AffordaBlue

With premiums as much as 25 percent lower than our two most popular major medical plans, AffordaBlue also provides our members access to 98 percent of all doctors and acute care hospitals in Kansas (excluding Johnson and Wyandotte counties).

Learn how the Blue Choice network enhances your AffordaBlue coverage

Benefit Summary

Covered Services
The following services are covered up to their benefit maximums. Then services are covered under the “Other Services” benefits portion of the program, subject to separate deductible and coinsurance amounts.

Office Visit Services*— $25 copay per visit (except for initial visit for an accidental injury) up to a maximum of five visits for each covered person (15 visits for three-or-more persons) each benefit period. Covered services include:

Office visits (well & ill)
Routine physicals
Immunizations & injections (100% of allowed charge)

Initial Outpatient Coverage for Accidental Injuries* — $50 copay for the 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 above.) 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 shown below.

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.

Hospice Rider — Pays 100% Home Health Care up to $2,500 per person each benefit period. Pays Hospice 100% with a $5,000 lifetime maximum.

BlueRx Direct Outpatient Prescription Drugs (optional)— $100 deductible for each covered person ($300 maximum for three-or-more persons). Then benefits are paid at 50% of allowable charges for the remainder of the benefit period.

Other Covered Services — You choose a deductible of $500, $1,000 or $2,000 for each covered person ($1,500, $3,000 or $6,000 maximum for three-or-more persons). After the deductible, you pay 20% of allowable charges to a maximum out-of-pocket expense of $1,000 for each covered person ($3,000 for 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).

Covered services include :

In-hospital care
Ambulance services
Surgery & anesthesia
Outpatient surgery
Nervous and mental services (limited)
Maternity & newborn services
*Amounts in excess of the maximum benefits for office visit and outpatient services as shown above

Optional Benefits:

Exclusions
See the Exclusions page for details.

Additional Program Information

Lifetime Maximum - Up to $5 million in lifetime benefits for each covered person.
Inpatient Admissions - Pre-admission certification is required for all planned inpatient admissions.
Dependent Coverage - Unmarried dependent children are covered to age 23.
Benefit Period - The 12-month period based on the group anniversary month.
Waiting Period - Businesses select a waiting period option.

Triple Option Plan
The Triple Option Plan is available to groups of 2 to 99 employees with this product. The plan offers employees one of three out-of-pocket choices annually within the AffordaBlue benefit program. The employer must contribute at least 25 percent of the employee-only premium amount for the highest out-of-pocket option. This stabilizes the group's base and gives the employees the option to "buy up" to a better level of coverage, based on their personal insurance needs.

More Information
Contact us to learn more about the features of AffordaBlue