Kaiser Permanente Medical Plan Details

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**
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****
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
Prescription Drugs: Mail Order (up to a 90-day supply)
Generic $20 copay $20 copay $20 copay
after deductible
Brand Formulary $60 copay $60 copay $60 copay
after deductible
Non-Formulary $120 copay $120 copay $120 copay
after deductible
Specialty 20% up to
$100 copay
20% up to
$100 copay
Deductible, then 20% up to
$100 copay

*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.

Your Rights

This website highlights some of your benefit plans. Your actual rights and benefits are governed by the official plan documents. If any discrepancy exists between this communication and the official plan documents, the plan documents will prevail. The State of Colorado reserves the right to change any benefit plan without notice. Benefits are not a guarantee of employment.

Your Benefits Team

Division of Human Resources
303-866-3434 or 800-719-3434 state_benefits@state.co.us

Your Department’s Human Resources Office: Benefit Administrator List

Accessibility

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