Copay Plan Comparison | DHR

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.

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		$750	Not Covered
Family	$3,000	$6,000		$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

* 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