Group Health Plans Overview

Group Health offers coverage to employers, government agencies, and individuals through two different corporations — Group Health Cooperative and Group Health Options, Inc.

Group Health Cooperative

Group Health Cooperative is a non-profit membership corporation, more specifically, a health carrier.

Group Health Cooperative offers only health management organization (HMO) plans, in which members select a primary care provider (or personal physician) to manage and coordinate their care. The plan pays coverage benefits when a member receives care from a defined network of Group Health Medical Centers and contracted providers. It does not cover care received outside the defined network, except for urgent and emergency care.

Group Health Options, Inc.

Group Health Options, Inc. is a subsidiary, and health carrier — more specifically, a health care service contractor (HCSC) in Washington, and in Idaho, a disability carrier including managed care. Group Health Options, Inc. offers both HMO-like coordinated care plans and plans that cover out-of-network care.

  • Point of Service (POS) plans couple coordinated care with the ability to see any out-of-network provider, usually at a lower level of coverage.
  • Preferred provider organization (PPO) plans have an extensive provider network and do not require that a personal physician coordinate a member's care and provide referrals. PPO members may self-refer to both personal physicians and specialists. Some services require health plan preauthorization.
Revised 11/22/2013

The Provider Manual is not intended for any use by any party other than as a resource for Group Health Cooperative's contracted providers in fulfilling their obligations under provider contracts. Group Health intends for the manual to be accurate for its intended purpose but doesn’t guarantee accuracy. Providers should comply with the terms of their provider contracts and any legal requirements in the event of an inconsistency between the manual and a requirement in their provider contracts or the law.