Shared Pay Comprehensive
This program offers comprehensive coverage without a deductible. The costs of services are shared on a 50/50 basis, beginning with your first dollar of expense, until the out-of-pocket amount reaches a predetermined dollar maximum. With the Shared Pay Comprehensive program you select your own health care providers. Payment will be made at the maximum allowance when eligible services are received from BCBSKS contracting providers.
Learn how the Blue Choice network enhances your Shared Pay Comprehensive coverage
Benefit Summary
Office Visit Services — Office visits are covered subject to shared payment. Covered services include:
- Office visits (well & ill)
- Routine physicals
- Immunizations & injections (100 percent of allowed charge)
Initial Outpatient Coverage for Accidental Injuries — Covered, subject to shared payment.
Outpatient Radiology & Lab Services (including accidental injury services) — Covered, subject to shared payment.
BlueRxSM Direct Outpatient Prescription Drugs — $100 deductible for each covered person ($200 maximum for two-or-more persons). Then benefits are paid at 50 percent of allowable charges for the remainder of the benefit period.
Additional coverage in the program includes:
- In-hospital care
- Ambulance services
- Surgery and anesthesia
- Outpatient surgery
- Maternity and newborn services (husband and wife must be enrolled in same plan)
- Vision and hearing tests
- Accidental injuries
- Mental health and substance use disorders
- Durable medical equipment and supplies
Preventive Services — Paid at 100 percent (specific services determined by the Department of Health and Human Services).
Deductible
With First Choice Shared Pay Comprehensive, you start receiving benefits immediately – there's no deductible. As benefits are paid, the cost of covered services is shared.
Coinsurance
The program pays 50 percent and you pay 50 percent. Your maximum out-of-pocket expense each benefit period is $1,500 per individual ($3,000 maximum for two-or-more individuals).
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 Shared Pay Comprehensive 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 Shared Pay Comprehensive 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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