Have questions about your Blue KC health insurance? Well, we're one step ahead of you. Here's where to find answers to things we're asked about most.
What can we help you with?
Learn about Blue KC business hours and services and how to get your Blue KC questions answered.
What does Blue KC offer?
Blue KC is a leader in the development of innovative managed care programs. Nearly one million members are enrolled in a wide range of group and individual insurance products, including health maintenance organizations (HMO), preferred provider organizations (PPO), dental, and Medicare insurance plans. Explore our website to learn more, or give us a call at 800-860-2227, Monday through Friday from 8 a.m. to 5 p.m. Central Time.
What is Blue KC's address?
The address of our main headquarters is One Pershing Square, 2301 Main, Kansas City, Missouri 64108. For the claims address specific to your health insurance plan, refer to the back of your member ID card.
What are Blue KC's business hours?
Blue KC is open from 8 a.m. to 8 p.m. Central time.
What geographic areas does Blue KC cover?
Blue KC is proud to be the largest provider of health insurance plans in a 32-county area serving greater Kansas City and northwest Missouri. The Missouri counties covered are: Andrew, Atchison, Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton, Daviess, DeKalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson, Johnson, Lafayette, Livingston, Mercer, Nodaway, Pettis, Platte, Ray, Saline, St. Clair, Vernon, and Worth. We also serve Johnson and Wyandotte counties in Kansas.
What is Blue KC's mission statement?
To provide affordable access to healthcare and to improve the health of our members.
Who do I contact for questions about the plans Blue KC offers?
If you work for an employer that offers Blue KC health insurance plans, check with your Human Resources department or your group benefits administrator for more information about our plans. If your company does NOT offer Blue KC health insurance plans, have your group benefits administrator contact us for more information on what we offer. You may also contact a licensed agent at 800-860-2227 for questions.
To see what plans we offer and apply online for health insurance, explore our website. If you have questions as you look at our plan options, contact a Blue KC marketing representative at 800-860-2227. You may also call the Customer Service department at 816-395-2583 or 800-645-8346.
I am having trouble using the Blue KC website. Who can I contact for help? Contact us for help using this website.
How are coverage decisions made?
Medical research continues to yield new technology for managing illness and disease. Blue KC determines coverage of new technology by verifying if the Blue Cross and Blue Shield Association has an existing policy. If so, Blue KC adopts that policy. If not, Blue KC researches the new technology by using scientific literature, technology reports and government agencies and by conferring with specialists in the greater Kansas City area. If there is sufficient information to demonstrate that the new technology is safe and effective, then the new technology will be considered medically necessary. Benefit coverage depends on your contract.
If there is inconclusive evidence regarding safety and efficacy, then the new technology is considered investigational. Blue KC will perform subsequent reviews to confirm any changes that may warrant coverage of the new technology.
If you are to receive a new medical test, procedure, equipment or surgery, we highly recommend calling Customer Service at the number listed on your Member ID card to determine if the specific service is covered.
Do you offer a translator?
Blue KC provides language assistance to members who do not speak English that allows communication with Blue KC staff regarding covered benefits. By placing a call to the Customer Service number provided on your ID card, arrangements will be made by the representative taking your call to provide translation services as needed to successfully provide requested information.
Find answers to billing questions for HMO, PPO and Medicare Supplement Insurance plans
Please note, these questions only apply to members who do not have health insurance through an employer.
If I do not agree with the information reflected on my billing summary page, what should I do?
To dispute information on your billing summary, call the Customer Service number listed on your member ID card. You may also contact us through our site. Log in and visit the Contact section. If you are a representative from an employer group, please call our Member Services department at 816-395-2950.
If my billing address is not correct on the website, how can I have it corrected?
To correct a billing address, call the Customer Service number listed on your member ID card or log in and visit the Contact Us section to send us an email. If you are a representative from an employer group, please call your Blue KC marketing representative.
How can I tell if my account has been billed for the current month?
Your billing information is available online. Log in and visit the Pay My Bill section. Your bill summary includes your billing date, amount due, due date and the coverage period for the bill. Please note that billing statements are sent to you for the upcoming month. For example, a statement is generated in July for your August premium.
How can I tell if my payment has been processed?
Your online billing summary shows your last statement activity and any activity since the date of your last statement. If we have received a payment, it will be reflected on this page. The total payment due is the amount you owe Blue KC as of the current calendar date.
How can I get a copy of my last billing statement?
Copies of your billing statement can be found in your member portal at MyBlueKC.com. Simply login and visit the Pay My Bill section.
How can I pay my bill?
To pay a bill, you may pay by mail, online, over the phone using a credit card or electronic funds transfer (EFT).
To pay by mail, send in your payment to:
Blue Cross and Blue Shield of Kansas City
P.O. Box 801285
Kansas City, MO 64180-1285
Blue Cross and Blue Shield of Kansas City
P.O. Box 801714
Kansas City, MO 64180-1714
Blue Cross and Blue Shield of Kansas City
P.O. Box 843928
Kansas City, MO 64184-3928
To ensure we post the payment to your account in a timely manner, please include the payment stub from the bottom of your statement with your payment.
To pay online, log in and visit the Pay My Bill section. Then click on the Mange Payments button. You will be directed to a secure payment site to enter your credit card or bank account information (for EFT payments).
To pay over the phone, call Blue KC Customer Service at the number listed on your member ID card. You must pay by credit card or EFT when making a payment over the phone.
Learn how we process your claims and pay your providers.
Do I pay my provider at the time of service?
Yes, you must pay your copayment when you see your in-network provider. Your copayment amount depends on the health insurance plan you have and the services you are receiving from your provider.
How can I find out the amount I'm responsible for paying on a claim?
To find out the amount you are responsible for paying on a claim, log in and visit the Claims and Usage section. Recent claims are listed in this section. If you do not see the claim you are looking for, you may search for a specific claim by the date of service.
Why is my HMO provider billing me?
