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

Covered services include but are not limited to:

• Office visits, both wellness check ups and treatment of illness
• Maternity and newborn care (husband and wife must be enrolled in same plan)
• Surgery and anesthesia
• In-hospital care
• Ambulance services
• Outpatient surgery
• Routine physicals
• Hearing tests
• Eye examinations
• Immunizations and injections (100% of allowed charges)
• Mental illness and substance use disorders
• Outpatient radiology and lab services
• Accidental injuries (100% up to $1,000)
• Home health care and hospice services
• Emergency room $100 copay

Preventive Care
Paid at 100 percent of the allowable charge. Includes routine screenings, immunizations, checkups and counseling received to prevent illness or disease.

Dependents
Your dependents are covered to age 26.

Outpatient Prescription Drugs
The BlueRx^SM Card prescription drug program provides savings using a three-tiered benefit. Copay is $15 for generic drugs, $30 for formulary brand drugs and $45 for non-formulary brand drugs. Mail order drugs have a copay of 2 ½ times the retail copay.

Lifetime Maximum
Each person covered has an unlimited lifetime maximum benefit.

Home Health Care & Hospice Rider
This plan pays 100% of the allowable charges for Home Health Care. It also pays 100% for Hospice Care with a $5,000 lifetime maximum.

Out-of-pocket Maximum Choices:

• $750 per person/$1,500 two or more persons
• $1,500 per person/$3,000 two or more persons
• $3,000 per person/$6,000 two or more persons

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

• Inpatient Admissions - Pre-admission certification is required for all planned inpatient admissions.
• 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 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.

More Information
Contact us to learn more about the features of Shared Pay Comprehensive.