Medical Benefits

Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family. Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility.

To find an in-network doctor, please visit bluekc.com.

LBA HRA Contribution: When first $500 of member deductible is met, LBA reimburses last $1,000 of member deductible.

	In-Network	Out-of-Network
Shared Coinsurance	20%	40%
Deductible i(Individual/Family)	$1,500 / $4,500	$1,500 / $4,500
Out-of-Pocket Max (Individual/Family)	$4,500 / $9,000	$9,000 / $18,000
Primary Care Visit	$35 Copay	Deductible + 40%
Specialist Visit	$35 Copay	Deductible + 40%
Routine Preventive	Covered at 100%	Deductible + 40%
Inpatient Hospitalization	Deducible + 20%	Deductible + 40%
Physician Services	Deducible + 20%	Deductible + 40%
Outpatient Surgery	Deducible + 20%	Deductible + 40%
Outpatient Diagnostics	Deducible + 20%	Deductible + 40%
Urgent Care Visit	$35 Copay	Deductible + 40%
Emergency Room Visit	$100 Copay then Deducible + 20%	$100 Copay then Deducible + 20%

Prescription Card	In-Network	Out-of-Network
Retail (Tier 1 /2/3)	$15 / $70 / $110	$15 / $70 / $110
Specialty (Tier 1 /2/3)	$15 / $110 / $200	$15 / $110 / $200
Mail Order (Tier 1 /2/3)	$37.50 / $175 / $275	$37.50 / $175 / $275

Per Weekly Pay Period Cost
Employee Only	$78.32
Employee + Spouse	$214.68
Employee + Child(ren)	$195.30
Employee + Family	$315.51

Downloads

Summary of Benefits

Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility.

To find an in-network doctor, please visit bluekc.com.

LBA HRA Contribution: When first $4,000 of member deductible is met, LBA reimburses last $1,000 of member deductible.

	In-Network	Out-of-Network
Shared Coinsurance	20%	40%
Deductible (Individual/Family)	$5,000 / $10,000	$5,000 / $10,000
Out-of-Pocket Max (Individual/Family)	$6,500 / $13,000	$13,000 / $26,000
Primary Care Visit	$40 Copay	Deductible + 40%
Specialist Visit	$40 Copay	Deductible + 40%
Routine Preventive	Covered at 100%	Deductible + 40%
Inpatient Hospitalization	Deducible + 20%	Deductible + 40%
Physician Services	Deducible + 20%	Deductible + 40%
Outpatient Surgery	Deducible + 20%	Deductible + 40%
Outpatient Diagnostics	Deducible + 20%	Deductible + 40%
Urgent Care Visit	$40 Copay	Deductible + 40%
Emergency Room Visit	$100 Copay then Deducible + 20%	$100 Copay then Deducible + 20%

Prescription Card	In-Network	Out-of-Network
Retail (Tier 1 /2/3)	$15 / $70 / $110	$15 / $70 / $110
Specialty (Tier 1 /2/3)	$15 / $110 / $200	$15 / $110 / $200
Mail Order (Tier 1 /2/3)	$37.50 / $175 / $275	$37.50 / $175 / $275

Per Weekly Pay Period Cost
Employee Only	$57.82
Employee + Spouse	$169.15
Employee + Child(ren)	$153.39
Employee + Family	$249.34

Downloads

Summary of Benefits

This plan is available only to employees who live in the Kansas City Metro Area. It is a narrow-network medical plan and offers only in-network coverage, except for emergency care.

This plan is only available exclusively to members who live in the following counties:
MISSOURI: Clay, Jackson, Platte, Cass, Clinton, DeKalb, Johnson, Lafayette, Ray, and Caldwell
KANSAS: Johnson and Wyandotte

To find an in-network doctor, please visit bluekc.com.

LBA HRA Contribution: No HRA Contribution for this plan

	In-Network	Out-of-Network
Shared Coinsurance	0%	N/A
Deductible (Individual/Family)	$5,000 / $10,000	N/Not Covered
Out-of-Pocket Max (Individual/Family)	$5,000 / $10,000	N/Not Covered
Primary Care Visit	SPIRA Care: No Member Cost Share Primary care: Deductible	N/V
Specialist Visit	SPIRA Care: No Member Cost Share Primary care: Deductible	Not Covered
Routine Preventive	Covered at 100%	Not Covered
Inpatient Hospitalization	Deducible	Not Covered
Physician Services	Deducible	Not Covered
Outpatient Surgery	Deducible	Not Covered
Outpatient Diagnostics	Deducible	Not Covered
Urgent Care Visit	SPIRA Care: No Member Cost Share Urgent care: Deductible	Subject to In-Network Deductible
Emergency Room Visit	Deducible	Subject to In-Network Deductible