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Compare CU Health Plans, 2023-24
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Who is Eligibile?
Type of plan
Provider
Cost for
Monthly premiums
- Retirees
Total Cost of
premiums for
the plan year,
July 1 - June 30
- Retirees
Cost for
Monthly premiums
- Surviving Spouses
Total Cost of
premiums for
the plan year,
July 1 - June 30
- Surviving Spouses
Coverage areas
Deductible(s)
Out-of-pocket
limits
Covered
Providers
Referrals for
Specialty care
Preventative care
(screenings,
Immunizations, etc.)
Medical office
visit costs
Diagnostic tests
(bloodworK,
X-RAYS, etc.)
imaging
(CT/PET Scans, MRI)
Prescription
drug coveragE
for Generic Drugs
(Tier 1)
Prescription
drug coverage for
PReferred-Brand
Drugs (Tier 2)
Prescription
drug coverage for
Non-preferred
Brand drugs
(Tier 3)
Prescription
drug coverage for
Specialty Oral &
Injectable drugs
(Tier 4)
Outpatient
surgery
Facility fees
OUTPATIENT
SURGERY
Physician &
Surgeon fees
Emergency Care
Urgent care
Hospital stays:
Facility FeeS
HOspital Stays:
Physician or
SurgeoN Fees
Mental or
behavioral
health and
substance
abuse coverage
PregnancY:
Office Visits
prEGNANCY:
dELIVERY
prOFESSIONAl
sERVICES
pregnancy:
dELIVERY
fACILITY
sERVICES
home health care
REHABILITATION
SERVICES
Habilitation
ServiCes
Skilled Nursing
Care
Durable MedicaL
Equipment
Hospice services
Child eye care
CHILD DENTAL
Uncovered
services
CU Health Plan - Exclusive
Non-Medicare-eligible retirees
Non-Medicare-eligible
Surviving spouse
Health Maintenance Organization (HMO)
Anthem Blue Cross Blue Shield
Retiree: $80.50
Retiree + Spouse: $234.50
Retiree + Child(ren): $148.50
Family: $289.00
Retiree: $966.00
Retiree + Spouse: $2,814.00
Retiree + Child(ren): $1,782.00
Family (3+): $3,468.00
Surviving Spouse: $105.50
Surviving Spouse + Child(ren): $173.50
Surviving Spouse: $1,266.00
Surviving Spouse + Child(ren): $2,082.00
Colorado
Out-of-state dependent coverage may be available.
Individual: $350
Family: $750
Individual:
$9,100
Family:
$18,200
Visit Anthem's
microsite
,
or call 1-800-735-6072.
No referral required
In network:
$0 per visit,
deductible does not apply
Out of network:
Not covered
In network:
$30 per visit for primary care
$40 per visit for specialists
Out of network:
Not covered
In network:
$0 per visit
after deductible is met
Out of network:
Not covered
In network:
$0 per visit
after deductible is met
Out of network:
Not covered
In network:
CVS Retail Network Pharmacies:
$10 for up to a 30-day supply
CVS Retail Pharmacies or CVS Mail Order: $20 for up to a 90-day supply
Out of network:
Not covered
In network:
CVS Retail Network Pharmacies:
$50 for up to a 30-day supply
CVS Retail Pharmacies
or CVS Mail Order:
$100 for up to a 90-day supply
Out of network:
Not covered
In network:
CVS Retail Network Pharmacies:
$75 for up to a 30-day supply
CVS Retail or CVS Mail Order:
$150 for up to a 90-day supply
Out of network:
Not covered
In network:
CVS Retail Network Pharmacies:
$100 for up to a 30-day supply
CVS Retail Pharmacies
or CVS Mail Order:
$75 for up to a 30-day supply
Out of network:
Not covered
In network:
$100 per visit after
deductible is met
Out of network:
Not covered
In network:
No charge
Out of network:
Not covered
In network:
Emergency room care:
$250 per visit
(waived if admitted)
Emergency medical transportation:
$0 after deductible is met
Out of network:
Emergency room care:
$250 per visit
(waived if admitted)
Emergency medical transportation:
$0 after deductible is met
In network:
$30 per visit
deductible does not apply
Out of network:
$30 per visit
deductible does not apply
In network:
$200 per visit after deductible is met
Out of network:
Not covered
In network:
No charge
Out of network:
Not covered
In network:
Outpatient:
$30 per office visit,
deductible does not apply
Inpatient:
$200 per visit
after deductible is met
Out of network:
Not covered
In network:
$15 copayment
for first prenatal care office visit, deductible does not apply
Out of network:
Not covered
In network:
No charge
Out of network:
Not covered
In network:
$200 per visit
after deductible is met
Out of network:
Not covered
In network:
$0 after deductible is met
Out of network:
Not covered
In network:
Inpatient: $200 per visit
after deductible is met
Outpatient:
$30 per visit,
