Group Health Plans Overview

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

Group Health Cooperative

Group Health Cooperative is a non-profit membership corporation in Washington state that offers HMO (health maintenance organization) plans. With our HMO plans, members select a personal primary care physician to manage and coordinate their care. The plan pays coverage benefits 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. It does not cover care received outside the defined network, 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. It offers point-of-service plans and preferred provider organization plans.

  • Point-of-service plans. This type of plan allows members to receive care from a subset of providers at their in-network cost shares, 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 offering medical care. 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 1/20/2016

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.