Kaiser Therapy Copay

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

Massage therapy is also limited to 12 visits. Prescription drug copayments are for a 30-day supply at Kaiser Permanente pharmacies. You pay only 2 copays for up to a 100-day supply for most drugs through Kaiser Permanente ’ s mail-order program. Eyewear allowance is available every 2 calendar years at Kaiser Permanente optical centers. If Kaiser is on the list, they should be able to proceed with pursuing treatment. States That Offer Kaiser Permanente Insurance. Kaiser Permanente currently offers health insurance plans in 8 states throughout the U.S. This is a list of the 8 states that are currently covered by Kaiser Permanente: California: Kaiser Permanente of California.

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

Kaiser Therapy Cost

You'll pay either our full copay rate or reduced copay rate. If you live in a high-cost area, you may qualify for a reduced inpatient copay rate no matter what priority group you're in. To find out if you qualify for a reduced inpatient copay rate, call us toll-free at 877-222-8387. We're here Monday through Friday, 8:00 a.m.
The Kaiser Permanente Medicare Advantage High MD (HMO) has a monthly premium of $142.00 and has an in-network Maximum Out-of-Pocket limit of $5,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,700 out of pocket.

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

Kaiser Copay List

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

Kaiser Permanente Washington Specialty Pharmacy is dedicated to helping you manage your specialty medications.

With more than four million prescriptions dispensed annually, Kaiser Permanente Washington is widely recognized as a regional leader in pharmaceutical services. Our focus on prescription effectiveness, patient safety, and affordability is key to our care delivery of specialty medications.

At the heart of our specialty pharmacy program is a team of highly skilled pharmacists and pharmacy technicians dedicated solely to managing your specialty medications. We are in constant contact with you and your doctor to make sure you are getting the most out of your treatment and to help improve your quality of life.

List of specialty medications (PDF)

Specialty pharmacy team

Our specialty pharmacy team members only work with patients on specialty medications. We review all of your medications for possible interactions, discuss dosage, administration, possible side effects, and review any therapy changes with you.

Treatment monitoring

We will contact you every month to coordinate your refill and see how you are doing. We may also provide reminders if you need labs or clinical monitoring to ensure your safety and treatment success.

Updates to your doctor

We are constantly on alert for possible issues that could interfere with your medication's effectiveness or outcomes. Should a problem arise, we will contact your doctor to help coordinate a solution. We will also proactively reach out to your doctor for refills to ensure there are no interruptions in your therapy.

Financial assistance options

Our internal records show that in 2017, we saved our patients over 90% of their out-of-pocket specialty prescription costs. By helping you enroll in eligible copay assistance programs, we increase your access to specialty medications.

24/7 advice and support

You can access the Kaiser Permanente Washington Specialty Pharmacy staff by phone 8:30 a.m.-5 p.m. Monday-Friday (except major holidays) or by secure message on kp.org/wa. We'll answer questions about medications, potential drug interactions, side effects, and any new symptoms. If there are problems with your medication, we'll contact your doctor immediately.

In addition, nurses are available 24/7 via our Consulting Nurse Service (1-800-297-6877) to help address any urgent medication concerns outside of our specialty pharmacy operating hours. On-call physicians and pharmacists are also available as needed.

Convenient refills

Our team will contact you about seven days before a refill is needed. Refills typically occur once a month and can be available for pick up at a Kaiser Permanente Washington clinic pharmacy of your choice or mailed to your home at no additional cost.

Kaiser Copay Cost

NOTE: Kaiser Permanente Washington Specialty Pharmacy may only provide services to Kaiser Permanente WA region members and Kaiser Permanente members from other regions that are visiting Washington state.