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​​51-99 EMPLOYEES – SUMMARY OF BENEFITS AND COVERAGE
 
To view an SBC, select a link under Name and click the plan. To sort Blue KC plans, scroll over the State, Plan Name, Individual Deductible, or Name.

 

 

  
  
  
  
KSAffordaBlue PBAB2A KS
$5,500.00
  
MOAffordaBlue PBAB2A MO
$5,500.00
  
KSAffordaBlue PBAB3A KS
$2,500.00
  
MOAffordaBlue PBAB3A MO
$2,500.00
  
KSASO BlueSaver PPO R20BS KS jmcCopy
$3,000.00
  
KSASO BlueSaver PPO R20BS KS
$3,000.00
  
KSASO BlueSaver PPO R20BS KS
$3,000.00
  
MOASO BlueSaver PPO R20BS MO
$3,000.00
  
MOASO BlueSaver PPO R20BS MO
$3,000.00
  
KSASO BlueSaver PPO R25BS KS
$5,000.00
  
KSASO BlueSaver PPO R25BS KS
$5,000.00
  
MOASO BlueSaver PPO R25BS MO
$5,000.00
  
MOASO BlueSaver PPO R25BS MO
$5,000.00
  
KSASO BlueSaver PPO R26BS KS
$5,000.00
  
KSASO BlueSaver PPO R26BS KS
$5,000.00
  
MOASO BlueSaver PPO R26BS MO
$5,000.00
  
MOASO BlueSaver PPO R26BS MO
$5,000.00
  
KSASO BlueSelectHSA Q21BS KS
$5,000.00
  
KSASO BlueSelectHSA Q21BS KS
$5,000.00
  
MOASO BlueSelectHSA Q21BS MO
$5,000.00
  
MOASO BlueSelectHSA Q21BS MO
$5,000.00
  
KSASO BlueSelectHSA Q2OBS KS
$5,000.00
  
KSASO BlueSelectHSA Q2OBS KS
$5,000.00
  
MOASO BlueSelectHSA Q2OBS MO
$5,000.00
  
MOASO BlueSelectHSA Q2OBS MO
$5,000.00
  
KSASO BlueSelectPPO Q05PS KS
$3,000.00
  
MOASO BlueSelectPPO Q05PS MO
$3,000.00
  
KSASO BlueSelectPPO Q10PS KS
$5,000.00
  
MOASO BlueSelectPPO Q10PS MO
$5,000.00
  
KSASO PPO R05PB KS
$1,000.00
  
MOASO PPO R05PB MO
$1,000.00
  
KSASO PPO R10PB KS
$3,000.00
  
MOASO PPO R10PB MO
$3,000.00
  
KSASO PPO R11PB KS
$3,000.00
  
MOASO PPO R11PB MO
$3,000.00
  
KSBlue KC Exchange BlueSaver (HSA) F60BS KS
$3,000.00
  
MOBlue KC Exchange BlueSaver (HSA) F60BS MO
$3,000.00
  
KSBlue KC Exchange BlueSaver (HSA) F65BS KS
$5,500.00
  
MOBlue KC Exchange BlueSaver (HSA) F65BS MO
$5,500.00
  
KSBlue KC Exchange F40AB KS
$5,500.00
  
MOBlue KC Exchange F40ABM MO
$5,500.00
  
KSBlue-Care BlueChoice HMO $0/$2600 KS
$0.00
  
KSBlue-Care BlueChoice HMO $0/$2600 KS
$0.00
  
MOBlue-Care BlueChoice HMO $0/$2600 MO
$0.00
  
MOBlue-Care BlueChoice HMO $0/$2600 MO
$0.00
  
KSBlue-Care BlueChoice HMO $0/$2950 KS
$0.00
  
KSBlue-Care BlueChoice HMO $0/$2950 KS
$0.00
  
MOBlue-Care BlueChoice HMO $0/$2950 MO
$0.00
  
MOBlue-Care BlueChoice HMO $0/$2950 MO
$0.00
  
KSBlue-Care BlueChoice HMO $0/$3300 KS
$0.00
  
KSBlue-Care BlueChoice HMO $0/$3300 KS
