BCBSKC $2,800 HDHP Deductible Plan
(Preferred-Care Blue)

nbkc is committed to providing quality health coverage for you and your dependents. Blue KC will continue to provide our Medical and Prescription Drug coverage for the 2022 plan year. For claim inquiries, help finding a provider, or general questions, please contact Blue KC at 816-395-3558 or visit MyBlueKC.com.

The chart below provides a high-level look at the amounts you pay when visiting in-network and out-of-network providers. Please refer to full plan descriptions for greater detail, in order to make the Medical/Rx choice that best meets the needs for you and your family.

Plan Features	In-Network	Out-of-Network
Deductible (Calendar year)	$2,800 individual / $5,600 family	$2,800 individual / $5,600 family
Out-of-Pocket Maximum (Calendar year)	$2,800 individual / $5,600 family	$5,600 individual / $11,200 family
Coinsurance (Plan pays/You pay)	100% / 0%	80% / 20%
Primary Care Physician Office Visits	Deductible, then 0% coinsurance	Deductible, then 20% coinsurance
Specialist Office Visits	Deductible, then 0% coinsurance	Deductible, then 20% coinsurance
Preventive Care	100%	Deductible, then 20% coinsurance
Urgent Care	Deductible, then 0% coinsurance	Deductible, then 20% coinsurance
Emergency Room	In-Network deductible, then 0% coinsurance
Inpatient Services	Deductible, then 0% coinsurance	Deductible, then 20% coinsurance
Outpatient Services	Deductible, then 0% coinsurance	Deductible, then 20% coinsurance
Retail Prescription Drug Coverage (up to 34-day supply)	Deductible, then 0% coinsurance	Deductible, then 50% coinsurance
Mail Order (up to 102-day supply)	Deductible, then 0% coinsurance	Deductible, then 50% coinsurance