Spreadsheet: 0fc287fb-217f-4d70-aece-e594e38da550
Sheet: All Carriers

 |  | Three Largest Small Group Plans |  |  | Largest HMO | State Employee Plans |  | Three Largest Federal Employee Plans |  |  | Mandates
 | Option Reference: | A | B | C | D | E | F | G | H | I
Carrier &  Plan Name: |  | Kaiser Ded/CO HMO 1200D | United Choice Plus Balanced 100 | [NAME]Lumenos HSA $5000/100% NGF | Kaiser  Plan A230 | Kaiser  State Employee Plan | United  State Employee Plan | BCBS Plan Standard [RI 71-005] | BCBS Plan Basic [RI 71-005] | GEHA Plan Standard [RI 71-006] | Colorado Mandate | Federal  Mandate
 | Enrollment: | 13703 | 10021 | 7218 | 52381 | 13253 | 8725 | NA - #1 | NA - #2 | NA - #3
1. AMBULATORY PATIENT SERVICES
a. | Primary care to treat illness/injury | √ | √ | √ | √ | √ | √ | √ | √ | √ |  | FB
b. | Specialist visits | √ | √ | √ | √ | √ | √ | √ | √
c. | Outpatient surgery | √ | √ | √ | √ | √ | √ | √ | √ | √
d. | Chiropractic (therapeutic, adjustive, manipulative) | NC | [NAME] to 20 visits per year | [NAME] 20 visits per year (combined with massage/ acupuncture) | NC | [NAME] 20 visits per year | √ | [NAME] visits/yr. | [NAME] 20 visits/yr. | [NAME] visits/yr.
e. | Chemotherapy services | √ | √ | √ | √ | √ | √ | √ | √ | √
f. | Radiation therapy | √ | √ | √ | √ | √ | √ | √ | √ | √
g. | Home health care | √ | [NAME] 60 visits per year | [NAME] 100 visits per year | √ | √ | [NAME] 100 visits per year | [NAME], limit of 2 hr./visit | [NAME], limit of 2 hr./visit | [NAME] 50/yr. | CO
h. | Access to clinical trials | NC | √ Some restrictions apply | √ Some restrictions apply | NC | NC | √ Some restrictions apply | √ | √ | √ | CB | FB
i. | Genetic evaluation & counseling | Excluded, but available upon referral if inherited susceptibility for breast cancer or otherwise deemed medically necessary | Available only when  reasonable to expect birth defects because of family history, parental age, or exposure to an agent | √ Some restrictions apply | May be covered if genetic testing is deemed medically necessary | May be covered if genetic testing is deemed medically necessary | √ Only covers fetal testing | √ Some restrictions apply | √ Some restrictions apply | NC
j. | Outpatient diagnostic labs, x-ray, and pathology | √ | √ | √ | √ | √ | √ | √ | √ | √
k. | Infertility treatment services | NC | NC | NC Only Diagnostic Services Provided, with  limits Some restrictions apply | Only covers services for involuntary infertility and artificial insemination | √ | Only diagnostic procedures covered | √ | √ | √ limit 3,000/yr.
l. | Sterilization | √ | √ | √ | √ | √ | √
category continued on next page
1. AMBULATORY PATIENT SERVICES, cont.
m. | Telemedical Services | Not specified | √ | √ Some restrictions apply | Not Specified | Not specified | √
n. | Dental Injury | NC | √ | √ Some restrictions apply | NC | NC | √ | √ only on emergencies and serious cavities for children 22 and under | √ only on emergencies and serious cavities for children 22 and under | √
o. | Cleft Palate and [NAME] | √ | √ | √ | √ | √ | √ | √ | √ | √ | CB
p. | Oral Anti-Cancer Medication | √ | √ | √ | √ | √ | √ | √ | √ | √ | CB
q. | Acupuncture | NC | NC | √ 20 visits per year (combined with massage/chiropractic); other restrictions | NC | NC | √ | √ limit 24 visits | √ | √ limit 20 visits/yr.
