This is a comparison of the copay medical plans for FY 2019-20 open enrollment. Please see the High Deductible Health Plan Comparison page as well.
- Kaiser Copay For Physical
- Kaiser Copay
- Kaiser Copay For Colonoscopy
- Kaiser Copayment Plans
- Kaiser Copay For Emergency Room
With a prescription when filled at a Kaiser Permanente pharmacy. For Southern Colorado members: Prescriptions for second fill and on. Habilitation services $30 Copay. Limited to 20 visits per therapy per year (autism spectrum disorders are not subject to. You'll pay either our full copay rate or reduced copay rate. If you live in a high-cost area, you may qualify for a reduced inpatient copay rate no matter what priority group you're in. To find out if you qualify for a reduced inpatient copay rate, call us toll-free at 877-222-8387. We're here Monday through Friday, 8:00 a.m.
Kaiser Copay For Physical
United Healthcare (UHC) Copay Choice Plus Plan | Kaiser Permanente (KP) DHMO Plan | ||||
---|---|---|---|---|---|
Annual Deductible | Network | Non-Network | Annual Deductible | Network | Non-Network |
Individual | $1,500 | $3,000 | Individual | $750 | Not Covered |
Family | $3,000 | $6,000 | Family | $1,500 |
Annual Out-of-Pocket Max: UHC | Annual Out-of-Pocket Max: KP | ||||
---|---|---|---|---|---|
Annual Deductible | Network | Non-Network | Annual Deductible | Network | Non-Network |
Individual | $5,000 | $10,000 | Individual | $2,000 | Not Covered |
Family | $10,000 | $20,000 | Family | $4,000 |
Co-Insurance: UHC | Co-Insurance: KP | ||||
---|---|---|---|---|---|
Annual Deductible | Network | Non-Network | Annual Deductible | Network | Non-Network |
Percentage you pay after you have satisfied your deductible. | 20% | 50% | Percentage you pay after you have satisfied your deductible. | 10% | Not Covered |
Office Visits/Urgent Care (1): UHC | Office Visits/Urgent Care (1): KP | ||||
---|---|---|---|---|---|
Service | Network | Non-Network | Service | Network | Non-Network |
Preventative Care/Screenings | No Charge | 50% of eligible expenses after deductible | Preventative Care/Screenings | No Charge | Not Covered |
Primary Care - Illness/Injury | $30 Copay | Primary Care - Illness/Injury | $30 Copay | ||
Specialist | $50 Copay | Specialist | $50 Copay | ||
Inpatient Hospital | 20% Co-insurance after $1,000 Copay | Inpatient Hospital | 10% Coinsurance | ||
Urgent Care | $75 Copay | Urgent Care | $75 Copay | ||
Ambulance | 20% after deductible | Ambulance | $500 Copay | ||
Emergency Room | $500 Copay | Emergency Room | |||
Virtual Visits (Network Benefits are available only when services are delivered through a Designated Virtual Network Provider.) | $30 Copay | Not Covered | Virtual Care - Primary/Specialty - Phone Visit, Video Visit - Chat Online, Email, E-visits | No Charge | Not Covered |
Mental Health (1): UHC | Mental Health (1): KP | ||||
---|---|---|---|---|---|
Service | Network | Non-Network | Service | Network | Non-Network |
Inpatient (Hospitalization/Day Treatment) | 20% Co-insurance after $1,000 Copay | 50% of eligible expenses after deductible | Inpatient (Hospitalization/Day Treatment) | 10% Coinsurance | Not Covered |
Outpatient (Therapy) | $30 Copay | Outpatient (Therapy) | $30 Copay |
Kaiser Copay
Substance-Related & Addictive Disorders Services (1): UHC | Substance-Related & Addictive Disorders Services (1): KP | ||||
---|---|---|---|---|---|
Service | Network | Non-Network | Service | Network | Non-Network |
Inpatient | 20% Co-insurance after $1,000 Copay | 50% of eligible expenses after deductible | Inpatient | 10% Coinsurance | Not Covered |
Outpatient (Therapy) | $30 Copay | Outpatient (Therapy) | $30 Copay |
Vision: UHC | Vision: KP | ||||
---|---|---|---|---|---|
Service | Network | Non-Network | Service | Pediatric (up to end of month he/she turns age 19) | Adult (members age 19 and over) |
Up to 1 Routine Exam per plan year under the Medical Plan | $50 Copay | - Allowances apply to network providers only. - Please refer to your plan details for out-of-network allowances | Optometrist/ Ophthalmologist | Optometrist: $30 Copay/ Ophthalmologist: $50 Copay (Includes contact lens fitting up to $175) | |