$0.00
  
KSBlue-Care BlueChoice HMO $0/$3300 KS
$0.00
  
MOBlue-Care BlueChoice HMO $0/$3300 MO
$0.00
  
MOBlue-Care BlueChoice HMO $0/$3300 MO
$0.00
  
MOBlue-Care BlueChoice HMO $0/$3300 MO
$0.00
  
KSBlue-Care BlueChoice HMO $0/$4000 KS
$0.00
  
KSBlue-Care BlueChoice HMO $0/$4000 KS
$0.00
  
KSBlue-Care BlueChoice HMO $0/$4000 KS
$0.00
  
MOBlue-Care BlueChoice HMO $0/$4000 MO
$0.00
  
MOBlue-Care BlueChoice HMO $0/$4000 MO
$0.00
  
MOBlue-Care BlueChoice HMO $0/$4000 MO
$0.00
  
KSBlue-Care HMO ASO KS
$0.00
  
MOBlue-Care HMO ASO MO
$0.00
  
KSBlue-Care HMO KS
$0.00
  
MOBlue-Care HMO MO
$0.00
  
KSBlueKCExchange SG F20PB KS
$500.00
  
MOBlueKCExchange SG F20PBM MO
$500.00
  
KSBlueKCExchange SG F25PB KS
$1,000.00
  
MOBlueKCExchange SG F25PB MO
$1,000.00
  
KSBlueKCExchange SG F30PB KS
$1,500.00
  
MOBlueKCExchange SG F30PBM MO
$1,500.00
  
KSBlueKCExchange SG F33PB KS
$2,000.00
  
MOBlueKCExchange SG F33PBM MO
$2,000.00
  
KSBlueKCExchange SG F35PB KS
$4,000.00
  
MOBlueKCExchange SG F35PBM MO
$4,000.00
  
KSBlueKCExchange SG F70HD KS
$3,000.00
  
KSBlueKCExchange SG F70HD KS
$3,000.00
  
MOBlueKCExchange SG F70HDM MO
$3,000.00
  
KSBlueKCExchange SG F75HD KS
$5,500.00
  
MOBlueKCExchange SG F75HDM MO
$5,500.00
  
KSBlueSaverHSA PBBS1A KS
$5,000.00
  
KSBlueSaverHSA PBBS1A KS
$5,000.00
  
MOBlueSaverHSA PBBS1A MO
$5,000.00
  
KSBlueSaverHSA PBBS2A KS
$3,000.00
  
MOBlueSaverHSA PBBS2A MO
$3,000.00
  
KSBlueSaverHSA PBBS3A KS
$2,000.00
  
MOBlueSaverHSA PBBS3A MO
$2,000.00
  
KSBlueSaverHSA PBBS5A KS
$1,500.00
  
MOBlueSaverHSA PBBS5A MO
$1,500.00
  
KSBlueSelect BlueSaver $5000/$5000 KS
$5,000.00
  
KSBlueSelect BlueSaver $5000/$5000 KS
$5,000.00
  
MOBlueSelect HSA PPO $5000/$5000 MO
$5,000.00
  
MOBlueSelect HSA PPO $5000/$5000 MO
$5,000.00
  
KSBlueSelect Plus ASO BlueSaver $3000 KS
$3,000.00
  
KSBlueSelect Plus ASO BlueSaver $3000 KS
$3,000.00
  
MOBlueSelect Plus ASO BlueSaver $3000 MO
$3,000.00
  
MOBlueSelect Plus ASO BlueSaver $3000 MO
$3,000.00
  
MOBlueSelect Plus ASO BlueSaver EPO $5000 MO
$5,000.00
  
KSBlueSelect Plus ASO BlueSaver EPO $5000 KS
$5,000.00
  
MOBlueSelect Plus ASO BlueSaver EPO $5000 MO
$5,000.00
  
KSBlueSelect Plus ASO BlueSaver EPO $5000 KS
$5,000.00
  
MOBlueSelect Plus ASO BlueSaver PPO $5000 MO
$5,000.00
  
KSBlueSelect Plus ASO BlueSaver PPO $5000 KS
$5,000.00
  
KSBlueSelect Plus ASO BlueSaver PPO $5000 KS
$5,000.00
  
MOBlueSelect Plus ASO BlueSaver PPO $5000 MO
$3,500.00
  
