2015-16 Plan Comparison Tool

Use this tool to compare the various coverage options for plans offered from July 1, 2015 - June 30, 2016.

Return to the Open Enrollment homepage.

First, check your plan eligibility:

CU Health Plan - Exclusive CU Health Plan - Extended CU Health Plan - High Deductible (HSA Compatible) CU Health Plan - Kaiser
Faculty
University staff
Classified staff
Retirees younger than 65
Surviving spouses younger than 65
Faculty
University staff
Classified staff
Faculty
University staff
Classified staff
Retirees younger than 65
Surviving spouses younger than 65
Faculty
University staff
Classified staff
Retirees younger than 65
Surviving spouses younger than 65

Note: This is just a guide. For details on coverage, please call the number listed on each plan summary document.

Type of plan

See descriptions of the three major types of health plans.

CU Health Plan - Exclusive CU Health Plan - Extended CU Health Plan - High Deductible (HSA Compatible) CU Health Plan - Kaiser
Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Preferred Provider Organization (PPO) Extended Provider Organization (EPO)

Where the plan is available

CU Health Plan - Exclusive CU Health Plan - Extended CU Health Plan - High Deductible (HSA Compatible) CU Health Plan - Kaiser
Available in Colorado, separated into three regional networks of coverage

You first select a plan-covered primary care physician; where he/she practices determines in which network you receive care:

 
  • Exclusive Central: Receive care at University of Colorado Hospital in Aurora
     
  • Exclusive North: Receive care at Poudre Valley Hospital in Fort Collins, and at Medical Center of the Rockies in Loveland 
     
  • Exclusive South: Receive care at Memorial Hospital in Colorado Springs
Available in Colorado and throughout the United States Available in Colorado and throughout the United States Available in the Denver/Boulder area in portions of the following counties:
  • Adams
  • Arapahoe
  • Boulder
  • Broomfield
  • Clear Creek
  • Denver
  • Douglas
  • Elbert
  • Gilpin
  • Jefferson
  • Larimer
  • ​Park
  • Weld

Available in southern Colorado in portions of the following counties:
  • Crowley
  • Custer
  • Douglas
  • El Paso
  • Fremont
  • Huerfano
  • Las Animas
  • Lincoln
  • Otero
  • Park
  • Pubelo
  • Teller

Deductible(s)

CU Health Plan - Exclusive CU Health Plan - Extended CU Health Plan - High Deductible (HSA Compatible) CU Health Plan - Kaiser
Individual
$250

Family
$750
Individual
$750

Family
$1,500
Individual
  • In network: $1,500
  • Out of network: $3,000

Family
  • In network: $3,000
  • Out of network: $6,000
None

Out-of-pocket limit

CU Health Plan - Exclusive CU Health Plan - Extended CU Health Plan - High Deductible (HSA Compatible) CU Health Plan - Kaiser
Individual
$6,600 (premiums, balance-billed charges and non-covered care not included)

Family
$13,200 (premiums, balance-billed charges and non-covered care not included)
Individual
$6,600 (premiums, balance-billed charges and non-covered care not included)

Family
$13,200 (premiums, balance-billed charges and non-covered care not included)

 
Individual
  • In network: $3,000 (includes deductible and coinsurance)
  • Out of network: 6,000 (includes deductible and coinsurance)

Family
  • In network: $6,000 (includes deductible and coinsurance)
  • Out of network: $12,000 (includes deductible and coinsurance)
Individual
$4,000 (includes copayments, except for prescriptions)

Family
$10,000 (includes copayments, except for prescriptions)

Covered providers

CU Health Plan - Exclusive CU Health Plan - Extended CU Health Plan - High Deductible (HSA Compatible) CU Health Plan - Kaiser
See a list of covered providers at www.anthem.com/cuhealthplan, or call 1-800-735-6072. See a list of covered providers at www.anthem.com/cuhealthplan, or call 1-800-735-6072. See a list of covered providers at www.anthem.com/cuhealthplan, or call 1-800-735-6072. See a list of covered providers at www.kp.org/cuhealthplan, or call 1-866-213-3062.