deductible does not apply
Out of network:
Not covered
In network:
Outpatient:
$30 per visit,
deductible does not apply
Out of network:
Not covered
In network:
$0 after deductible is met
Out of network:
Not covered
In network:
20% coinsurance
not subject to deductible for prosthetic appliances;
$0 after deductible for all other durable medical equipment (100% covered)
Out of network:
Not covered
In network:
$0 after deductible is met
Out of network:
Not covered
In network:
Eye exam:
$20 per visit (exam only,
deductible does not apply)
Glasses:
Not covered
Out of network:
Eye exam:
$35 maximum reimbursement
Glasses:
Not covered
In network:
Not covered
Out of network:
Not covered
Abortion (except in cases of rape, incest, or when the life of the mother is endangered)
Adult dental care
Cosmetic surgery
Long-term care
Non-emergency care
when traveling outside
the United States
Private-duty nursing
Weight-loss programs
CU Health Plan - High Deductible
Non-Medicare-eligible retirees Non-Medicare-eligible
Surviving spouses
Preferred Provider
Organization (PPO)
Anthem Blue Cross Blue Shield
Retiree: $0
Retiree + Spouse: $27.00
Retiree + Child(ren): $24.00
Family: $39.00
Retiree: $0
Retiree + Spouse: $324.00
Retiree + Child(ren): $288.00
Family (3+): $468.00
Surviving Spouse: $25.00
Surviving Spouse + Child(ren): $49.00
Surviving Spouse: $300.00
Surviving Spouse + Child(ren): $588.00
Colorado and nationwide
Individual:
In network: $1,500
Out of network: $3,000
Family:
In network: $3,000
Out of network: $6,000
Individual:
In network: $3,000
Out of network: $6,000
Family:
In network: $6,000
Out of network: $12,000
Visit Anthem's
microsite
,
or call 1-800-735-6072.
No referral required
In network:
$0 per visit
Out of network:
35% coinsurance after deductible is met
In network:
15% coinsurance after deductible is met for primary care or specialist visits
Out of network:
35% coinsurance after deductible is met
In network:
15% coinsurance after deductible is met
Out of network:
35% coinsurance after deductible is met
In network:
15% coinsurance after deductible is met
Out of network:
35% coinsurance after deductible is met
In network:
CVS Retail Network Pharmacies:
10% coinsurance after deductible for up to
a 30-day supply
CVS Retail Pharmacies
or CVS Mail Order:
5% coinsurance after deductible for up to a 90-day supply
Out of network:
20% coinsurance after deductible for up to
a 30-day supply
In network:
CVS Retail Network Pharmacies:
20% coinsurance after deductible for up to
a 30-day supply
CVS Retail Pharmacies or
CVS Mail Order:
15% coinsurance after deductible for up to a
90-day supply
Out of network:
20% coinsurance after deductible for a 30-day supply
In network:
CVS Retail Network Pharmacies:
20% coinsurance after deductible for up to
a 30-day supply
CVS Retail Pharmacies or
CVS Mail Order:
15% coinsurance after deductible for up to a
90-day supply
Out of network:
20% coinsurance after deductible for a 30-day supply
In network:
CVS Retail Network Pharmacies:
20% coinsurance after deductible for up to
a 30-day supply
CVS Retail Pharmacies
or CVS Mail Order:
15% coinsurance after deductible for up to
a 30-day supply
Out of network:
20% coinsurance after deductible for a 30-day supply
In network:
15% coinsurance after deductible is met
Out of network:
35% coinsurance after deductible is met
In network:
15% coinsurance
after deductible is met
Out of network:
35% coinsurance after deductible is met
In network:
Emergency room care:
15% coinsurance after deductible is met
Emergency medical transportation:
15% coinsurance after deductible is met
Out of network:
Emergency room care:
15% coinsurance after deductible is met
Emergency medical transportation:
15% coinsurance after deductible is met
In network:
15% coinsurance after deductible is met
Out of network:
35% coinsurance after deductible is met
In network:
15% coinsurance after deductible is met
Out of network:
35% coinsurance after deductible is met
In network:
15% coinsurance after deductible is met
Out of network:
35% coinsurance after you've met your deductible
In network:
Outpatient:
15% coinsurance after deductible is met
Inpatient:
15% coinsurance after deductible is met
Out of network:
35% coinsurance after deductible is met
In network:
15% coinsurance after deductible is met
Out of network:
35% coinsurance after deductible is met
In network:
15% coinsurance after deductible is met
Out of network:
35% coinsurance after deductible is met
In network:
15% coinsurance after deductible is met
Out of network:
35% coinsurance after deductible is met
In network:
15% coinsurance after deductible is met
Out of network:
35% coinsurance after deductible is met
In network:
15% coinsurance
after deductible is met
Out of network:
35% coinsurance after deductible is met
In network:
15% coinsurance
after deductible is met
Out of network:
35% coinsurance after deductible is met
In network:
15% coinsurance
after deductible is met
Out of network:
35% coinsurance
after deductible is met
In network:
15% coinsurance after deductible is met
Out of network:
Not covered
In network:
15% coinsurance after deductible is met
Out of network:
35% coinsurance after deductible is met
In network:
Not covered
Out of network:
Not covered
In network:
Not covered
Out of network:
Not covered
Abortion (except in cases of rape, incest, or when the life of the mother is endangered)
Adult dental care
Cosmetic surgery
Long-term care
Private-duty nursing
Routine foot care, unless
you have been diagnosed
with diabetes
Routine vision exam
Weight-loss programs
CU Health Plan - Kaiser
Non-Medicare-eligible retirees
Non-Medicare-eligible
Surviving spouses
Exclusive Provider
Organization (EPO)
Kaiser Permanente
Retiree: $151.00
Retiree + Spouse: $382.50
Retiree + Child(ren): $264.50
Family: $493.00
Retiree: $1,812.00
Retiree + Spouse: $4,590.00
Retiree + Child(ren): $3,174.00
Family: $5,916.00
Surviving Spouse: $176.00
Surviving Spouse + Child(ren): $289.50
Surviving Spouse: $2,112.00
Surviving Spouse + Child(ren): $3,474.00
Colorado
Out-of-state dependent coverage may be available.
$0, no deductibles
Individual:
$9,100
Family:
$18,200
Visit Kaiser's
microsite
or
call 1-866-213-3062.
Referral required, but you can self-refer to certain specialists
In network:
$0 per visit
Out of network:
Not covered
In network:
$30 per visit for primary care
$40 per visit for specialists
Out of network:
Not covered
In network:
$0 per visit
Out of network:
Not covered
In network:
$100 per scan
Out of network:
Not covered
In network:
Retail:
$10 for a 30-day supply
Mail Order:
$20 for a 90-day supply
Out of network:
Not covered
In network:
Retail:
$50 for a 30-day supply
Mail Order:
$100 for a 90-day supply
Out of network:
Not covered
In network:
Not covered
Out of network:
Not covered
In network:
20% coinsurance
up to $100 per prescription
Out of network:
20% coinsurance up to
$100 per prescription
In network:
$250 per procedure
Out of network:
Not covered
In network:
Included in facility fee
Out of network:
Not covered
In network:
Emergency room care:
$250 per visit
(waived if admitted)
Emergency medical transportation:
$0 per trip
Out of network:
Emergency room care:
$250 per visit
(waived if admitted)
Emergency medical transportation:
$0 per trip
In network:
$30 per visit
Out of network:
$30 per visit
In network:
$250 copay per day ($1,000 maximum per admission)
Out of network:
Not covered
In network:
Included in facility fee
Out of network:
Not covered
In network:
Outpatient:
$30 per visit
Inpatient:
$250 copayment per day ($1,000 max. per admission)
Out of network:
Not covered
In network:
$0 - fully covered
Out of network:
Not covered
In network:
Included in facility fee
Out of network:
Not covered
In network:
$250 copayment per day ($1,000 maximum per admission)
Out of network:
Not covered
In network:
$0 per visit - fully covered
Out of network:
Not covered
In network:
$30 per visit
Out of network:
Not covered
In network:
$30 per visit
Out of network:
Not covered
In network:
$0 per day
Out of network:
Not covered
In network:
$0 per item
Out of network:
Not covered
In network:
$0 per visit
Out of network:
Not covered
In network:
Eye exam:
$30 for an optometrist
$40 for an opthalmologist
Glasses:
Not covered
Out of network:
Not covered
In network:
Not covered
Out of network:
Not covered
Adult hearing aids
Children's glasses
Cosmetic surgery
Dental care
Long-term care
Non-emergency care outside the United States
Non-preferred brand drugs
Private-duty nursing
Weight-loss programs (unless in conjunction with approved bariatric surgery plan)
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