Sometimes providers send statements to their patients before Blue KC has finished processing and paying the claim. You might see a note on the bill that says "Insurance Pending." We will send you an Explanation of Benefits (EOB) once we have processed your claim. The EOB will tell you how much you owe to your provider. If you are still unsure if you owe the provider, call their billing office. Please note, if your provider was not in the Blue KC HMO network, you will be responsible for paying all services and fees for seeing that provider. You can view your EOBs and details about your claims, including how much you owe, by logging in and visiting the Claims and Usage section.
Why is my PPO provider billing me?
Sometimes providers send statements to their patients before Blue KC has finished processing and paying the claim. You might see a note on the bill that says "Insurance Pending." If the provider you saw is in-network or contracted for payment from Blue KC, we will send you an Explanation of Benefits (EOB.) The EOB will tell you what you will be responsible for paying. If the provider you saw is out-of-network you will be responsible for paying the provider directly. Blue KC will process your claim. We will send you a payment for the amount that is covered by your plan. The EOB will explain how we calculated that amount. You can view your EOBs and details about your claims, including how much you owe, by logging in and visiting the Claims and Usage section.
I received a check from Blue KC. What is it for?
When you see an out-of-network provider, we send a check to you for the covered amount of those services. You are responsible for paying your provider directly. We will send you an EOB that explains how that amount was calculated. You can view your EOBs and details about your claims, including how much you owe, by logging in and visiting the Claims and Usage section.
What claim information is on the website?
A summary of your claims, the status of those claims and details regarding each claim can be found online. Log in and visit the Claims and Usage section to view claims processed during the past 24 months.
How can I get a claim form?
To get a claim form, you can log in and visit the Claims and Usage section. From here, select Submit a Claim near the bottom of the page.
For your convenience, you may also obtain a claim form by selecting one of the following:
What do I do if I disagree with how my claim was processed?
If you have questions about how a claim was processed or you think it was processed incorrectly, please let us know. Call the number listed on your member ID card or log in and visit the Contact Us section.
What is a 1095 form?
The 1095 form is used to report your insurance coverage to the IRS. The Affordable Care Act requires all individuals to have health insurance coverage unless they qualify for an exemption.
You will use the information on the 1095 form to verify that you, your spouse and/or any dependents had coverage for each month during the year.
Do I need to file my 1095 form with my taxes?
You do not need to submit the 1095 form with your tax return; it is provided for your reference and should be retained with your other important documents.
What is the difference between forms 1095-A, 1095-B and 1095-C?
There are three types of 1095 forms:
1095-A: If you bought your Blue KC health insurance from the Health Insurance Marketplace (Exchange), you will receive form 1095-A. If you need to make corrections, or request a duplicate copy, please contact the Exchange at 1-800-318-2596.
1095-B: If you or your employer purchased health insurance directly from Blue KC (not through the Exchange) you will receive form 1095-B from Blue KC.
1095-C: Employers with 50 or more employees are required to send out a 1095-C, even if its employees also received a 1095-B. If your employer-provided coverage is self-funded, you will only receive the 1095-C. If you aren't sure whether your employer-provided coverage is insured or self-funded, contact your HR department.
When will I receive my 1095 form?
The deadline for the Health Insurance Marketplace to provide Form 1095-A is January 31, 2019.
The deadline for insurers (including Blue KC), other coverage providers and certain employers to provide forms 1095-B and 1095-C is March 4, 2019.
How do I request a duplicate 1095 form?
To request a duplicate 1095 form, please contact the following:
1095-A: Call the Exchange at 1-800-318-2596.
1095-B: Call Blue KC at the number listed on your member ID card.
1095-C: Contact your employer.
What if the information on my 1095 form isn't correct?
To make corrections to your form, please contact the following:
1095-A: Call the Exchange at 1-800-318-2596.
1095-B: If you purchased your insurance directly from Blue KC, call us at the number listed on your member ID card. If your insurance is provided by your employer, make the corrections with your employer, who will then inform us of the changes and an updated 1095-B will be sent.
1095-C: Contact your employer.
Why did you use my SSN on my 1095-B instead of my Tax Identification Number (TIN)?
If Blue KC has a SSN on file, that is what we are required to use for the 1095-B form. The IRS will match the 1095-B form with your individual tax returns; whatever number you use on your individual tax forms is what will be used to match the 1095-B.
Why did I receive more than one 1095 form?
You should receive a 1095 form from any company that provided you with minimum essential coverage during the prior year.
In addition, there may be corrections to your information that prompt a revised 1095-B form to be created. Following is a list of reasons why you might receive an updated 1095-B form:
Blue KC received information from your employer informing us of a change to:
Who was covered on your policy
The coverage dates for those covered on your policy
SSNs for those covered on your policy
Dates of birth for those covered on your policy
Your Employer's Employer Identification Number (EIN).
Blue KC received corrected information from you regarding:
Who was covered on your policy
The coverage dates for those covered on your policy
SSNs for those covered on your policy
Dates of birth for those covered on your policy
Will dependents over age 18 covered on my plan receive a separate 1095 form?
No. All individuals covered on your policy will appear on a single form that is mailed to the subscriber (policyholder) of the Blue KC policy. The 1095 does not need to be submitted with an individual's tax return.
Will I receive a 1095-B form for my Blue KC dental insurance?
Dental policies do not qualify as minimum essential coverage; 1095-B forms are not created for dental insurance.
Will I receive a 1095-B form for my Blue KC short term policy?
Short term policies do not qualify as minimum essential coverage; 1095-B forms are not created for short term policies.
Will I receive a 1095-B form for my Blue KC Medicare Supplement policy?
Medicare Supplement policies are not minimum essential coverage therefore there is no need to generate and mail 1095-B forms.
What is the Communications Preference section?
Communication Preferences is a place for you to tell us how you want to receive your Blue KC communications. You can select email, text or US mail as your preferred delivery option.
What types of communications are included?
The Communication Preferences section page:
Blue KC Bill: Information related to your Blue KC premium bill (only applies to direct pay members).
Your Explanation of Benefits (EOB).
My Plan Information: Your member certificate, communication about activity status, and requests for information.
Blue KC Listens: Special member panel to provide input about Blue KC products, services & staff.
Do I have to use the email I registered with on MyBlueKC.com to receive my communications? Or, can I designate a different email address for my communication preference?
