Medical + Vision Plans

With the traditional HMO plan, you’ll need to use in-network Kaiser providers for your plan to cover basic medical services.

You can use the CHP group network to access alternative care – naturopaths, acupuncturists, massage therapists, and chiropractors.

---

This plan might be right for you if:

• You’d like the lowest premium cost with a fixed cost on services you receive.
• You don’t want to see a traditional healthcare provider outside the Kaiser network.

A quick overview of covered services:

• Primary Care:
  • $5 for first 3 visits, then $10 for additional visits
• Lab Testing, Imaging, and Special Diagnostics:
  • 20% coinsurance after deductible
• Prescription Coverage:
  • $15 generic
  • $30 preferred
  • $50 non-preferred
  • $150 specialty

Plan Documents:

2025 HMO Summary of Benefits

2025 HMO Summary of Medical Benefits and Coverage

The HDHP + HSA plan provides the lowest monthly premiums for employees. Like the traditional HMO, this plan requires you to stay in the Kaiser or CHP Group networks in order to receive coverage.

It has two parts: a high deductible, HSA-compatible medical plan, and a Health Savings Account (HSA) with a triple tax advantage.

---

This plan might be right for you if:

• You prefer to pay a lower monthly premium, even if it means you have to pay out-of-pocket for medical services before you meet your deductible.
• You have very few medical expenses, and rarely visit the doctor outside of your annual preventative visit.
• You want to take advantage of the triple tax savings offered through the HSA account.

Here’s how it works:

HDHP:

• You pay the total cost out-of-pocket for all healthcare services and prescriptions, except your annual preventative visit.
• Once you meet your deductible, the plan will pay its share of the cost as listed in the Summary of Benefits.
• Once you meet your out-of-pocket maximum, the plan will pay the total cost for any services for the rest of the calendar year.

HSA:

• Your Health Savings Account is administered through Allegiance.
• Allegiance will provide a debit card connected to your HSA account, and you can use this card to pay for any qualified healthcare expenses, including those that apply to your deductible and out-of-pocket maximums.
• Lewis & Clark will contribute to employees’ HSA accounts:
  • $83.33 per month, not to exceed $1,000 annually for individuals with employee-only coverage
  • $166.66 per month, not to exceed $2,000 annually for individuals with employee + spouse or employee + family coverage
• You can also contribute to the HSA pre-tax, and you can change your monthly contribution through Workday any time during the year.
• Triple Tax‐Advantage:
  • Contribute pre-tax money through payroll deductions
  • Funds accrue tax‐free and are invested tax-free
  • Funds can be withdrawn tax‐free (if used for eligible medical expenses)

A quick overview of coverage after your deductible is met:

• Primary Care:
  • $5 for first 3 visits, then $10 for additional visits
• Lab Testing, Imaging, and Special Diagnostics:
  • 10% coinsurance after deductible
• Prescription Coverage:
  • $15 generic
  • $30 preferred
  • $50 non-preferred
  • $150 specialty

Plan Documents:

2025 HDHP Summary of Benefits

2025 HDHP Summary of Medical Benefits and Coverage

Allegiance HSA Advantage

Health Savings Account Reimbursement List

 

2025 IRS Limits for HSA Contributions:

Employee and employer contributions have a combined IRS maximum amount. This means that together, yours and Lewis & Clark’s contributions cannot exceed:

• $4,300 for individuals
• $8,550 for family coverage

If you are 55 or older, you can contribute an additional catch-up contribution of:

• $1,000 for individuals

OR

If you and your spouse are both 55 or older and have separate HSA accounts, you can contribute an additional catch-up contribution of:

• $1,000 in each account

With KP Plus, you’ll get all the benefits of the traditional HMO plan with an added 10 out-of-network visits or services per year (covered at different rates).

Alternative care would still be accessible through the CHP network. Services provided by out-of-network alternative care providers are not covered through the extra 10 visits provided in the KP Plus plan.

This plan might be right for you if:

• You want to see a provider outside the Kaiser network, but you only need a few visits with them per year.
• You will get most of your routine and other medical services through a provider, pharmacy or testing center within the Kaiser network.
• You aren’t planning to access maternity or newborn care, fertility care, emergency or surgical services, inpatient mental health services, or specialty imaging through an out-of-network provider.

---

A quick overview of covered services:

• Primary Care:
  • $5 for first 3 visits, then $10 for additional visits
• Lab Testing, Imaging, and Special Diagnostics:
  • 20% coinsurance after deductible
• Prescription Coverage:
  • $15 generic
  • $30 preferred
  • $50 non-preferred
  • $150 specialty

A quick overview of coverage for the 10 out-of-network visits/services:

• Primary Care:
  • $30
• Lab Testing, Imaging, and Special Diagnostics:
  • 30% coinsurance after deductible
• Prescription Coverage:
  • $35 generic
  • $50 preferred
  • $50 non-preferred
  • $170 specialty

*** Alternative care is not covered outside the Kaiser/CHP Group networks under the HMO Plus plan. ***

Click here to view the KP Plus Overview Video, specific to our Lewis & Clark Employee plan!

