Under this Kaiser-administered plan, you can choose any healthcare providerProviderAn individual or facility that provides health care services such as a doctor, nurse, chiropractor, hospital, rehabilitation center, etc. within one single statewide network.NetworkThe facilities, providers and suppliers with whom your health insurer or plan has contracted to provide health care services It is recommended that you select a primary care physician to direct your care. In most cases, referralsReferralA written order from your primary care provider for you to see a specialist or receive certain health care services for any covered service that cannot be performed by your primary care provider. This applies to our Anthem Exclusive and Kaiser plans. are required. However, you may self-refer to certain specialistsSpecialistA physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent, or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.. In place of a deductibleDeductible - Kaiser PlanAn amount that you are required to pay before the plan will begin to reimburse for covered services. This plan has no deductible. , enrollees will be responsible for a copayCopayment (copay)A fixed-dollar amount that you must pay out of your pocket at the time of service to a provider or a facility for a specific health covered service. Copays do not apply to the deductible requirement. For example, an office visit may have a copay of $30 under the Exclusive Plan and $40 under the Extended. You must pay the amount at the time of service. for medical visits, diagnostic testing and hospital/facilities services.
Out-of-networkOut-of-NetworkNon-participating providers or facilities that do not enter into a network agreement, usually resulting in higher out of pocket expenses to you. care is not covered except for emergencyEmergency CareA medical or behavioral health condition that must be treated at the emergency department of a hospital due to an illness, injury, symptom or condition severe enough to risk serious danger to your health (or, with respect to a pregnant woman, the health of her unborn child) if you didn’t get medical attention. See where and when to get care. and/or urgent careUrgent CareCare for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.
- CU Health Plan - Kaiser Benefits Coverage Summary (6 pages)
- CU Health Plan - Kaiser Benefits Booklet (133 pages)
- Kaiser Preventative Care Guidelines
Covered providers and medications
Out-of-area benefit for dependents only
This benefit applies to services listed in the Summary Chart (page 128 of Benefits Booklet).
Primary care, Specialty, Mental Health/Chemical Dependency, Well Child prevention, Gynocological and Allergy injection visits are covered. All other visits are not covered.
|Office visit limits (procedures and labs are excluded)||5 visits per plan year|
|Diagnostic X-ray service limits (X-ray and Ultrasound only)||20% coinsurance
5 per plan year
|Physical, Occupational & Speech Therapies||5 combined visits per plan year|