Referrals for specialty care

CU Health Plan - Exclusive CU Health Plan - Extended CU Health Plan - High Deductible (HSA Compatible) CU Health Plan - Kaiser
Referral required No referral required No referral required Referral required

 

Uncovered services

Following are the major services each plan does not cover. Note: This is not a complete list; please see each plan's benefits booklet for additional information about excluded services.

CU Health Plan - Exclusive CU Health Plan - Extended CU Health Plan - High Deductible (HSA Compatible) CU Health Plan - Kaiser
  • Adult dental care
  • Cosmetic surgery
  • Infertility treatment
  • Long-term care
  • Non-emergency care outside the United States
  • Private-duty nursing
  • Routine foot care
  • Weight-loss programs (unless in conjunction with approved bariatric surgery plan)
  • Adult dental care
  • Cosmetic surgery
  • Infertility treatment
  • Long-term care
  • Private-duty nursing
  • Routine foot care
  • Routine vision exam
  • Weight-loss programs (unless in conjunction with approved bariatric surgery plan)
  • Adult dental care
  • Cosmetic surgery
  • Infertility treatment
  • Long-term care
  • Private-duty nursing
  • Routine eye care
  • Routine foot care
  • Weight-loss programs (unless in conjunction with approved bariatric surgery plan)
  • Adult hearing aids
  • Cosmetic surgery
  • Dental care
  • Long-term care
  • Non-emergency care outside the United States
  • Private-duty nursing
  • Weight-loss programs (unless in conjunction with approved bariatric surgery plan)

Medical office visit costs

All preventive care visits, including immunizations and screenings, are fully covered by each of the plans below when you see an in-network provider. Out-of-network preventive care is not covered*.

Use the icons below to determine costs for care from in-network providers versus care from out-of-network providers:

 = in-network provider
 = out-of-network provider

  CU Health Plan - Exclusive CU Health Plan - Extended CU Health Plan - High Deductible (HSA Compatible) CU Health Plan - Kaiser

 
$30 ($40 for specialists) $40 ($50 for specialists) 15 percent coinsurance after you've met your deductible $30 ($40 for specialists)

Not covered Not covered 35% coinsurance after you've met your deductible (*this includes out-of-network preventive care) Not covered

Diagnostic and imaging tests (blood work, X-rays and scans)

Use the icons below to determine costs for care from in-network providers versus care from out-of-network providers:

 = in-network provider
 = out-of-network provider

  CU Health Plan - Exclusive CU Health Plan - Extended CU Health Plan - High Deductible (HSA Compatible) CU Health Plan - Kaiser
Blood work and X-rays

No copayment after you've met your deductible 10% coinsurance after you've met your deductible 15% coinsurance after you've met your deductible Fully covered

Not covered 10% coinsurance after you've met your deductible 35% coinsurance after you've met your deductible Not covered
Scans (CT and PET) and MRIs

No copayment after you've met your deductible 10% coinsurance after you've met your deductible 15% coinsurance after you've met your deductible $100 per procedure

Not covered 10% coinsurance after you've met your deductible 35% coinsurance after you've met your deductible Not covered

Prescription drug coverage

For details about costs at each covered pharmacy, please review each plan's benefits summary.

Use the icons below to determine costs for care from in-network providers versus care from out-of-network providers:

 = in-network provider
 = out-of-network provider

  CU Health Plan - Exclusive CU Health Plan - Extended CU Health Plan - High Deductible (HSA Compatible)
all costs reflect charges after you've met your deductible
CU Health Plan - Kaiser
Generic drugs (Tier 1)
UCHealth Retail
  • $13 for a 30-day supply
  • $26 for a 90-day supply
     
Anthem Retail
  • $15 for a 30-day supply
  • $26 for a 90-day supply
Anthem & UCHealth Retail
$15 for a 30-day supply

UCH Mail Order
$30 for a 90-day supply
Anthem Retail
20% coinsurance for a 30-day supply


UCHealth Retail or UCH Mail Order
20% coinsurance for a 90-day supply
Retail
$15 for a 30-day supply