You can designate any email address you want for delivery of your Blue KC communication notifications; it does not have to be the same email address you use to register on MyBlueKC.com.
Once you register your preferred email in the Communication Preferences section, we'll send an email to validate your preferred email address.
If at any time you change email addresses, be sure to update your personal information in the Communications Preferences section to ensure you continue receiving information from Blue KC.
Can I select communication preferences for my dependents?
The communication preferences you select for yourself will automatically be applied to dependents on your policy that are under the age of 18 and have not registered on the member portal or established their own communication preferences. Due to HIPAA privacy rules, you can't establish communication preferences for dependents over the age of 18. They will need to register on the website, using the information from their member ID card, and designate their own preferences in the Communication Preferences section.
How can I update my personal information for my communication preferences?
Simply log in to MyBlueKC.com and visit the Communication Preferences section in your profile (small icon on top right of page). Here you can update your preferences, including your preferred communication email and mobile phone number. At the time you change your preference, you may have communication from Blue KC that is in progress and may not be delivered according to your new preference.
What is Blue KC Listens?
Blue KC Listens is a special member panel we've created to gather input from our customers. As a participant of this panel, you'll be asked to complete a brief online survey to tell us what Blue KC is already doing that works for you, what doesn't work for you, and how our products, services and people can serve you better. Participants will be sent a new survey periodically. You can sign up for Blue KC Listens on the Communication Preferences section.
Learn about the differences between brand name and prescription drugs.
What is the difference between brand-name drugs and generic drugs?
When a drug company develops a new medication they apply for a patent. This patent protects the drug from being copied by other drug companies for a certain period of time. These drugs are brand name drugs. Once the patent period expires, other manufacturers can produce the same drug as long as they follow strict guidelines established by the Food and Drug Administration's (FDA) guidelines. These same drugs are generic drugs. Generic drugs are less expensive versions of those brand name drugs whose patents have expired. They are made with the same active ingredients of the brand name drug, but they may have a different color, shape or filler material. The cost of a generic drug is typically less than a brand name drug. All generic medications are approved by the FDA before they are released on the market. Some examples of generic drugs and their brand name equivalent include furosemide and Lasix®, ranitidine and Zantac®, and cephalexin and Keflex®.
What is the difference between a generic equivalent and a generic alternative?
A generic equivalent is a medication that contains the same active ingredient and works the same way as the original brand name drug. A generic alternative is a generic medication that may not have the same active ingredient, but works in the same way as another drug. An example of a generic alternative is ranitidine. It is the generic equivalent of Zantac®, but it works in the same way to relieve stomach acid as Axid® and Pepcid®.
Zantac, Axid, and Pepcid are the same "class" of medicine but contain different active ingredients. So, the generic form of Zantac, "ranitidine," is a lower cost alternative in the same class of medicine as Axid and Pepcid.
How is the tier level status determined for medications?
The Prescription Drug List (PDL) is a list of prescription medications that have been reviewed and recommended by the Blue KC Medical and Pharmacy Management Committee. The list has a combination of brand name and generic medications. Each of these medications has been reviewed for its safety, effectiveness, clinical outcomes, and cost. Physicians and pharmacists on the committee look at drug utilization issues, the number of adverse events, and any proven advantages over other drugs on the PDL. The most efficient and cost effective drugs are on Tier 1 of the PDL. All other drugs are designated Tier 2 or Tier 3 status.
To make sure you are viewing the correct PDL Login at MyBlueKC.com.
What is a maintenance drug?
A maintenance drug is a medication used to treat a chronic condition like diabetes or high blood pressure. The FDA must approve maintenance drugs as safe for long-term use. Blue KC uses a national drug information database called First DataBank to determine which medications are included on the maintenance drug list. If your prescription is a maintenance drug, you can have it filled for several months instead of just one prescription at a time.
Do I need to show my member ID card at the pharmacy?
Yes, show your member ID card to your pharmacist whenever you have a prescription filled. Your prescription claim is electronically transmitted to Blue KC when you fill your prescription. Please make sure the pharmacy has your most current health insurance information and correct birth date so there won't be any delays or claim denials when we process your claim.
What do I do if I need to refill my prescription early (i.e., leaving on vacation, the doctor increased my dosage)?
To have a prescription refilled early, have your pharmacist call the Pharmacy Customer Service unit at 816-395-2176 or 800-228-1436, Monday through Friday from 8 a.m. to 5 p.m. Central Time.
What if I am out of town and need to have a prescription filled?
Blue KC contracts with most major pharmacy chains and has a network of over 44,000 pharmacies nationwide. If the pharmacy you are using has difficulty in processing your prescription claim, have them contact the Pharmacy Customer Service unit for assistance at 816-395-2176 or 800-228-1436, Monday through Friday from 8 a.m. to 5 p.m. Central Time.
Why does Blue KC require prior authorization for some drugs before they are covered?
Blue KC may require prior authorization for some drugs or a class. Medications on the prior authorization list may have safety concerns or have FDA approval, only for a certain use. Some of the prior authorization medications may also have a lower-cost alternative that should be considered first or the drug may not be as effective as something else in the same drug class. Some medications are also on the prior authorization list because they have the potential to be misused. Your provider and Blue KC will work together to get prior authorization and approval for your prescription when needed.
What if I have questions about my prescription drug coverage?
For more information on your prescription drug coverage, call the Pharmacy Customer Service unit at 816-395-2176 or 800-228-1436, Monday through Friday from 8 a.m. to 5 p.m. Central Time.
Learn about the health insurance eligibility requirements for you and your dependents and information on enrollment.
When can I change from individual to family enrollment or from family to an individual?
There are two times you can make a change to your enrollment options. The first time is during the open enrollment period. Your employer schedules an open enrollment period once a calendar year when all employees may make changes to their health insurance plan. You may also make a change during a special enrollment period if you acquire a new dependent or if your coverage is terminated under another health insurance plan. If you have health insurance through an employer, your group benefits administrator, typically someone in your Human Resources department, can help you make changes to your health insurance plan. If you do not have health insurance through an employer and instead pay your monthly premiums directly to Blue KC, call the Customer Service number listed on your member ID card.