KSBlueSelect Plus ASO EPO $4000 KS
$4,000.00
  
KSBlueSelect Plus ASO EPO $4000 KS
$4,000.00
  
MOBlueSelect Plus ASO EPO $4000 MO
$4,000.00
  
MOBlueSelect Plus ASO EPO $4000 MO
$4,000.00
  
KSBlueSelect Plus ASO PPO $2000 KS
$2,000.00
  
KSBlueSelect Plus ASO PPO $2000 KS
$2,000.00
  
KSBlueSelect Plus ASO PPO $2000 KS
$2,000.00
  
MOBlueSelect Plus ASO PPO $2000 MO
$2,000.00
  
MOBlueSelect Plus ASO PPO $2000 MO
$2,000.00
  
MOBlueSelect Plus ASO PPO $2000 MO
$2,000.00
  
KSBlueSelect Plus ASO PPO $3000 (OOPM $3000) KS
$3,000.00
  
MOBlueSelect Plus ASO PPO $3000 (OOPM $3000) MO
$3,000.00
  
KSBlueSelect Plus ASO PPO $3000 (OOPM $5000) KS
$3,000.00
  
MOBlueSelect Plus ASO PPO $3000 (OOPM $5000) MO
$3,000.00
  
KSBlueSelect Plus ASO PPO $4000 KS
$4,000.00
  
KSBlueSelect Plus ASO PPO $4000 KS
$4,000.00
  
KSBlueSelect Plus ASO PPO $4000 KS
$4,000.00
  
MOBlueSelect Plus ASO PPO $4000 MO
$4,000.00
  
MOBlueSelect Plus ASO PPO $4000 MO
$4,000.00
  
MOBlueSelect Plus ASO PPO $4000 MO
$4,000.00
  
KSBlueSelect Plus ASO Spira Care EPO $1,500 KS
$1,500.00
  
KSBlueSelect Plus ASO Spira Care EPO $1,500 KS
$1,500.00
  
KSBlueSelect Plus ASO Spira Care EPO $1,500 KS
$1,500.00
  
MOBlueSelect Plus ASO Spira Care EPO $3,500 MO
$3,500.00
  
KSBlueSelect Plus ASO Spira Care EPO $3,500 KS
$3,500.00
  
KSBlueSelect Plus ASO Spira Care EPO $3,500 KS
$3,500.00
  
MOBlueSelect Plus ASO Spira Care EPO $3,500 MO
$3,500.00
  
KSBlueSelect Plus ASO Spira Care EPO $3,500 KS
$3,500.00
  
MOBlueSelect Plus ASO Spira Care EPO $3,500 MO
$3,500.00
  
MOBlueSelect Plus ASO Spira Care EPO $7,000 MO
$7,000.00
  
KSBlueSelect Plus ASO Spira Care EPO $7,000 KS
$7,000.00
  
MOBlueSelect Plus ASO Spira Care EPO $7,000 MO
$7,000.00
  
KSBlueSelect Plus ASO Spira Care EPO $7,000 KS
$7,000.00
  
KSBlueSelect Plus ASO Spira Care EPO $7,000 KS
$7,000.00
  
MOBlueSelect Plus ASO Spira Care EPO $7,000 MO
$7,000.00
  
KSBlueSelect Plus BlueSaver $3000 KS
$3,000.00
  
KSBlueSelect Plus BlueSaver $3000 KS
$3,000.00
  
MOBlueSelect Plus BlueSaver $3000 MO
$3,000.00
  
MOBlueSelect Plus BlueSaver $3000 MO
$3,000.00
  
KSBlueSelect Plus BlueSaver EPO $5000 KS
$5,000.00
  
KSBlueSelect Plus BlueSaver EPO $5000 KS
$5,000.00
  
MOBlueSelect Plus BlueSaver EPO $5000 MO
$5,000.00
  
MOBlueSelect Plus BlueSaver EPO $5000 MO
$5,000.00
  
KSBlueSelect Plus BlueSaver PPO $5000 KS
$5,000.00
  
KSBlueSelect Plus BlueSaver PPO $5000 KS
$5,000.00
  
MOBlueSelect Plus BlueSaver PPO $5000 MO