r. | TMJ services | Some services if medically necessary | NC | NC | Some services if medically necessary | Some services if medically necessary | NC | √ | √ | √
s. | Orthotics | √ | NC | NC Some exceptions may apply | √ | √ | √ | √ | √ | Not specified
t. | Vision Hardware | NC | NC | NC Some exceptions may apply | NC | NC | NC | √ Only covered for medical injury | √ Only covered for medical injury | √ Only covered for medical injury
2. EMERGENCY SERVICES
a. | Emergency room - Facility | √ | √ | [NAME] care received in an ER not covered | √ | √ | √ | √ | √ | √ |  | FB
b. | Ambulance service | √ | √ | √ | √ | √ | √ | √ | √ | √
c. | Urgent care centers/facilities (Provider-type, not a benefit) | √ | √ | √ | √ | √ | √ | √ | √ | √
3. HOSPITALIZATION
a. | Inpatient medical and surgical care | √ | √ | √ | √ | √ | √ | √ | √ | √ |  | FB
b. | Bariatric surgery | NC | NC | NC | √ | √ | √ Some restrictions apply. | √ | √ | √ only morbidly obese
c. | Organ & tissue transplants | √ Transplants limited to specified organs | √ Transplants limited to specified organs | √ Transplants limited to specified organs | √ Transplants limited to specified organs | √ Transplants limited to specified organs | √ Transplants limited to specified organs | √ Transplants limited to specified organs | √ Transplants limited to specified organs | √ Transplants limited to specified organs
d. | Chemotherapy services | √ | √ | [NAME] | √ | √ | √ | √ | √ | √
e. | Radiation therapy | √ | √ | [NAME] | √ | √ | √ | √ | √ | √
f. | Anesthesia | √ | √ | √ Some restrictions apply | √ | √ | √ | √ | √ | √
g. | Breast reconstruction | √ | √ | √ | √ | √ | √ | √ following mastectomy | √ following mastectomy | √ following mastectomy |  | FB
h. | Hospice | √ | √ | √ | √ | √ | √ | [NAME] episode every 30 days, where an episode is 7 consecutive days | [NAME] episode every 30 days, where an episode is 7 consecutive days | √ | CB
i. | Dental Anesthesia | NC | NC | NC | NC | NC | NC | √ | √ | √
4. MATERNITY AND NEWBORN CARE
a. | Pre- & postnatal care | √ | √ | √ | √ | √ | √ | √ | √ | √ | CB | FB
b. | Delivery & inpatient maternity services | √ | √ | √ | √ | √ | √ | √ | √ | √ | CB | FB
c. | Newborn child coverage | √ | √ | √ | √ | √ | √ | √ | √ | √ | CB | FB
5. MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES, INCLUDING BEHAVIORAL HEALTH TREATMENT
a. | Benefits for treating alcoholism & drug dependency | √ | [NAME] 45 inpatient days per year (90 partial); limit 20 outpatient visits | [NAME] authorization for facility care required if not emergent. | √ | √ | √ | √ | √ | √ |  | FB
b. | Benefits for mental health services | √ | √ | [NAME] authorization for facility care required if not emergent. | √ | √ | √ | √ | √ | √ | CB | FB
c. | Biologically-based mental illnesses and disorders | √ | √ | √ | √ | √ | √ | √ | √ | √ | CB
d. | Outpatient hospital & physician | √ | [NAME] 20 visits per year | [NAME] authorization for facility care required if not emergent. | √ | √ | √ | √ | √ | √
e. | Inpatient hospital | √ | [NAME] 45 days per year (90 partial) | [NAME] authorization for facility care  required if not emergent. | √ | √ | √ | √ | √ | √
6. PRESCRIPTION DRUGS
a. | Retail | √ | NC | √ | √ | √ | √ | √ | NC | √
b. | Mail service (home delivery) | √ | NC | √ | √ | √ | √ | √ | NC | √
c. | Contraceptives | √ | √ | √ | √ | √ | √ | √ | √ | √ | CB | FB
d. | Home infusion therapy | √ | NC | √ | √ | √ | [NAME] as pharmaceutical products | √ | √ | √
7. REHABILITATIVE AND HABILITATIVE SERVICES AND DEVICES
a. | Physical, speech & occupational therapy | [NAME] 20 each therapy per year | [NAME] 20 each therapy per year | [NAME] 20 visits each therapy per year | [NAME] 20 each therapy per year | [NAME] 20 each therapy per year | [NAME] 20 each therapy per year | √ 75 visits/yr. | √ 50 visits/yr. | √ 60 visits/yr. for physical and occupational 30 visits/yr. for speech
b. | Massage Therapy | NC | NC | [NAME] 20 visits per year (combined with chiropractic/acupuncture) | NC | NC | NC | NC | NC | Not mentioned
c. | Cardiac rehabilitation | √ | [NAME] 36 visits per year | √ Some restrictions apply | √ | √ | √ | √ | √ | √
d. | [NAME] rehabilitation | √ | [NAME] 36 visits per year | √ | √ | √ | √ | √ | √ | √
e. | Durable medical equipment | √ | √ | √ | √ Limited to home oxygen dispensing equipment, diabetes supplies, infant apnea equipment, prosthetics | √ | √ | √ | √ | √ |  | FB
e. | Prosthetics - arm or leg | √ | √ | √ | √ | √ | √ | √ | √ | √ | CB | FB
f. | Rehabilitative Services - outpatient | √ | √ | √ Some restrictions apply | √ | √ | √ | √ | √ | √
g. | Skilled nursing & rehab (inpatient) | [NAME] nursing limit 100 days per year | [NAME] nursing limit 60 days per year | [NAME] 30 rehab days; limit 100 skilled nursing days | [NAME] 100 days per year | [NAME] 100 days per year | [NAME] 30 days per year | [NAME] up to 30 days but only with Medicare Part A | [NAME] up to 30 days but only with Medicare Part A | √ 14 day limit, $700 limit per day |  | -
