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 |