Kaiser Permanente Medical
You have three plan options to choose from through Kaiser Permanente. All plans include free preventive care and free preventive care medications.
Medical Plan Comparison – Kaiser Permanente
You have access to three medical plan options through Kaiser Permanente. Kaiser plans offer in-network coverage only, meaning there is no benefit for medical services provided by out-of-network providers.
| Plan Features | Kaiser Copay Plus | Kaiser Copay Basic | Kaiser HDHP (HSA Qualified) | |||
|---|---|---|---|---|---|---|
| In-Network | In-Network | In-Network | ||||
| Annual Deductible | $750 individual* $1,500 family* |
$1,500 individual* $3,000 family* |
$1,500 individual** $3,000 family** |
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| Employee Coinsurance | 20% | 20% | 25% | |||
| Annual Out-of-Pocket Maximum |
$3,500 individual*** $7,000 family*** |
$4,000 individual*** $8,000 family*** |
$4,000 individual**** $8,000 family**** |
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| Annual Company HSA Contribution | None | None | $720 | |||
| You pay: | ||||||
| Preventive Care Visit |
Covered in full | Covered in full | Covered in full | |||
| Primary Care Visit |
$10 copay | $15 copay | 25% after deductible | |||
| Specialist Visit | $25 copay | $35 copay | 25% after deductible | |||
| Urgent Care | $75 copay | $75 copay | 25% after deductible | |||
| Emergency Room (copay waived if admitted) |
$500 copay | 20% after deductible | 25% after deductible | |||
| Inpatient Services | 20% after deductible | 20% after deductible | 25% after deductible | |||
| Prescription Drugs: Retail (up to a 30-day supply) | ||||||
| Generic | $10 copay | $10 copay | $10 copay after deductible | |||
| Brand Formulary | $30 copay | $30 copay | $30 copay after deductible | |||
| Non-Formulary | $60 copay | $60 copay | $60 copay after deductible | |||
| Specialty | 20% up to $120 copay |
20% up to $120 copay |
20% after deductible up to $120 copay |
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| Prescription Drugs: Mail Order (up to a 90-day supply) | ||||||
| Generic | $20 copay | $20 copay | $20 copay after deductible |
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| Brand Formulary | $60 copay | $60 copay | $60 copay after deductible |
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| Non-Formulary | $120 copay | $120 copay | $120 copay after deductible |
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| Specialty | 20% up to $100 copay |
20% up to $100 copay |
Deductible, then 20% up to $100 copay |
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*Deductible is embedded. Family members meet only their individual deductible and then their claims will be covered under the plan coinsurance; if the family deductible has been met prior to their individual deductible being met, their claims will be paid at the plan coinsurance.
**Deductible is aggregate. All family members contribute towards the family deductible. An individual cannot have claims covered under the plan coinsurance until the total family deductible has been satisfied.
***Out-of-pocket max is embedded. After each eligible family member meets his or her individual out-of-pocket maximum, the plan will pay 100% of their covered expenses. Or, after the family out-of-pocket maximum has been met, the plan will pay 100% of each eligible family member’s covered expenses.
****Out-of-pocket max is aggregate. If you have other family members in this plan, the overall family out-of-pocket limits must be met.
No-Cost Preventive Prescriptions
Both Cigna and Kaiser medical plans include preventive care medications at no out-of-pocket cost to you. You can use your Kaiser member ID card to get free preventive care medications providing that the medication is:
- Prescribed by a health care professional
- Age and condition appropriate
- Filled at an in-network pharmacy
Examples of covered medications include:
- Asprin, folic acid, and other select common over-the-counter medications
- Nicotine cessation medications
- Human immunodeficiency virus preventive medications
- Breast cancer preventive medications
- Statin preventive medications
- Birth control products
- Flu shots and other vaccines
Finding a Doctor
Kaiser Members: Visit https://my.kp.org/stateofcolorado, download the app, or call (888) 413-0591.
