AffordaBlue
You want affordable coverage and low out-of-pocket copays for routine office visits and related services that keep your family healthy. But you still need protection from larger expenses. You like the idea of up front benefits for preventive services, and a higher deductible for more costly services such as hospital and surgical care.
AffordaBlue could be just the health insurance plan you’ve been looking for. It covers preventive services at 100%. It also covers radiology, lab and accidental injury services. Non-routine services and outpatient services over and above the maximum allowed benefits are also covered at a separate deductible and coinsurance. The program also offers coverage for prescription drugs.
Learn how the Blue Choice network enhances your AffordaBlue coverage
Benefit Summary
Home & Office Visit Services*
$25 copayment per visit. Maximum of five visits for each covered person (15 visits for three or more persons) each benefit period.
- Office visits (well & ill)
- Routine physicals
- Immunizations & injections (100% of allowed charge)
Accidental Injuries*
$50 copayment for initial outpatient visit, when received within 60 days of the date
of injury. (This initial visit does not apply to the 5/15 office visit maximums shown.) If admitted
within 24 hours of the initial visit, the copay is
waived and benefits are subject to the “Other Services” deductible and coinsurance amounts.
Outpatient Radiology & Lab Services (including accidental injury services)*
Pays a maximum of $300 of combined services for each covered person ($900 for three-or-more
persons) each benefit period.
Preventive Services
Paid at 100 percent (specific services determined by the
Department of Health and Human Services).
Outpatient Prescription Drugs (optional)
Benefits are paid at 50 percent after a $100 deductible per covered person is met ($300 for three or more persons).
Other Covered Services
A choice of deductibles are available for benefits that include:
- In-hospital care
- Ambulance services
- Surgery & anesthesia
- Outpatient surgery
- Maternity & newborn services (husband and wife must be enrolled in same plan)
- *Amounts in excess of the maximum benefits for office visit and outpatient services as shown above
Deductible and Coinsurance
Covered (non-routine/non-preventive) medical services are subject to a deductible of either $1,000 or $2,000 for each covered person ($3,000 or $6,000 maximum for three-or-more persons). After the deductible is met, you pay 20 percent of allowable charges to a maximum out-of-pocket expense of $1,000 for each covered person ($3,000 three-or-more persons).
As an alternative, you may choose a deductible of $1,000 ($3,000 maximum for three-or-more persons). After the deductible, you pay 50% of allowable charges to a maximum out-of-pocket expense of $5,000 ($15,000 maximum for three-or-more persons).
Optional Benefits:
- Dental Program
- Hospital Indemnity Program
- Life Insurance
- Long-term Care Insurance
- Plan 150 (Cancer Policy)
Exclusions
See the Exclusions page for details.
Additional Program Information
- Dependent Coverage — Eligible children covered to age 26.
- Lifetime Maximum - Unlimited for each covered person.
- Inpatient Admissions - Pre-admission certification is required for all planned inpatient admissions.
- Deductible & Coinsurance: Your deductible and coinsurance will start over again on April 1 of each year.
- Waiting Period - A 240-day waiting period on new contracts applies to obstetrical services; operations for removal of tonsils and/or adenoids; treatment for tumors or growths; treatment for hernia; and treatment for conditions of gallbladder, rectum and genito-urinary tract.
More Information
- Phone: Learn more about the features of AffordaBlue by calling 291-4303 in Topeka or toll-free at 1-800-874-1823, 8 a.m. to 4:30 p.m., Monday through Friday.
- E-mail: Send a note to our AffordaBlue representative. Please provide a daytime phone number in your message indicating where and when you can be reached. All requests will be responded to via phone within two business days.
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