Mail Order
$30 for 90-day


Not covered

Not covered

20% coinsurance for a 30-day supply after you've met your deductible

Not covered
Preferred-brand drugs (Tier 2)

UCHealth Retail
  • $30 for a 30-day supply
  • $60 for a 90-day supply
Anthem Retail
$35 for a 30-day supply

UCH Mail Order
$60 for a 90-day supply
Anthem & UCH Retail
$35 for a 30-day supply

UCH Mail Order
$70 for a 90-day supply
Anthem Retail
20 percent coinsurance for a 30-day supply

UCHealth Retail or UCH Mail Order
20 percent coinsurance for a 90-day supply

Retail $35 for a 30-day supply

Mail Order
$70 for a 90-day supply


 Not covered

 Not covered

20% coinsurance for a 30-day supply

 Not covered
Non-preferred-brand drugs (Tier 3)

UCHealth Retail
  • $50 for a 30-day supply
  • $100 for a 90-day supply

Anthem Retail
$50 for a 30-day supply

UCH Mail Order
$100 for a 90-day supply
Anthem & UCHealth Retail
$50 for a 30-day supply

UCH Mail Order
$100 for a 90-day supply
Anthem Retail
20 percent coinsurance for a 30-day supply

UCHealth Retail or UCH Mail Order
20 percent coinsurance for a 90-day supply
Not covered


​ Not covered

Not covered

20% coinsurance for a 30-day supply

Not covered
Specialty oral and injectable drugs (Tier 4)

Anthem Retail, UCHealth Retail and UCH Mail Order
$75 for a 30-day supply
Anthem Retail, UCHealth Retail & Mail Order
$75 for a 30-day supply
Anthem Retail, UCHealth Retail & Mail Order
20 percent coinsurance for a 30-day supply
20% coinsurance (up to a maximum of $75 per drug for 30 days)


Not covered

Not covered

20 percent coinsurance for a 30-day supply

Not covered

Surgery (includes facility and surgeon/physician fees)

Use the icons below to determine costs for care from in-network providers versus care from out-of-network providers:

 = in-network provider
 = out-of-network provider

  CU Health Plan - Exclusive CU Health Plan - Extended CU Health Plan - High Deductible (HSA Compatible) CU Health Plan - Kaiser
No copayment after you've met your deductible (100% covered) 10% coinsurance after you've met your deductible 15% coinsurance after you've met your deductible $250 copayment

Not covered Not covered 35% coinsurance after you've met your deductible Not covered

Emergency or urgent care (includes transportation and care)

Use the icons below to determine costs for care from in-network providers versus care from out-of-network providers:

 = in-network provider
 = out-of-network provider

  CU Health Plan - Exclusive CU Health Plan - Extended CU Health Plan - High Deductible (HSA Compatible) CU Health Plan - Kaiser
ER services
$150 per visit


Transportation
No copayment after you've met your deductible


Urgent care
$30 per visit
ER services
$150 per visit


Transportation
10 percent coinsurance after you've met your deductible


Urgent care
$40 per visit
ER services, transportation and urgent care
15 percent coinsurance after you've met your deductible
ER services
$150 copayment


Transportation
Fully covered


Urgent care
$30 copayment

ER services
$150 per visit


Transportation
No copayment after you've met your deductible


Urgent care
$30 per visit
ER services
$150 per visit


Transportation
10 percent coinsurance after you've met your deductible


Urgent care
$40 per visit
ER services, transportation and urgent care
35 percent coinsurance after you've met your deductible
ER services
$150 copayment


Transportation
Fully covered


Urgent care
$30 copayment

Hospital stays

Use the icons below to determine costs for care from in-network providers versus care from out-of-network providers:

 = in-network provider
 = out-of-network provider

  CU Health Plan - Exclusive CU Health Plan - Extended CU Health Plan - High Deductible (HSA Compatible) CU Health Plan - Kaiser

Facility fee
No copayment after you've met your deductible


Physician/surgeon fee
Fully covered
Facility and physician/surgeon fee
10 percent coinsurance after you've met your deductible
Facility and physician/surgeon fee
15 percent coinsurance after you've met your deductible
Facility and physician/surgeon fee
$250 copayment per day

