Kaiser Er Copay

With copayment plans, you pay set charges (or copays) for certain covered services so you know your out-of-pocket costs for doctor’s visits, prescriptions, etc., in advance. And since no services are subject to a medical deductible, you can pay copayments for most. Kaiser Permanente. Kaiser Permanente. If you elect to participate in the Kaiser Permanente HMO plan, you are limited to using physicians and facilities that are part of Kaiser Permanente’s network of providers. All health care services (except for emergencies) must be coordinated and approved by your primary care physician (PCP). After a $300 copay and your deductible, emergency room visits are covered at 100%. The copay is waived if you’ve been admitted to the hospital. However, any other services you’ve received in the emergency room that are typically billed separately, like any testing that is done or the physician’s portion of the bill. An in-network provider will bill your health plan directly, collecting only the copay or deductible amount from you at the time of services (for coinsurance, which is a percentage of the total amount—rather than a flat rate like the copay and deductible—it's generally better to ask the provider to bill the insurance first, and then your bill will be determined based on a percentage of the.

We’ve made changes to help lessen the chances you’ll come into contact with COVID-19.

Already scheduled an appointment? Visit the appointment waiting room.

Urgent COVID-19 and flu problems

Open Monday through Friday, 7:30 a.m. to 7:30 p.m. and Saturday and Sunday, 8 a.m. to 5 p.m.

Marysville**
Shoreline*
Smokey Point*
Book a virtual visit. Call 1-425-257-1400.

These sites will ONLY see flu or COVID-19 symptoms.

For problems that are not COVID-19 or flu

Open Monday through Friday, 7:30 a.m. to 7:30 p.m., and Saturday and Sunday, 8 a.m. to 5 p.m.

Marysville**
Mill Creek
Shoreline*
Smokey Point**
Snohomish

These sites will NOT see flu or COVID-19 symptoms.

*Kaiser Medicare Advantage HMO and Commercial HMO are out of network in King County.
**Kaiser Core and Medicare Advantage HMO are out of network at Marysville and Smokey Point.

Walk-in clinic or ER, what's the difference?

- Abdominal pain
- Allergies
- Asthma
- Colds
- Cough or upper respiratory symptoms
- Ear or sinus pain
- Fevers
- Flu symptoms
- Foreign object in nose
- Headaches
- Minor burns and bruises
- Possible broken bones
- Rash or hives
- Scrapes and cuts
- Sprains
- Stings and bites
- Urinary symptoms
- Work-related injuries
Call 911 and seek emergency care for sudden or unexpected medical problems, like:
- Amputation of limbs or deep wounds with severe bleeding
- Chest pain (suspected heart attack or stroke)
- Inhaled smoke or chemical
- Major burns to the face or large areas of the body
- Physical or sexual assault
- Poisoning, overdoses and suicidal behavior
- Pregnancy problems over 20 weeks, including labor, bleeding, fluid leaks or the fetus has stopped moving
- Severe head injuries with loss of consciousness or new seizures
- Sudden confusion, weakness, dizziness, numbness, severe headache or difficulty speaking or breathing
- Vomiting blood

Walk-in clinic FAQs

It depends, and we’ll do our best to help you quickly. Typical waits are 15 minutes to an hour. Often, our walk-in clinics can see you faster than an emergency room. Schedule your spot or check the wait times before you go.
You’ll see one of our experts: a medical doctor, a nurse practitioner, a physician assistant or a doctor of osteopathic medicine. They have a great deal of skill and knowledge. Each one is devoted to making lives better through health and healing and doing what is right for each patient.
Check with your health plan for details and copay amounts. We bill urgent care visits as an office visit, not ER care. Walk-in clinic care tends to cost patients less than an ER visit.
Use our price sheet to view current prices for primary care and walk-in clinic services. This includes physician visits, preventive visits, preventive screenings and other services.
If you’re in severe pain, call 911. If you’re not, the walk-in-clinic might be faster, more helpful and less costly. Your health information from the visit can be shared with your primary care doctor and any specialists as needed.
No, you can seek urgent care in our walk-in clinics, even if you don’t have a primary care provider (PCP). If you don’t have a PCP, we think it’s important to find one. We are happy to help you do so. You want a doctor who knows you and your unique health care needs. Everyone is different. For the best health, find yourself a PCP for annual visits.
Walk-in clinic visits are billed as office visits, not as ER or urgent care center visits. Please check with your health plan to find out how walk-in visits are covered.

COVID-19 FAQs

- Congestion or runny nose
- Cough
- Diarrhea
- Fatigue
- Fever or chills
- Headache
- Muscle or body aches
- Nausea or vomiting
- New loss of taste or smell
- Shortness of breath or difficulty breathing
- Sore throat
If you have a higher chance of becoming very sick with COVID-19, you may want to stay home and book a virtual walk-in clinic visit instead. Can you answer “yes” to any of these?
- Age 65 or older?
- Severely overweight?
- Have diabetes (whether you use insulin or not)?
- Have asthma (moderate or severe)?
- Have COPD, emphysema or other serious lung problem?
- Have a serious heart problem?
- Have kidney disease with dialysis?
- Have liver disease?
- Live in a nursing home or long-term care facility?
- Have problems with your immune system?
If you answered “yes,” think about booking a virtual visit. To book a virtual visit, call 1-425-257-1400.

This is a comparison of the copay medical plans for FY 2019-20 open enrollment. Please see the High Deductible Health Plan Comparison page as well.