$5,000.00
  
MOBlueSelect Plus BlueSaver PPO $5000 MO
$5,000.00
  
KSBlueSelect Plus EPO $4000 Kansas
$4,000.00
  
KSBlueSelect Plus EPO $4000 Kansas
$4,000.00
  
MOBlueSelect Plus EPO $4000 MO
$4,000.00
  
MOBlueSelect Plus EPO $4000 MO
$4,000.00
  
KSBlueSelect Plus PPO $2000 KS
$2,000.00
  
KSBlueSelect Plus PPO $2000 KS
$2,000.00
  
KSBlueSelect Plus PPO $2000 KS
$2,000.00
  
MOBlueSelect Plus PPO $2000 MO
$2,000.00
  
MOBlueSelect Plus PPO $2000 MO
$2,000.00
  
MOBlueSelect Plus PPO $2000 MO
$2,000.00
  
KSBlueSelect Plus PPO $3000 (OOPM $3000) KS
$3,000.00
  
MOBlueSelect Plus PPO $3000 (OOPM $3000) MO
$3,000.00
  
MOBlueSelect Plus PPO $3000 (OOPM $5000) MO
$3,000.00
  
KSBlueSelect Plus PPO $3000(OOPM $5000) KS
$3,000.00
  
KSBlueSelect Plus PPO $4000 KS
$4,000.00
  
KSBlueSelect Plus PPO $4000 KS
$4,000.00
  
KSBlueSelect Plus PPO $4000 KS
$4,000.00
  
MOBlueSelect Plus PPO $4000 MO
$4,000.00
  
MOBlueSelect Plus PPO $4000 MO
$4,000.00
  
MOBlueSelect Plus PPO $4000 MO
$4,000.00
  
MOBlueSelect Plus Spira Care ASO EPO $1,500 MO
$1,500.00
  
MOBlueSelect Plus Spira Care ASO EPO $1,500 MO
$1,500.00
  
MOBlueSelect Plus Spira Care ASO EPO $1,500 MO
$1,500.00
  
KSBlueSelect Plus Spira Care EPO $1,500 KS
$1,500.00
  
KSBlueSelect Plus Spira Care EPO $1,500 KS
$1,500.00
  
KSBlueSelect Plus Spira Care EPO $1,500 KS
$1,500.00
  
MOBlueSelect Plus Spira Care EPO $1,500 MO
$1,500.00
  
MOBlueSelect Plus Spira Care EPO $1,500 MO
$1,500.00
  
MOBlueSelect Plus Spira Care EPO $1,500 MO
$1,500.00
  
KSBlueSelect Plus Spira Care EPO $3,500 KS
$3,500.00
  
KSBlueSelect Plus Spira Care EPO $3,500 KS
$3,500.00
  
KSBlueSelect Plus Spira Care EPO $3,500 KS
$3,500.00
  
MOBlueSelect Plus Spira Care EPO $3,500 MO
$3,500.00
  
MOBlueSelect Plus Spira Care EPO $3,500 MO
$3,500.00
  
MOBlueSelect Plus Spira Care EPO $3,500 MO
$3,500.00
  
KSBlueSelect Plus Spira Care EPO $7,000 KS
$7,000.00
  
KSBlueSelect Plus Spira Care EPO $7,000 KS
$7,000.00
  
KSBlueSelect Plus Spira Care EPO $7,000 KS
$7,000.00
  
MOBlueSelect Plus Spira Care EPO $7,000 MO
$7,000.00
  
MOBlueSelect Plus Spira Care EPO $7,000 MO
$7,000.00
  
MOBlueSelect Plus Spira Care EPO $7,000 MO
$7,000.00
  
KSBlueValue KS
$6,500.00
  
MOBlueValue MO
$6,500.00
  
MOBSP ASO PPO $1000 (OOPM $4000) MO
$1,000.00
  
KSBSP ASO PPO $3000/$6000 KS
$3,000.00
  
MOBSP ASO PPO $3000/$6000 MO
$3,000.00
  
KSBSP ASO PPO $5000/$6250 KS
$5,000.00
  
MOBSP ASO PPO $5000/$6250 MO
