Blue KC Choice Bronze 7000 Blue Select EPO with Spira Care

94248KS0560005
Expanded Bronze
EPO

Blue KC Choice Bronze 7000 Blue Select EPO with Spira Care is an Expanded Bronze EPO plan by Blue Cross and Blue Shield of Kansas City.

IMPORTANT: You are viewing the 2023 version of Blue KC Choice Bronze 7000 Blue Select EPO with Spira Care 94248KS0560005. You can enroll in this plan if you qualify for special enrollment until the end of 2023.

Locations

Blue KC Choice Bronze 7000 Blue Select EPO with Spira Care is offered in the following counties.

Plan Overview

This is a plan overview for 2023 version of Blue KC Choice Bronze 7000 Blue Select EPO with Spira Care 94248KS0560005.
Insurer: Blue Cross and Blue Shield of Kansas City
Network Type: EPO
Metal Type: Expanded Bronze
HSA Eligible?: No
Plan ID: 94248KS0560005

Cost-Sharing Overview

Blue KC Choice Bronze 7000 Blue Select EPO with Spira Care offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for Blue KC Choice Bronze 7000 Blue Select EPO with Spira Care?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

Blue KC Choice Bronze 7000 Blue Select EPO with Spira Care offers the following features and referral requirements.

Wellness Program: No
Disease Program: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy
Notice Pregnancy: No
Referral Specialist: No
Specialist Requiring Referral:
Plan Exclusions: Services received from Out-of-Network Providers except as specified. For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war/any action of war. For court ordered services, including but not limited to examinations, treatment and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal regardless of reason or diagnosis. For health or dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, missed appointments, completion of forms or other non-medical charges. Services which are related to complications arising from treatments/services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of sexual dysfunction, including drugs and prosthesis. For services/supplies received from any provider in a country where any sanction, embargo, etc would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services/supplies to the extent they are payable by Medicare.
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what Blue KC Choice Bronze 7000 Blue Select EPO with Spira Care covers when you are out of the service area or out of the country.

Out of Country Coverage: No
Out of Country Coverage Description: We provide limited services outside the United States through Global Core. Such services are limited to emergency services.
Out of Service Area Coverage: No
Out of Service Area Coverage Description: Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.
National Network: No

Additional Benefits and Cost-Sharing

Blue KC Choice Bronze 7000 Blue Select EPO with Spira Care includes the following benefits at the cost sharing rates listed below.

Free Preventive Services

There is no copayment or coinsurance for any of the following Blue KC Choice Bronze 7000 Blue Select EPO with Spira Care preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Additional Resources

Below are additional resources for Blue KC Choice Bronze 7000 Blue Select EPO with Spira Care including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.

Summary of Benefits: Summary of Benefits Link
Plan Brochure: Plan Brochure Link
Formulary: Formulary Link
Premium Payment Website: Premium Payment Link
Ready to sign up for Blue KC Choice Bronze 7000 Blue Select EPO with Spira Care?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Table of Contents