INDIVIDUALS AND FAMILY – 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.

 

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KSAFFORDABLUE $10,000 DEDUCTIBLE (PBK5266A)
$10,000.00
  
KSAFFORDABLUE $10,000 DEDUCTIBLE (PBK5266A)
$10,000.00
  
KSAFFORDABLUE $10,000 DEDUCTIBLE (PBK5266A)
$10,000.00
  
KSAFFORDABLUE $10,000 DEDUCTIBLE (PBK7010A)
$10,000.00
  
KSAFFORDABLUE $10,000 DEDUCTIBLE (PBK7010A)
$10,000.00
  
KSAFFORDABLUE $10,000 DEDUCTIBLE (PBK7010A)
$10,000.00
  
MOAFFORDABLUE $10,000 DEDUCTIBLE (PBM5269A)
$10,000.00
  
MOAFFORDABLUE $10,000 DEDUCTIBLE (PBM5269A)
$10,000.00
  
MOAFFORDABLUE $10,000 DEDUCTIBLE (PBM5269A)
$10,000.00
  
MOAFFORDABLUE $10,000 DEDUCTIBLE (PBM7013A)
$10,000.00
  
MOAFFORDABLUE $10,000 DEDUCTIBLE (PBM7013A)
$10,000.00
  
MOAFFORDABLUE $10,000 DEDUCTIBLE (PBM7013A)
$10,000.00
  
MOAFFORDABLUE $2,500 DEDUCTIBLE  (PBM5267A)
$2,500.00
  
MOAFFORDABLUE $2,500 DEDUCTIBLE  (PBM5267A)
$2,500.00
  
MOAFFORDABLUE $2,500 DEDUCTIBLE  (PBM5267A)
$2,500.00
  
KSAFFORDABLUE $2,500 DEDUCTIBLE (PBK5264A)
$2,500.00
  
KSAFFORDABLUE $2,500 DEDUCTIBLE (PBK5264A)
$2,500.00
  
KSAFFORDABLUE $2,500 DEDUCTIBLE (PBK5264A)
$2,500.00
  
KSAFFORDABLUE $2,500 DEDUCTIBLE (PBK7008A)
$2,500.00
  
KSAFFORDABLUE $2,500 DEDUCTIBLE (PBK7008A)
$2,500.00
  
KSAFFORDABLUE $2,500 DEDUCTIBLE (PBK7008A)
$2,500.00
  
MOAFFORDABLUE $2,500 DEDUCTIBLE (PBM7011A)
$2,500.00
  
MOAFFORDABLUE $2,500 DEDUCTIBLE (PBM7011A)
$2,500.00
  
MOAFFORDABLUE $2,500 DEDUCTIBLE (PBM7011A)
$2,500.00
  
MOAFFORDABLUE $5,000 DEDUCTIBLE  (PBM5268A)
$5,000.00
  
MOAFFORDABLUE $5,000 DEDUCTIBLE  (PBM5268A)
$5,000.00
  
MOAFFORDABLUE $5,000 DEDUCTIBLE  (PBM5268A)
$5,000.00
  
MOAFFORDABLUE $5,000 DEDUCTIBLE  (PBM7012A)
$5,000.00
  
MOAFFORDABLUE $5,000 DEDUCTIBLE  (PBM7012A)
$5,000.00
  
MOAFFORDABLUE $5,000 DEDUCTIBLE  (PBM7012A)
$5,000.00
  
MOAFFORDABLUE $5,000 DEDUCTIBLE  (PBM7012A)
$5,000.00
  
KSAFFORDABLUE $5,000 DEDUCTIBLE (PBK5265A)
$5,000.00
  
KSAFFORDABLUE $5,000 DEDUCTIBLE (PBK5265A)
$5,000.00
  
KSAFFORDABLUE $5,000 DEDUCTIBLE (PBK5265A)
$5,000.00
  
KSAFFORDABLUE $5,000 DEDUCTIBLE (PBK7009A)
$5,000.00
  
KSAFFORDABLUE $5,000 DEDUCTIBLE (PBK7009A)
$5,000.00
  
KSAFFORDABLUE $5,000 DEDUCTIBLE (PBK7009A)
$5,000.00
  
MOAFFORDABLUE PCB $10,000 DEDUCTIBLE (PBM4001A)
$10,000.00
  
MOAFFORDABLUE PCB $10,000 DEDUCTIBLE (PBM4001A)
$10,000.00
  
MOAFFORDABLUE PCB $10,000 DEDUCTIBLE (PBM4001A)
$10,000.00
  
MOAFFORDABLUE PCB $2,500 DEDUCTIBLE  (PBM3999A)
$2,500.00
  
MOAFFORDABLUE PCB $2,500 DEDUCTIBLE  (PBM3999A)
$2,500.00
  
MOAFFORDABLUE PCB $2,500 DEDUCTIBLE  (PBM3999A)
$2,500.00
  
MOAFFORDABLUE PCB $5,000 DEDUCTIBLE  (PBM4000A)
$5,000.00
  
MOAFFORDABLUE PCB $5,000 DEDUCTIBLE  (PBM4000A)
$5,000.00
  
MOAFFORDABLUE PCB $5,000 DEDUCTIBLE  (PBM4000A)
$5,000.00
  
KSBlue Care HMO -  Kansas Plan (BCK1213A)
$0.00
  
KSBlue Care HMO -  Kansas Plan (BCK1213A)
$0.00
  
KSBlue Care HMO -  Kansas Plan (BCK1213A)
$0.00
  
KSBlue Care HMO -  Kansas Plan (BCK1214A)
$0.00
  
