KP Select CO Gold 0/30 RX Copay - AI/LTD
Kaiser Foundation Health Plan of Colorado · 2027 plan year
Gold
- Ind. deductible
- $0
- Family deductible
- $0
- Ind. OOP max
- $8,500
- Family OOP max
- $17,000
Other cost-sharing reduction variants for this plan:
More Kaiser Foundation Health Plan of Colorado plans in CO
Live premium estimate
Benefits & cost sharing
Primary Care
| Benefit | In-network |
|---|---|
| Preventive Care/Screening/Immunization | No charge |
| Primary Care Visit to Treat an Injury or Illness | $30.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $60.00 |
Hospital
| Benefit | In-network |
|---|---|
| Inpatient Hospital Services (e.g., Hospital Stay) | 40.00% |
| Urgent Care Centers or Facilities | $75.00 |
| Emergency Room Services | $750.00 |
| Outpatient Surgery Physician/Surgical Services | 40.00% |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $15.00 |
| Medical Service Drugs | $625.00 |
| Non-Preferred Brand Drugs | $375.00 |
| Non-Preferred Generic Drugs | $375.00 |
| Preferred Brand Drugs | $50.00 |
| Preventive Drugs | No charge |
| Specialty Drugs | $625.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Substance Use Disorder Prenatal Care | $30.00 |
| Telehealth Mental/Behavioral Health | No charge |
| Telehealth Substance Use Disorder | No charge |
| Intensive Outpatient for Mental/Behavioral Health | No charge |
| Intensive Outpatient for Substance Use Disorder | No charge |
| Mental Health Wellness Visit | No charge |
| Mental/Behavioral Health Inpatient Services | 40.00% |
| Mental/Behavioral Health Outpatient Services | $30.00 |
| Mental/Behavioral Health Prenatal Care | $30.00 |
| Office Visit - Mental/Behavioral Health | $30.00 |
| Office Visit - Substance Use Disorder | $30.00 |
| Partial Hospitalization for Mental/Behavioral Health | No charge |
| Partial Hospitalization for Substance Use Disorder | No charge |
| Postpartum Mental/Behavioral Health | $30.00 |
| Postpartum Substance Use Disorder | $30.00 |
| Residential Day Treatment for Mental/Behavioral Health | No charge |
| Residential Day Treatment for Substance Use Disorder | No charge |
Other
| Benefit | In-network |
|---|---|
| Infertility Treatment | 40.00% |
| Infusion Therapy | $625.00 |
| Inpatient Physician and Surgical Services | 40.00% |
| Inpatient Rehabilitation | 40.00% |
| Substance Abuse Disorder Inpatient Services | 40.00% |
| Substance Abuse Disorder Outpatient Services | $30.00 |
| Telehealth PCP | No charge |
| Telehealth Specialist | No charge |
| Transplant | 40.00% |
| Treatment for Temporomandibular Joint Disorders | 40.00% |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | 40.00% |
| Abortion for Which Public Funding is Prohibited | No charge |
| Acupuncture | $40.00 |
| Allergy Testing | $60.00 |
| Applied Behavior Analysis Based Therapies | $30.00 |
| Autism Spectrum Disorders - Assessment and Evaluation Services | $30.00 |
| Bariatric Surgery | 40.00% |
| Basic Dental Care - Child | 50.00% Coinsurance after deductible |
| Chemotherapy | $625.00 |
| Chiropractic Care | $40.00 |
| Delivery and All Inpatient Services for Maternity Care | 40.00% |
| Dental Check-Up for Children | No Charge after deductible |
| Diabetes Education | $30.00 |
| Diabetic Supplies | 20.00% |
| Dialysis | $60.00 |
| Durable Medical Equipment | 40.00% |
| Emergency Transportation/Ambulance | 40.00% |
| Eye Glasses for Children | 50.00% |
| Gender Affirming Care | 40.00% |
| Habilitation Services | $60.00 |
| Hearing Aids | $30.00 |
| Home Health Care Services | No charge |
| Hospice Services | No charge |
| Imaging (CT/PET Scans, MRIs) | $500.00 |
| Laboratory Outpatient and Professional Services | 40.00% |
| Major Dental Care - Child | 50.00% Coinsurance after deductible |
| Nutritional Counseling | $30.00 |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $60.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 40.00% |
| Outpatient Rehabilitation Services | $60.00 |
| Prenatal and Postnatal Care | 40.00% |
| Private-Duty Nursing | 40.00% |
| Prosthetic Devices | 40.00% |
| Prosthetics: Legs and Arms | 20.00% |
| Prosthetics: Recreational | 20.00% |
| Radiation | 40.00% |
| Reconstructive Surgery | 40.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $60.00 |
| Rehabilitative Occupational Therapy | $60.00 |
| Rehabilitative Physical Therapy | $60.00 |
| Rehabilitative Speech Therapy | $60.00 |
| Routine Eye Exam for Children | $30.00 |
| Skilled Nursing Facility | 40.00% |
| Standalone Laboratory | 40.00% |
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