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 www.member.bluekc.com.

	In-Network	Out-of-Network
Deductible (Individual/Family)	$5,000 / $10,000	$5,000 / $10,000
Out-of-Pocket Max (Individual/Family)	$6,500 / $13,000	$13,000 / $26,000
Member Coinsurance (Plan pays/Member pays)	80% / 20%	60% / 40%
Physician Visits
Primary Care	$35 Copay	Deductible+ 40%
Routine Preventive	No charge	Deductible+ 40%
Specialist	$70 Copay	Deductible+ 40%
Hospital Services
Physician Services	Deductible+ 20%	Deductible+ 40%
Inpatient Hospitalization	Deductible+ 20%	Deductible+ 40%
Outpatient Surgery	Deductible+ 20%	Deductible+ 40%
Basic Outpatient Diagnostics	Deductible+ 20%	Deductible+ 40%
Urgent Care	$70 Copay	Deductible+ 40%
Emergency Room	$100 Copay, then Deductible+ 20%	$100 Copay, then Deductible+ 20%
Retail Prescriptions (Up to 34-Day Supply)
Tier 1 - Generic	$15 Copay	$15 Copay + 50%
Tier 2 - Preferred Brand	$70 Copay	$70 Copay + 50%
Tier 3 - Non-preferred Brand	$110 Copay	$110 Copay + 50%
Specialty Prescriptions
Tier 1 - Generic	$15 Copay	$15 Copay + 50%
Tier 2 - Preferred Brand	$110 Copay	$110 Copay + 50%
Tier 3 - Non-preferred Brand	$200 Copay	$200 Copay + 50%
Mail Order Prescriptions (35-102 Day Supply)
Tier 1 - Generic	$37.50 Copay	$37.50 Copay + 50%
Tier 2 - Preferred Brand	$175 Copay	$175 Copay + 50%
Tier 3 - Non-preferred Brand	$275 Copay	$275 Copay + 50%

	Per Pay Period Cost
Employee Only	$82.18
Family	$206.96

Downloads

Summary of Benefits Coverage

Rx-Savings Solutions

2026 Member Guide

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 www.member.bluekc.com.

	In-Network	Out-of-Network
Deductible (Individual/Family)	$6,500 / $13,000	$6,500 / $13,000
Out-of-Pocket Max (Individual/Family)	$6,500 / $13,000	$13,000 / $26,000
Member Coinsurance (Plan pays/Member pays)	100% / 0%	80% / 20%
Physician Visits
Primary Care	Deductible	Deductible+ 20%
Preventive Care	No Charge	Deductible+ 20%
Specialist	Deductible	Deductible+ 20%
Hospital Services
Physician Services	Deductible	Deductible+ 20%
Inpatient Hospitalization	Deductible	Deductible+ 20%
Outpatient Surgery	Deductible	Deductible+ 20%
Basic Outpatient Diagnostics	Deductible	Deductible+ 20%
Urgent Care	Deductible	Deductible+ 20%
Emergency Room	Deductible	Deductible
Retail Prescriptions (Up to 34-Day Supply)
Tier 1 - Generic	Deductible	Deductible+ 20%
Tier 2 - Preferred Brand	Deductible	Deductible+ 20%
Tier 3 - Non-preferred Brand	Deductible	Deductible+ 20%
Specialty Prescriptions
Tier 1 - Generic	Deductible	Deductible+ 20%
Tier 2 - Preferred Brand	Deductible	Deductible+ 20%
Tier 3 - Non-preferred Brand	Deductible	Deductible+ 20%
Mail Order Prescriptions (35-102 Day Supply)
Tier 1 - Generic	Deductible	Deductible+ 20%
Tier 2 - Preferred Brand	Deductible	Deductible+ 20%
Tier 3 - Non-preferred Brand	Deductible	Deductible+ 20%