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Blue Cross Blue Shield of Kansas Benefits Plan Options. USD 336 Holton. Current Triple Option Plan. Deductible Option 1: $500/$1000 Option 2: $1000/$2000 Option 3: $1500/$3000 Coinsurance - $1000/$2000 (80/20%) Office Visit Copay - $20 no limits
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Blue Cross Blue Shield of Kansas Benefits Plan Options USD 336 Holton
Current Triple Option Plan • Deductible • Option 1: $500/$1000 • Option 2: $1000/$2000 • Option 3: $1500/$3000 • Coinsurance - $1000/$2000 (80/20%) • Office Visit Copay- $20 no limits • Accident Coverage – Subject to deductible / coinsurance • Prescription Drugs - $15/30/45 copay, Mail order $37.50/75/112.50
High Deductible Health Plan 1 (HDHP) • Deductible - $2500/$5000 • Coinsurance - $0 • Office Visit Copay– Subject to deductible / coinsurance • Accident Coverage – Subject to deductible / coinsurance • Prescription Drugs – Subject to deductible/coinsurance, then • $15/50/75 copay, Mail order $37.50/125/187.50
AffordaBlue Triple Option • Deductible • Option 1: $500/$1500 • Option 2: $1000/$3000 • Option 3: $2000/$6000 • Coinsurance - $1000/$3000 (80/20%) • Office Visit Copay- $25, limited to 5 visits per person, 15 per family • Accident Coverage – $50 copay for initial visit • Prescription Drugs - $100 / $300 deductible, then 50%
High Deductible Health Plan 2 (HDHP) • Deductible - $3000/$6000 • Coinsurance - $0 • Office Visit Copay– Subject to deductible / coinsurance • Accident Coverage – Subject to deductible / coinsurance • Prescription Drugs – Subject to deductible/coinsurance, then • $15/50/75 copay, Mail order $37.50/125/187.50
Comprehensive Major Medical • Deductible - $1500/3000 • Coinsurance - $2000/$4000 (60/40%) • Office Visit Copay- $30 Primary Care (PCP) or $60 Specialist, • limited to 5 visit per person / 15 family • Accident Coverage – Pays 100% up to $1000 per person, then • subject to deductible/coinsurance • Prescription Drugs - $15/50/75/150 copay, Mail order • $37.50/125/187.50/375
High Deductible Health Plan 3 (HDHP) • Deductible - $5000/$10,000 • Coinsurance - $0 • Office Visit Copay– Subject to deductible / coinsurance • Accident Coverage – Subject to deductible / coinsurance • Prescription Drugs – Subject to deductible/coinsurance, then • $15/50/75 copay, Mail order $37.50/125/187.50