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 VisitsDeductible, then 0% coinsuranceDeductible, then 20% coinsurance
Specialist Office VisitsDeductible, then 0% coinsuranceDeductible, then 20% coinsurance
Preventive Care100%Deductible, then 20% coinsurance
Urgent CareDeductible, then 0% coinsuranceDeductible, then 20% coinsurance
Emergency RoomIn-Network deductible, then 0% coinsurance
Inpatient ServicesDeductible, then 0% coinsuranceDeductible, then 20% coinsurance
Outpatient ServicesDeductible, then 0% coinsuranceDeductible, then 20% coinsurance
Retail Prescription Drug Coverage
(up to 34-day supply)
Deductible, then 0% coinsuranceDeductible, then 50% coinsurance
Mail Order
(up to 102-day supply)
Deductible, then 0% coinsuranceDeductible, then 50% coinsurance
Monthly Premium
$2,800 HDHP
Preferred-Care Blue
    Employee only
$118.77
    Employee + Spouse
$509.16
    Employee + Child(ren)
$460.67
    Family
$703.16

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