Am I eligible for health insurance through my employer if I have a pre-existing condition?
Yes, you are eligible for health insurance through an employer if you have a pre-existing condition. However, you may not have coverage for your pre-existing condition for a certain period of time.
How do I add a dependent to my health insurance plan?
If you have health insurance through your employer, check with your group benefits administrator to have a dependent added to your plan. He or she has the information and/or forms you need to add your dependent to your health insurance plan. If you do not have health insurance through an employer and instead pay your monthly premiums directly to Blue KC, call the Customer Service number listed on your member ID card.
Are my children covered when they are away from home and at school?
Your children's coverage while they are away from home depends on the type of health insurance plan you have. If you have health insurance through your employer, check with your group benefits administrator for more information. If you do not have health insurance through an employer and instead pay your monthly premiums directly to Blue KC, call the Customer Service number listed on your member ID card.
I noticed my membership information was wrong during enrollment. How do I have it corrected?
Log in and visit "Contact Us." Please make sure your e-mail includes your member ID number, the current date and the correct information.
Learn how to select and change your Primary Care Physician.
What is a Primary Care Physician?
A Primary Care Physician (PCP) is the physician you choose to be your primary source for medical care. Your PCP coordinates all your medical care and knows your specific health history. You can designate a physician who specializes in family practice, general practice, internal medicine or pediatrics and is in your network as your PCP. Each dependent on your health insurance plan will also need a designed PCP. Everyone on your health insurance plan may have a different PCP.
Do I need to select a PCP?
Blue KC members who enroll in the BlueCare® HMO health insurance plans need to select a PCP. If you enroll in a PPO plan, you do not need to designate a PCP.
How do I select or change my PCP?
You will first select your PCP during open enrollment. To change a PCP, log in and visit you Profile by clicking on the icon by your name in the top right corner of your homepage. In the Coverage Information section you’ll see a list of covered members for your Blue KC policy. From here select “Change PCP” for the appropriate member and you can search for and designate a new PCP. Once we have processed your PCP change request, we will send you a new member ID card that contains the information of your newly selected PCP. You may also call the Customer Service number listed on your member ID card to change your PCP. Please note that if you have health insurance through your employer, you may be required to contact your group benefits administrator to change your PCP.
What if my PCP no longer participates in the network?
If your PCP no longer participates in the network, you will be assigned a new PCP. If you are not satisfied with the PCP assigned to you, you may change your PCP.
Why didn't I receive the PCP I signed up for during open enrollment?
The PCP you may have selecting during open enrollment may not be accepting new patients. Or, you may have chosen a physician who is classified as a specialist. Specialists cannot be designated as a PCP. Physicians who specialize in family practice, general practice, internal medicine or pediatrics can be designated as your PCP. If you are not satisfied with the PCP assigned to you, you may change your PCP.
Learn More About PPO deductibles, copayments and coinsurance.
What are billed charges?
Billed charges are the amount charged or billed by your healthcare provider for the services/supplies you received. Not all provider charges will be paid by your health insurance plan.
What are allowable charges?
Allowable charges are the maximum amount payable to you under your health insurance plan for a particular service. Contracted providers have agreed to accept this amount as payment in full. For example, if the provider charges $100 for a service and Blue KC pays $80 as the allowable charge, the provider cannot ask the member to pay the remaining $20. Keep in mind, however, that some health insurance plans have coinsurance. In those cases, members are required to pay a percentage of the allowable charge. For specific details about your plan, review your Blue KC certificate, which outlines your payment responsibility.
What is a provider write-off?
Providers who have entered into a contract with Blue KC have agreed to accept a specific payment amount for each of their services. This is often a discounted amount versus what these providers might normally charge. The provider write-off is the difference between what they normally charge and the discounted amount specified in our agreement with that provider. We refer to this as the "provider write-off." Ultimately three things determine what Blue KC pays a provider:
The agreed-upon fee
The amount of your copayment and/or coinsurance
The amount of your deductible that has been satisfied
What is a copayment?
A copayment, or copay, is the dollar amount that you pay to a provider at the time you receive a service. For example, you might pay a $30 copay each time you visit your allergy doctor. The copay amount is defined in your Blue KC certificate, which outlines your responsibilities for health insurance plan payments.
What is a deductible?
A deductible is the amount that you are responsible for paying annually for healthcare services. You pay coinsurance after you've met your deductible. Exceptions are outlined in your Blue KC certificate, which lists the exclusions related to your health insurance plan.
How is my deductible calculated?
Each payment you make for covered healthcare services you've received from your providers such as a physical exam (not counting copays that you make at the time of your visits) counts toward your deductible. Once Blue KC processes the claims we receive from your providers showing the payments that you have made for covered healthcare services, we apply those payments toward your deductible.
What services and charges do not count toward the deductible?
When you pay for certain services, those payments may not count toward you meeting your deductible. For details about exclusions, review your Blue KC certificate.
What is coinsurance?
If your plan has coinsurance, you will have to pay a portion of the allowable charge for a covered service. You pay coinsurance after you've met your deductible. For details about your payment responsibilities, please review your Blue KC certificate.
How Blue KC Chooses Your Network of Healthcare Providers.
How does Blue KC select physicians for each of their networks?
Blue KC selects physicians for our networks through a credentialing and contracting process. Once a provider meets the criteria established in our process, and is approved they are included in our network. Setting standards for participating providers is part of our commitment to bring you quality healthcare coverage.
Is my physician in the Blue KC provider network
You can easily check the Doctor and Hospital Finder on our website to see whether your physician is a participating provider in your Blue KC network.
To view the most accurate information related to your Blue KC network, be sure to first log in MyBlueKC.com. By doing so, the search results will be tailored to your specific network. Because healthcare providers in your Blue KC network may change, we recommend that you verify your provider's participation before you receive care.
Besides physicians, what can I find in the provider finder?
Through the provider finder, you can also search for healthcare hospitals, facilities (e.g., home health facilities), and labs.
How do I find out if a provider is accepting new patients?
When you look up a provider and the description says, "New Patients," it means that a physician is taking new patients at that time.
