BCBSKS Logo circle-r-cross circle-r-shield reg-marks cross-outer cross-inner cross-inner-neg cross-mid-left-neg cross-upper-left-neg cross-mid-right-neg cross-upper-right-neg cross-lower-neg cross-inner-gap cross-mid-left-gap cross-upper-left-gap cross-mid-right-gap cross-upper-right-gap cross-lower-gap shield-outer shield-inner shield-outline-neg shield-inner-gap shield-stick-neg shield-stick-2-neg shield-stick-3-neg shield-stick-4-neg shield-stick-1-neg shield-snake-neg shield-snake-top-neg shield-snake-mid-neg shield-snake-bottom-neg shield-snake-tail-neg shield-snake-eye-gap kansas kansas-k kansas-a kansas-n kansas-s kansas-a kansas-s
Skip Navigation

Member Card
BlueAccess® Login / Pay Bill
BlueAccess® Login / Pay Bill

Group Health Plans | More than 50 Employees

BlueEdge Comprehensive Major Medical Program

Employer groups may select from a choice of deductible options.

Basic plan summary Member pays
Deductible (per group anniversary benefit period) $500/$1,000; $1,000/$2,000; $1,500/$3,000; individual/two-or-more persons
Coinsurance (member portion for most services) 20% of allowed amounts after deductible has been met
Maximum out-of-pocket (includes copays, deductible and coinsurance where applicable) $5,000/$10,000 individual/two-or-more persons.
After the maximum out-of-pocket amount has been reached, eligible benefits will be paid at 100% of the allowed amount for the remainder of the benefit period.
Doctor's office visits
Home and office visits $35 office visit copay
Telemedicine visits $35 office visit copay
Preventive care as defined by the Affordable Care Act These services are paid at 100% of the allowable charge.
Some of the services include:
  • Routine screenings
  • Preventive immunizations
  • Well-woman visits/screenings
  • Contraceptive methods
Drug coverage
Prescription drugs and mail order The quantity per prescription is a 30-day pharmacy supply
or 90-day mail order supply.

BlueRx Card $15/$50/$75; $150/20% up to $250 with mail order is 2½ x copay with ResultsRx formulary.

BlueRx Card $15/$50/$75; $150/20% up to $250 with mail order is 2½ x copay with Select formulary.

Must use designated specialty pharmacy for all specialty prescriptions.
Medical services
Emergency medical transportation Subject to deductible/coinsurance
Inpatient surgery physician/surgical
Inpatient facility fee
Outpatient surgery physician/surgical
Outpatient lab and radiology (includes advanced imaging) Pays at 100% of allowable charges up to a combined maximum of $300 for each covered person, each benefit period
Emergency room $250 copay then subject to deductible/coinsurance
Recovery/special needs
Outpatient rehabilitation Subject to deductible/coinsurance
Home social work visits
Mental health
Mental/behavioral health – inpatient services
Requires pre-admission certification from New Directions Behavioral Health at (800) 952-5906
Subject to deductible/coinsurance
Mental/behavioral health – outpatient services $35 office visit copay
Lifetime maximum Unlimited
Eligible dependents Covered to age 26

Exclusions: Following is a list of common non-covered services. For a complete list of limitations and exclusions, refer to your certificate.

Duplicate benefits provided under federal, state or local laws, regulations or programs except Medicaid; services involving cosmetic or reconstructive surgery (except as stated in the contract); charges for personal items; convalescent or custodial care or rest cure; all keratotomy procedures; blood or payments to donors of blood; any service or supply related to the medical management of obesity, except services covered as preventive health benefits; services or supplies related to sex transformations; services related to the reversal of sterilization procedures; any medically-aided insemination procedure; charges for services by immediate relatives or by members of the household; acupuncture and admission for acupuncture; medically unnecessary services and admissions; services covered and payable under any medical expense payment provision of any automobile insurance policy; mental illness or substance use disorder services provided by a non-eligible provider; services, supplies or treatments not specifically listed as covered in the member’s contract.

Drug coverage limitation: Generic drugs are mandatory if available unless physician prescribes a brand drug.

Optional benefits:

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 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.

More Information
Contact us to learn more about the features of BlueEdge Comprehensive Major Medical.