Medical Benefits

Your employer offers medical insurance that covers expenses such as visits to the doctor’s office, emergency care, and prescription drugs. 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 a doctor in the Preferred Care Blue Network please visit www.member.bluekc.com.

	In-Network	Out-of-Network
Deductible (Individual/Family)	$1,000/$2,000	$1,000/$2,000
Member Coinsurance	20%	40%
Out-of-Pocket Max (Individual/Family)	$2,500/$5,000	$5,000/$10,000
Preventive Care	No Charge	Deductible + 40%
Primary Care	$20 Copay	Deductible + 40%
Specialist	$40 Copay	Deductible + 40%
Urgent Care	$40 Copay	Deductible + 40%
Emergency Care	$100 Copay, then Deductible + 20%	$100 Copay, then Deductible + 20%
Retail Prescriptions (up to a 34-day supply)
Tier 1	$15 Copay	Retail Copay + 50%
Tier 2	$70 Copay	Retail Copay + 50%
Tier 3	$110 Copay	Retail Copay + 50%
Tier 4	$200 Copay	Retail Copay + 50%
Mail Order Prescriptions (up to a 102-day supply)
All Tiers	2.5 Retail Copay	Retail Copay + 50%

	Rate	Employer Share	Employee Share	Bi-Weekly Rate (26 Pay Periods)
Employee Only	$969.71	$484.86	$484.85	$223.78
Employee + Spouse	$2,443.67	$484.86	$1,958.81	$904.07
Employee + Child(ren)	$1,871.54	$484.86	$1,386.68	$640.01
Employee + Family	$2,773.37	$484.86	$2,288.51	$1,056.24

Downloads

Summary of Benefits

Summary of Benefits-Spanish

BlueKC Member Guide

Virtual Care Flyer

Blue KC Mindful Flyer

	In-Network	Out-of-Network
Deductible (Individual/Family)	$3,400/$6,800	$3,400/$6,800
Member Coinsurance	0%	20%
Out-of-Pocket Max (Individual/Family)	$3,400/$6,800	$6,800/$13,600
Preventive Care	No Charge	Deductible + 20%
Primary Care	Deductible	Deductible + 20%
Specialist	Deductible	Deductible + 20%
Urgent Care	Deductible	Deductible + 20%
Emergency Care	Deductible	Deductible
Retail Prescriptions (up to a 34-day supply)
Tier 1	Deductible	Deductible + 50%
Tier 2	Deductible	Deductible + 50%
Tier 3	Deductible	Deductible + 50%
Mail Order Prescriptions (up to a 102-day supply)
All Tiers	Deductible	Deductible + 50%

	Rate	Employer Share	Employee Share	Bi-Weekly Rate (26 Pay Periods)
Employee Only	$881.55	$440.78	$440.77	$203.43
Employee + Spouse	$2,221.51	$440.78	$1,780.73	$821.88
Employee + Child(ren)	$1,701.39	$440.78	$1,260.61	$581.82
Employee + Family	$2,521.23	$440.78	$2,080.45	$960.21

Downloads

Summary of Benefits

Summary of Benefits-Spanish

BlueKC Member Guide

Blue KC Mindful Flyer

Virtual Care Flyer

Your employer offers medical insurance that covers expenses such as visits to the doctor’s office, emergency care, and prescription drugs. 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 a doctor in the Blue Select Plus Network please visit www.member.bluekc.com.

	SPIRA Care Centers	BlueSelect Plus Network
Deductible (Individual/Family)	$7,000/$14,000	$7,000/$14,000
Member Coinsurance	0%	0%
Out-of-Pocket Max (Individual/Family)	$7,000/$14,000	$7,000/$14,000
Preventive Care	No Member Cost	No Charge
Primary Care	No Member Cost	Deductible
Specialist	N/A	Deductible
Urgent Care	No Member Cost	Deductible
Emergency Care	N/A	Deductible
Retail Prescriptions (up to a 31-day supply)
Tier 1	Some Generics Dispensed on site at Spira Care Centers	$15 Copay
Tier 2	Some Generics Dispensed on site at Spira Care Centers	$50 Copay
Tier 3	Some Generics Dispensed on site at Spira Care Centers	Deductible
Mail Order Prescriptions (up to a 90-day supply)
Tier 1	N/A	$15 Copay
Tier 2	N/A	$125 Copay
Tier 3	N/A	Deductible

Please note there is NO out-of-network coverage wtih this plan except in a true emergency.

You have access to all Spira Care Centers throughout the Kansas City Metro, as well as the entirety of the
BlueSelect Plus network of hospitals and providers!

	Rate	Employer Share	Employee Share	Bi-Weekly Rate (26 Pay Periods)
Employee Only	$683.21	$341.61	$341.60	$157.66
Employee + Spouse	$1,721.69	$341.61	$1,380.08	$636.96
Employee + Child(ren)	$1,318.60	$341.61	$976.99	$450.92
Employee + Family	$1,953.98	$341.61	$1,612.37	$744.17