BLUE OPTIONS®

2015
BLUE OPTIONS
FOR ADULTS, FAMILIES & CHILDREN
MCM DP15-10/14
®
BLUE & U BASIC*
Network:
Silver
Bronze
BlueSelect for Basic Individual
BlueSelect for Basic Individual
What You Pay:
Deductible
KS Residents
MO Residents
KS Residents
MO Residents
Coinsurance
PCP Visits
Urgent Care
Specialist Visits
Deductible then
Deductible
Deductible then
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
1
Rx Deductible
Rx Deductible
Rx Deductible
1
NEED RATES?
MCM DP15-10/14
Visit us online at BlueKC.com or call 888-800-4478.
7
Rx Deductible
Deductible
QUESTIONS?
broker or call Blue KC at
816-395-2583 or toll free
LET’S GET STARTED
If you need more information or have questions,
contact your broker or call Blue KC at 888-800-4478. You can also visit us online at BlueKC.com.
Exclusions and Limitations
BlueKC.com/2015exclusions.
Blood donor expenses
keratoplasty procedures
MCM DP15-10/14
14
Exclusions and Limitations, continued
Sales tax
Contract
Biofeedback (including neurofeedback)
Kansas Only Exclusions and Limitations
procedures
Language access services
Disclosure Notices
Missouri Only Exclusions and Limitations
infertility or related conditions
paid by third parties unless related to the Contractholder by blood or
MCM DP15-10/14
15
BlueKC.com | 888-800-4478
MCM DP15-10/14
Blue Cross and Blue Shield of Kansas City is an Indepedent Licensee of the Blue Cross and Blue Shield Association.