Added Choice Medical PPO

Willamette University offers a PPO medical insurance plan through Added Choice - First Choice Health Network. Added Choice is a comprehensive PPO provider network and Kaiser Permanente is the Third Party Administrator / claims processor.  Employees who select this plan have the flexibility to receive the care they want from the provider of their choice.

Resources

• Contact Sheet - Member services contact information
• Summary of Benefits and Coverage - A detailed description of what is covered by this plan
• Added Choice PPO Group Agreement and Evidence of Coverage - A description of the rules of the PPO plan
• Alternative Care Flyer
• Added Choice Member FAQs - includes information regarding submitting claims, getting prior approval for services, and more
• Added Choice Pharmacy Locator - Find a Select or MedImpact pharmacy location

Find Your Provider

In-Network

• Members located in states OR and Washington
• Phone number: 1-800-467-5281

• Members located in states CA, CO, GA, HI,MD, VA, and Washington DC
• Phone number: 1-888-685-7774

• Members located in all remaining states

• Phone number: 1-866-616-0047

Out-of-Network

The out-of-network component of the plan provides you with the ability to see any physician of your choice, but at a greater cost.

• Non-participating providers
• The CHP Group, Alternative Care Provider Search 
  (Participating Plan – "Kaiser Permanente Self-Referred")

Be sure to take your Added Choice ID card with you to your appointment. This will let your provider's office know that Added Choice uses the First Choice Health Network. It will also help with claims and prior authorization information. Before obtaining care or undergoing a procedure, be sure that you know whether your provider is in-network or out-of-network, and the corresponding level of coverage you can expect. We encourage our employees to choose in-network providers when possible. Certain procedures and/or treatments require precertification in order to be covered under the plan.

Filing Claims

Added Choice Member Reimbursement Form for Medical, Rx, Vision Claims (PDF)

Print and fill out the above form to request reimbursement for medical, Rx, and Vision services. Reimbursement requests must be received by Kaiser within 12 months from the date of service. 

Attach an itemized statement from the provider which includes the following information:

• Member name and identification number
• Provider name and address
• Date of service
• Place of service (doctor’s office, emergency room, urgent care, etc.)
• Physician/medical provider’s name
• Itemized charges and proof of payment

You should be able to obtain this information from the provider. Valid proof of payment includes a charge card receipt, a canceled check, or a statement from the provider showing the services have been paid.

Mail the completed form to:

Kaiser Permanente
Attn: Claims Administration 
PO Box 370050
Denver, CO 80237-9998

Claims processing can take four to six weeks. Keep a copy of all documents for your records. Please be aware, claims with missing required information may be returned without reimbursement. 

Prescription Benefits 

• When you enroll in the Added Choice PPO Medical Plan, you will also be provided with prescription benefits.
• Your prescription benefits include different pricing structures or “tiers” that enable you to control cost based on the types of medications you select.
• In most cases, more than one drug is available to treat the same medical condition.
• Generic medications include the same active ingredients as brand name medications, but cost less. Therefore, selecting a formulary generic medication over a formulary brand name medication will result in you paying a lower copay.
• Your prescriptions can be filled at any of these locations or at a participating MedImpact pharmacy.
• Specific copay amounts are listed within the “Prescription Drugs” section of the Medical Plan Summary.

There are four ways to get an Added Choice prescription filled

1. Take it to a Kaiser Permanente Pharmacy
2. Call it in (or use the transfer your prescription form) to Kaiser's Mail order pharmacy
3. Take the prescription to any network pharmacy — all major chains are MedImpact pharmacies, like RiteAid, Walgreens, Safeway, Fred Meyer, Walmart, Costco, etc., and many more. If you are already using one of these pharmacies, you just have to show your new Added Choice card to get the billing/coverage changed to your new insurer.  
4. Use the Caremark mail-order pharmacy. The quickest way to transfer a current prescription from a MedImpact pharmacy (like Walgreens) to Caremark mail order pharmacy is to call them with prescription in hand.  Call 1-800-237-2767. The Caremark pharmacy technician will gather the prescription information found on the medication label, call Walgreens and have it transferred for you. They can take payment information over the phone. You can also use the tools found at caremark.com/micro/kpnw, register and create an online account to order your prescriptions or print out the order form and mail it in by US mail.

Mail Order Pharmacy 

• You can save money and time with the pharmacy mail order prescription program.
• This home-delivery service allows you to purchase up to 90-day supplies of maintenance medications (medications taken on a daily or routine basis) for the cost of two copayments, or 3-for-2 savings.
• In addition, the mail order prescription program saves you trips to the pharmacy because prescriptions are delivered right to your door. For more details on the mail order prescription program, please see the kp mail-order pharmacy. 
• You also have the option to use the Caremark pharmacy but there is no discounted benefit co-pay savings for a 90 day supply.

Vision Benefits

• The Added Choice PPO Medical Plan also provides vision benefits.
• These benefits provide you with access to affordable, quality vision care coverage.
• You and your family may receive a complete eye examination and materials (if needed).
• You can choose to receive care from a participating provider through Kaiser or Added Choice (in-network) or from any doctor of your choosing (out-of-network).
• Dollar for dollar, you get the best value from your vision benefit when you visit a participating provider.
• If you decide to see an out-of-network provider, you will receive a lesser benefit and typically pay more out-of-pocket.

Acupuncture, Chiropractic, Naturopathic, and Massage Therapy

• To help you achieve total health, your PPO plan also includes alternative care benefits.
• For your convenience, no referral is required and you are free to choose from more than 700 qualified and credentialed complementary and alternative medicine providers.
• Choose your alternative care provider at chpgroup.com or through Added Choice and call the provider you select to schedule an appointment at a time that works for you.