KSBlue Care HMO -  Kansas Plan (BCK1214A)
$0.00
  
MOBlue Care HMO Missouri Plan (BCM1214A)
$0.00
  
MOBlue Care HMO Missouri Plan (BCM1214A)
$0.00
  
MOBlue KC - Spira Care BlueSelect 1250 ($0 Cost Share Office Visits/Labs/X-Rays at Spira Care Centers; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
KSBlue KC - Spira Care BlueSelect 1250 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
MOBlue KC - Spira Care BlueSelect 300 ($0 Cost Share Office Visits/Labs/X-Rays at Spira Care Centers; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$300.00
  
MOBlue KC - Spira Care BlueSelect 3750 ($0 Cost Share Office Visits/Labs/X-Rays at Spira Care Centers; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$3,750.00
  
KSBlue KC - Spira Care BlueSelect 3750 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$3,750.00
  
MOBlue KC - Spira Care BlueSelect 5000 ($0 Cost Share Office Visits/Labs/X-Rays at Spira Care Centers; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$5,000.00
  
MOBlue KC - Spira Care BlueSelect 5000 ($0 Cost Share Office Visits/Labs/X-Rays at Spira Care Centers; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$5,000.00
  
MOBlue KC - Spira Care BlueSelect 5000 ($0 Cost Share Office Visits/Labs/X-Rays at Spira Care Centers; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC - Spira Care BlueSelect 5000 ($0 Cost Share Office Visits/Labs/X-Rays at Spira Care Centers; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$5,000.00
  
MOBlue KC - Spira Care BlueSelect 5000 ($0 Cost Share Office Visits/Labs/X-Rays at Spira Care Centers; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
KSBlue KC - Spira Care BlueSelect 5000 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$5,000.00
  
KSBlue KC - Spira Care BlueSelect 5000 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$5,000.00
  
KSBlue KC - Spira Care BlueSelect 5000 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
KSBlue KC - Spira Care BlueSelect 5000 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$5,000.00
  
KSBlue KC - Spira Care BlueSelect 5000 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC - Spira Care BlueSelect 7300 ($0 Cost Share Office Visits/Labs/X-Rays at Spira Care Centers; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,300.00
  
MOBlue KC - Spira Care BlueSelect 7300 ($0 Cost Share Office Visits/Labs/X-Rays at Spira Care Centers; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,300.00
  
MOBlue KC - Spira Care BlueSelect 7300 ($0 Cost Share Office Visits/Labs/X-Rays at Spira Care Centers; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC - Spira Care BlueSelect 7300 ($0 Cost Share Office Visits/Labs/X-Rays at Spira Care Centers; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,300.00
  
MOBlue KC - Spira Care BlueSelect 7300 ($0 Cost Share Office Visits/Labs/X-Rays at Spira Care Centers; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
KSBlue KC - Spira Care BlueSelect 7300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,300.00
  