How can I obtain a hard copy of the provider directory?
You can print a copy of the directory directly from the Doctor and Hospital Finder.
How does the Cost Estimate tool work?
Using 12 months of claims data we are able to provide a cost-range for a specific procedure. For example, the total cost for a knee replacement at a specific hospital may be $19,000 to $22,000.
The tool includes cost on up to 1,623 of the most common, elective procedures for inpatient, outpatient and diagnostic services at area hospitals, ambulatory surgery centers and free-standing radiology centers.
How can I rate my doctor?
Rate Your Doctor allows you to score doctors you've recently seen. The process is simple. All you have to do is sign in to or register at MyBlueKC.com, which enables you to share your patient experience. Visit the “Find Care” section to access the Doctor and Hospital finder where you can provide a patient review. All feedback is confidential. Your doctors will not know if or how you rated them. Here's how to get started:
Sign on to MyBlueKC.com
Select "Find Care"
Locate your doctor using the search tool
Select "Leave a review" for your doctors
Answer a few questions about your experience and submit.
What is BlueCard®?
BlueCard is a national provider program offered by Blue KC and other Blue Cross and/or Blue Shield Plans across the country. This program provides in-network benefits to PPO members who need healthcare services when they are away from home.
How can I access a PPO BlueCard provider away from the Kansas City area?
If you are traveling out of the Blue KC service area and need to access a provider, you can visit the Blue KC Doctor and Hospital Finder to find providers in this program. Be sure to first log in as a member on the website before using this tool so your network information is populated in the search results. You can also call 1-800-810-BLUE. We will provide you with the name and address of a participating provider. If you need a provider directory from another health insurance plan, please call the Customer Service number on your member ID card.
How can I access a HMO provider away from Kansas City?
If you're an HMO member, you will need to receive services from an in-network HMO provider. However, you will be able to receive emergency or urgent care services no matter where you are. For details about your coverage, please review your Blue KC certificate, which outlines the benefits and exclusions related to your health insurance plan. You can view your certificate by logging in and accessing the Plan Benefit section.
Learn How to Coordinate Blue KC Benefits with Other Health Insurance.
What is Coordination of Benefits?
Coordination of Benefits (COB) establishes the order of payment when two or more medical plans (primary and secondary) cover an individual and makes sure that no insured person receives more than 100 percent of the allowable expenses for an insured service. The primary plan pays benefits as it would without the presence of a secondary plan. A secondary plan reduces its benefits so that the total benefits provided by both it and the primary plan are not more than the total allowable expenses.
Why does Blue KC need to know about other health/dental coverage that I have?
Many people are insured under more than one health and/or dental insurance plan at the same time. Because of dual insurance, Medicare Secondary Plans (MSP) and Coordination of Benefit (COB) requirements, Blue KC needs to determine primary insurance based on the facts of each situation. Most health insurance and dental plans include a COB provision that defines these requirements. This provision prevents payments from all Plans from exceeding the total allowable expense.
Will my claim be delayed because of COB?
Blue KC is committed to processing your claims in a timely manner. However, if a claim is received and updated COB information is needed, the claims for that member will be delayed until Blue KC receives the requested information. After Blue KC receives the requested information and the COB information is updated with the appropriate information, Blue KC will process your claims. If you receive a COB letter requesting information about Medicare or other insurance, please respond as soon as possible.
Please note, Blue KC will send letters to you requesting the required information that may be missing in our COB file. Please follow the instructions given in the letter to respond by mail, phone or through our website. We update our files annually, so you will receive a request for updated COB information every 12 months.
How can I avoid the delay in the processing of COB claims?
To avoid a delay in the processing of COB claims, please follow these steps:
When your providers submit claims to Blue KC, make sure that they have the most current information on your family and other insurance. This will assist your provider in filing the claim first with the primary plan and then with the secondary plan.
Make sure that Blue KC has current information on your family regarding other health insurance.
Follow the instructions given in the letters that Blue KC mails to you requesting updated health information and whether to provide that information to us by mail, phone or through our website.
How does Blue KC determine whether they should pay my claim before or after my other plan pays?
For a detailed explanation of COB and order of benefit determination rules, please review your Blue KC certificate. If you need a current copy, please call the Customer Service number listed on your Blue KC member ID card.
Who is included in COB?
Yourself, if you are insured under two or more group health insurance plans or Medicare; your spouse, if your spouse has health and/or dental insurance coverage through his or her employer or Medicare and also has coverage under your health insurance plan; and your dependent children, if they are insured under two or more health insurance plans or Medicare.
Why does Blue KC need a copy of my divorce decree?
We want to make sure that we have the order of benefits determination identified correctly so that we can process claims accurately. Please refer to your Blue KC certificate for detailed information.
Why does Blue KC need a copy of my Medicare card?
Sometimes it's unclear as to whether or not a member has both parts A & B of Medicare. Or, the effective date of Medicare benefits is unclear. When Blue KC receives a copy of your Medicare card, it helps us input the Medicare information accurately and process claims in a timely manner. Other information that helps with COB determinations include the age of the insured and reason for Medicare insurance (e.g., Disability, End Stage Renal Disease, etc.).
What is a Health Savings Account?
A Health Savings Account (HSA) allows members enrolled in a qualified high-deductible health plan to contribute funds on a tax-free basis into the member's account. A member's employer may also contribute funds to the account. These funds are used for payment of qualified medical expenses as defined by the IRS. Unused funds in an HSA roll over in the member's account at the end of each calendar year.
Am I eligible for an HSA?
You are eligible for an HSA if you are covered under a qualified high-deductible health plan, are not covered by any other health plan (with exception for certain types of permitted coverage), are not enrolled in Medicare benefits and cannot be claimed as a tax dependent on another person's tax return.
How much does an HSA cost? Are there fees charged for the account and/or services?
An HSA generally has a low monthly service fee used to maintain the account. Other fees may apply depending upon the services selected. A fee schedule will be provided for you with your enrollment kit from your HSA bank. For more information on HSA fees, contact your HSA bank.
What is a qualified high-deductible health plan?
