Summit PPO
Kaiser Permanente Summit PPO plans give you the best value with a maximum choice of providers throughout the state and the country.
Summit PPO includes 3 tiers of coverage for different groups of clinicians. You receive the best value when you choose high-quality care from Kaiser Permanente clinicians. When choice is most important, you have access to more than one million in-network health professionals anywhere in the United States.
Note: Kaiser Permanente WA Options Summit PPO plans are available in the following counties: King, Kitsap, Pierce, Snohomish, Spokane, and Thurston.
Tier 1: Preferred in-network
Kaiser Permanente providers and pharmacies, and preferred contracted providers
Available in King, Kitsap, Pierce, Snohomish, Spokane, and Thurston counties.
Tier 2: In-network
Directly contracted in-network providers and First Choice Health network
Available in Alaska, Idaho, Montana, Oregon, and Washington.
First Health network
Available anywhere else in the United States.
Tier 3: Out-of-network
Includes all providers throughout the United States that are not contracted with Kaiser Permanente, First Choice Health network, or First Health network.
Summit PPO also includes Kaiser Permanente Washington pharmacies, as well as the OptumRx network of pharmacies throughout the nation. Note: You’ll have lower copays for office visits and most prescriptions if you use Kaiser Permanente Washington providers and pharmacies.1
Kaiser Permanente WA Options Summit PPO 3
The Summit PPO 3 plan is ideal for members looking for an excellent value and high quality of care. Of the 3 Summit PPO plans, this plan features the lowest out-of-pocket maximum and lowest deductible for medical services – which doesn’t apply to most office visits. Primary care office visits are covered at $20, or $10 when services are received at a Kaiser Permanente Washington medical facility. As with all the Summit PPO plans, preventive care is covered at 100%.
| Annual Deductible | Rx Deductible | Primary Care Office Visit |
|---|---|---|
| $250 individual $500 family |
$0 | Tier 1: $10 ($0 under 18) Tier 2: $20 ($0 under 18) |
| Employee | $142 |
| Employee & spouse/SRDP* | $284 |
| Employee & child(ren) | $249 |
| Employee, spouse/SRDP*, and child(ren) | $426 |
*(SRDP) state-registered domestic partner
Kaiser Permanente WA Options Summit PPO 2
The Summit PPO 2 plan has a lower monthly employee contribution than Summit PPO 3, but with a higher out-of-pocket maximum and a higher annual deductible for medical services. Primary care office visits are covered at $20, or $10 when services are received at a Kaiser Permanente Washington medical facility. In addition, preventive care is covered at 100%.
| Annual Deductible | Rx Deductible | Primary Care Office Visit |
|---|---|---|
| $750 individual $1,500 family |
$0 | Tier 1: $10 ($0 under 18) Tier 2: $20 ($0 under 18) |
| Employee | $106 |
| Employee & spouse/SRDP* | $212 |
| Employee & child(ren) | $186 |
| Employee, spouse/SRDP*, and child(ren) | $318 |
*(SRDP) state-registered domestic partner
Kaiser Permanente WA Options Summit PPO 1
Summit PPO 1 has the lowest monthly premium of the Kaiser Permanente Summit PPO plans and may be an attractive option for people who want provider choice, excellent value, and quality of care, but don’t expect to need a lot of care in the coming year. The basic coverage this plan provides is great for the average user as the deductible does not apply to most office visits and prescription drugs. In addition, preventive care is covered at 100%.
| Annual Deductible | Rx Deductible | Primary Care Office Visit |
|---|---|---|
| $1,250 individual $2,500 family |
$0 | Tier 1: $20 ($0 under 18) Tier 2: $40 ($0 under 18) |
| Employee | $77 |
| Employee & spouse/SRDP* | $154 |
| Employee & child(ren) | $135 |
| Employee, spouse/SRDP*, and child(ren) | $231 |
*(SRDP) state-registered domestic partner
Note: Monthly premiums are for school employees. If you are a SEBB Continuation Coverage subscriber, visit HCA's website to see your premiums.
Premium surcharges
You (the subscriber) may be charged a premium surcharge in addition to your monthly medical premium:
If you or a dependent age 13 or older enrolled on your SEBB medical coverage uses a tobacco product. To avoid the premium surcharge, you and your dependents — ages 18 and older — who use tobacco products can enroll in the Quit for Life Program. Dependents ages 13 to 17 can use the resources at teen.smokefree.gov/.
Spouse or state-registered domestic partner coverage premium surcharge
If your spouse or state-registered domestic partner is enrolled on your SEBB medical coverage and they have elected not to enroll in their employer-based group medical insurance.
*Source: School Employees Benefits Board (SEBB) Program
1 The first time you fill a prescription for a maintenance drug, you’re welcome to use any pharmacy in your network and after that, it’s simple to transfer to mail order so you can receive refills quickly and safely at home, with no delivery charge. To refill your prescriptions for medications you take regularly, you can use mail order or a Kaiser Permanente retail pharmacy. Maintenance drugs are used on a continuing basis for the treatment of ongoing conditions.
Quick links
Use the Kaiser Permanente Washington Plan Comparison Tool to find the plans available to you in your area. You can compare benefit information, networks, and monthly premiums.
Questions?
Please call Member Services to speak with a representative Monday through Friday, 8 a.m. to 6 p.m.
1-888-901-4636 (TTY 711)
Provider Directories
Find a Provider for our Core HMO plans ›
Find a Provider for our SoundChoice HMO plan ›
Find a Provider for Summit PPO plans:
Drug Formulary
Core & SoundChoice Drug Formulary (4-Tier In-Network Pharmacy Benefit)
Summit PPO Drug Formulary (5-Tier In-Network Pharmacy Benefit)