Optical hardware | - Frames $130 allowance OR - Contact lens $150 allowance | Optical hardware | - 10% Coinsurance - 1 pair of glasses & lenses every 2 years or 2 years of contact lenses | $150 Credit once every 24 months towards optical hardware |
Prescription: UHC | Prescription: KP (2) | ||||
---|---|---|---|---|---|
Retail: 30-day supply | Mail Order: 90-day supply | Retail: 30-day supply | Mail Order: 90-day supply | ||
Tier 1 | $10 Copay | $20 Copay | Generic | $10 Copay | $20 Copay |
Tier 2 | $30 Copay | $60 Copay | Preferred Brand Name | $30 Copay | $60 Copay |
Tier 3 | $50 Copay | $100 Copay | Non-Preferred Brand Name | Approved drugs covered at generic costshare | |
Specialty (30 day supply) | 20% up to $100 | Specialty | 20% up to $100 |
* Please refer to the official plan documents for detailed information and listing of covered services
- If a procedure is preformed during a Primary Care, Specialty Care, or Urgent Care Visit then the service is covered at coinsurance after deductible is met.
- For Southern Colorado Kaiser Permanente members: maintenance medications must be filled at a Pharmacy in a Kaiser Permanente medical office or through Kaiser Permanente mail order.
Kaiser Copay For Colonoscopy
Rates - Employee Monthly Contribution
United Healthcare Copay Choice Plus Plan | Kaiser Permanente DHMO Plan | ||
---|---|---|---|
Employee Only | $159.14 | Employee Only | $93.72 |
Employee + Spouse | $437.52 | Employee + Spouse | $298.02 |
Employee + Child(ren) | $310.30 | Employee + Child(ren) | $190.34 |
Family | $638.86 | Family | $440.48 |
Most Kaiser Permanente plans require members to make copayments directly to the provider. Copayments for office visits, pharmacy services, emergency room care, and inpatient hospital care can be found online if you are registered through One Health Port to access Kaiser Permanente.
For members on Medicare hospice plans or contracts, copayment applies to non-hospice services only.
You should collect copayments from our members at the time service is provided. You may charge interest, a reasonable billing fee, or both on unpaid copayments as stated in your office policy. The exceptions are Medicare and Medicaid enrollees, for whom it is against federal regulation to collect such fees.
Never collect a copayment from approved Medicaid enrollees; it is against federal regulation to collect such fees.
You should collect copayments for office visits only when the member sees a physician, physician's assistant, or nurse practitioner. There is no copay for seeing a lab technician.
![Kaiser Copay Kaiser Copay](/uploads/1/1/9/8/119860348/903880248.png)
Some group plans cover preventive care visits in full. If a member is on such a plan, do not collect a copayment.
Kaiser Copayment Plans
Outpatient services requiring copayments
- Audiology/hearing tests
- Family planning, prenatal, post-partum visits, and prenatal tests (but not if the provider bills globally)
- Injectable medications that may be self-administered at home
- Office visits and consultations
- Pharmacy services
- Physical, occupational, and speech therapies
- Radiation therapy and chemotherapy (except PEBB)
- Emergency room visits where there is no hospital admission
- Most mental health and substance use disorder visits
Outpatient services generally not requiring copayments
- Diagnostic radiology, ultrasound, and lab services. Exception: High-end radiology may have a copayment.
- Echocardiograms
- EEG and EKG cardiac tests
- Preventive care visits, depending on the group plan
- Injections and immunizations except injectable medications that may be self-administered at home
- Nursing home services
- Pulmonary function tests
- Tympanometry
- Visiting nurse services
- Psychological tests
- Methadone treatment
Contact the Provider Assistance Unit (PAU) with questions about copayments.
Kaiser Copay For Emergency Room
Content on this page is from the provider manual | Disclaimer