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Medical Plan
OPTION 1 - $3,000 DEDUCTIBLE HSA | In-Network |
|---|---|
Medical Networks | Preferred Care Blue |
Deductible (Calendar Year) | $3,000 individual / $6,000 family |
Coinsurance | 50% |
Out-of-pocket maximum | $6,500 individual / $13,000 family |
Physician office visit | $40 Copay |
Specialty offcie visit | $65 Copay |
Prescription drugs Tier 1 / Tier2 / Tier 3 | $10 / $40 / $70 / 25% Copay |
Mail order drug program Tier 1 / Tier 2 / Tier 3 | $25 / $100 / $175 Copay |
Routine preventative care | No charge |
Inpatient hospital service / Outpatient surgery | Deductible then Coinsurance |
Emergency room (copay waived if admitted) | Deductible & Coinsurance |
Urgent care | $65 Copay |
MRI, MRA, CT and PET scans | Deductible then Coinsurance |
Lab services | Deductible then Coinsurance |
X-rays | Deductible then Coinsurance |
Lifetime maximum | Unlimited |
SBC
Find a provider
To obtain a list of providers participating in your BlueKC network simply go to www.mybluekc.com or call 888.989.8842
47737000
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