Medical Benefits

Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.

Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit bcbsks.com. For more information, see plan documents below.

	In-Network	Out-of-Network
Deductible1 (Individual/Family)	$5,000/$10,000	See Blue Choice Network Payment Determination for Details
Out-of-Pocket Max2 (Individual/Family)	$6,350/$12,700	See Blue Choice Network Payment Determination for Details
Member Coinsurance	0%	See Blue Choice Network Payment Determination for Details
Physician Visits
Routine Preventive Care	100% Benefit of ACA allowable charge	See Blue Choice Network Payment Determination for Details
Primary Care Visit	$35 Copay	See Blue Choice Network Payment Determination for Details
Specialist Visit	$70 Copay	See Blue Choice Network Payment Determination for Details
Hospital Services
Inpatient Hospitalization	Deductible	See Blue Choice Network Payment Determination for Details
Outpatient Surgery	Deductible	See Blue Choice Network Payment Determination for Details
Outpatient Radiology & Labs	100% of allowable charges to a maximum of $300 per person, then subject to Deductible + Coinsurance	See Blue Choice Network Payment Determination for Details
Urgent Care	$35 Copay	See Blue Choice Network Payment Determination for Details
Emergency Room	Deductible	Deductible

Prescription Drugs	In-Network & Out-of-Network
Retail (BlueRx Card)	$15 / $50 / $75 / $150 / 20% up to $250
Mail Order (Results Rx Formulary)	2.5x Retail Copay (90 Day Supply)

	Cost Per Pay Period (26 Per Year)
Employee Only	$80.10
Employee + Spouse	$525.66
Employee + Child(ren)	$477.73
Employee + Family	$923.30

Downloads

Summary of Benefits

Uniform Glossary

SBC & Uniform Glossary

Telehealth flyer

BlueAccess one-sheet

BlueChoice Payment Flowchart

Cost Transparency card

	In-Network	Out-of-Network
Deductible1 (Individual/Family)	$1,500/$3,000	See Blue Choice Network Payment Determination for Details
Out-of-Pocket Max2 (Individual/Family)	$6,350/$12,700	See Blue Choice Network Payment Determination for Details
Member Coinsurance	20%	See Blue Choice Network Payment Determination for Details
Physician Visits
Routine Preventive Care	100% Benefit of ACA allowable charge	See Blue Choice Network Payment Determination for Details
Primary Care Visit	$35 Copay	See Blue Choice Network Payment Determination for Details
Specialist Visit	$70 Copay	See Blue Choice Network Payment Determination for Details
Hospital Services
Inpatient Hospitalization	Deductible + Coinsurance	See Blue Choice Network Payment Determination for Details
Outpatient Surgery	Deductible + Coinsurance	See Blue Choice Network Payment Determination for Details
Outpatient Radiology & Labs	100% of allowable charges to a maximum of $300 per person, then subject to Deductible + Coinsurance	See Blue Choice Network Payment Determination for Details
Urgent Care	$35 Copay	See Blue Choice Network Payment Determination for Details
Emergency Room	$250 Copay, then Deductible + Coinsurance	$250 Copay, then Deductible + Coinsurance