KP Select CO Bronze 8500/50 - AI/LTD

Kaiser Foundation Health Plan of Colorado · 2027 plan year

Expanded BronzeHSA eligible
Ind. deductible
$8,500
Family deductible
$17,000
Ind. OOP max
$9,200
Family OOP max
$18,400

More Kaiser Foundation Health Plan of Colorado plans in CO

Live premium estimate

$

Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$50.00 Copay with deductible

Specialist

BenefitIn-network
Specialist Visit50.00% Coinsurance after deductible

Hospital

BenefitIn-network
Emergency Room Services50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)50.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services50.00% Coinsurance after deductible
Urgent Care Centers or Facilities$150.00 Copay with deductible + 50.00% Coinsurance after deductible

Pharmacy

BenefitIn-network
Generic Drugs$30.00
Medical Service Drugs50.00% Coinsurance after deductible
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Non-Preferred Generic Drugs50.00% Coinsurance after deductible
Preferred Brand Drugs50.00% Coinsurance after deductible
Preventive DrugsNo charge
Specialty Drugs50.00% Coinsurance after deductible

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 Services50.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient ServicesNo Charge after deductible
Mental/Behavioral Health Prenatal CareNo Charge after deductible
Office Visit - Mental/Behavioral HealthNo Charge after deductible
Office Visit - Substance Use DisorderNo Charge after deductible
Partial Hospitalization for Mental/Behavioral HealthNo charge
Partial Hospitalization for Substance Use DisorderNo charge
Postpartum Mental/Behavioral HealthNo Charge after deductible
Postpartum Substance Use DisorderNo Charge after deductible
Residential Day Treatment for Mental/Behavioral HealthNo charge
Residential Day Treatment for Substance Use DisorderNo charge
Substance Use Disorder Prenatal CareNo Charge after deductible
Telehealth Mental/Behavioral HealthNo charge
Telehealth Substance Use DisorderNo charge

Other

BenefitIn-network
Abortion for Which Public Funding is ProhibitedNo charge
Acupuncture50.00% Coinsurance after deductible
Allergy Testing50.00% Coinsurance after deductible
Applied Behavior Analysis Based TherapiesNo Charge after deductible
Autism Spectrum Disorders - Assessment and Evaluation ServicesNo Charge after deductible
Bariatric Surgery50.00% Coinsurance after deductible
Basic Dental Care - Child50.00% Coinsurance after deductible
Chemotherapy50.00% Coinsurance after deductible
Chiropractic Care50.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care50.00% Coinsurance after deductible
Dental Check-Up for ChildrenNo Charge after deductible
Diabetes EducationNo Charge after deductible
Diabetic Supplies20.00%
Dialysis50.00% Coinsurance after deductible
Durable Medical Equipment50.00% Coinsurance after deductible
Emergency Transportation/Ambulance50.00% Coinsurance after deductible
Eye Glasses for Children50.00%
Gender Affirming Care50.00% Coinsurance after deductible
Habilitation Services50.00% Coinsurance after deductible
Hearing Aids50.00% Coinsurance after deductible
Home Health Care Services50.00% Coinsurance after deductible
Hospice ServicesNo charge
Imaging (CT/PET Scans, MRIs)50.00% Coinsurance after deductible
Infertility Treatment50.00% Coinsurance after deductible
Infusion Therapy50.00% Coinsurance after deductible
Inpatient Physician and Surgical Services50.00% Coinsurance after deductible
Inpatient Rehabilitation50.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services50.00% Coinsurance after deductible
Major Dental Care - Child50.00% Coinsurance after deductible
Nutritional CounselingNo Charge after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)50.00% Coinsurance after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)50.00% Coinsurance after deductible
Outpatient Rehabilitation Services50.00% Coinsurance after deductible
Prenatal and Postnatal Care50.00% Coinsurance after deductible
Private-Duty Nursing50.00% Coinsurance after deductible
Prosthetic Devices50.00% Coinsurance after deductible
Prosthetics: Legs and Arms20.00%
Prosthetics: Recreational20.00%
Radiation50.00% Coinsurance after deductible
Reconstructive Surgery50.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy50.00% Coinsurance after deductible
Rehabilitative Occupational Therapy50.00% Coinsurance after deductible
Rehabilitative Physical Therapy50.00% Coinsurance after deductible
Rehabilitative Speech Therapy50.00% Coinsurance after deductible
Routine Eye Exam for Children$50.00 Copay with deductible
Skilled Nursing Facility50.00% Coinsurance after deductible
Standalone Laboratory50.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services50.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient ServicesNo Charge after deductible
Telehealth PCPNo charge
Telehealth SpecialistNo charge
Transplant50.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders50.00% Coinsurance after deductible
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging50.00% Coinsurance after deductible

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