Below are some of the questions that are frequently asked by our members, as well as information on more general topics. If you have any questions not addressed in this space please do not hesitate to contact us.

Commonly Prescribed Medications

Specialty Medications

When does my PPO deductible start and end?

The deductible is on a calendar year basis, from January 1, to December 31.

Do I have a separate co-payment for lab charges on the PPO plans?

Yes, the same amount as the office visit co-payment when the lab work is being done by a different provider.

Do emergency room charges apply toward the PPO deductible?

Yes, even if your doctor directs you toward the emergency room.

On the PPO plans will x-rays be covered under my office visit co-pays?

If performed in an office setting and billed with the office visit, then the co-pay would apply. Otherwise it may be subject to your deductible/out of pocket maximum

Do I have to get a referral on the EPO to see a specialist?

No, but you must see a contracted provider.

When do my annual dental benefits re-set?

January 1st of each year.

Are Flu Shots Covered on Kaiser?

Please see flyers below - based on your Kaiser area

Flu Flyer Southern Colorado

Flu Flyer Northern Colorado

Flu Flyer Denver-Boulder


Relevant Topics

Maternity

PPO – at a contracted provider, there is one office visit co-payment if plan has co-pay. Then charges are paid at the end of the pregnancy, billed on a global basis, subject to the plan deductible and coinsurance.

EPO – office visit co-pay for 1st prenatal visit, then hospital co-pay at the time of delivery.

Newborn

A newborn is covered for the first 30 days, in the absence of other coverage. If the child is added to the CEBT plan, premiums will be due from the date of birth. The deductible is waived if the mom and newborn are discharged with mom, then the plan deductible would be applied.

An employee has 30 days from the date of birth to add the newborn to the CEBT plan. If the child is added to another plan we will need an Other insurance form completed and proof from other carrier.

COBRA

An employee who loses their coverage, unless due to gross misconduct, can continue on COBRA for up to 18 months at their own cost. Dependents are able to go onto the members COBRA coverage; however, the dependents must be covered on the policyholder's coverage at the time of employee termination.

Deductible

The following are some, but not all examples of charges that would apply toward the PPO plan deductible.

  • X-rays, MRI’s, CT Scans, PET Scans, etc
  • Hospital charges (in or out patient)
  • Emergency room charges and related providers
  • Charges from any non-contracted provider. These charges would be subject to Reasonable & Customary guidelines based on the geographic location of the provider.
  • Durable medical equipment.
  • Prosthetic devices and orthopedic appliances.

Preventative Services

Preventative Services Women

Preventative Services Men

Preventative Services Children

If you have questions or problems that this site could not answer please contact us via email or phone.