KP Select CO Silver 2200/25 - 21032CO0410030 Health Insurance Plan

Kaiser Foundation Health Plan of Colorado health insurance plan with the Plan ID 21032CO0410030. The plan is called KP Select CO Silver 2200/25.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 73.98% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 26.02% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 21032CO0410030
Health Insurance Plan Year 2024
State Colorado
Health Insurance Issuer Kaiser Foundation Health Plan of Colorado
Health Insurance Plan Variant 21032CO0410030-04
Provider Network(s) ['CON002']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 24 Dec 2024 06:21 GMT).

Providers Colorado All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
Available Variants of the Health Plan

Standard On Exchange Plan - 21032CO0410030-01

Open to Indians below 300% FPL - 21032CO0410030-02

Open to Indians above 300% FPL - 21032CO0410030-03

73% AV Silver Plan - 21032CO0410030-04

87% AV Silver Plan - 21032CO0410030-05

94% AV Silver Plan - 21032CO0410030-06

Last Plan Update Date Fri, 31 May 2024 00:00 GMT
Last Import Date Tue, 24 Dec 2024 06:21 GMT

KP Select CO Silver 2200/25/73% CSR Health Insurance Plan Variant 21032CO0410030-04 Attributes

Plan Attribute Value
Business Year 2024
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type 73% AV Level Silver 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 35.00%
Drug EHB Deductible, In Network (Tier 1), Family $875 per person | per group not applicable
Drug EHB Deductible, In Network (Tier 1), Individual $875
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
Design Type Not Applicable
Disease Management Programs Offered High Blood Pressure & High Cholesterol, Diabetes, Asthma
EHB Percent of Total Premium 99%
First Tier Utilization 100%
Formulary ID COF005
HIOS Product ID 21032CO041
Import Date 5/31/2024
HSA Eligible No
IsItANewPlan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer Actuarial Value 73.98%
Issuer ID 21032
Market Coverage Individual
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 35.00%
Medical EHB Deductible, In Network (Tier 1), Family $2200 per person | $4400 per group
Medical EHB Deductible, In Network (Tier 1), Individual $2,200
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 Silver
Multiple In Network Tiers No
National Network No
Network ID CON002
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 1/1/2024
Plan Expiration Date 12/31/2024
Plan ID (Standard Component ID with Variant) 21032CO0410030-04
Plan Level Exclusions Refer to EOC
Plan Marketing Name KP Select CO Silver 2200/25
Plan Type HMO
Plan Variant Marketing Name KP Select CO Silver 2200/25/73% CSR
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $3,200
SBC Scenario, Having a Baby, Copayment $200
SBC Scenario, Having a Baby, Deductible $2,200
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $200
SBC Scenario, Having Diabetes, Copayment $1,600
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $70
SBC Scenario, Treatment of a Simple Fracture, Copayment $200
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,000
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID COS002
Source Name SERFF
Plan ID 21032CO0410030
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 $7100 per person | $14200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $7,100
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 Silver 2200/25 Health Insurance Plan, 21032CO0410030

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about KP Select CO Silver 2200/25, 21032CO0410030 Health Insurance Plan, 21032CO0410030

  • Does KP Select CO Silver 2200/25 Health Insurance Plan, 21032CO0410030 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (21032CO0410030) Health Insurance Plan, Variant (21032CO0410030-04) offer Disease Management Programs?

    Yes, and here is the list of available programs: High Blood Pressure & High Cholesterol, Diabetes, Asthma

    Does (21032CO0410030) Health Insurance Plan, Variant (21032CO0410030-04) have Out Of Country Coverage?

    Yes. Details: Emergency Services

    Does (21032CO0410030) Health Insurance Plan, Variant (21032CO0410030-04) have Out of Service Area Coverage?

    Yes. Details: Emergency Services

    Does (21032CO0410030) Health Insurance Plan, Variant (21032CO0410030-04) offer Disease Management Programs?

    Yes, and here is the list of available programs: High Blood Pressure & High Cholesterol, Diabetes, Asthma

    Does KP Select CO Silver 2200/25/73% CSR Health Insurance Plan, Variant (21032CO0410030-04) offer Disease Management Programs for Asthma?

    Yes, the KP Select CO Silver 2200/25/73% CSR Health Insurance Plan Variant 21032CO0410030-04 offers Disease Management Program for Asthma.

    Does KP Select CO Silver 2200/25/73% CSR Health Insurance Plan, Variant (21032CO0410030-04) offer Disease Management Programs for Diabetes?

    Yes, the KP Select CO Silver 2200/25/73% CSR Health Insurance Plan Variant 21032CO0410030-04 offers Disease Management Program for Diabetes.

    Does KP Select CO Silver 2200/25/73% CSR Health Insurance Plan, Variant (21032CO0410030-04) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the KP Select CO Silver 2200/25/73% CSR Health Insurance Plan Variant 21032CO0410030-04 offers Disease Management Program for High blood pressure & high cholesterol.

 

Disclaimer: This is based on the import(Date: Tue, 24 Dec 2024 06:21 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