Blue KC First Bronze Preferred-Care Blue EPO
Blue Cross and Blue Shield of Kansas City
Plan overview
Medical deductible
Individual: $7000
Family: $14000
Per Person: $7000
Prescription drug deductible
Individual: $0
Family: $0
Per Person: $0
Combined medical and drug out of pocket maximum
Individual: $10600
Family: $21200
Per Person: $10600
Office visit
Primary Doctor
CoPay: $40.00
CoInsurance: 50.00% Coinsurance after deductible
Covered: Covered
Benefit Explanation: You have a $0 copay for telehealth visits with your doctor, saving you money and time. This Plan offers first dollar coverage for the first four (4) office visits. Eligible services include primary care, specialist, urgent care, mental health, and/or substance abuse services received in an office. Deductible and coinsurance apply after you have received four (4) visits in the calendar year. Office visits are subject to the applicable copayment, see Plan Documents for more information.
Specialist
CoPay: $40.00
CoInsurance: 50.00% Coinsurance after deductible
Covered: Covered
Benefit Explanation: You have a $0 copay for telehealth visits with your doctor, saving you money and time. This Plan offers first dollar coverage for the first four (4) office visits. Eligible services include primary care, specialist, urgent care, mental health, and/or substance abuse services received in an office. Deductible and coinsurance apply after you have received four (4) visits in the calendar year. Office visits are subject to the applicable copayment, see Plan Documents for more information.
Prescription drug information
Preferred brand drugs
CoPay: $125.00 Copay after deductible
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation:
Non preferred brand drugs
CoPay: $325.00 Copay after deductible
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation:
Generic drugs
CoPay: $5.00
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation: The cost sharing shown applies to Low-Cost Generic tier drugs only. See Summary of Benefits & Coverage (SBC) or Plan Document for more information on cost sharing for other Generic drugs, which may apply a higher cost-share. Plan covers up to a 34-day supply. Prior authorization may be required. Refer to the Prescription Drug List or Plan Document for plan details.
Specialty drugs
CoPay: Not Applicable
CoInsurance: 50.00% Coinsurance after deductible
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation:
Inpatient coverage
Hospital services
CoPay: Not Applicable
CoInsurance: 50.00% Coinsurance after deductible
Covered: Covered
Inpatient services
CoPay: Not Applicable
CoInsurance: 50.00% Coinsurance after deductible
Covered: Covered
Emergency and urgent care
Emergency room
CoPay: Not Applicable
CoInsurance: 50.00% Coinsurance after deductible
Covered: Covered
Urgent care facility
CoPay: $40.00
CoInsurance: 50.00% Coinsurance after deductible
Covered: Covered
Benefit Explanation: Save money and time with Blue KC Virtual Care. You may access virtual care for a $0 copay, 24/7. This Plan offers first dollar coverage for the first four (4) office visits. Eligible services include primary care, specialist, urgent care, mental health, and/or substance abuse services received in an office. Deductible and coinsurance apply after you have received four (4) visits in the calendar year. Office visits are subject to the applicable copayment, see Plan Documents for more information.
Maternity
Labor and delivery hospital stay
CoPay: Not Applicable
CoInsurance: 50.00% Coinsurance after deductible
Covered: Covered
Pre and Postnatal office visit
CoPay: Not Applicable
CoInsurance: 50.00% Coinsurance after deductible
Covered: Covered
Vision
Routine Eye Exams for Children
CoPay: No Charge
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity: 1
Limit Unit: Exam(s) per Benefit Period
Major dental care
Routine dental checkups for children
CoPay:
CoInsurance:
Covered: Not Covered
Limit Quantity:
Limit Unit:
Routine dental checkups for adults
CoPay:
CoInsurance:
Covered: Not Covered
Limit Quantity:
Limit Unit:
Benefit Explanation:
These policies have exclusions, limitations, reduction of benefits, terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company (whichever is applicable).