KP Select CO Gold 1500/25 RX Copay - 21032CO0710054 Health Insurance Plan
Kaiser Foundation Health Plan of Colorado health insurance plan with the Plan ID 21032CO0710054. The plan is called KP Select CO Gold 1500/25 RX Copay.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 80.33% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 19.67% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 21032CO0710054 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Colorado | ||||||||||||||||||
| Health Insurance Issuer | Kaiser Foundation Health Plan of Colorado | ||||||||||||||||||
| Health Insurance Plan Variant | 21032CO0710054-01 | ||||||||||||||||||
| Provider Network(s) | ['CON004'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 07 May 2024 06:08 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Mon, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
KP Select CO Gold 1500/25 RX Copay Health Insurance Plan Variant 21032CO0710054-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Gold On Exchange Plan |
| Drug EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 20.00% |
| Drug EHB Deductible, In Network (Tier 1), Family | $0 per person | $0 per group |
| Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| Drug EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Diabetes, High Blood Pressure & High Cholesterol |
| First Tier Utilization | 100% |
| Formulary ID | COF022 |
| HIOS Product ID | 21032CO071 |
| HSA/HRA Employer Contribution | No |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 80.33% |
| Issuer ID | 21032 |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | No |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Medical EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 20.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $1500 per person | $3000 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $1,500 |
| Medical EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | CON004 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Services |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergency Services |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 21032CO0710054-01 |
| Plan Level Exclusions | Refer to the EOC |
| Plan Marketing Name | KP Select CO Gold 1500/25 RX Copay |
| Plan Type | HMO |
| Plan Variant Marketing Name | KP Select CO Gold 1500/25 RX Copay |
| QHP/Non QHP | On the Exchange |
| SBC Scenario, Having a Baby, Coinsurance | $2,200 |
| SBC Scenario, Having a Baby, Copayment | $10 |
| SBC Scenario, Having a Baby, Deductible | $1,500 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $200 |
| SBC Scenario, Having Diabetes, Copayment | $1,500 |
| SBC Scenario, Having Diabetes, Deductible | $70 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $100 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $300 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,500 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | COS005 |
| Source Name | SERFF |
| Plan ID | 21032CO0710054 |
| State Code | CO |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family | per person not applicable | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | Not Applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $7500 per person | $15000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,500 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | per person not applicable | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of KP Select CO Gold 1500/25 RX Copay Health Insurance Plan, 21032CO0710054
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about KP Select CO Gold 1500/25 RX Copay, 21032CO0710054 Health Insurance Plan, 21032CO0710054
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Does KP Select CO Gold 1500/25 RX Copay Health Insurance Plan, 21032CO0710054 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (21032CO0710054) Health Insurance Plan, Variant (21032CO0710054-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Diabetes, High Blood Pressure & High Cholesterol
Does (21032CO0710054) Health Insurance Plan, Variant (21032CO0710054-01) have Out Of Country Coverage?
Yes. Details: Emergency Services
Does (21032CO0710054) Health Insurance Plan, Variant (21032CO0710054-01) have Out of Service Area Coverage?
Yes. Details: Emergency Services
Does (21032CO0710054) Health Insurance Plan, Variant (21032CO0710054-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Diabetes, High Blood Pressure & High Cholesterol
Does KP Select CO Gold 1500/25 RX Copay Health Insurance Plan, Variant (21032CO0710054-01) offer Disease Management Programs for Asthma?
Yes, the KP Select CO Gold 1500/25 RX Copay Health Insurance Plan Variant
21032CO0710054-01 offers Disease
Management Program for Asthma.
Does KP Select CO Gold 1500/25 RX Copay Health Insurance Plan, Variant (21032CO0710054-01) offer Disease Management Programs for Diabetes?
Yes, the KP Select CO Gold 1500/25 RX Copay Health Insurance Plan Variant
21032CO0710054-01 offers Disease
Management Program for Diabetes.
Does KP Select CO Gold 1500/25 RX Copay Health Insurance Plan, Variant (21032CO0710054-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the KP Select CO Gold 1500/25 RX Copay Health Insurance Plan Variant
21032CO0710054-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Disclaimer: This is based on the import(Date: Tue, 07 May 2024 06:08 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API