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Medical Plan
OPTION 3 - $1,500 DEDUCTIBLE | In-Network |
|---|---|
Medical Networks | Preferred Care Blue |
Deductible | $1,500 individual / $3,000 family |
Coinsurance | 100% |
Out-of-pocket maximum | $6,500 individual / $13,000 family |
Physician office visit | $40 Copay |
Specialty office visit | $100 Copay |
Prescription drugs Tier 1 / Tier2 / Tier 3 | $10 / $45 / $90 / 25% Copay |
Mail order drug program Tier 1 / Tier 2 / Tier 3 | $25 / $112.50 / $225 Copay |
Routine preventative care | No charge |
Inpatient hospital service / Outpatient surgery | Deductible |
Emergency room (copay waived if admitted) | Deductible |
Urgent care | $100 Copay |
MRI, MRA, CT and PET scans | Deductible |
Lab services | Deductible |
X-rays | Deductible |
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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