Kaiser Copay

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 Permanente partners with American Specialty Health so you can get care from their network of acupuncture and chiropractic practitioners at a discounted rate. When you need chiropractic care or acupuncture, you have direct access to more than 3,400 licensed chiropractors and more than 2,000 licensed acupuncturists in California. Comparing network costs versus non-network costs between Kaiser Permanente and United Healthcare in the Co-Pay plans; 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.

Comparing network costs versus non-network costs between Kaiser Permanente and United Healthcare in the Co-Pay plans
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	Not Covered

Out of Pocket Max Comparison
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	Not Covered

Co-Insurance Comparison
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 Visit and Urgent Care Cost Comparison
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	$500 Copay
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 Benefits Comparison
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	50% of eligible expenses after deductible	Outpatient (Therapy)	$30 Copay	Not Covered

Inpatient and Outpatient Addictive Disorders Services Comparison
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	50% of eligible expenses after deductible	Outpatient (Therapy)	$30 Copay	Not Covered

Vision Benefits Comparison
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 Comparison
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

Mozilla old version 40. * 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.

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

All Kaiser Permanente health plans cover the medical benefits you and your family need, with an emphasis on preventive care and your overall wellness. Plus, every plan includes access to high-quality virtual care with Kaiser Permanente doctors and clinicians. Choose from online chat, video, phone, and more¹ to get the care and prescriptions you need or help finding in-person care.

Our plans offer you a wide range of choices in monthly premiums and cost shares, such as copays and coinsurance, to fit your budget and your needs. Learn more about the benefits of each plan.

Kaiser Copay Basic Program

Once you’ve browsed plan rates, benefits, and evidence of coverage documents (linked below), get a quote and enroll directly through Kaiser Permanente.

Kaiser Copay For Emergency Room

If you qualify for financial help with your cost of coverage (use our tool to find out), then you'll need to enroll through the exchange, Washington Healthplanfinder.

More resources

2021 enrollment guide & rates (PDF)
2021 WA Healthplanfinder enrollment guide (PDF)
Summary of benefits and coverage
Enrollment application (PDF)
Dental coverage
Account change form (PDF)
Tobacco affidavit (PDF)
Affordable Care Act
Evidence of coverage