KSBlue KC - Spira Care BlueSelect 7300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,300.00
  
KSBlue KC - Spira Care BlueSelect 7300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
KSBlue KC - Spira Care BlueSelect 7300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,300.00
  
KSBlue KC - Spira Care BlueSelect 7300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC - Spira Care BlueSelect Plus 1250 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
KSBlue KC - Spira Care BlueSelect Plus 1250 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
MOBlue KC - Spira Care BlueSelect Plus 300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$300.00
  
MOBlue KC - Spira Care BlueSelect Plus 3750 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$3,750.00
  
KSBlue KC - Spira Care BlueSelect Plus 3750 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$3,750.00
  
MOBlue KC - Spira Care BlueSelect Plus 5000  (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$5,000.00
  
MOBlue KC - Spira Care BlueSelect Plus 5000 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$5,000.00
  
MOBlue KC - Spira Care BlueSelect Plus 5000 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC - Spira Care BlueSelect Plus 5000 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$5,000.00
  
KSBlue KC - Spira Care BlueSelect Plus 5000 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$5,000.00
  
KSBlue KC - Spira Care BlueSelect Plus 5000 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$5,000.00
  
KSBlue KC - Spira Care BlueSelect Plus 5000 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC - Spira Care BlueSelect Plus 5000 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
KSBlue KC - Spira Care BlueSelect Plus 5000 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC - Spira Care BlueSelect Plus 7300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,300.00
  
MOBlue KC - Spira Care BlueSelect Plus 7300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,300.00
  
MOBlue KC - Spira Care BlueSelect Plus 7300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,300.00
  
MOBlue KC - Spira Care BlueSelect Plus 7300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
KSBlue KC - Spira Care BlueSelect Plus 7300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,300.00
  
KSBlue KC - Spira Care BlueSelect Plus 7300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,300.00
  
KSBlue KC - Spira Care BlueSelect Plus 7300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
KSBlue KC - Spira Care BlueSelect Plus 7300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,300.00
  
KSBlue KC - Spira Care BlueSelect Plus 7300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,300.00
  
MOBlue KC - Spira Care BlueSelect Plus 7300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
KSBlue KC - Spira Care BlueSelect Plus 7300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
KSBlue KC - Test Faith Spira Care BlueSelect 7300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,300.00
  
MOBlue KC Community BlueSelect 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
MOBlue KC Community BlueSelect 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC Community BlueSelect 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
MOBlue KC Community BlueSelect 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
KSBlue KC Community BlueSelect 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
KSBlue KC Community BlueSelect 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
KSBlue KC Community BlueSelect 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
KSBlue KC Community BlueSelect 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC Community BlueSelect 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC Community BlueSelect 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
MOBlue KC Community BlueSelect 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
KSBlue KC Community BlueSelect 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC Community BlueSelect Plus 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
MOBlue KC Community BlueSelect Plus 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC Community BlueSelect Plus 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
MOBlue KC Community BlueSelect Plus 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
KSBlue KC Community BlueSelect Plus 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
KSBlue KC Community BlueSelect Plus 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
KSBlue KC Community BlueSelect Plus 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
KSBlue KC Community BlueSelect Plus 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC Community BlueSelect Plus 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
MOBlue KC Community BlueSelect Plus 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC Community BlueSelect Plus 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,250.00
  
KSBlue KC Community BlueSelect Plus 1250 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC Community Preferred-Care Blue 2900 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$2,900.00
  
MOBlue KC Community Preferred-Care Blue 2900 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$2,900.00
  
MOBlue KC Community Preferred-Care Blue 300 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$300.00
  
MOBlue KC Community Preferred-Care Blue 300 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$300.00
  
MOBlue KC Community Preferred-Care Blue 300 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$300.00
  
MOBlue KC Community Preferred-Care Blue 300 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$300.00
  
MOBlue KC Community Preferred-Care Blue 300 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$300.00
  
MOBlue KC Community Preferred-Care Blue 300 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$300.00
  
MOBlue KC Community Preferred-Care Blue 3375 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$3,375.00
  
MOBlue KC Community Preferred-Care Blue 3375 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC Community Preferred-Care Blue 3375 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$3,375.00
  
MOBlue KC Community Preferred-Care Blue 3375 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$3,375.00
  
