Medical Benefits to Serve Your Needs

We work with CEBT to offer three medical insurance plan options for eligible employees. These plans are not bundled with dental or vision, and enrollment elections must be made separately. To estimate your benefit costs, use our Benefits Calculator.

PPO Select 2

Employee Cost

The monthly medical premiums listed below are based on full-time employment / 1.0 FTE. To estimate your benefit costs, use our Benefits Calculator.

  • Employee Only: $0
  • Employee and Spouse: $696
  • Employee and Children: $622
  • Family: $985

Coverage:

  • Office Visit (Primary and Specialty): 
    • Primary: Tier 1 $0 Copay; Tier 2 Ded + 50% to OOP Max  
    • Specialty: Tier 1 $100 Copay; Tier 2 Ded + 50% OOP Max
  • Deductible
    • Single: $2,000
    • Family: 
      • Tier 1: $5,000
      • Tier 2: $8,000 *Embedded
  • Coinsurance: Tier 1 20%, Tier 2 50%
  • Out-of-Pocket (OOP) Maximum
    • Single: Tier 1 $4,500 | Tier 2 $9,000
    • Family: Tier 1 $9,000 | Tier 2 $18,000
  • Inpatient Hospital: Tier 1 Deductible + 20% to OOP Max Tier 2 Deductible + 50% to OOP Max
  • Outpatient Hospital: Tier 1 Deductible + 20% to OOP Max Tier 2 Deductible + 50% to OOP Max
  • Rx Retail: Generic $20 | Preferred $40 | Non-Preferred $60
  • Rx Mail Order: Two times Copay
  • Preventative Visit: Covered 100%
  • Chiropractic: *$45 Copay | 20 Visits per year
  • Teladoc: Covered 100%
  • Telehealth: Covered 100%
  • Advanced Imaging: Tier 1 $500 Copay | Tier 2 Deductible + 50% to OOP Max
  • X-Ray: Tier 1 & 2 | $25 Copay outpatient setting
  • Lab: Tier 1 & 2 | $25 Copay outpatient setting
  • Urgent Care: Covered 100%
  • Emergency Care: Tier 1 & 2 | Deductible + 20% to OOP Maximum
  • Individual Mental Health: Covered 100% if provider is in the United Healthcare Choice Plus Network or the Colorado Select Network

PPO 5

Employee Cost

The monthly medical premiums listed below are based on full-time employment / 1.0 FTE. To estimate your benefit costs, use our Benefits Calculator.

  • Employee Only: $109
  • Employee and Spouse: $904
  • Employee and Children: $818
  • Family: $1,235

Coverage:

  • Office Visit (Primary and Specialty): $45 Copay
  • Deductible
    • Single: $2,500
    • Family: $5,000 Embedded
  • Coinsurance: 20% In-Network, *40% Out-of-Network
  • Out-of-Pocket (OOP) Maximum
    • Single: $4,500 In-Network, $9,000 Out-of-Network
    • Family: $9,000 In-Network, $18,000 Out-of-Network
  • Inpatient Hospital: Deductible + 20% to OOP Maximum
  • Outpatient Hospital: Deductible + 20% to OOP Maximum
  • Rx Retail: $20 Generic, $40 Preferred, $60 Non-Preferred
  • Rx Mail Order: Two times Copay
  • Preventative Visit: Covered 100%
  • Chiropractic: *$45 Copay, 20 visits per year
  • Teladoc: Covered 100%
  • Telehealth: $45 Copay
  • Advanced Imaging: Deductible + 20% to OOP Maximum
  • X-Ray:
    • Office Setting: $45 Copay
    • Outpatient Setting: Deductible + 20% to OOP Maximum
  • Lab: $45 Copay
  • Urgent Care: $75 Copay
  • Emergency Care: Deductible + 20% to OOP Maximum

Kaiser Permanente HMO 50

Employee Cost

The monthly medical premiums listed below are based on full-time employment / 1.0 FTE. To estimate your benefit costs, use our Benefits Calculator.

  • Employee Only: $155
  • Employee and Spouse: $992
  • Employee and Children: $902
  • Family: $1,338

Coverage:

  • Office Visit (Primary and Specialty): $50 Copay | $65 Copay
  • Deductible: Copay where indicated
  • Coinsurance: N/A
  • Out-of-Pocket (OOP) Maximum:
    • Single: $5,500
    • Family: $11,000
  • Inpatient Hospital: $2,000 Copay
  • Outpatient Hospital: Plan Hospital $1,000 Copay | Amb Surg Center $500 Copay
  • Rx Retail: Generic $20 | Preferred $40 | Non-Preferred $60 | Specialty 20% coinsurance up to $250
  • Rx Mail Order: Two times Copay
  • Preventative Visit: Covered 100%
  • Chiropractic: $50 Copay | 20 Visits per year
  • Teladoc: N/A
  • Telehealth: Covered 100%
  • Advanced Imaging: $250 Copay
  • X-Ray: Diagnostic $0 Copay | Therapeutic $65 Copay
  • Lab: Covered 100%
  • Urgent Care: $50 Copay
  • Emergency Care: $250 Copay

This comparison of coverage is intended only as a general description for the principle in-network features of the benefit plans. If there are questions about a particular benefit or the coverage tier, please refer to the full plan documents on the CEBT website.

*Charges are subject to Usual & Customary (U&C). These charges are considered in excess of the Reasonable Reimbursement, the Recognized Amount, the Usual and Customary charge, the Negotiated Rate, or the fee schedule. Exclusions under this category do not apply to payments that may be required under the No Surprises Act.

Preventative Services will be processed following the Federal Patient Protection and Affordable Care Act. For more information, visit the CEBT website.

PPO Note: Combination of PPO and Non PPO out of pocket limit will never exceed the Non PPO out of pocket limit.

PPO Plan deductibles fall under the definition of an Embedded deductible where any single member of a family doesn't have to meet the full family deductible for the after-deductible benefits to kick in. Once they meet the individual deductible, plan benefits will start to pay.

Kaiser Note: The member must use a contracted Kaiser Permanente provider for all care. Out-of-network providers are only covered if the charges are for emergency treatment. If this is not done, there is no guarantee that the charges will be covered. Kaiser Preventative Services will be processed following the Federal Patient Protection and Affordable Care Act. For a full list, visit the Kaiser Permanente website.