Comparing network costs versus non-network costs between Kaiser Permanente and United Healthcare in the Co-Pay plans
United Healthcare (UHC) Copay Choice Plus Plan			Kaiser Permanente (KP) DHMO Plan
Annual Deductible	Network	Non-Network	Annual Deductible	Network	Non-Network
Individual	$1,500	$3,000	Individual	$750	Not Covered
Family	$3,000	$6,000	Family	$1,500	Not Covered

Out of Pocket Max Comparison
Annual Out-of-Pocket Max: UHC			Annual Out-of-Pocket Max: KP
Annual Deductible	Network	Non-Network	Annual Deductible	Network	Non-Network
Individual	$5,000	$10,000	Individual	$2,000	Not Covered
Family	$10,000	$20,000	Family	$4,000	Not Covered

Co-Insurance Comparison
Co-Insurance: UHC			Co-Insurance: KP
Annual Deductible	Network	Non-Network	Annual Deductible	Network	Non-Network
Percentage you pay after you have satisfied your deductible.	20%	50%	Percentage you pay after you have satisfied your deductible.	10%	Not Covered

Office Visit and Urgent Care Cost Comparison
Office Visits/Urgent Care ⁽¹⁾: UHC			Office Visits/Urgent Care ⁽¹⁾: KP
Service	Network	Non-Network	Service	Network	Non-Network
Preventative Care/Screenings	No Charge	50% of eligible expenses after deductible	Preventative Care/Screenings	No Charge	Not Covered
Primary Care - Illness/Injury	$30 Copay		Primary Care - Illness/Injury	$30 Copay
Specialist	$50 Copay		Specialist	$50 Copay
Inpatient Hospital	20% Co-insurance after $1,000 Copay		Inpatient Hospital	10% Coinsurance
Urgent Care	$75 Copay		Urgent Care	$75 Copay
Ambulance	20% after deductible		Ambulance	$500 Copay
Emergency Room	$500 Copay		Emergency Room	$500 Copay
Virtual Visits (Network Benefits are available only when services are delivered through a Designated Virtual Network Provider.)	$30 Copay	Not Covered	Virtual Care - Primary/Specialty - Phone Visit, Video Visit - Chat Online, Email, E-visits	No Charge	Not Covered

Mental Health Benefits Comparison
Mental Health ⁽¹⁾: UHC			Mental Health ⁽¹⁾: KP
Service	Network	Non-Network	Service	Network	Non-Network
Inpatient (Hospitalization/Day Treatment)	20% Co-insurance after $1,000 Copay	50% of eligible expenses after deductible	Inpatient (Hospitalization/Day Treatment)	10% Coinsurance	Not Covered
Outpatient (Therapy)	$30 Copay	50% of eligible expenses after deductible	Outpatient (Therapy)	$30 Copay	Not Covered

What Does Er Copay Cover

Inpatient and Outpatient Addictive Disorders Services Comparison
Substance-Related & Addictive Disorders Services ⁽¹⁾: UHC			Substance-Related & Addictive Disorders Services ⁽¹⁾: KP
Service	Network	Non-Network	Service	Network	Non-Network
Inpatient	20% Co-insurance after $1,000 Copay	50% of eligible expenses after deductible	Inpatient	10% Coinsurance	Not Covered
Outpatient (Therapy)	$30 Copay	50% of eligible expenses after deductible	Outpatient (Therapy)	$30 Copay	Not Covered

Vision Benefits Comparison
Vision: UHC			Vision: KP
Service	Network	Non-Network	Service	Pediatric (up to end of month he/she turns age 19)	Adult (members age 19 and over)
Up to 1 Routine Exam per plan year under the Medical Plan	$50 Copay	- Allowances apply to network providers only. - Please refer to your plan details for out-of-network allowances	Optometrist/ Ophthalmologist	Optometrist: $30 Copay/ Ophthalmologist: $50 Copay (Includes contact lens fitting up to $175)
Optical hardware	- Frames $130 allowance OR - Contact lens $150 allowance		Optical hardware	- 10% Coinsurance - 1 pair of glasses & lenses every 2 years or 2 years of contact lenses	$150 Credit once every 24 months towards optical hardware

Prescription Comparison
Prescription: UHC			Prescription: KP ⁽²⁾
Retail: 30-day supply	Mail Order: 90-day supply	Retail: 30-day supply	Mail Order: 90-day supply
Tier 1	$10 Copay	$20 Copay	Generic	$10 Copay	$20 Copay
Tier 2	$30 Copay	$60 Copay	Preferred Brand Name	$30 Copay	$60 Copay
Tier 3	$50 Copay	$100 Copay	Non-Preferred Brand Name	Approved drugs covered at generic costshare
Specialty (30 day supply)	20% up to $100	Specialty	20% up to $100

* Please refer to the official plan documents for detailed information and listing of covered services

Kaiser Permanente Copay

If a procedure is preformed during a Primary Care, Specialty Care, or Urgent Care Visit then the service is covered at coinsurance after deductible is met.
For Southern Colorado Kaiser Permanente members: maintenance medications must be filled at a Pharmacy in a Kaiser Permanente medical office or through Kaiser Permanente mail order.

Rates - Employee Monthly Contribution

Kaiser Copay List

United Healthcare Copay Choice Plus Plan		Kaiser Permanente DHMO Plan
Employee Only	$159.14	Employee Only	$93.72
Employee + Spouse	$437.52	Employee + Spouse	$298.02
Employee + Child(ren)	$310.30	Employee + Child(ren)	$190.34
Family	$638.86	Family	$440.48