MOBlue KC Community Preferred-Care Blue 3375 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC Community Preferred-Care Blue 3375 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$3,375.00
  
MOBlue KC Community Preferred-Care Blue 3375 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$3,375.00
  
MOBlue KC Community Preferred-Care Blue 3950 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$3,950.00
  
MOBlue KC Community Preferred-Care Blue 3950 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$3,950.00
  
MOBlue KC Community Preferred-Care Blue 4650 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$4,650.00
  
MOBlue KC Community Preferred-Care Blue 4650 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$4,650.00
  
MOBlue KC Community Preferred-Care Blue 5750 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$5,750.00
  
MOBlue KC Community Preferred-Care Blue 5750 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC Community Preferred-Care Blue 5750 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$5,750.00
  
MOBlue KC Community Preferred-Care Blue 5750 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$5,750.00
  
MOBlue KC Community Preferred-Care Blue 5750 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC Community Preferred-Care Blue 5750 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$5,750.00
  
MOBlue KC Community Preferred-Care Blue 5750 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$5,750.00
  
MOBlue KC Community Preferred-Care Blue 6000 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$6,000.00
  
MOBlue KC Community Preferred-Care Blue 6000 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC Community Preferred-Care Blue 6000 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$6,000.00
  
MOBlue KC Community Preferred-Care Blue 6000 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$6,000.00
  
MOBlue KC Community Preferred-Care Blue 6000 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC Community Preferred-Care Blue 6000 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$6,000.00
  
MOBlue KC Community Preferred-Care Blue 6000 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$6,000.00
  
MOBlue KC Community Preferred-Care Blue 900 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$900.00
  
MOBlue KC Community Preferred-Care Blue 900 - 2400 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$900.00
  
MOBlue KC Community Preferred-Care Blue 900 - 2400 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$900.00
  
MOBlue KC Community Preferred-Care Blue 900 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$900.00
  
MOBlue KC Community Preferred-Care Blue 900 - 2400 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$900.00
  
MOBlue KC Community Preferred-Care Blue 900 - 2400 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$900.00
  
MOBlue KC First Preferred-Care Blue 1500 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,500.00
  
MOBlue KC First Preferred-Care Blue 1500 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC First Preferred-Care Blue 1500 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,500.00
  
MOBlue KC First Preferred-Care Blue 1500 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,500.00
  
MOBlue KC First Preferred-Care Blue 1500 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,500.00
  
MOBlue KC First Preferred-Care Blue 1500 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC First Preferred-Care Blue 1500 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$1,500.00
  
MOBlue KC First Preferred-Care Blue 7000 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,000.00
  
MOBlue KC First Preferred-Care Blue 7000 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC First Preferred-Care Blue 7000 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,000.00
  
MOBlue KC First Preferred-Care Blue 7000 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,000.00
  
MOBlue KC First Preferred-Care Blue 7000 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,000.00
  
MOBlue KC First Preferred-Care Blue 7000 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC First Preferred-Care Blue 7000 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$7,000.00
  
MOBlue KC Saver Preferred-Care Blue 6500 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$6,500.00
  
MOBlue KC Saver Preferred-Care Blue 6500 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$6,500.00
  
MOBlue KC Saver Preferred-Care Blue 6500 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC Saver Preferred-Care Blue 6500 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$6,500.00
  
MOBlue KC Saver Preferred-Care Blue 6500 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$6,500.00
  
MOBlue KC Saver Preferred-Care Blue 6500 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$0.00
  
MOBlue KC Saver Preferred-Care Blue 6500 (Telehealth: $10 Copay for Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$6,500.00
  
KSBlue KC Spira Care Blue Select 300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$300.00
  
KSBlue KC Spira Care BlueSelect Plus 300 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$300.00
  
KSBlue KC Spira Care BlueSelect Plus 5000 (Spira Care Centers: $0 Cost Share Office Visits/Labs/X-Rays; Telehealth: $0 Copay Primary Care Office Visit & Behavioral Health Therapy; $0 Preventive Care)
$5,000.00
  
