BlueCare EPO Silver – EPO
87% cost sharing reduction [Popular Plan]
Network type: EPO
Coverage tier: Silver
Primary care visit: $25 copay
Specialist visit: $50 copay
Urgent care visit: $25 copay
Description
This plan has 87% cost sharing reduction [Popular Plan]
Health Care Plan Details
Network type | EPO |
Deductible | $1,100 per person $1,100 per person |
Out-of-pocket max | $2,200 per person $4,400 per family |
Metal tier | Silver |
Visit Copay
Primary care visit | $25 copay |
Specialist visit | $50 copay |
Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
Urgent care | $25 copay |
Emergency room | 20% coinsurance after deductible |
Ambulance | 20% coinsurance after deductible |
Hospital stay (facility) | 20% coinsurance after deductible |
Hospital stay (physician) | 20% coinsurance after deductible |
Outpatient procedure (facility) | 20% coinsurance after deductible |
Outpatient procedure (physician) | 20% coinsurance after deductible |
Physical rehabilitation | 20% coinsurance after deductible |
Maternitowny and Pregnancy
Well baby care | No charge |
Labor, delivery, hospital stay | 20% coinsurance after deductible |
Pharmacy, Drugs, and Medication
Generic | $10 copay |
Brand | $65 copay |
Non-preferred Brand | $100 copay |
Specialty | 25% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
X-rays | 20% coinsurance after deductible |
Imaging (CT/PET/MRI) | 20% coinsurance after deductible |
Blood work | 20% coinsurance after deductible |
Mental and Psychiatric Health Care
Mental Health outpatient services | $25 copay |
Psychiatric hospital stay | 20% coinsurance after deductible |
Health Plan Provider Information
Health Plan Benefits | https://www.bcbsks.com/qhp-data/plan-docs/2024/MT013_BlueCareEPOSilver2_2024.pdf |
Drug and medication plan formulary | https://www.myprime.com/content/dam/prime/memberportal/WebDocs/2024/Formularies/HIM/2024_KS_7T_BlueCare_Medication_List.pdf |
Search doctor list | https://www.bcbsks.com/ProviderDirectory/?prefix=XSN |