KP CO Silver 500/20 RX Copay 87% CSR

Kaiser Foundation Health Plan of Colorado · 2027 plan year

Silver
Ind. deductible
$500
Family deductible
$1,000
Ind. OOP max
$2,850
Family OOP max
$5,700

More Kaiser Foundation Health Plan of Colorado plans in CO

Live premium estimate

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Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$20.00

Specialist

BenefitIn-network
Specialist Visit$70.00

Hospital

BenefitIn-network
Emergency Room Services30.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)30.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services30.00% Coinsurance after deductible
Urgent Care Centers or Facilities$75.00

Pharmacy

BenefitIn-network
Generic Drugs$15.00
Medical Service Drugs$400.00
Non-Preferred Brand Drugs$200.00
Non-Preferred Generic Drugs$200.00
Preferred Brand Drugs$80.00
Preventive DrugsNo charge
Specialty Drugs$400.00

Mental Health

BenefitIn-network
Intensive Outpatient for Mental/Behavioral HealthNo charge
Intensive Outpatient for Substance Use DisorderNo charge
Mental Health Wellness VisitNo charge
Mental/Behavioral Health Inpatient Services30.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services$20.00
Mental/Behavioral Health Prenatal Care$20.00
Office Visit - Mental/Behavioral Health$20.00
Office Visit - Substance Use Disorder$20.00
Partial Hospitalization for Mental/Behavioral HealthNo charge
Partial Hospitalization for Substance Use DisorderNo charge
Postpartum Mental/Behavioral Health$20.00
Postpartum Substance Use Disorder$20.00
Residential Day Treatment for Mental/Behavioral HealthNo charge
Residential Day Treatment for Substance Use DisorderNo charge
Substance Use Disorder Prenatal Care$20.00
Telehealth Mental/Behavioral HealthNo charge
Telehealth Substance Use DisorderNo charge

Other

BenefitIn-network
Abortion for Which Public Funding is ProhibitedNo charge
Acupuncture$35.00
Allergy Testing$70.00
Applied Behavior Analysis Based Therapies$20.00
Autism Spectrum Disorders - Assessment and Evaluation Services$20.00
Bariatric Surgery30.00% Coinsurance after deductible
Basic Dental Care - Child50.00% Coinsurance after deductible
Chemotherapy$400.00
Chiropractic Care$35.00
Delivery and All Inpatient Services for Maternity Care30.00% Coinsurance after deductible
Dental Check-Up for ChildrenNo Charge after deductible
Diabetes Education$20.00
Diabetic Supplies20.00%
Dialysis30.00% Coinsurance after deductible
Durable Medical Equipment30.00% Coinsurance after deductible
Emergency Transportation/Ambulance30.00% Coinsurance after deductible
Eye Glasses for Children50.00%
Gender Affirming Care30.00% Coinsurance after deductible
Habilitation Services$40.00
Hearing Aids30.00% Coinsurance after deductible
Home Health Care Services30.00% Coinsurance after deductible
Hospice ServicesNo charge
Imaging (CT/PET Scans, MRIs)30.00% Coinsurance after deductible
Infertility Treatment30.00% Coinsurance after deductible
Infusion Therapy$400.00
Inpatient Physician and Surgical Services30.00% Coinsurance after deductible
Inpatient Rehabilitation30.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services30.00% Coinsurance after deductible
Major Dental Care - Child50.00% Coinsurance after deductible
Nutritional Counseling$20.00
Other Practitioner Office Visit (Nurse, Physician Assistant)$70.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)30.00% Coinsurance after deductible
Outpatient Rehabilitation Services$40.00
Prenatal and Postnatal Care30.00% Coinsurance after deductible
Private-Duty Nursing30.00% Coinsurance after deductible
Prosthetic Devices30.00% Coinsurance after deductible
Prosthetics: Legs and Arms20.00%
Prosthetics: Recreational20.00%
Radiation30.00% Coinsurance after deductible
Reconstructive Surgery30.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy$40.00
Rehabilitative Occupational Therapy$40.00
Rehabilitative Physical Therapy$40.00
Rehabilitative Speech Therapy$40.00
Routine Eye Exam for Children$20.00
Skilled Nursing Facility30.00% Coinsurance after deductible
Standalone Laboratory30.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services30.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services$20.00
Telehealth PCPNo charge
Telehealth SpecialistNo charge
Transplant30.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders30.00% Coinsurance after deductible
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging30.00% Coinsurance after deductible

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