March 19, 2010

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Kaiser Permanente Colorado – 2000 HSA-Qualified Deductible Plan (80%) – COLORADO

A comparison of the 2000 HSA-Qualified Deductible Plan (80%) offered by Kaiser Permanente Colorado is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application 2000 HSA-Qualified Deductible Plan (80%) Application 2000 HSA-Qualified Deductible Plan (80%) Application
Brochure 2000 HSA-Qualified Deductible Plan (80%) Brochure 2000 HSA-Qualified Deductible Plan (80%) Brochure
Copay
  • Primary Care- 80% coinsurance per visit after deductible is met
  • Specialist Care- 80% coinsurance per visit after deductible is met
    		•
  • Primary Care- 80% coinsurance per visit after deductible is met
  • Specialist Care- 80% coinsurance per visit after deductible is met
    		•
    Office Visit
  • Primary Care- 80% coinsurance per office visit after deductible is met
  • Specialist Care- 80% coinsurance per office visit after deductible is met
    		•
  • Primary Care- 80% coinsurance per office visit after deductible is met
  • Specialist Care- 80% coinsurance per office visit after deductible is met
    		•
    Deductible $2,000 Individual / $4,000 Family $2,000 Individual / $4,000 Family
    Coinsurance 80% 80%
    Coinsurance Limit 2000 HSA-Qualified Deductible Plan (80%) 2000 HSA-Qualified Deductible Plan (80%)
    Out-of-Pocket Maximum $5,000 Individual / $10,000 Family $5,000 Individual / $10,000 Family
    Lifetime Maximum Unlimited lifetime coverage Unlimited lifetime coverage
    Prescription Drugs Not covered Not covered
    Emergency Room Emergency and Urgent Care -
    • Emergency room visits (At a designated Kaiser Permanente emergency room or non-Plan emergency room): 80% coinsurance
    • Ambulance Services: 80% coinsurance
    • Nonroutine Care (Per visit at a Kaiser Permanente medical office or non-Plan facility outside the service area during office hours): 80% coinsurance
    • After-hours Care (Per after-hours visit at a designated Kaiser Permanente after-hours medical office): 80% coinsurance
    		 Emergency and Urgent Care -
    • Emergency room visits (At a designated Kaiser Permanente emergency room or non-Plan emergency room): 80% coinsurance
    • Ambulance Services: 80% coinsurance
    • Nonroutine Care (Per visit at a Kaiser Permanente medical office or non-Plan facility outside the service area during office hours): 80% coinsurance
    • After-hours Care (Per after-hours visit at a designated Kaiser Permanente after-hours medical office): 80% coinsurance
    Adult Preventative Care No charge No charge
    Child Preventative Care No charge No charge
    Lab / X-Ray Laboratory and X-ray -
    • Diagnostic Lab and X-ray: 80% coinsurance
    • Therapeutic X-ray: 80% coinsurance
    		 Laboratory and X-ray -
    • Diagnostic Lab and X-ray: 80% coinsurance
    • Therapeutic X-ray: 80% coinsurance
    Maternity Not covered Not covered
    Physical Therapy 2000 HSA-Qualified Deductible Plan (80%) 2000 HSA-Qualified Deductible Plan (80%)
    Skilled Nursing 2000 HSA-Qualified Deductible Plan (80%) 2000 HSA-Qualified Deductible Plan (80%)
    Home Health Care 2000 HSA-Qualified Deductible Plan (80%) 2000 HSA-Qualified Deductible Plan (80%)
    Mental Health 2000 HSA-Qualified Deductible Plan (80%) 2000 HSA-Qualified Deductible Plan (80%)
    Hospital Care Inpatient Hospital -
    • Hospital Care: 80% coinsurance per admission
    • Inpatient Professional Visits: 80% coinsurance
    Outpatient -
    • Ambulatory Surgery: 80% coinsurance
    		 Inpatient Hospital -
    • Hospital Care: 80% coinsurance per admission
    • Inpatient Professional Visits: 80% coinsurance
    Outpatient -
    • Ambulatory Surgery: 80% coinsurance
    Optional Benefits 2000 HSA-Qualified Deductible Plan (80%) 2000 HSA-Qualified Deductible Plan (80%)