Facility and physician/surgeon fee
Not covered
Facility and physician/surgeon fee
Not covered
Facility and physician/surgeon fee
35 percent coinsurance after you've met your deductible
Facility and physician/surgeon fee
Not covered

Mental or behavioral health, and substance abuse coverage

Use the icons below to determine costs for care from in-network providers versus care from out-of-network providers:

 = in-network provider
 = out-of-network provider

  CU Health Plan - Exclusive CU Health Plan - Extended CU Health Plan - High Deductible (HSA Compatible) CU Health Plan - Kaiser

Outpatient
$30 per office visit and no copayment after you've met your deductible for the outpatient facility


Inpatient
No copayment after you've met your deductible
Outpatient
$40 per office visit and 10 percent coinsurance after you've met your deductible for the outpatient facility


Inpatient
10 percent coinsurance after you've met your deductible
Inpatient and Outpatient
15 percent coinsurance after you've met your deductible


 
Outpatient
$30 copayment


Inpatient
$250 copayment per day

Not covered Not covered 35 percent coinsurance after you've met your deductible Not covered

Pregnancy (includes prenatal and postnatal care, delivery, and all inpatient services)

Use the icons below to determine costs for care from in-network providers versus care from out-of-network providers:

 = in-network provider
 = out-of-network provider

  CU Health Plan - Exclusive CU Health Plan - Extended CU Health Plan - High Deductible (HSA Compatible) CU Health Plan - Kaiser
Prenatal and postnatal care
$15 copayment for first prenatal care office visit


Delivery and all inpatient services
No copayment after you've met your deductible
Prenatal and postnatal care
$25 copayment for the first prenatal care office visit


Delivery and all inpatient services
10 percent coinsurance after you've met your deductible
Prenatal and postnatal care, and delivery and all inpatient services
15 percent coinsurance after you've met your deductible
Prenatal and postnatal care
Fully covered


Delivery and all inpatient services
$250 copayment per day

Not covered Not covered 35 percent coinsurance after you've met your deductible Not covered

Recovery (includes home health care, rehabilitation, habilitation, skilled nursing care, durable medical equipment and hospice service

Use the icons below to determine costs for care from in-network providers versus care from out-of-network providers:

 = in-network provider
 = out-of-network provider

  CU Health Plan - Exclusive CU Health Plan - Extended CU Health Plan - High Deductible (HSA Compatible) CU Health Plan - Kaiser

Home Health Care, Skilled Nursing Care & Hospice Care
No copayment after you've met your deductible

Rehabilitation & Habilitation
  • Inpatient: No copayment after you've met your deductible
  • Outpatient: $30 per visit
     
Durable Medical Equipment
20 percent coinsurance (not subject to deductible for prosthetic appliances, and no copayment after you've met your deductible for all other durable medical equipment
All services
10 percent coinsurance after you've met your deductible
All services
15 percent coinsurance after you've met your deductible
Home Health Care, Skilled Nursing Care & Hospice Care
Fully covered

Rehabilitation & Habilitation
$30 copayment

Not covered Durable Medical Equipment
10 percent coinsurance after you've met your deductible

All other services
Not covered
All services
35 percent coinsurance after you've met your deductible
All services
Not covered

Child dental and eye care

Use the icons below to determine costs for care from in-network providers versus care from out-of-network providers:

 = in-network provider
 = out-of-network provider

  CU Health Plan - Exclusive CU Health Plan - Extended CU Health Plan - High Deductible (HSA Compatible) CU Health Plan - Kaiser
Eye exam
$30 per visit (exam only)

Glasses
Not covered

Dental checkup
Not covered
All services
Not covered
All services
Not covered
Eye exam
  • $30 for an optometrist
  • $40 for an ophthalmologist

Glasses
Not covered

Dental checkup
Not covered

Eye exam
Up to a $35 maximum reimbursement

Glasses
Not covered

Dental checkup
Not covered
All services
Not covered
All services
Not covered
All services
Not covered

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