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Cigna Providers Outside a Kaiser Permanente State (Outside CA, CO, DC, GA, HI, MD, OR, VA, WA)
Effective date
Not stated in the notice
Identified
Jul 21, 2026
Summary
Kaiser Permanente members with HMO, EPO, POS, and PPO plans traveling outside Kaiser Permanente states (CA, CO, DC, GA, HI, MD, OR, VA, WA) now have access to emergency, urgent, and covered services through Cigna Healthcare's PPO network at negotiated rates. Cigna PPO network providers outside KP states should collect applicable cost-sharing only from eligible KP 3-Tier POS and KPIC PPO members at time of service; other eligible members require no upfront payment until claims are processed.
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What to do
Action · 9 steps
01REQUIREMENTS:
- Immediately: Billing team must update claim submission and collection protocols for Kaiser Permanente members presenting Cigna Healthcare-branded Travel Cards or co-branded membership cards indicating KP plan participation when treated outside Kaiser Permanente states (outside CA, CO, DC, GA, HI, MD, OR, VA, WA).
02- By next billing cycle: Update front desk and collection staff to recognize which KP plan types require upfront cost-sharing collection vs. post-claim processing.
03KP 3-Tier POS members—collect applicable cost-sharing at time of service.
04KPIC PPO members—collect applicable cost-sharing at time of service.
05KP HMO, EPO, POS 2-Tier members—DO NOT collect payment at time of service; bill Cigna/KP after claim pricing.
06- Verify eligibility: Confirm members are NOT enrolled in Medicare, Medicaid (Medi-Cal), or Washington situs coverage (Kaiser Foundation Health Plan of Washington, Kaiser Foundation Health Plan of Washington Options, Inc., or Washington situs PPO/3-Tier POS issued by Kaiser Foundation Health Plan of Northwest) before applying this network.
07- Update billing system: Route claims for eligible KP members treated outside KP states through Cigna Healthcare PPO network billing pathway, not regional/national legacy processes.
08- Document in patient record: Note when services are provided under Cigna Healthcare PPO network access for KP out-of-state travel to ensure proper claim routing.
09- Failure to correctly identify eligible members and apply appropriate collection rules may result in improper patient balance collection, claim denials, or compliance issues with KP contracting terms.
Original notice
Cigna Providers Outside a Kaiser Permanente State (Outside CA, CO, DC, GA, HI, MD, OR, VA, WA)
healthy.kaiserpermanente.org · Always check the source before changing claims.