$1,500 PPO Deductible Plan
nbkc is committed to providing quality health coverage for you and your dependents. Auxiant will provide our Medical and Prescription Drug coverage. For claim inquiries, help finding a provider, or general questions, please contact Auxiant.
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, 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) | $1,500 individual / $3,000 family | $3,000 individual / $6,000 family |
| Out-of-Pocket Maximum (Calendar year) | $3,000 individual / $6,000 family | $15,000 individual / $30,000 family |
| Coinsurance (Plan pays/You pay) | 80% / 20% | 50% / 50% |
| Primary Care Physician Office Visits | $25 copay | Deductible, then 50% coinsurance |
| Specialist Office Visits | $50 copay | Deductible, then 50% coinsurance |
| Preventive Care | 100% | Deductible, then 50% coinsurance |
| Urgent Care | $50 copay | Deductible, then 50% coinsurance |
| Emergency Room | $300 Copay, then deductible, then 20% coinsurance | |
| Inpatient Services | Deductible, then 20% coinsurance | Deductible, then 50% coinsurance |
| Outpatient Services | $1,500 individual / $3,000 family | Deductible, then 50% coinsurance |
| Retail Prescription Drug Coverage (up to 34-day supply) | Tier 1: $10 copay Tier 2: $35 copay Tier 3: $60 copay | Copay + 50% coinsurance |
| Mail Order (up to 102-day supply) | Tier 1: $25 copay Tier 2: $87.50 copay Tier 3: $150 copay | Copay + 50% coinsurance |
| Monthly Premium | $1,500 PPO |
|---|---|
| $199.00 |
| $694.80 |
| $628.60 |
| $959.50 |
Contact Information
Medical
- Auxiant
- 800-788-7569
- Auxiant.com
- Group # #2081
Pharmacy
- SmithRX
- member.mysmithrx.com
Benefit Questions
- nbkc human resources
- Human. Resources@nbkc.com
PLACE OF SERVICE GUIDE
Understanding where to receive care is crucial in a self-funded plan. This Place of Service Guide will help you navigate the healthcare system, find the best value, and make informed decisions about your care.
FREQUENTLY ASKED QUESTIONS
A TPA is an entity (such as Auxiant) contracted to establish and provide administration for a health plan, such as nbkc bank. A TPA is not an insurance company. Auxiant’s primary role is to process and pay claims as instructed to by the employer group via the Plan Document, which outlines all medical benefits.
Auxiant ID cards identify all relevant information on your medical plan including in-network providers and contact information. Present your Auxiant ID card to all of your medical providers, including your physicians/clinics and hospitals. Use of the Auxiant ID card will ensure prompt claims payment when going to a medical provider.
Auxiant can be reached by phone at 800-788-7569, or by going online at www.auxiant.com. You have access to your claims and benefit information via our website.
Aetna Network Provider Directory: www.aetna.com/asa
Pre-certification: 866-726-6584
Admission Notification is required for inpatient hospitalizations. For pre-certification call 866-726-6584. It is recommended that you or your doctor call at least 48 hours in advance of a scheduled inpatient hospitalization or within 48 hours or the first business day following an emergency admission.
Case Management – Auxiant is able to identify cases for early intervention through the claims and pre-certification process. A case manager may contact you to offer you guidance, education and assistance in understanding your treatment plan.
The nbkc bank health plan has partnered with the Aetna network. This partnership gives members access to a broad network of doctors and facilities with great savings and quality care. You can get the most out of your benefits by using providers that belong to the Aetna Signature Administrators network, as those providers have agreed to provide a discounted fee for services.
It is easy to find an Aetna network provider by using the online provider directory at www.aetna.com/asa. The online directory includes the most detailed provider information available. It is very important that you verify that your providers are in the Aetna network prior to any scheduled visit.
Important notes to consider: Members should contact Auxiant at 800-788-7569 to verify eligibility status and confirm benefits. This information can also be confirmed by logging onto a member account at www.auxiant.com.
Reminder: Auxiant is the TPA which is a separate entity from the provider network with Aetna; therefore, Auxiant cannot locate providers on behalf of Aetna. Similarly, Aetna cannot view eligibility or benefit information that is housed by Auxiant.
The online directory provides details like board certification, hospital affiliations, medical school, year of graduation, gender, specialties, languages spoken, and if the provider is accepting new patients. Additional information such as maps, driving directions, and website addresses (if available) may also be accessible.
You can refine your search by filtering for characteristics like provider specialty, languages spoken, gender, hospital affiliation, and board certification. You can also adjust the geographic radius, sort results by best match or distance, and view maps with driving directions.