MOBLUE4U $1,000 DEDUCTIBLE  (PAM0016A)
$1,000.00
  
MOBLUE4U $1,000 DEDUCTIBLE  (PAM0016A)
$1,000.00
  
MOBLUE4U $1,000 DEDUCTIBLE  (PAM0106A)
$1,000.00
  
KSBLUE4U $1,000 DEDUCTIBLE (PAK0014A)
$1,000.00
  
KSBLUE4U $1,000 DEDUCTIBLE (PAK0014A)
$1,000.00
  
KSBLUE4U $1,000 DEDUCTIBLE (PAK0014A)
$1,000.00
  
KSBLUE4U $1,000 DEDUCTIBLE (PAK0086A)
$1,000.00
  
KSBLUE4U $1,000 DEDUCTIBLE (PAK0086A)
$1,000.00
  
KSBLUE4U $1,000 DEDUCTIBLE (PAK0086A)
$1,000.00
  
MOBLUE4U $2,500 DED Rate Guaranteed (PAM0003A)
$2,500.00
  
MOBLUE4U $2,500 DED Rate Guaranteed (PAM0003A)
$2,500.00
  
MOBLUE4U $2,500 DED Rate Guaranteed (PAM0003A)
$2,500.00
  
MOBLUE4U $2,500 DEDUCTIBLE  (PAM0011A)
$2,500.00
  
MOBLUE4U $2,500 DEDUCTIBLE  (PAM0011A)
$2,500.00
  
MOBLUE4U $2,500 DEDUCTIBLE  (PAM0011A)
$2,500.00
  
MOBLUE4U $2,500 DEDUCTIBLE  (PAM0018A)
$2,500.00
  
MOBLUE4U $2,500 DEDUCTIBLE  (PAM0018A)
$2,500.00
  
MOBLUE4U $2,500 DEDUCTIBLE  (PAM0018A)
$2,500.00
  
MOBLUE4U $2,500 DEDUCTIBLE  (PAM0107A)
$2,500.00
  
MOBLUE4U $2,500 DEDUCTIBLE  (PAM0107A)
$2,500.00
  
MOBLUE4U $2,500 DEDUCTIBLE  (PAM0107A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE (PAK0001A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE (PAK0001A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE (PAK0001A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE (PAK0009A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE (PAK0009A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE (PAK0009A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE (PAK0087A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE (PAK0087A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE (PAK0087A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE RATE GUARANTEE (PAK0017A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE RATE GUARANTEE (PAK0017A)
$2,500.00
  
KSBLUE4U $2,500 DEDUCTIBLE RATE GUARANTEE (PAK0017A)
$2,500.00
  
MOBLUE4U $5,000 DEDUCTIBLE  (PAM0020A)
$5,000.00
  
MOBLUE4U $5,000 DEDUCTIBLE  (PAM0020A)
$5,000.00
  
MOBLUE4U $5,000 DEDUCTIBLE  (PAM0020A)
$5,000.00
  
MOBLUE4U $5,000 DEDUCTIBLE  (PAM0108A)
$5,000.00
  
MOBLUE4U $5,000 DEDUCTIBLE  (PAM0108A)
$5,000.00
  
MOBLUE4U $5,000 DEDUCTIBLE  (PAM0108A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE (PAK0002A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE (PAK0002A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE (PAK0002A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE (PAK0010A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE (PAK0010A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE (PAK0010A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE (PAK0088A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE (PAK0088A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE (PAK0088A)
$5,000.00
  
MOBLUE4U $5,000 DEDUCTIBLE (PAM0004A)
$5,000.00
  
MOBLUE4U $5,000 DEDUCTIBLE (PAM0004A)
$5,000.00
  
MOBLUE4U $5,000 DEDUCTIBLE (PAM0004A)
$5,000.00
  
MOBLUE4U $5,000 DEDUCTIBLE (PAM0012A)
$5,000.00
  
MOBLUE4U $5,000 DEDUCTIBLE (PAM0012A)
$5,000.00
  
MOBLUE4U $5,000 DEDUCTIBLE (PAM0012A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE RATE GUARANTEE (PAK0019A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE RATE GUARANTEE (PAK0019A)
$5,000.00
  
KSBLUE4U $5,000 DEDUCTIBLE RATE GUARANTEE (PAK0019A)
$5,000.00
  
KSBLUE4U $500 DEDUCTIBLE (PAK0013A)
$1,000.00
  
KSBLUE4U $500 DEDUCTIBLE (PAK0013A)
$1,000.00
  
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