$5,000.00
  
KS BSP ASO Spira Care HSA EPO KS
$3,000.00
  
KS BSP ASO Spira Care HSA EPO KS
$3,000.00
  
KS BSP ASO Spira Care HSA EPO KS
$3,000.00
  
KS BSP ASO Spira Care HSA EPO KS
$3,000.00
  
MOBSP ASO Spira Care HSA EPO MO
$3,000.00
  
MOBSP ASO Spira Care HSA EPO MO
$3,000.00
  
MOBSP ASO Spira Care HSA EPO MO
$3,000.00
  
MOBSP ASO Spira Care HSA EPO MO
$3,000.00
  
KSBSP PPO $1000 (OOPM $4000) KS
$1,000.00
  
MOBSP PPO $1000 (OOPM $4000) MO
$1,000.00
  
KSBSP Spira Care HSA EPO KS
$3,000.00
  
KSBSP Spira Care HSA EPO KS
$3,000.00
  
KSBSP Spira Care HSA EPO KS
$3,000.00
  
KSBSP Spira Care HSA EPO KS
$3,000.00
  
KSBSP Spira Care HSA EPO KS
$3,000.00
  
MOBSP Spira Care HSA EPO MO
$3,000.00
  
MOBSP Spira Care HSA EPO MO
$3,000.00
  
MOBSP Spira Care HSA EPO MO
$3,000.00
  
MOBSP Spira Care HSA EPO MO
$3,000.00
  
KSCHOICE ASO BlueSelect Plus PPO $4500 KS
$4,500.00
  
KSCHOICE ASO BlueSelect Plus PPO $4500 KS
$4,500.00
  
MOCHOICE ASO BlueSelect Plus PPO $4500 MO
$4,500.00
  
MOCHOICE ASO BlueSelect Plus PPO $4500 MO
$4,500.00
  
MOCHOICE ASO BlueSelect Plus PPO $4500 MO
$4,500.00
  
MOCHOICE ASO BlueSelect Plus PPO $4500 MO
$4,500.00
  
KSCHOICE ASO BSP Spira Care EPO $3,000 KS
$3,000.00
  
KSCHOICE ASO BSP Spira Care EPO $3,000 KS
$3,000.00
  
KSCHOICE ASO BSP Spira Care EPO $3,000 KS
$3,000.00
  
MOCHOICE ASO BSP Spira Care EPO $3,000 MO
$3,000.00
  
MOCHOICE ASO BSP Spira Care EPO $3,000 MO
$3,000.00
  
MOCHOICE ASO BSP Spira Care EPO $3,000 MO
$3,000.00
  
KSCHOICE ASO PCB BlueSaver HSA $3500 KS
$3,500.00
  
KSCHOICE ASO PCB BlueSaver HSA $3500 KS
$3,500.00
  
KSCHOICE ASO PCB BlueSaver HSA $3500 KS
$3,500.00
  
KSCHOICE ASO PCB BlueSaver HSA $3500 KS
$3,500.00
  
MOCHOICE ASO PCB BlueSaver HSA $3500 MO
$3,500.00
  
MOCHOICE ASO PCB BlueSaver HSA $3500 MO
$3,500.00
  
MOCHOICE ASO PCB BlueSaver HSA $3500 MO
$3,500.00
  
MOCHOICE ASO PCB BlueSaver HSA $3500 MO
$3,500.00
  
KSCHOICE ASO PCB PPO $1000 KS
$1,000.00
  
KSCHOICE ASO PCB PPO $1000 KS
$1,000.00
  
MOCHOICE ASO PCB PPO $1000 MO
$1,000.00
  
MOCHOICE ASO PCB PPO $1000 MO
$1,000.00
  
MOCHOICE ASO PCB PPO $1000 MO
$1,000.00
  
MOCHOICE ASO PCB PPO $1000 MO
$1,000.00
  
KSCHOICE ASO PCB PPO $2500 KS
$2,500.00
  
KSCHOICE ASO PCB PPO $2500 KS
$2,500.00
  
MOCHOICE ASO PCB PPO $2500 MO
$2,500.00
  
MOCHOICE ASO PCB PPO $2500 MO
$2,500.00
  
MOCHOICE ASO PCB PPO $2500 MO
$2,500.00
  
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