Kaiser Through BHT: HMO, Virtual Plus, PPO, and KP Plus Explained

Kaiser’s plan name can change whether an employee can keep an outside doctor, where they can have surgery, and how they get care when they’re away from home. Access PPO and Kaiser Northwest’s PPO Plus offer broad provider networks and out-of-network medical benefits. KP Plus offers a limited allowance for outside care, even when its plan type is listed as PPO.

Core HMO centers care within its participating network. Virtual Plus starts care virtually and offers lower costs for referred in-person treatment. Added Choice, available in Kaiser Northwest’s small-group lineup, uses three provider tiers with different costs.

Which options are available through BHT?

BHT offers Kaiser plans through its Industry Health Trusts (IHTs) and through the small-group market. The January 2027 IHT lineup includes Core HMO, Virtual Plus, KP Plus, and PPO plans, plus HSA-qualified HMO and PPO options. Names such as HMO 1000, VP 1000, and PPO 1000 identify different benefit designs. The IHT PPO options use the Access PPO network.

Washington’s direct small-group lineup offers Core HMO, KP Plus, and Access PPO, with metal-level names such as KP Plus Gold 600 LX and Gold Access PPO 600 LX. Employers in southwest Washington may also encounter Kaiser Northwest products, including PPO Plus and Added Choice. Those regional small-group offerings are separate from the IHT lineup. Added Choice is a point-of-service (POS) plan, while PPO Plus is a broad-network PPO.

The examples below use 2027 benefits. PPO Plus and Added Choice belong to Kaiser Northwest’s small-group lineup, including southwest Washington, and are covered separately below.

Core HMO: Start with the care team and network

With Core HMO, employees choose a primary-care provider in the Core network and use that team for appointments, testing, prescriptions, and most specialist referrals. The network includes Kaiser clinicians and contracted community providers and hospitals, so some covered care takes place outside a Kaiser-owned building.

For someone comfortable getting most care through that network, the practical experience is straightforward: book an appointment, have the clinician arrange any needed testing or specialty care, and use the plan’s participating facilities. BHT’s 2027 HMO 1000, for example, has a $15 primary-care visit copay before the deductible and covered-in-full virtual care.

An employee hoping to keep an existing specialist should check the exact Core network and the referral requirements. Some specialties accept self-referrals; others require the care team to arrange the appointment. A routine visit to a nonparticipating doctor generally needs Kaiser’s authorization to be covered.

Virtual Plus: Start virtually to get the lower in-person cost

Virtual Plus is built around starting most care by phone, video, chat, or an e-visit at no charge. The clinician can treat the problem, prescribe medication, or refer the employee for an in-person appointment. Following that referral route gives the employee lower out-of-pocket costs for most in-person services.

For example, an employee with knee pain could start with a video visit. If an examination is needed, the clinician arranges the in-person next step. Booking an in-person appointment independently can mean higher deductible or coinsurance charges. Preventive care and the first in-person primary-care visit are covered at no charge; urgent and emergency care also have exceptions to the referral-first approach.

Virtual Plus uses the Connect network. Employees switching from Core should search their doctors and hospitals under Connect. Referrals can also come from an in-person visit, such as a preventive appointment.

The plan is available to employer-group members who live or work in King, Kitsap, Pierce, Snohomish, Spokane, or Thurston County. It also emphasizes mail-order pharmacy: employees can fill a new prescription at a network pharmacy, then get most refills and maintenance medications by mail. These details are explained in Kaiser’s Virtual Plus guide.

KP Plus: Keep an outside provider for occasional care

KP Plus can suit an employee who wants most care through Kaiser but would like to keep seeing an outside therapist or specialist occasionally. Its outside-care allowance covers 10 eligible outpatient services per member per year, with a separate allowance for 5 covered prescription fills.

Those 10 services can go faster than 10 appointments. An outside office visit plus two separately counted lab tests can use three services. Kaiser explains this counting method in its KP Plus member guide. Someone seeing an outside therapist every week could use the annual allowance in about ten weeks.

The next step in treatment is just as important. The outside allowance covers specified outpatient services, while planned out-of-network surgery, hospital stays, and advanced imaging such as MRI or CT scans are excluded. An employee seeing an outside orthopedist may need to return to the participating network for an MRI or operation.

This is why BHT’s comparison tool identifies KP Plus as a limited PPO. Its 2027 small-group SBC lists PPO as the plan type, alongside the service cap and outside-care exclusions. Emergency care and qualifying urgent care away from home have their own coverage provisions.

