Comprehensive Major Medical
This program combines basic hospital, medical and surgical coverage with major medical coverage to offer you a complete range of health care services. A choice of deductible and coinsurance options is available. You'll enjoy the freedom to choose any health care provider. Payment will be made at the maximum allowance when eligible services are received from BCBSKS contracting providers.
With Comprehensive Major Medical, you pay a predetermined deductible for covered services. After that deductible has been met, you pay 20 percent of allowed charges to a predetermined maximum. After that maximum has been met, Blue Cross and Blue Shield of Kansas pays 100 percent of allowed charges for the balance of the benefit period. Accident care may or may not be subject to a deductible and coinsurance.
Learn how the Blue Choice network enhances your Comprehensive Major Medical coverage
Benefit Summary
Covered Hospital Services
The following services are covered when
medically necessary, subject to the deductible
and coinsurance.
Room, Board and General Nursing Services — Pays average semi-private (two or more beds) room allowance; approved intensive and cardiac units and allows the hospital’s average semi-private room charge toward a private room.
Miscellaneous Inpatient Services — Pays for services and supplies such as radiology services, lab work, anesthesia, operating room, physical therapy, etc.
Inpatient Drugs and Medicine — Pays for drugs approved by the Food and Drug Administration (except for experimental drugs).
Other Hospital Services —
– Maternity & newborn services (husband and wife must be enrolled in same plan)
– Emergency and ambulance services
– Mental health and substance use disorders
– Services provided in the outpatient department of a hospital
Covered Medical Services
Accidental Injuries — You may choose from:
– $500 deductible program which is not subject to deductible and coinsurance
– $1,000 deductible program which is subject to deductible and coinsurance
Immunizations — Pays 100 percent of the maximum allowance on immunizations for children up to 72 months of age (subject to contract limitations).
Preventive Services — Paid at 100 percent (specific services to be determined by Department of Health and Human Services).
Other Medical Services —
– Vision and hearing tests
– Prescription drugs
– Doctor’s office visits
– Durable medical equipment and supplies
Deductible
- $500 per person/$1,000 family
- $1,000 per person/$2,000 family
Coinsurance
Expenses are covered at 80 percent up to $1,000 per person/$2,000 family, then BCBSKS pays 100 percent of allowed charges for the remainder of the benefit period.
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 Comprehensive Major Medical by calling 785-291-4303 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 Comprehensive Major Medical 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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