington and northern Oregon. This division is called Kaiser Permanente NW to distinguish it from the Puget Sound Kaiser WA plans.

Use the information on this page for help choosing the plan that’s best for you and your family. You can find step-by-step instructions for enrolling in benefits on the Integrated Service Center’s website.

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.

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 Core CDHP network search
Kaiser WA Classic Core Classic plan network search
Kaiser WA SoundChoice PEBB SoundChoice SoundChoice network search
Kaiser WA Value Core Value plan network search

Cost overview

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 receive the service.

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

2022

Plan Employee premium
(per month)
Employee
Deductible
(per year)
Primary care visit
(your cost)
Kaiser WA Classic $204 $175 $15 copayment
Kaiser WA Value $113 $250 $30 copayment
Kaiser WA SoundChoice $50 $125 0% coinsurance
Kaiser WA CDHP $24 $1,400 10% coinsurance

Complete table of Employee monthly medical premiums 2022

2021

Plan Employee premium
(per month)
Employee
Deductible
(per year)
Primary care visit
(your cost)
Kaiser WA Classic $189 $175 $15 copayment
Kaiser WA Value $112 $250 $30 copayment
Kaiser WA SoundChoice $55 $125 0% coinsurance
Kaiser WA CDHP $26 $1,400 10% coinsurance

Complete table of Employee monthly medical premiums 2021


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.


2022

Plan Certificate of Coverage (2022) Summary of Benefits
and Coverage (2022)
Kaiser WA CDHP 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

2021

Plan Certificate of Coverage (2021) Summary of Benefits
and Coverage (2021)
Kaiser WA CDHP 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 is a deductible for prescriptions with the Kaiser Permanente Classic, SoundChoice, and Value plans. This deductible does not apply to value or tier prescriptions. Mail-order drugs are available in all plans.

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

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

Plan ID Cards

After you enroll, your health plan will send you an identification (ID) card to show to providers when you receive care. If you have questions about your ID card, contact your plan directly.

Other resources

How CDHPs and HSAs work