Access PPO: Broader access for ongoing care

Access PPO provides a broader range of participating providers for employees who want to keep community doctors, use a particular hospital, or receive routine care in another state. Its participating networks include Kaiser clinicians and other local providers, First Choice Health in Washington and Idaho’s Kootenai and Latah counties, and Aetna Signature Administrators outside those areas.

An employee’s longtime doctor may therefore be in-network even though the office has no Kaiser branding. Checking that participation first can preserve the relationship at the plan’s in-network cost, rather than moving straight to the more expensive out-of-network benefit.

Access PPO also covers a wider range of eligible services from nonparticipating providers. Employees may owe a higher deductible and coinsurance, potentially plus the difference between the provider’s charge and the amount recognized by the plan, called balance billing.

The national network changed on March 1, 2025, when Aetna Signature Administrators replaced the previous out-of-area arrangement for these Washington plans. For care outside Washington and the two Idaho counties, use the current Aetna directory linked by Kaiser.

Two Gold plans with $600 deductibles can cover very different care

Compare these two January 2027 direct small-group designs. Both have a $600 individual in-network deductible, but their benefits for planned out-of-network care differ considerably.

Sources: KP Plus Gold 600 LX SBC and Gold Access PPO 600 LX SBC.

The Access plan’s outside-care benefits give an employee more options, but it has no annual out-of-pocket limit for out-of-network care. Someone planning an expensive procedure should compare the surgeon and facility’s network status, the coinsurance, and any balance bill before scheduling.

Southwest Washington: PPO Plus and Added Choice

Employers in Clark and Cowlitz counties also encounter Kaiser Permanente Northwest’s small-group plans. PPO Plus is the broad-network PPO offering; KP Plus is the limited outside-care offering.

For Washington employer groups, PPO Plus includes Kaiser providers and First Choice Health in Washington, Oregon, Idaho, Montana, Wyoming, North Dakota, South Dakota, and Alaska. First Health supplies the network elsewhere in the country. These are the Northwest plan’s network arrangements, separate from Access PPO’s use of Aetna outside Washington and the two Idaho counties.

Added Choice offers another way to use community providers. It is a point-of-service (POS) plan with three levels: Kaiser/select providers, preferred PPO providers, and nonparticipating providers. An employee’s deductible and share of the bill change with the level they use.

For example, the 2027 KP WA Gold Added Choice 1500 plan has individual deductibles of $1,500 for select providers, $2,000 for preferred PPO providers, and $6,000 for nonparticipating providers. BHT’s app groups non-PPO plan types under its limited-network filter, so an Added Choice result still deserves a look at its three provider levels.

Referrals and travel: Plan the next appointment

For specialty care at Kaiser, some departments accept self-referrals and others ask the primary-care team to arrange the visit. The 2027 Gold Access PPO 600 LX SBC also specifies referrals, with exceptions for certain specialists. Before booking, ask whether the particular appointment needs a referral or prior authorization and who will obtain it.

Travel coverage should match what employees expect to do away from home. Urgent and emergency care are covered while traveling under Kaiser’s Virtual Plus travel provisions, for example. Someone who needs ongoing specialist appointments or regular therapy in another state should check the providers through the applicable PPO network and confirm enrollment eligibility for their home address. Aetna participation for Access PPO and First Health participation for Northwest PPO Plus answer different provider searches.

Where HSA plans and Nice fit

BHT offers HSA-qualified versions of both its Kaiser HMO and PPO designs. Choose the care network first, then compare the deductible and other costs. HSA-qualified coverage can change what employees pay for appointments and virtual care; use the specific HSA plan’s benefits when estimating those costs.

For 2027, BHT medical coverage also includes Nice Healthcare at $0 for covered services. Kaiser employers work with BHT on a Nice Connect orientation so employees know how to get started. For specialty care billed to Kaiser, continue to follow the Kaiser plan’s referral and authorization process.

Compare the care employees actually expect to use

Bring your broker the providers employees want to keep, any planned procedures, and the locations where covered family members need routine care. Ask for a comparison showing the exact network and outside-care benefits alongside the premium and payroll contribution.

An occasional outside appointment may fit KP Plus. Regular outside treatment or a planned hospital procedure calls for a closer look at Access PPO, Northwest PPO Plus, or Added Choice. Employees comfortable receiving most care through Kaiser can compare Core HMO with the virtual-first approach of Virtual Plus.

BHT’s 2027 plan documents separate IHT and small-group options, so your broker and BHT can compare the right benefits for your business rather than relying on the PPO label alone.