Group Number
#41187000
Provided By
BlueCross BlueShield of Kansas City
Provider Website
Customer Service
Resources
Frequently Asked QuestionsMedical Benefits
Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.bluekc.com.
In-Network |
Out-of-Network |
|
|---|---|---|
Deductible |
$1,500/$3,000 |
$3,000/$6,000 |
Out-of-Pocket Max |
$3,000/$6,000 |
$6,000/$12,000 |
Member Coinsurance (Plan pays/Member pays) |
90% / 10% |
70% / 30% |
Physician Visits |
||
Primary Care |
$20 |
Deductible, then Coinsurance |
Routine Preventive |
Covered at 100% |
Deductible, then Coinsurance |
Specialist |
$20 |
Deductible, then Coinsurance |
Telehealth |
$20 |
Deductible, then Coinsurance |
Hospital Services |
||
Physician Services |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Inpatient Hospital |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Outpatient Surgery |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Basic Outpatient Diagnostics |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Urgent Care |
$50 |
Deductible, then Coinsurance |
Emergency Room |
$300 + Ded, then Coinsurance |
$300 + Ded, then Coinsurance |
Retail Prescriptions |
||
Tier 1 - Generic |
$10 |
$10, then 50% |
Tier 2 - Preferred Brand |
$35 |
$35, then 50% |
Tier 3 - Non-preferred Brand |
$70 |
$70 Copay, then 50% |
Mail Order Prescriptions |
||
Tier 1 - Generic |
$25 |
$25, then 50% |
Tier 2 - Preferred Brand |
$87.50 |
$87.50, then 50% |
Tier 3 - Non-preferred Brand |
$175 |
$175, then 50% |
Per Pay Period Cost |
|
|---|---|
Employee Only |
$35.15 |
Employee + Spouse |
$73.09 |
Employee + Child(ren) |
$66.18 |
Employee + Family |
$107.58 |
Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.bluekc.com.
In-Network |
Out-of-Network |
|
|---|---|---|
Deductible |
$2,000/$3,400 |
$4,000/$6,000 |
Out-of-Pocket Max |
$3,000/$6,000 |
$6,000/$12,000 |
Member Coinsurance (Plan pays/Member pays) |
80% / 20% |
60% / 40% |
Physician Visits |
||
Primary Care |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Routine Preventive |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Specialist |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Telehealth |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Hospital Services |
||
Physician Services |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Inpatient Hospital |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Outpatient Surgery |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Basic Outpatient Diagnostics |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Urgent Care |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Emergency Room |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Retail Prescriptions |
||
Tier 1 - Generic |
Deductible, then $10 |
Deductible, then $10 + 50% |
Tier 2 - Preferred Brand |
Deductible, then $35 |
Deductible, then $35 + 50% |
Tier 3 - Non-preferred Brand |
Deductible, then $70 |
Deductible, then $70 + 50% |
Mail Order Prescriptions |
||
Tier 1 - Generic |
Deductible, then $25 |
Deductible, then $25 + 50% |
Tier 2 - Preferred Brand |
Deductible, then $87.50 |
Deductible, then $87.50 + 50% |
Tier 3 - Non-preferred Brand |
Deductible, then $175 |
Deductible, then $175 + 50% |
Per Pay Period Cost |
|
|---|---|
Employee Only |
$35.65 |
Employee + Spouse |
$74.15 |
Employee + Child(ren) |
$67.13 |
Employee + Family |
$109.14 |
Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.bluekc.com.
In-Network |
Out-of-Network |
|
|---|---|---|
Deductible |
$2,500/$5,000 |
$5,000/$10,000 |
Out-of-Pocket Max |
$5,000/$10,000 |
$10,000/$20,000 |
Member Coinsurance (Plan pays/Member pays) |
80% / 20% |
60% / 40% |
Physician Visits |
||
Primary Care |
$35 |
Deductible, then Coinsurance |
Routine Preventive |
Covered at 100% |
Deductible, then Coinsurance |
Specialist |
$35 |
Deductible, then Coinsurance |
Telehealth |
$35 |
Deductible, then Coinsurance |
Hospital Services |
||
Physician Services |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Inpatient Hospital |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Outpatient Surgery |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Basic Outpatient Diagnostics |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Urgent Care |
$70 |
Deductible, then Coinsurance |
Emergency Room |
$300 + Ded, then Coinsurance |
$300 + Ded, then Coinsurance |
Retail Prescriptions |
||
Tier 1 - Generic |
$10 |
$10, then 50% |
Tier 2 - Preferred Brand |
$35 |
$35, then 50% |
Tier 3 - Non-preferred Brand |
$70 |
$70, then 50% |
Mail Order Prescriptions |
||
Tier 1 - Generic |
$25 |
$25, then 50% |
Tier 2 - Preferred Brand |
$87.50 |
$87.50, then 50% |
Tier 3 - Non-preferred Brand |
$175 |
$175, then 50% |
Per Pay Period Cost |
|
|---|---|
Employee Only |
$44.50 |
Employee + Spouse |
$92.48 |
Employee + Child(ren) |
$83.68 |
Employee + Family |
$138.80 |
Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.bluekc.com.
In-Network |
Out-of-Network |
|
|---|---|---|
Deductible |
$5,000/$10,000 |
$15,000/$30,000 |
Out-of-Pocket Max |
$7,000/$14,000 |
$25,000/$50,000 |
Member Coinsurance (Plan pays/Member pays) |
80% / 20% |
60% / 40% |
Physician Visits |
||
Primary Care |
$20 |
Deductible, then Coinsurance |
Routine Preventive |
Covered at 100% |
Deductible, then Coinsurance |
Specialist |
$20 |
Deductible, then Coinsurance |
Telehealth |
$20 |
Deductible, then Coinsurance |
Hospital Services |
||
Physician Services |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Inpatient Hospital |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Outpatient Surgery |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Basic Outpatient Diagnostics |
Deductible, then Coinsurance |
Deductible, then Coinsurance |
Urgent Care |
$50 |
Deductible, then Coinsurance |
Emergency Room |
$300 + Ded, then Coinsurance |
$300 + Ded, then Coinsurance |
Retail Prescriptions |
||
Tier 1 - Generic |
$10 |
$10, then 50% |
Tier 2 - Preferred Brand |
$35 |
$35, then 50% |
Tier 3 - Non-preferred Brand |
$70 |
$70, then 50% |
Mail Order Prescriptions |
||
Tier 1 - Generic |
$25 |
$25, then 50% |
Tier 2 - Preferred Brand |
$87.50 |
$87.50, then 50% |
Tier 3 - Non-preferred Brand |
$175 |
$175, then 50% |
Per Pay Period Cost |
|
|---|---|
Employee Only |
$40.29 |
Employee + Spouse |
$83.65 |
Employee + Child(ren) |
$75.70 |
Employee + Family |
$125.35 |
Group Number
#41187000
Provided By
BlueCross BlueShield of Kansas City
Provider Website
Customer Service
Resources
Frequently Asked Questions