BCBSKC $4,000 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) | $4,000 individual / $8,000 family | $1,500 individual / $3,000 family |
Out-of-Pocket Maximum (Calendar year) | $5,000 individual / $10,000 family | $6,000 individual / $12,000 family |
Coinsurance (Plan pays/You pay) | 90% / 10% | 60% / 40% |
Primary Care Physician Office Visits | Deductible, then 10% coinsurance | Deductible, then 30% coinsurance |
Specialist Office Visits | Deductible, then 10% coinsurance | Deductible, then 30% coinsurance |
Preventive Care | 100% | Deductible, then 30% coinsurance |
Urgent Care | Deductible, then 10% coinsurance | Deductible, then 30% coinsurance |
Emergency Room | In-Network deductible, then 10% coinsurance | |
Inpatient Services | Deductible, then 10% coinsurance | Deductible, then 30% coinsurance |
Outpatient Services | Deductible, then 10% coinsurance | Deductible, then 30% 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 |
Monthly Premium | $4,000 HDHP Preferred-Care Blue |
---|---|
| $23.49 |
| $309.05 |
| $279.62 |
| $426.81 |
Contact Information
Medical
- Blue KC
- 816-395-3558
- BlueKC.com
Pharmacy
- OptumRx
- optumrx.com
Benefit Questions
- nbkc human resources
- Human. Resources@nbkc.com