2022 4000 BSP

BCBSKC $4,000 HDHP Deductible Plan
(BlueSelect Plus + SPIRA CARE)

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.

Blue KC Members who select the BlueSelect Plus network, now have access to SPIRA CARE, an integrated primary care center, meant to simplify the healthcare experience, making it more personal and affordable.

With SPIRA CARE, you have access to convenient Care Centers located across the metro area, the expertise of our Care Guides to help them on their health journey, and all of the benefits of the BlueSelect Plus network.

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)	$4,000 individual / $8,000 family	$8,000 individual / $16,000 family
Out-of-Pocket Maximum (Calendar year)	$5,000 individual / $10,000 family	$25,000 individual / $50,000 family
Coinsurance (Plan pays/You pay)	90% / 10%	60% / 40%
Primary Care Physician Office Visits	Deductible, then 10% coinsurance	Deductible, then 40% coinsurance
Specialist Office Visits	Deductible, then 10% coinsurance	Deductible, then 40% coinsurance
Preventive Care	100%	Deductible, then 40% coinsurance
Urgent Care	Deductible, then 10% coinsurance	Deductible, then 40% coinsurance
Emergency Room	In-Network deductible, then 10% coinsurance
Inpatient Services	Deductible, then 10% coinsurance	Deductible, then 40% coinsurance
Outpatient Services	Deductible, then 10% coinsurance	Deductible, then 40% coinsurance
Retail Prescription Drug Coverage (up to 34-day supply)	Deductible, then Tier 1: $10 copay Tier 2: $35 copay Tier 3: $60 copay	Deductible, then 50% coinsurance
Mail Order (up to 102-day supply)	Deductible, then Tier 1: $25 copay Tier 2: $87.50 copay Tier 3: $150 copay	Deductible, then 50% coinsurance