Shared Pay Comprehensive
This program offers comprehensive coverage without a deductible. The costs of services are shared on a 50/50 basis, beginning with your first dollar of expense, until the out-of-pocket amount reaches a predetermined dollar maximum. With the Shared Pay Comprehensive program you select your own health care providers. Payment will be made at the maximum allowance when eligible services are received from BCBSKS contracting providers.
Learn how the Blue Choice network enhances your Shared Pay Comprehensive coverage
Benefit Summary (Benefits include but are not limited to:)
- In-hospital care
- Surgery & anesthesia
- Maternity & newborn services (husband and wife must be enrolled in same plan)
- Radiology & lab services
- Immunizations
- Outpatient prescription drugs
- Ambulance
- Hearing tests
- Eye exams
- Allergy tests
- Physical medicine
- Medical equipment
- Routine physicals
- Private duty nursing (limited)
- Dental (limited to covered services)
- Outpatient surgery
- Second surgical opinion
- Emergency services
- Outpatient nervous & mental services (limited)
- Inpatient nervous & mental services (limited)
Deductible
With First Choice Shared Pay Comprehensive, you start receiving benefits immediately – there's no deductible. As benefits are paid, the cost of covered services is shared.
Coinsurance
The program pays 50 percent and you pay 50 percent. Your maximum out-of-pocket expense each benefit period is $1,500 per individual ($3,000 maximum for two-or-more individuals).
Optional Benefits:
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 - 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 Shared Pay Comprehensive 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 Shared Pay Comprehensive 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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