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Shared Pay Comprehensive

This program offers comprehensive coverage without a deductible. The costs of services are shared on a 50/50 basis, beginning with the member's first dollar of expense, until the out-of-pocket amount reaches a predetermined dollar maximum. With the Shared Pay Comprehensive program members select their own health care providers. Payment will be made at the maximum allowance when eligible services are received from Blue Cross and Blue Shield of Kansas contracting providers.

Learn how the Blue Choice network enhances your Shared Pay Comprehensive coverage

Benefit Summary (Benefits include but are not limited to:)

• In-hospital care
• Surgery & anesthesia
• Maternity & newborn services (husband and wife must be enrolled in same plan)
• Radiology & lab services
• Immunizations
• Ambulance
• Hearing tests
• Eye exams
• Allergy tests
• Physical medicine
• Medical equipment
• Routine physicals
• Home health care/Hospice
• Dental (limited to covered services)
• Outpatient surgery
• Second surgical opinion
• Emergency services
• Outpatient nervous & mental services (limited)
• Inpatient nervous & mental services (limited)

Optional Benefits:

• Outpatient prescription drugs
• Dental program
• CAPplus - inpatient hospital pre-admission certification
• HMS - nervous & mental treatment pre-certification process

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 50 employees with this product. The plan offers employees one of three out-of-pocket choices annually within the Shared Pay Comprehensive 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 Shared Pay Comprehensive.