h. | Autism Spectrum Disorders | √ | √ | √ | √ | √ | √ |  | Not specified |  | CB
i. | Physical, occupational, speech therapy for congenital defects up to age 5 | √ | √ | √ Some restrictions apply | √ | √ | [NAME] for congenital defects from age 3 to 6 | √ | √ | Not specified | CB
8. LABORATORY SERVICES
a. | Lab tests, x-ray services, & pathology | √ | √ | √ | √ | √ | √ | √ | √ | √
b. | Imaging/diagnostics (e.g.,  MRI, CT scan, PET scan) | √ | √ | √ | √ | √ | √ | √ | √ | √
9. PREVENTIVE AND WELLNESS SERVICES AND CHRONIC DISEASE MANAGEMENT
a. | Preventive care | √ | √ | √ | √ | √ | √ | √ | √ | √ | CB | FB
b. | Immunizations | √ | √ Not covered when required only for school, employment, activities, etc. | √ Not covered when required only for school, employment, activities, etc. | √ | √ Limited to non-experimental and medically indicated | √ | √ | √ | √ | CB | FB
c. | Colorectal cancer screening | √ | √ | √ | √ | √ | √ | √ | √ | √ | CB | FB
d. | Screening mammography | [NAME] Annually for women over 40; earlier based upon risk | √ | [NAME] Annually regardless of age | [NAME] Annually for women over 40; earlier based upon risk | √ | √ | √ | √ | √ | CB | FB
e. | Vision Care (1 exam/24 months) | [NAME] not covered | [NAME] exam every 2 years | NC | √ | √ | [NAME] year | NC | NC | NC
f. | Audiology/hearing tests | [NAME] hearing aids not covered | [NAME] one purchase every 3 years | Limited | [NAME] hearing aids not covered | √ | [NAME] aids supplied every 3 years | [NAME], related to injury or illness | [NAME], related to injury or illness | [NAME], related to injury or illness
g. | Nutritional counseling | √ | NC - except for when nutritional education is required for a disease in which patient self-management is an important component of treatment. | [NAME] visits per year | √ | √ | √ | √ | √ | √
h. | Smoking cessation program | √ | √ | √ | √ | √ | √ | √ | √ | [NAME] attempts/yr | CB
i. | Allergy testing & injections | √ | √ | √ | √ | √ | √ | √ | √ | √
j. | Diabetes - medically necessary equip. & supplies; education | √ | √ | √ | √ | √ | √ | √ | √ | √ | CB
k. | Screening Pap tests | √ | √ | √ |  | √ | √ | √ | √ | √ | CB
l. | Annual gynecological exam | √ | √ | √ | √ | √ | √ | √ | √ | √
m. | Annual prostrate cancer screening | √ | √ | √ | √ | √ | √ | √ | √ | √ | CB | FB
n. | [NAME] | NC | NC | NC Some exceptions may apply. | NC | NC | NC | √ | √ | √ Only when under active treatment for metabolic or peripheral vascular disease
10. PEDIATRIC SERVICES, INCLUDING ORAL AND VISION CARE
a. | Preventive care - physician svcs | √ | √ | √ | √ | √ | √ | √ | √ | √ | CB | FB
b. | Immunizations | √ | √ | √ | √ | √ | √ | √ | √ | √ | CB | FB
c. | 1 routine eye exam per year, to age 19 | √ | √ | NC | √ | √ | √ | √ | √ | √
d. | Routine hearing exams, to age 19 | √ | √ | √ | √ | √ | √ | √ | √ | √
e. | Dental - diagnostic & preventive | NC | NC | NC | NC | NC | NC | √ | √ | [NAME] per year
f. | Dental - basic | NC | NC | NC | NC | NC | NC | √ | √ | √
g. | Dental - major | NC | NC | NC | NC | NC | NC | √ | √ | √
h. | Hearing aids to age 18 | √ | √ | [NAME] aids supplied every five years | [NAME] aids supplied every five years | √ | √ | [NAME] | [NAME] | [NAME] aids supplied every 5 years | CB
i. | Children's early intervention services | √ | √ | √ | √ | √ | √ | NC | Not specified | Not specified | CB
j. | Children's dental anesthesia | √ | √ | √ | √ | √ | √ | Not specified | √ | √ | CB
[NAME]
a. | Phenylketonuria (PKU) Testing and Treatment | √ | √ | √ | √ | √ | √ | Not specified | Not specified | √ | CB
b. | Private Duty Nursing | √ | Only under Home Health & Hospice | Only under Home Health & Hospice | √ | √ | NC | √ | √ | √
 | NOTES
 | 1.  [NAME]
 | √  : Indicates service is a covered benefit per plan documents.
NC: Not Covered.  Indicates service is not a covered benefit per plan documents.
FB: Federal Mandate.  Benefit required to be covered by federal law.
CB: Colorado Mandate.  Benefit required to be covered by Colorado law.
CO: Colorado Mandated Offer.  Benefit required to be offered as add-on to benefit package by Colorado law.
 | 2.  Compilation Process
 | Detailed enrollment and benefit information regarding each plan was submitted to DOI by each carrier.  It was then summarized and compiled into this format.  Where possible, we have included specified quantitative limits on benefits  (eg, limited number of visits per year).  However, table may not reflect all limitations on a particular benefit.  Table does not include annual dollar limits on benefits, as these will be prohibited beginning in 2014.