Group Health Plans Overview

Group Health provides coverage to employer groups, government programs, individuals, and families through two health carriers — Group Health Cooperative and Group Health Options, Inc.

Group Health Cooperative

Group Health Cooperative is a nonprofit membership organization in Washington state that offers HMO (health maintenance organization) plans. With our HMO plans, members select a primary care physician to manage and coordinate their care. The plan pays for covered services when a member receives care from a defined network featuring roughly 10,000 providers across Washington state, including Group Health Physicians who practice at Group Health Medical Centers and area hospitals. Care received outside the defined network is not covered, except for medically necessary urgent and emergency care.

Group Health Options, Inc.

Group Health Options, Inc. (registered in Washington and Idaho) is a for-profit subsidiary of Group Health Cooperative offering point-of-service (POS) and preferred provider organization (PPO) plans.

  • Point-of-service plans. This type of plan pays for services members receive from a subset of providers at the in-network level, and also allows members to receive care from a larger network of providers for, in most cases, higher cost shares.
  • Preferred provider organization plans. This type of plan has an extensive network of providers. It does not require a primary care physician to provide referrals. PPO members may self-refer to most doctors and specialists; some services do require health plan authorization.
Revised 10/07/2016

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.