Blue - Saver PCB Gold

Kansas, 2017

  • Plan Type

    PPO

  • Metal Tier

    Gold

  • Out of Pocket Maximum

    $3,000

  • Deductible

    $1,500

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $1,500
Deductible (Family) $3,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $3,000
Out of Pocket Maximum (Family) $6,000

Doctor Visits

Primary Care Visit 10% Coinsurance after deductible
Specialist Visit 10% Coinsurance after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Emergency Room Services 10% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 10% Coinsurance after deductible
Laboratory Outpatient and Professional Services 10% Coinsurance after deductible
X-Ray and Diagnostic Imaging 10% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 10% Coinsurance after deductible
Mental / Behavioral Health Outpatient 10% Coinsurance after deductible
Rehabilitative Speech Therapy 10% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 10% Coinsurance after deductible
Outpatient Facility 10% Coinsurance after deductible
Outpatient Surgery 10% Coinsurance after deductible

Prescription Drugs

Generic Rx $10 Copay after deductible
Preferred Brand Rx $55 Copay after deductible
Non Preferred Brand Rx 20% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

Other Plans in Kansas

Plan First PCB Bronze Deductible $6,900 Coinsurance Not applicable Out of Pocket $7,150
Plan First Select Bronze Deductible $6,900 Coinsurance Not applicable Out of Pocket $7,150
Plan Basic Select Silver Deductible $3,500 Coinsurance Not applicable Out of Pocket $5,000
Plan Saver PCB Bronze Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,550
Plan Standard PCB Silver Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Standard PCB Bronze Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,150
Plan Saver PCB Silver Deductible $3,000 Coinsurance Not applicable Out of Pocket $5,000
Plan First Select Silver Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,000
Plan Basic Select Bronze Deductible $6,350 Coinsurance Not applicable Out of Pocket $7,150
Plan Saver Select Gold Deductible $1,500 Coinsurance Not applicable Out of Pocket $3,000
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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $1,500
Deductible (Family) $3,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $3,000
Out of Pocket Maximum (Family) $6,000

Doctor Visits

Primary Care Visit 10% Coinsurance after deductible
Specialist Visit 10% Coinsurance after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Emergency Room Services 10% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 10% Coinsurance after deductible
Laboratory Outpatient and Professional Services 10% Coinsurance after deductible
X-Ray and Diagnostic Imaging 10% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 10% Coinsurance after deductible
Mental / Behavioral Health Outpatient 10% Coinsurance after deductible
Rehabilitative Speech Therapy 10% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 10% Coinsurance after deductible
Outpatient Facility 10% Coinsurance after deductible
Outpatient Surgery 10% Coinsurance after deductible

Prescription Drugs

Generic Rx $10 Copay after deductible
Preferred Brand Rx $55 Copay after deductible
Non Preferred Brand Rx 20% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

Other Plans in Kansas

Plan First PCB Bronze Deductible $6,900 Coinsurance Not applicable Out of Pocket $7,150
Plan First Select Bronze Deductible $6,900 Coinsurance Not applicable Out of Pocket $7,150
Plan Basic Select Silver Deductible $3,500 Coinsurance Not applicable Out of Pocket $5,000
Plan Saver PCB Bronze Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,550
Plan Standard PCB Silver Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Standard PCB Bronze Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,150
Plan Saver PCB Silver Deductible $3,000 Coinsurance Not applicable Out of Pocket $5,000
Plan First Select Silver Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,000
Plan Basic Select Bronze Deductible $6,350 Coinsurance Not applicable Out of Pocket $7,150
Plan Saver Select Gold Deductible $1,500 Coinsurance Not applicable Out of Pocket $3,000