KP CO Silver 2200/25 – HMO
Network type: HMO
Coverage tier: Silver
Primary care visit: $25 copay
Specialist visit: $50 copay
Urgent care visit: $100 copay
Description
Health Care Plan Details
| Network type | HMO |
| Deductible | $2,200 per person $2,200 per person |
| Out-of-pocket max | $8,800 per person $17,600 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $25 copay |
| Specialist visit | $50 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $100 copay |
| Emergency room | 35% after deductible |
| Ambulance | 35% after deductible |
| Hospital stay (facility) | 35% after deductible |
| Hospital stay (physician) | 35% after deductible |
| Outpatient procedure (facility) | 35% after deductible |
| Outpatient procedure (physician) | 35% after deductible |
| Physical rehabilitation | $50 copay |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | 35% after deductible |
Pharmacy, Drugs, and Medication
| Generic | $20 copay |
| Brand | $85 copay after deductible |
| Non-preferred Brand | 35% after deductible |
| Specialty | 35% after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | 35% after deductible |
| Imaging (CT/PET/MRI) | $500 copay |
| Blood work | $30 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $25 copay |
| Psychiatric hospital stay | 35% after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://d2ed110nmrd591.cloudfront.net/blobs/WCGvEpgqhneHwgrmPCPLHn9s.pdf |