A qualified health-deductible health plan is a health plan with an annual deductible for an individual (a member) or a family (a member and covered tax dependents) that meet the minimum deductible amount published annually by the U.S. Treasury Department. The annual out-of-pocket expenses required by the high-deductible health plan also does not exceed the out-of-pocket maximums published by the U.S. Treasury Department. Out-of-pocket expenses include deductibles, copayments and other amounts the member must pay for, but do not include premiums or amounts incurred for non-covered benefits.
How do I enroll in a high-deductible health plan and open an HSA?
To enroll in a high-deductible health plan, complete the Blue KC application process. The Blue-Saver® PPO health insurance plan is a high-deductible health plan that allows you to establish an HSA as part of your health benefits. When you enroll in the Blue Saver plan, you may be offered the opportunity to establish a HSA with one of our preferred banks. You will be presented with appropriate banking authorizations and disclosures necessary for Blue KC to work with the bank that will establish your HSA. Please note all financial institutions offering HSA products must comply with the USA Patriot Act, requiring your HSA bank to collect and verify information about you when processing your HSA application.
Once your HSA has been established, you will be mailed a welcome kit and HSA debit card from the bank.
What happens to my HSA funds if I no longer have high-deductible health plan?
Once funds are deposited into your HSA, those funds can be used to pay for qualified medical expenses tax-free, even if you no longer have high-deductible health plan coverage. The funds in your account automatically roll over each year and remain in the account indefinitely until used. There is no time limit on using the funds. Once you discontinue coverage under a high-deductible health plan and/or get coverage under another health plan that disqualifies you from an HSA, you can no longer make contributions to your HSA. However, since you own the HSA, you can continue to use it for future qualified medical expenses.
What are qualified medical expenses?
Qualified medical expenses include doctor visits, hospital charges, chiropractic care, prescriptions, dental care, vision care, COBRA premiums and qualified long-term care insurance premiums.
Please note it is your responsibility to withdraw funds for qualified medical expenses and maintain receipts for those expenses according to the IRS guidelines. Failure to do so could result in income taxes and a 20 percent penalty.
Read the list and description of all qualified medical expenses.
Who is responsible for determining whether HSA funds are used for qualified medical expenses?
It is your sole responsibility to ensure HSA funds are used for qualified medical expenses. It is also your responsibility to determine the tax consequences of any distributions, for maintaining adequate records for tax purposes, and for paying any taxes and penalties arising as a result of any such distribution. Please contact a legal or tax adviser with questions.
Can I use funds in my HSA to pay for qualified medical expenses incurred before I enrolled in my high-deductible health plan?
No. You cannot use HSA funds to pay for qualified medical expenses incurred before you enrolled in a high-deductible health plan. In order to establish an HSA, you must enroll in a high-deductible health plan. Therefore, contributions to an HSA are not permitted before you enrolled in a high-deductible health plan and you cannot use HSA funds to pay for qualified medical expenses incurred prior to the date your HSA was established. Your eligibility to contribute to an HSA is determined by the effective date of your high-deductible health plan coverage.
Can I use funds in my HSA for my tax dependents' expenses if they are not covered by the high-deductible health plan?
Yes, funds may be withdrawn and used to pay for qualified medical expenses for you and/or your tax dependent(s) without a tax penalty. For purposes of medical deductible of a child of divorced or separated parents, they can be treated as a dependent of both parents. Each parent can include the medical expenses he or she pays for the child, even if the other parent claims the child's dependency exemption. Please consult a legal or tax adviser concerning questions you may have.
How long do I have to use the funds in my HSA for qualified medical expenses?
You can use your HSA funds to pay for eligible expenses incurred any time after you open your HSA. There is no time limit between when you incur the qualified expenses and when you withdraw the corresponding amount from your HSA. You may also elect to pay for current qualified medical expenses out-of-pocket, so that you may invest your HSA funds and grow the account for future use. It is recommended that you always save your itemized receipts and other paperwork to verify eligible expense for when you do withdraw funds, whether it is now or in the future.
How can I access my HSA funds to pay for a qualified medical expense?
Use your HSA debit card or other means provided by your HSA bank to pay for qualified medical expenses. You should only use the debit card at healthcare-related locations. This may include an Internet transaction as long as the items being purchased are qualified medical expenses. You may also use your HSA debit card for online capabilities such as online bill pay.
How do I activate my HSA debit card?
When you receive your HSA debit card in the mail from the HSA bank, you will receive instructions on activating the card. Please contact the HSA bank where you established your HSA regarding questions you may have about your HSA debit card.
What if my HSA debit card doesn't work or my transaction is declined?
If your debit card does not work or is declined, you may need to use another form of payment. A declined transaction may be due to any of the following reasons:
Your purchase was not considered a qualified medical expense under your HSA plan
Your HSA balance was too low and there were insufficient funds to cover the cost of your transaction
Please contact the HSA bank to discuss problems with your debit card.
Do I need to save my itemized receipts from making qualified medical expense purchases?
Yes, always retain your itemized receipts as proof of your qualified medical purchases. You will need the receipts if the IRS requests documentation to verify the funds in your HSA were used only for qualified medical expenses.
How can I make an HSA deposit?
Deposits to your HSA may be made directly with the HSA bank. If your employer allows payroll deductions, you may also make automatic deposits into your account. You may mail in a deposit by check or take advantage of wire transfer or electronic funds transfer. Please contact the HSA bank for more information on depositing funds into your account.
What are the contribution limits to my HSA?
The maximum amount that may be contributed to your HSA for any year is a certain amount established annually by the IRS. This amount depends on whether you have individual or family coverage under your qualified high-deductible health plan. The same annual contribution limit applies regardless of whether the contributions are made by an employee, an employer or both. You are allowed to make the full deductible HSA contribution for the year regardless of when you enroll in a high-deductible health plan as long as you maintain coverage under the high-deductible health plan for 12 months.
For 2019, the maximum HSA contribution for individual high-deductible health plan coverage is $3,500. The maximum HSA contribution for family coverage is $7,000.
