Lowest cost Blue KC plan offered to small group employees.

Provides two visits to a Primary Care Physician (PCP) at a low copayment before deductible or coinsurance applies.

Available only in the BlueSelect network service area (Johnson and Wyandotte counties in Kansas and Clay, Jackson and Platte counties in Missouri)

Basic Plan Variations

Basic Silver
BlueSelect5 with BlueCard
(Available for purchase directly from Blue KC)
Basic Bronze
BlueSelect5 with BlueCard
(Available for purchase directly from Blue KC)
Network IN OUT IN OUT
DEDUCTIBLE
SINGLE $2,750 not covered $6,000 not covered
FAMILY $5,500 not covered $12,000 not covered
OUT OF POCKET MAX
SINGLE $5,000 not covered $7,000 not covered
FAMILY $10,000 not covered $14,000 not covered
COST SHARING
COINSURANCE 40% not covered 40% not covered
PCP1 $10 Copay first 2 visits, Ded/Coins 3+ visits not covered $25 Copay first 2 visits, Ded/Coins 3+ visits not covered
SPECIALIST Ded then 40% not covered Ded then 40% not covered
URGENT CARE Ded then 40% not covered Ded then 40% not covered
ER Ded then 40% Ded then 40%
PHARMACY2 Tiers 2-4: $1,000 Deductible
Tier 1: $10/$20
Tier 2: Ded then $55 / Ded then $80
Tier 3: Ded then 20% (Max $250) / Ded then 20%
Tier 43: Ded then 30% / Ded then 30%
Tiers 2-4: $1,000 Deductible
Tier 1: $20/$40
Tier 2: Ded then $80 / Ded then $100
Tier 3: Ded then 20% (Max $250) / Ded then 20%
Tier 43: Ded then 30% / Ded then 30%
DEDUCTIBLE TYPE4 EMBEDDED EMBEDDED

Summary of Benefits and Coverage

View a complete list of Summary of Benefits and Coverage Documents.

  • Basic products are Exclusive Provider Organization (EPO) products. Groups enrolled in Basic products do not have out-of-network benefits. In-network pharmacy utilizes the Walgreens Advantage Network, which allows members to fill prescriptions at Walgreens and many other pharmacies. All other pharmacies, including CVS, are considered out-of-network. The mail order ratio for long-term prescriptions is 2.5 times the retail copayments.
  • 1 Primary Care Physicians include General Practice, Family Practice, Internal medicine and Pediatrics.
  • 2 Maintenance medications must be filled through the mail-order pharmacy to receive the lowest copay. Individuals will be charged two times the applicable copay for a maintenance medication at retail pharmacies after the second prescription is filled. Cost-sharing for out-of-network pharmacy claims in all PPO products is 50% coinsurance after deductible.
  • 3 Tier 4 specialty medications should be filled through the mail-order pharmacy to receive the lowest copay. Members will be charged up to two times the applicable copay for a specialty medication at retail pharmacies. Some specialty medications are only available through the mail order pharmacy. A list of those medications for Missouri members is available in the 2018 Missouri Prescription Drug List and for Kansas members in the 2018 Kansas Prescription Drug List.
  • 4 Embedded – An individual deductible you must satisfy each calendar year before benefits will be paid. Aggregate – The entire family deductible must be satisfied each calendar year before benefits for any covered person will be paid.
  • 5 A more limited provider network, BlueSelect is recommended only for groups located in the 5-county Kansas City metro area, which includes Clay, Jackson and Platte counties in Missouri and Johnson and Wyandotte counties in Kansas. BlueSelect offers affordability by using a smaller hospital network than Preferred-Care Blue.

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