Buy-Up PPO

The BCBSKC Buy-Up PPO is a comprehensive medical plan that covers both in-network and out-of-network providers. You pay a co-pays, deductible and co-insurance and the insurance pays the remaining costs. If you choose to go outside of the network for healthcare, you will be subject to a higher deductible and coinsurance than if you use an in-network provider.

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Plan Information

 
In-Network
Non-Network
Employer Health Savings Account (HSA) Contribution 1/1/21 Prorated for New Hires
    Single

Not Applicable

    Family

Not Applicable

DEDUCTIBLES
    Single

$1,500

    Family

$3,000

OUT-OF-POCKET MAXIMUMS (includes deductible)
    Single
$5,000 $10,000
    Family
$10,000 $20,000
PLAN CO-PAYMENTS
    Office Visit
$35 copay50% after deductible
    Specialist Office Visit
$70 copay50% after deductible
    Preventive Care
Covered at 100%50% after deductible
    Urgent Care Visit
$70 copay50% after deductible
    Emergency Room

$200 copay, plus 20% after deductible

    Hospitalization
20% after deductible50% after deductible
    Outpatient Surgery
20% after deductible50% after deductible
PRESCRIPTION DRUG COPAY
    Retail Generic
$10 copay

50% after applicable copay

    Retail Preferred Brand
$40 copay
    Retail Non-Preferred
50%
    Mail Order
102 days for 3 copays