If you are not covered by a high-deductible health plan for 12 months at the end of the calendar year in which you enrolled in the plan, you will be subject to income tax and a 10 percent excise tax on HSA contributions for the months not covered by the plan. Under the last-month rule, if you are an eligible individual on the first day of the last month of your tax year (December 1 for most taxpayers), you are considered an eligible individual for the entire year. You are treated as having the same high-deductible health plan coverage for the entire year as you had on the first day of that last month. The total contribution for the year can be made in one or more payments at any time up to your tax-filing deadline (without extensions). However, if you wish to have a contribution made between January 1 and April 15 treated as a contribution for the preceding tax year, please contact the HSA bank.
Can I make contributions through my employer on a pre-tax basis?
If your employer offers a "salary reduction" plan (also known as a Section 125 plan or cafeteria plan), you can make contributions to your HSA on a pre-tax basis (meaning before income taxes and FICA taxes). If you make a contribution on a pre-tax basis, you cannot take the "above-the-line" deduction on your personal taxes.
When can "catch-up" contributions be made to my HSA?
If you are age 55 or older, you can make additional "catch-up" contributions to your HSA. The amount of this additional catch-up contribution is published annually by the U.S. Treasury Department. For 2019, the catch-up contribution amount is $1,000.
When is the deadline for contributions to an HSA for any particular year?
You may make HSA contributions for a particular year no later than the deadline, without extensions, for filing your federal income tax return for that year. For calendar year taxpayers, this is generally April 15 following the year for which the contributions were made.
What happens when HSA contributions exceed the amount that may be deducted or excluded from gross income?
A contribution made by you or your employer to an HSA that exceeds the amount allowed by law, or which is made during any year when you are not eligible to contribute, is called an "excess contribution." Excess contributions are not deductible by you or your employer and are included in your gross income for each year they remain in your HSA. In addition, excess contributions are subject to a six-percent excise tax. However, you may avoid the excise tax if you remove the excess contribution from your HSA, together with any net income attributable to the excess contribution, before the due date for filing your federal income tax return, including extensions, for the year in which the excess contribution was made. In that case, the net income attributable to the excess contribution would be taxable as income for the year in which the distribution is made, but the removed excess contribution would not be taxable as income to you. Rollover contributions do not count in determining whether an excess contribution has been made.
How are contributions treated for owners and shareholders of S corps?
Owners and officers with greater than 2% share of a Subchapter S corporation cannot make pretax contributions to their HSAs through the company by salary reduction. In addition, any contributions made to their HSAs by the corporation are taxable as income. However, they can make their own personal contributions to their HSAs and take the "above-the-line" deduction on their personal income taxes.
How are contributions treated for partners in a partnership or limited liability company (LLC)?
Partners in a partnership or LLC cannot make pre-tax contributions to their HSAs through the partnership by salary reduction. However, they can make their own personal contributions to their HSAs and take the "above-the-line" deduction on their personal income taxes.
May a self-employed person contribute to an HSA on a pre-tax basis?
Self-employed persons may not contribute to an HSA on a pre-tax basis and may not take the amount of their HSA contribution as a deduction for SECA purposes. However, they may contribute to an HSA with after-tax dollars and take the above-the-line deduction.
How are distributions from an HSA taxed?
Distributions from an HSA for the qualified medical expense of you or your spouse or tax dependents who are covered by the high-deductible health plan are generally excludable from income for federal tax income purposes if such expenses are not covered by insurance. Distributions used for any other purpose are includable in income and may also be subject to an additional 20 percent tax. This 20-percent penalty tax does not apply to distributions made after your death, disability or attainment of age 65.
What is the tax treatment of an eligible individual's HSA contributions?
When you make an eligible contribution to an HSA, the amount of your contribution (up to the maximum contribution limit) is deductible in computing your adjusted gross income. This means that your contributions are deductible whether or not you itemize your deductions.
Any person who may be claimed as a tax dependent on another taxpayer's return may not claim a deduction for a contribution to an HSA.
A special rule applies to certain married couples. If either spouse has family coverage under a high-deductible health plan, both spouses will be treated as having only the family coverage (and if such spouses each have family coverage under different plans, both spouses will be treated as having the family coverage with the lowest annual deductible). The amount allowed as a deduction after application of this rule will be divided equally between the spouses unless they agree on a different division.
What is the tax treatment of employer contributions to an HSA?
If your employer makes a contribution to your HSA, you are not allowed to deduct that contribution on your income tax return. Your employer, however, will be able to deduct the contribution up to your maximum contribution limit for that year. Although you cannot deduct your employer's HSA contribution, the contribution is not taxable to you or subject to income tax withholding or other employment taxes if it does not exceed your maximum contribution limit for the year.
Will any tax advice be provided to me in connection with my HSA?
No, neither Blue KC nor the HSA bank will provide tax advice concerning your HSA. The tax consequences of your HSA, including all contributions to and distributions from your HSA, are your sole responsibility. Please contact a tax adviser concerning questions you may have.
What happens to the funds in my HSA after I turn age 65?
You can continue to use the funds in your account tax-free for out-of-pocket health expenses. If you enroll in Medicare, you can use your account to pay Medicare premiums, deductibles, copayments and coinsurance under any part of Medicare. If you have retiree health benefits through your former employer, you can also use your account to pay for your share of retiree medical insurance premiums. The one expense you cannot use your account for is to purchase a Medicare supplement insurance or "Medigap" policy.
Once you turn age 65, you can also use your account to pay for things other than qualified medical expenses. If you do choose to use your account for other expenses, the amount withdrawn will be taxable as income but will not be subject to any other penalties. Individuals under age 65 who use their accounts for non-medical expenses must pay income tax and a 20 percent penalty on the amount withdrawn.
What happens to the funds in my HSA upon my death?
You have the right at any time to designate one or more beneficiaries to whom distribution of your HSA will be made upon your death. You also have the right to revoke a prior beneficiary designation and, if desired, designate different individuals as beneficiaries. Please contact the HSA bank for beneficiary designation forms or for more information.
What are the tax consequences of HSA distributions following my death?
If your spouse is the named beneficiary of your HSA, your HSA becomes the HSA of your spouse upon your death, subject to the completion of documents as required by your bank. Your surviving spouse is not required to include any amount in gross income for tax purposes as a result of your death and he or she is subject to income tax only on those distributions that are not made for qualified medical expenses.
