Medical 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.mybluekc.com.

Blue KC Pharmacy Information:
• RX BIN Number: 021825
• PCN: IRX
• GROUP: BlueKC

Click the link below to view the Rx Savings Solutions and Rx Rewards webinar CLICK HERE

Preferred Care Blue Network	In-Network	Out-of-Network
Deductible (Individual/Family)	$3,300/$6,600	$6,600/$13,200
Out-of-Pocket Max (Individual/Family)	$3,300/$6,600	$6,600/$13,200
Shared Coinsurance	0%	0%
Physician Visits
Preventive Care	Covered at 100%0%	Covered at 100%
Physician Office Visit	100% after deductible	100% after deductible
Specialist Visit	100% after deductible	100% after deductible
Telehealth/Virtual Visits	100% after deductible	100% after deductible
Hospital Services
Inpatient Hospitalization	100% after deductible	100% after deductible
Physician Services	100% after deductible	100% after deductible
Outpatient Surgery	100% after deductible	100% after deductible
Outpatient Diagnostics	100% after deductible	100% after deductible
Urgent Care	100% after deductible	100% after deductible
Emergency Room	100% after deductible	100% after deductible

Prescription Drugs	In-Network	Out-of-Network
Retail/Specialty (30 day supply)	100% After deductible	100% after deductible
Mail Order Drugs (90 Day Supply)	100% After deductible	100% after deductible

Employee Semi-Monthly Rates	Tier 1 Salary under $49,999	Tier 2 Salary $50,000- $89,999	Tier 3 Salary $90,000+	Tier 4 Part-Time Employees
Employee Only	$46.01	$52.38	$57.51	$287.54
Employee + Spouse	$142.03	$153.81	$164.46	$635.43
Employee + Child(ren)	$123.82	$127.82	$143.38	$553.96
Employee + Family	$253.95	$270.31	$285.69	$952.29

Employer Monthly HSA Contribution	Only if you are enrolled in the High Deductible Health Plan
Employee Only	$50.00
Employee + Spouse	$70.00
Employee + Child(ren)	$70.00
Employee + Family	$70.00

Downloads

Health Benefit Plan Summary

Summary of Benefits Coverage

Preventive Wellness Incentive

Blue KC DPP Member Flyer

Blue KC DPP Employer FAQs

Blue 365 FAQs

Blue 365 National Offers

Livongo Member Flyer

Livongo Employer FAQs

Rx Savings Overview

SmartShopper Member Guide Overview

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.mybluekc.com.

Blue KC Pharmacy Information:
• RX BIN Number: 021825
• PCN: IRX
• GROUP: BlueKC

Click the link below to view the Rx Savings Solutions and Rx Rewards webinar CLICK HERE

Blue Select Plus Network	In-Network	Out-of-Network
Deductible (Individual/Family)	$0/$0	N/A
Out-of-Pocket Max (Individual/Family)	$2,850 / $8,550	N/A
Shared Coinsurance		N/A
Physician Visits
Preventive	Covered at 100%	N/A
Physician Office Visit	$30 Copay	N/A
Specialist Visit	$60 Copay	N/A
Telehealth/Virtual Visits	$30 Copay	N/A
Hospital Services
Inpatient Hospitalization	$300 per day to a maximum of 5 days	N/A
Physician Services	IP or OP proffessional services covered at 100%	N/A
Outpatient Surgery	$300 per day to a maximum of 5 days (copay applies to annual inpatient/ outpatient copay max)	N/A
Outpatient Diagnostics	Included in the Hospital Copay above	N/A
Urgent Care	$60 Copay	N/A
Emergency Room	$100 Copay	N/A

Prescription Drugs	In-Network	Out-of-Network
Retail / Specialty Drugs	$10/$50/$70 Copay	N/A
Mail Order (90 day supply)	$30/$150/$210 Copay	N/A

Employee Semi-Monthly Rates	Tier 1 Salary under $49,999	Tier 2 Salary $50,000-	Tier 3 Salary $90,000+	Tier 4 Part-Time Employees
Employee Only	$164.16	$172.36	$180.57	$410.40
Employee + Spouse	$378.83	$394.84	$410.84	$907.07
Employee + Child(ren)	$339.41	$344.07	$367.32	$790.42
Employee + Family	$596.62	$619.27	$641.93	$1,359.38

Downloads

Health Benefit Plan Summary

Summy of Benefits Coverage

Preventive Wellness Incentive

Blue KC DPP Member Flyer

Blue KC DPP Employer FAQs

Blue 365 FAQs

Blue 365 National Offers

Livongo Member Flyer

Livongo Employer FAQs

Rx Savings Overview

SmartShopper Member Guide Overview

Your employer offers medical insurance to full-time employees 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.mybluekc.com.

Blue KC Pharmacy Information:
• RX BIN Number: 021825
• PCN: IRX
• GROUP: BlueKC

Click the link below to view the Rx Savings Solutions and Rx Rewards webinar CLICK HERE

Blue Select Plus Network	In-Network	Out-of-Network
Deductible (Individual/Family)	$3,300/$6,600	N/A
Out-of-Pocket Max (Individual/Family)	$3,300/$6,600	N/A
Shared Coinsurance	0%	N/A
Physician Visits	at Spira Care Facilities
Preventive Care	Covered at 100%	N/A
Primary Care Office Visit	100% After Deductible	N/A
Specialist Visit	100% After Deductible	N/A
Telehealth/Virtual Visits	100% After Deductible	N/A
Hospital Services
Inpatient Hospitalization	100% After Deductible	N/A
Physician Services	100% After Deductible	N/A
Outpatient Surgery	100% After Deductible	N/A
Outpatient Diagnostics	100% After Deductible	N/A
Urgent Care	100% After Deductible	N/A
Emergency Room	100% After Deductible	N/A

Prescription Drugs	In-Network	Out-of-Network
Retail / Specialty Drugs	100% After Deductible	N/A
Mail Order (90 day supply)	100% After Deductible	N/A

Employee Semi-Monthly Rates	Tier 1 Salary under $49,999	Tier 2 Salary $50,000-	Tier 3 Salary $90,000+	Tier 4 Part-Time Employees
Employee	$31.17	$37.41	$40.53	$233.80
Employee + Spouse	$103.33	$115.49	$121.57	$516.67
Employee + Child(ren)	$90.08	$95.38	$105.98	$450.42
Employee + Family	$189.28	$206.48	$215.09	$774.31