Under this option of our Comprehensive Major Medical plan, cost sharing of some of the coverages is built right into the plan. That means you still receive a complete care package, but you also see a flexible affordability.
Coverage includes hospital, surgical, medical, accident, even maternity and newborn benefits. Plus, the comprehensive care you receive is provided by your choice of doctors and hospitals from our comprehensive network – 99% of all health care providers in our service area.
This plan and the people who manage it are all Kansas-based. Even claims and customer service phone calls are handled right here in Kansas. Blue Cross and Blue Shield of Kansas is Kansans serving Kansans.
Benefit Summary (Benefits include but are not limited to:)
Office Visit & Services
Your Primary care office visit copay is $30.
Your Specialist office visit copay is $60.
Office visits are subject to deductible and coinsurance starting with the 6th office visit.
The services listed below are considered office visits subject to appropriate copays and, if applicable, deductible and coinsurance.
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.
The BlueRx CardSM prescription drug program provides savings using a four-tiered benefit. (If generics for a prescription are available, they must be used.) Copay is $15 for generic drugs, $50 for formulary brand drugs, $75 for non-formulary brand drugs and $150 for specialty drugs. Mail order drugs have a copay of 2 ½ times retail copay.
With Comprehensive Major Medical, each person covered has an unlimited lifetime maximum benefit.
Deductibles and Coinsurance
Deductibles are $1,500 for each person covered ($3,000 maximum for two-or-more person coverage). After meeting your deductible, you pay 40% coinsurance (Blue Cross pays the other 60%) to a maximum out-of-pocket expense of $2,000 for each person ($4,000 for two-ormore- person coverage). After the out-of-pocket maximum is met, Blue Cross pays 100% of the allowed charges for covered services for the remainder of your 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 Comprehensive Major Medical 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 Comprehensive Major Medical.