If someone other than your spouse is named the beneficiary of your HSA, the HSA will no longer be considered an HSA as of the date of your death. Rather the beneficiary is required to include the fair market value of the HSA assets as of the date of death in his or her gross income for the taxable year that includes the date of death. The included amount is reduced by the amount in the HSA used, within one year of your death, to pay your qualified medical expenses that incurred prior to your death.
If there is no named beneficiary of your HSA, the HSA will no longer be considered an HSA as of the date of your death, and the fair market value of the HSA assets as of the date of death is included in your gross income for the year of your death.
How do I designate or change the beneficiary of my HSA?
You have the right at any time to designate one or more beneficiaries to whom distribution of your HSA will be made upon your death. You also have the right to revoke a prior beneficiary designation and, if desired, designate different individuals as beneficiaries. If no beneficiary is designated, the HSA bank will distribute the assets of your HSA upon your death to your estate. Please contact your bank for beneficiary designation forms or for more information.
How do I establish an HSA?
If eligible, you can establish an HSA with a qualified HSA custodian or trustee. No permission or authorization from the IRS is required. The custodian or trustee will furnish you a written HSA trust or custodial agreement.
You can pick any bank you like or you can use one of our preferred banks.
Who can serve as an HSA custodian or trustee?
Any insurance company or bank can be an HSA custodian or trustee. Any other persons already approved by the IRS to be custodians or trustees of IRAs are automatically approved to be HSA custodian or trustees.
What are the rules regarding rollovers and transfers of my HSA?
You may withdraw a portion or all of the funds from one HSA and roll them into an HSA with another custodian or trustee. However, you are required to roll the funds into a new HSA within 60 calendar days of your receipt of the funds. You are allowed to make only one HSA rollover in a 12-month period. The 12-month period begins on the date you receive the distribution, not on the date you roll it into another HSA. You may also transfer your HSA funds directly from one HSA custodian or trustee to another without ever having direct custody or control of the funds. Rollover and transfer contributions are not deductible and do not count against annual contribution limits.
What are the rules regarding the rollover of IRA funds into an HSA?
You are allowed a one-time, tax-free, trustee-to-trustee transfer of IRA funds into your HSA if the following certain conditions are met:
The transfer of funds from the IRA to the HSA is made in direct trustee-to-trustee transfer
You are covered by a high-deductible health plan and remain eligible for 12 months after your IRA rollover. If you are not eligible for 12 months after the rollover, the funds transferred will be treated as taxable income and subject to a 10 percent excise tax
The IRA being rolled over into the HSA is a traditional or Roth IRA
The amount of the IRA rollover to the HSA does not exceed the maximum annual contribution limits. The amount transferred from your IRA, plus your employer contributions, plus your contributions will all apply against the maximum annual contribution and you must ensure the total of all these do not exceed the maximum annual contribution limits
What are my HSA investment options? After establishing an HSA and reaching financial benchmarks set by the HSA bank, you may choose to maximize your potential wealth by electing investment options. For more information on HSA investment options, contact the HSA bank.
Learn More about PersonalBlue Personal Care Accounts
Blue KC is committed to keeping you informed when it comes to your health insurance plan. PersonalBlue is a type of health insurance plan that pairs a PPO plan with a Personal Care Account (PCA) also known as a Health Reimbursement Arrangement (HRA). Your employer puts money in the PCA that is used to pay for a portion of your PPO deductible. You only have to help pay for the deductible after your HRA balance has been spent. And if you don't use all of the money in your PCA, some or all of it will typically roll over for use in the following year.
What is PersonalBlue?
Your PersonalBlue plan will cover your healthcare needs.
The first part of your PersonalBlue plan is called a PCA. Your employer adds funds to this account each year. Those funds are used to pay for covered healthcare expenses.
After the funds in your PCA have been used, you will be responsible for a certain amount of your healthcare costs until your deductible amount has been met. You do have the benefit of the negotiated prices for healthcare from network providers, but you will pay for all of the healthcare until your individual or family deductible is met.
Note: Your PCA and individual or family deductible make up the total plan deductible amount. This is the amount that you will see referenced in your Explanation of Benefits (EOB).
Once your PCA funds are exhausted and the remainder of your deductible has been met, your health insurance plan will start paying. A majority of in-network expenses will be covered by your health insurance plan. You will be responsible for the coinsurance. Once your out-of-pocket maximum has been met, your health insurance plan pays 100% of your covered expenses.
What is covered under my PersonalBlue health insurance plan?
Your PersonalBlue health insurance plan includes a prescription drug coverage plan with set copayments for both generic and brand name prescription drugs. The PCA portion of your plan cannot be used to reimburse you for these copayments.
Routine Preventive care is a care benefit that is not subject to a deductible. For example, when you receive your annual well-woman exam, annual mammography, annual prostate exam, etc. from a Blue KC in-network physician, you pay only the coinsurance amount (no deductible.) The coverage of some preventive healthcare services may be subject to a calendar year maximum limit.
How are PCA claims paid?
After you see a provider for healthcare services, your provider will send a claim for those services to Blue KC. The claim is paid directly from your PCA funds. Blue KC will send you an Explanation of Benefits (EOB) showing what was paid to the provider.
What if I have questions about my PCA balance or how a claim was paid?
If you have questions about your PCA balance or how a claim was processed, please let us know. Call the number listed on your member ID card or log in and click on "Contact Us.
How can I keep track of what is left in my PCA?
To view detailed information about your PCA including the status or your funds and claims data, log in, then visit the Claims and Usage section to access your Personal Care Account page.
What happens if I don't spend all of the funds in my PCA?
Unused funds may be rolled over to the next year. By staying healthy and by managing your healthcare dollars wisely, you can build up a sizable account.
This Medical Policy is designed for informational purposes only and is not an authorization, an explanation of benefits, or a contract. Medical technology is constantly changing, and Blue KC reserves the right to review and revise medical policy. This information is proprietary and confidential and cannot be shared without the written permission of Blue KC.