Plan Documents:

2025 HMO Plus Summary of Benefits

2025 HMO Plus Summary of Benefits and Coverage

Out-of-Network (OON) Service Limits:

• Limited to 10 covered services combined, per plan year
• Each service may count as one service
• Example: Member has a primary care office visit, lab services for non-preventive labs, and an x-ray done = 3 services
• OON limits do not cross-accumulate with in-network limits (e.g., Physical, Occupational, Speech Therapy)
• Labs/X-Rays from OON providers may be brought back into KP for fulfillment
• Lab & x-rays filled within a KP facility do not count towards the OON service limit
• 5 prescription drug fills at a non-Kaiser pharmacy
• Prescriptions written by an OON provider can be brought into KP
• Formulary & prior authorizations still apply
• Prescriptions filled within a KP facility do not count towards the OON Rx limit

Referrals and Prior Authorizations

• No referral required, claims will be processed at the Out-Of-Network tier (see Summary of Benefits for exact cost-sharing)
• Claims with an approved referral will be processed as In-Network, and will not apply to OON limits

Claims Reimbursement Process:

• You may have to pay your provider directly, and submit a claim to Kaiser for reimbursement
• You can request reimbursement on the kp.org member portal. Select “Coverage & Costs” and Click “Submit a Claim”. You will be asked to provide documentation.
• You can also download and the print the member reimbursement form at www.kp.org/kpplus/nw.
• You have up to 180 days from the date you received care to submit a claim
• Reimbursement can typically take up to 30 days.

The Added Choice PPO network is a three-tiered plan that allows you to see any licensed provider in the country.

However, your plan will cover a higher percentage of the cost when you use Kaiser (Select) or preferred PPO providers.

This plan might be right for you if:

• You frequently use medical providers outside of Kaiser.
• You don’t mind paying a higher monthly premium.
• You don’t mind paying for higher cost-sharing that varies depending on the network in which you access care.

---

Prescription coverage under the Added Choice PPO plan:

Select Network:

• Kaiser Permanente Mail Order Services or 5 onsite contracted pharmacies.
  • $15 generic
  • $30 preferred
  • $50 non-preferred
  • $150 specialty

PPO and Non-Participating Networks:

• MedImpact Pharmacies Customer Ph: 1-800-788-2949*
  • $20 generic
  • $40 preferred
  • $60 non-preferred
  • $150 specialty
• General Pharmacy Locater: https://mp.medimpact.com/pharmacylocator

To verify cost share or to see how a medication is covered, contact Rx team at 503-261-7900.

 

Finding a Provider:

Added Choice PPO Providers - First Choice Health provider search, select “Entire First Choice Health network” from the drop down menu

What if my provider is NOT in network? (Non Contracted Provider under Tier 3)

• Please contact the POS team to verify that provider is not in network.
• First Choice Health may reach out to provider to determine interest in becoming a contracted provider.
• Continuing to seek care with a non-contracted provider WILL significantly increase your cost share.
• Services are typically subject to a higher deductible, co-insurance (%), and balance billing.
• Balance billing is when a provider bills you for the difference between the provider’s charge and the allowed amount.
  • Example: Provider’s charge is $100 and the allowed amount is $70, the provider may bill you for remaining $30.
  • A Preferred Provider is not allowed to balance bill for covered services.

How do I ensure that the facilities that I am being referred to for surgery, lab work or imaging are in network?

• It is true of any PPO network that the member is responsible to ensure that the services they are receiving are in network.
• Common pitfalls include such services as outpatient lab, radiology, and even inpatient anesthesiology when you are having a surgery/procedure.
• Nothing is worse than to receive a surprise invoice for a service that you thought was covered. Please speak with your provider or contact our patient care navigators for assistance if you are not able to get the answers you need through normal channels.
• You may print a directory of contracted providers, facilities, laboratories, imaging services, etc. at the PPO network search page. Refer to www.kp.org/addedchoice/nw

 

Plan Documents:

2025 Added Choice PPO Summary of Medical Benefits

2025 Added Choice PPO Summary of Medical Benefits & Coverage

Kaiser Added Choice Brochure

Kaiser Added Choice Member Resources

I like to get my glasses at Costco. What is the coverage there?

There is no coverage at Costco for our vision plans.

Can I use my Flexible Spending Account on glasses?

Yes! If you are enrolled in a Healthcare Spending Account, you can submit your receipts for out of pocket costs for glasses and copays for eye exams. You can even use your FSA debit card to purchase reading glasses and contact lens solutions at the FSA Store, where all purchases are pre approved and no documentation is required to submit for proof.

Where can I get inexpensive glasses?

Kaiser’s Vision Essentials program offers multiple discounts for vision hardware:

• Save 30% off each additional pair of frames and lenses.
• Kids’ lenses are 50% off full price.
• Glasses and contact lenses can be direct-shipped at no additional cost.
• Receive 50% off the original price paid for frames and/or lenses (of the same prescription) if they become damaged or broken within one year of purchase at a Northwest Vision Essentials by Kaiser Permanente location.

Alternatively, you can shop glasses, enter your prescription, and order online at Zenni Optical for affordable glasses (lots of options for kids, too!).

Can I get contacts through my vision coverage?

Yes, contact lenses are covered under the “Vision Hardware and Optical Services” category at the levels listed in your plan’s Summary of Benefits.