BLUE OPTIONS ADULTS, FAMILIES & CHILDREN

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Agnes Brooks
6 years ago
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1 2016 FOR BLUE OPTIONS ADULTS, FAMILIES & CHILDREN FEDERAL COST-SHARING REDUCTION PLANS

2016 BLUE OPTIONS All Blue KC plans include 100% Individuals or families may qualify for an out-of-pocket savings through the Federally Facilitated Marketplace (FFM).

2 2016 BLUE OPTIONS All Blue KC plans include 100% Individuals or families may qualify for an out-of-pocket savings through the Federally Facilitated Marketplace (FFM). This brochure provides a summary of cost-saving plans offered by Blue Cross and Blue Shield of Kansas City (Blue KC) on the FFM through the healthcare.gov website. Blue Cross and Blue Shield of Kansas City (Blue KC) can help guide you to sort out what s OUR NETWORKS Preferred Care Blue Preferred Care Blue BlueSelect BlueSelect for Basic Individual. 2

provider in the: Preferred-Care Blue Network Select Find a Doctor Under the heading Choose Your Network click the down arrow and check the box next to Preferred-Care Blue Network (PCB) BlueSelect

3 FIND AN IN-NETWORK PROVIDER Provider Networks In-network providers offer benefits covered at the highest level. Blue KC Doctor & Hospital Provider Finder on Provider Finder Features Ability to search for in-network doctors and in your neighborhood or across the country network To find an in-network doctor or provider in the: Preferred-Care Blue Network Select Find a Doctor Under the heading Choose Your Network click the down arrow and check the box next to Preferred-Care Blue Network (PCB) BlueSelect Network Select Find a Doctor Under the heading Choose Your Network click the down arrow and check the box next to BlueSelect Network (Select) BlueSelect for Basic Individual Network Select Find a Doctor Under the heading Choose Your Network click the down arrow and check the box next to BlueSelect for Basic Individual Network 3

4 THE BLUE KC PRODUCT FAMILIES FINANCIAL ASSISTANCE Basic* Lowest cost Blue KC plan other than the SafetyNet plan. at a low copay before deductible or coinsurance applies. only. Classic Copays on prescription drugs. First unexpected accidents or illnesses. Low cost generic prescription drugs. Cost-Sharing is purchased Federal Poverty Level Guidlines Household Size 100% FPL 150% FPL 200% FPL 250% FPL Each Additional do not guarantee your eligibility for cost-sharing reductions. Health Insurance Marketplace. Saver Account (HSA). 4

5 UNDERSTANDING METAL LEVELS Platinum Gold Silver Bronze HOW TO BUY BLUE KC PLANS LiveFearlessKC.com. Regardless of where you choose to purchase your health This brochure provides a summary of cost-sharing reduction silver plans offered by Blue KC on the FFM through the healthcare.gov website. 5

6 2016 INDIVIDUAL AND FAMILY PLAN COMPARISON Coinsurance Deductible Out-of-Pocke Network Cost Sharing Reduction Level Plan Name 1 In Network Out of Network In Network Out of Network In Network Single Family Single Family Single Family % 30% % 0% 20% % % 30% Preferred-Care Blue with BlueCard % 0% 20% % % 30% % 0% 20% % % 30% % 0% 20% % % 30% BlueSelect 6 with BlueCard % 0% 20% % % 30% % 0% 20% % % Basic % % Missouri residents enrolled in Basic plans do not have out-of network benefits. 6

7 t Maximum Copay/Per Occurance Pharmacy 4 Out of Network BDTC 2 Urgent Single Family PCP PCP 3 Specialist Care ER Tier 1 Tier 2 Tier 3 Tier 4 Deductible Type 5 Ded Ded Aggregate Ded Ded Aggregate Ded Ded Aggregate Ded Ded Aggregate Ded Ded Aggregate 25% 25% 25% Ded Ded Ded Aggregate than 7

8 NETWORK AND BENEFIT MAPS choose the right option. Preferred-Care Blue BlueSelect BlueCard OUT-OF-NETWORK NOT COVERED OUT-OF-NETWORK OUT-OF-NETWORK NOT COVERED NETWORK Preferred-Care Blue + Blue Card NETWORK BlueSelect + Blue Card NETWORK BlueSelect for Basic Individual NETWORK BlueSelect for Basic Individual PRODUCT TYPE Preferred Provider Organization (PPO) PRODUCT TYPE Preferred Provider Organization (PPO) PRODUCT TYPE Preferred Provider Organization (PPO) PRODUCT TYPE Exclusive Provider Organization (EPO) PLAN FAMILY First, Saver, Classic, SafetyNet, Short Term PLAN FAMILY First, Saver, Classic, SafetyNet, Basic PLAN FAMILY Basic (Direct Pay KS) PLAN FAMILY Basic ( Direct Pay MO) 8

9 EXCLUSIONS AND LIMITATIONS P BlueKC.com/2016exclusions. applicable Cost-Sharing. Blood donor expenses infertility Non-prescription enteral feedings and other nutritional and education or special education Non-prescription enteral feedings and other nutritional and education or special education Missouri Only Exclusions and Limitations drugs) of infertility or related conditions procedures Sales tax 9

10 EXCLUSIONS AND LIMITATIONS (CONTINUED) Missouri Only Exclusions and Limitations (continued) calendar year for cancer Kansas Only Exclusions and Limitations Biofeedback (including neurofeedback) facility of functioning for each Language access services Disclosure Notices conditions. eligible for cost-sharing subsidies). Please contact Blue KC classifications. paid by third parties unless related to the Contractholder by blood 10

11 QUESTIONS? broker or call Blue KC at LET S GET STARTED If you need more information or have questions, contact your broker or call Blue KC at You can also visit us online at BlueKC.com. 11

12 BlueKC.com Blue Cross and Blue Shield of Kansas City is an Indepedent Licensee of the Blue Cross and Blue Shield Association.

2018 BLUE OPTIONS BUSINESSES WITH 2-50 EMPLOYEES MCM SG18 9/17

2018 BLUE OPTIONS BUSINESSES WITH 2-50 EMPLOYEES MCM SG18 9/17 2018 Blue Options 2018 BLUE OPTIONS BLUE OPTIONS All Blue KC plans apply all in-network member cost-sharing (copays, deductibles, and coinsurance)