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Value Blue

Value Blue is designed especially for income-eligible individuals who have gone the past 12 months without being covered on a health insurance policy. This special low-cost program is made possible through Blue Cross and Blue Shield of Kansas, with the endorsement of the Kansas Medical Society, Kansas Hospital Association and the Kansas Insurance Department.

Benefit Summary

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 copayment 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.

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.

* Once the maximum of these services (above) has been reached, any additional services will be covered under the “Other Services” benefits portion of the program (see below) — and will be subject to separate deductible and coinsurance amounts.

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

The Other Services section also includes coverage for in-hospital care, ambulance services, surgery and anesthesia, outpatient surgery, maternity and newborn services and amounts in excess of the maximums for office visit and outpatient medical services as shown above.

Optional Benefits:

• Dental Program
• Hospital Indemnity Program
• Life Insurance
• Plan 150 (Cancer Policy)

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.

More Information
Contact us to learn more about the features of Value Blue.