Blue Cross and Blue Shield of Kansas City

Blue KC Catastrophic BlueSelect EPO

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Major Dental Care

Links

Plan Overview

Combined Medical and Drug Deductible	Individual: $9,200.00 Family: $18400 Per Person: $9200
Combined Medical and Drug Out of Pocket Maximum	Individual: $9,200.00 Family: $18400 Per Person: $9200

Office Visit

Primary Doctor	CoPay: $100.00 CoInsurance: No Charge after deductible Covered: Covered Benefit Explanation: You have a $0 copay for telehealth visits with your doctor, saving you money and time.
Specialist	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered Benefit Explanation: You have a $0 copay for telehealth visits with your doctor, saving you money and time.

Prescription Drug Information

Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered
Non Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered
Generic Drugs	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered Benefit Explanation: See the Prescription Drug formulary for more information on drug costs.
Specialty Drugs	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered

Inpatient Coverage

Hospital Services	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered
Inpatient Services	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered

Emergency and Urgent Care

Emergency Room	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered
Urgent Care Facility	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered Benefit Explanation: Save money and time with Blue KC Virtual Care. You may access virtual care for a $0 copay, 24/7.

Maternity

Labor and Delivery Hospital Stay	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered Benefit Explanation: Also covers surrogate mother if there is a petition to adopt within 90 days of birth.
Pre and Postnatal Office Visit	CoPay: Not Applicable CoInsurance: No Charge after deductible Covered: Covered Benefit Explanation: Also covers surrogate mother if there is a petition to adopt within 90 days of birth.

Vision

Routine Eye Exams for Children

CoPay: Not Applicable
CoInsurance: No Charge after deductible
Covered: Covered

Major Dental Care

Routine Dental Checkups for Children

Covered: Not Covered