Healthy Blue
Healthy Blue's preventive covered services are designed as a strategy to maintain good health and prevent illness. A combination of several fully covered medical services and fully covered preventive radiology and lab services serve as the cornerstone of an affordable health care insurance plan. Early detection through preventive screenings is a key part of Healthy Blue's approach to health care.
Learn how the Blue Choice network enhances your Healthy Blue coverage
Benefit Summary
Office Visits & Services
Up to three office visits are paid at 100% during the benefit period, then subject to deductible and coinsurance. The benefit period is the 12-month period that begins on the first day of a given month. There is no family limit. Office visits include both wellness checkups and treatment of illness.
Immunizations
Immunizations up to age 72 months are covered 100% of the maximum allowance.
Preventive Radiology & Lab Services
From routine Ob/Gyn exams to heart disease prevention, screenings for a multitude of diseases and disorders are covered 100% of maximum allowance.
Flu Shots
One shot per member, per year, is covered 100% of maximum allowance.
Non-preventive Outpatient Radiology & Lab Services
Pays 100% of the allowable charge to a maximum of $300 per person each benefit period, then subject to deductible and coinsurance. There is no family limit. This benefit includes radiology and services resulting from an accidental injury.
Accidental Injury Services
Pay 100% up to $500 person each benefit period, then subject to deductible and coinsurance. This benefit does not include radiology, lab services or ambulance services.
Outpatient Prescription Drugs
Benefits are paid at 50 percent after a $100 deductible per covered person is met ($300 for three or more persons).
Maximum Lifetime Benefit
Each covered person has a $250,000 lifetime benefit.
Deductible and Other Covered Services
Healthy Blue includes a $2,000 deductible for each covered person and $6,000 maximum for three or more persons. After meeting the deductible, you pay 50% of allowed amounts to a maximum of $5,000; $15,000 maximum for three or more persons. After the annual out-of-pocket is met, Healthy Blue pays 100% of the allowed charges for the remainder of the benefit period.
Covered Services include:
- Surgery - inpatient and outpatient
- Inpatient and outpatient hospital care
- Injections – includes infusion and intravenous
- Ambulance
- Emergency room
- Maternity & newborn services (husband and wife must be enrolled in same plan)
- Mental illness & substance use disorders
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.
- Dependent Coverage - Unmarried dependent children are covered to age 23.
- Benefit Period - A 12-month period beginning on the date your health insurance coverage starts.
- Waiting Period - A 240-day waiting period on new contracts applies to obstetrical services; operations for removal of tonsils and/or adenoids; treatment for tumors or growths; treatment for hernia; and treatment for conditions of gallbladder, rectum and genito-urinary tract.
More Information
- Phone: Learn more about the features of Healthy Blue by calling 785-291-4304 in Topeka or toll-free at 1-800-438-1565, 8 a.m. to 4:30 p.m., Monday through Friday.
- E-mail: Send a note to our Healthy Blue representative. Please provide a daytime phone number in your message indicating where and when you can be reached. All requests will be responded to via phone within two business days.
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