True to its name, AffordaBlue is for Kansans who want affordable preventive hospital and surgical benefits to help pay for everyday and unexpected medical costs. Family friendly, AffordaBlue includes maternity and newborn benefits. AffordaBlue is the choice of many because it’s a solid value that makes health care budgeting easier.
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
Your office visit copay is $25 per visit with a maximum of five visits per person during the benefit period (total of 15 visits for a family of three or more persons). The benefit period is the 12-month period that begins the date your coverage goes into effect. You pay the $25 copay and AffordaBlue pays the remaining charges for:
Accidental Injuries: Initial Outpatient Coverage
Your copay is $50 for the initial outpatient visit when paid within 60 days of the date of injury. (This initial visit does not apply to the 5/15 office visit maximum mentioned above.) When admitted to the hospital within 24 hours of this initial visit, the copay is waived and benefits are subject to the “Other Services” deductible and coinsurance amounts explained later.
Outpatient Radiology & Lab Services (including accidental injury services)
Pays a maximum of $300 of combined services for each person covered during a benefit period ($900 for a family of three or more).
Paid at 100 percent of the allowable charge. Includes routine screenings, immunizations, checkups and counseling received to prevent illness or disease.
Your dependents are covered to age 26.
Outpatient Prescription Drugs (optional)
BlueRxSM Direct: $100 deductible ($300 maximum for three or more people), then benefits paid at 50% of the allowable charges.
Each person covered has an unlimited lifetime maximum benefit.
Home Health Care & Hospice Rider
AffordaBlue pays 100% of allowable charges for Home Health Care. It also pays 100% for Hospice Care with a $5,000 lifetime maximum.
Deductibles & Other Covered Services
You have a choice of deductibles – $500, $1,000 and $2,000 for each person covered ($1,500, $3,000 and $6,000 maximum for three or more persons). After meeting the deductible, you pay 20% of the allowable charges to a maximum out-of-pocket expense of $1,000 for each person covered ($3,000 for three or more people).
As an alternative, you may choose a deductible of $1,000 ($3,000 maximum for three or more persons). After deductible, you pay 50% of allowable charges to a maximum out-of-pocket expense of $5,000 ($15,000 for three or more persons). After the out-of-pocket maximum is met, AffordaBlue pays 100% of the allowed charges for the remainder of the benefit period.
Covered services include:
See the Exclusions page for details.
Additional Program Information
Triple Option Plan
The Triple Option Plan is available to large groups 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.
Contact us to learn more about the features of AffordaBlue.