Kaiser [1]
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. [2] within one single statewide network.NetworkThe facilities, providers and suppliers with whom your health insurer or plan has contracted to provide health care services [3] 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. [4] 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. [5]. 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. [6], 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. [7] for medical visits, diagnostic testing and hospital/facilities services.
This plan provides one no-cost preventative mental health visit per plan year. Learn more about your mental health benefit options on our Mental Health Resources page [8].
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. [9] 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. [10] 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 [11].
Plan details
- CU Health Plan - Kaiser Benefits Coverage Summary [12] (9 pages)
- CU Health Plan - Kaiser Benefits Booklet [13] (144 pages)
- Kaiser Preventative Care Guidelines [14]
Covered providers and medications
- Find a provider/urgent care [15]
- Visit Kaiser's microsite [16]
- Access the Kaiser Formulary [17]
- Preventive tier drug list [18]
- Call 1-877-883-6698
Out-of-area benefit for dependents only
This benefit applies to services listed in the Summary Chart (page 124 of Benefits Booklet).
Office visit Primary care, Specialty, Mental Health/Chemical Dependency, Well Child prevention, Gynocological and Allergy injection visits are covered. All other visits are not covered. |
$30 |
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 |
Prescription Drug | Brand/Generic |
Physical, Occupational & Speech Therapies | 5 combined visits per plan year |