Funded by the employer, a HRA sets aside a specific amount of pre-tax dollars for employees to pay for health care expenses and must be established for each covered employee.

Funds available are applied toward any deductible or coinsurance the employee may owe for covered medical services.

Office visit and prescription drug copays are not reimbursable from the HRA.

Available only in the Preferred-Care network.

HRA Plan

HRA PCA-$750 PCB Gold4
Preferred-Care Blue with BlueCard
(Available for purchase directly from Blue KC)
Network IN OUT
SINGLE $3,000 $3,000
FAMILY $6,000 $6,000
SINGLE $6,000 $12,000
FAMILY $12,000 $24,000
PCP1 Visits $25/$50 Ded then 50%
URGENT CARE Ded then 20% Ded then 50%
SPECIALIST VISITS Ded then 20% Ded then 50%
Emergency Room Deductible then 20%
Prescription drugs at a retail pharmacy2 Tier 1: $10
Tier 2: $55
Tier 3: 20% (Max $250)
Tier 43: Ded then 30%

Summary of Benefits and Coverage

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

  • 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 These Preferred-Care Blue plans use the lower PCP copayment for Patient-Centered Medical Home (PCMH) visits and the higher for all others; for parity purposes, mental health providers are treated as PCPs.
  • 5 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.

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Good health starts with good support. That's why every Blue KC member has access to the resources they need to live healthy. From Health Risk Assessments to health and wellness programs. From prenatal programs to preventive care. We're committed to improving the health of our members and our community.

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Health Insurance Matters

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