Group Number
47425000
Provided By
Blue Cross Blue Shield 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 |
$3,000 / $6,000 |
$3,000 / $6,000 |
Out-of-Pocket Max |
$5,000 / $10,000 |
$10,000 / $20,000 |
Coinsurance (Plan pays/You pay) |
80% / 20% |
60% / 40% |
Physician Visits |
||
Primary Care |
$40 Copay |
Deductible + 40% |
Routine Preventive |
Fully Covered |
Deductible + 40% |
Specialist |
$40 Copay |
Deductible + 40% |
Telehealth |
Fully Covered |
Deductible + 40% |
Hospital Services |
||
Physician Services |
Deductible + 20% |
Deductible + 40% |
Inpatient Hospital |
Deductible + 20% |
Deductible + 40% |
Outpatient Surgery |
Deductible + 20% |
Deductible + 40% |
Basic Outpatient Diagnostics |
Deductible + 20% |
Deductible + 40% |
Urgent Care |
$40 Copay |
Deductible + 40% |
Emergency Room |
$100 Copay, then 20% |
$100 Copay, then 20% |
Retail Prescriptions |
||
Tier 1 - Generic |
$15 Copay |
$15 Copay, then 50% |
Tier 2 - Preferred Brand |
$70 Copay |
$70 Copay, then 50% |
Tier 3 - Non-preferred Brand |
$110 Copay |
$110 Copay, then 50% |
Mail Order Prescriptions |
||
Tier 1 - Generic |
$37.50 Copay |
$37.50 Copay, then 50% |
Tier 2 - Preferred Brand |
$175 Copay |
$175 Copay, then 50% |
Tier 3 - Non-preferred Brand |
$275 Copay |
$275 Copay, then 50% |
Per Pay Period Cost |
with Wellness |
without Wellness |
|---|---|---|
Employee Only |
$35 |
$45 |
Employee + Spouse |
$300 |
$320 |
Employee + Child(ren) |
$250 |
$260 |
Employee + Family |
$375 |
$395 |
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 |
$3,400 / $6,800 |
$3,400 / $6,800 |
Out-of-Pocket Max |
$3,400 / $6,800 |
$6,800 / $13,600 |
Coinsurance (Plan pays/You pay) |
100% / 0% |
80% / 20% |
Physician Visits |
||
Primary Care |
Deductible |
Deductible + 20% |
Preventive Care |
Fully Covered |
Deductible + 20% |
Specialist |
Deductible |
Deductible + 20% |
Telehealth |
Deductible |
N/A |
Hospital Services |
||
Physician Services |
Deductible |
Deductible + 20% |
Inpatient Hospital |
Deductible |
Deductible + 20% |
Outpatient Surgery |
Deductible |
Deductible + 20% |
Basic Outpatient Diagnostics |
Deductible |
Deductible + 20% |
Urgent Care |
Deductible |
Deductible + 20% |
Emergency Room |
Deductible |
In-Network Deductible |
Retail Prescriptions |
||
Tier 1 - Generic |
Deductible |
Deductible + 50% |
Tier 2 - Preferred Brand |
Deductible |
Deductible + 50% |
Tier 3 - Non-preferred Brand |
Deductible |
Deductible + 50% |
Mail Order Prescriptions |
||
Tier 1 - Generic |
Deductible |
Deductible + 50% |
Tier 2 - Preferred Brand |
Deductible |
Deductible + 50% |
Tier 3 - Non-preferred Brand |
Deductible |
Deductible + 50% |
Per Pay Period Cost |
with Wellness |
without Wellness |
|---|---|---|
Employee Only |
$45 |
$55 |
Employee + Spouse |
$350 |
$370 |
Employee + Child(ren) |
$300 |
$310 |
Employee + Family |
$475 |
$495 |
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 |
$4,000 / $8,000 |
$4,000 / $8,000 |
Out-of-Pocket Max |
$5,500 / $11,000 |
$11,000 / $22,000 |
Coinsurance (Plan pays/You pay) |
80% / 20% |
60% / 40% |
Physician Visits |
||
Primary Care |
Deductible + 20% |
Deductible + 40% |
Preventive Care |
Fully Covered |
Deductible + 40% |
Specialist |
Deductible + 20% |
Deductible + 40% |
Telehealth |
Deductible |
N/A |
Hospital Services |
||
Physician Services |
Deductible + 20% |
Deductible + 40% |
Inpatient Hospital |
Deductible + 20% |
Deductible + 40% |
Outpatient Surgery |
Deductible + 20% |
Deductible + 40% |
Basic Outpatient Diagnostics |
Deductible + 20% |
Deductible + 40% |
Urgent Care |
Deductible + 20% |
Deductible + 40% |
Emergency Room |
Deductible + 20% |
In-Network Deductible + 20% |
Retail Prescriptions |
||
Tier 1 - Generic |
Deductible + 20% |
Deductible + 50% |
Tier 2 - Preferred Brand |
Deductible + 20% |
Deductible + 50% |
Tier 3 - Non-preferred Brand |
Deductible + 20% |
Deductible + 50% |
Mail Order Prescriptions |
||
Tier 1 - Generic |
Deductible + 20% |
Deductible + 50% |
Tier 2 - Preferred Brand |
Deductible + 20% |
Deductible + 50% |
Tier 3 - Non-preferred Brand |
Deductible + 20% |
Deductible + 50% |
Per Pay Period Cost |
with Wellness |
without Wellness |
|---|---|---|
Employee Only |
$30 |
$40 |
Employee + Spouse |
$275 |
$295 |
Employee + Child(ren) |
$225 |
$235 |
Employee + Family |
$350 |
$370 |
Group Number
47425000
Provided By
Blue Cross Blue Shield of Kansas City
Provider Website
Customer Service
Resources
Frequently Asked Questions