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U.S. Engineering Company
Medical Benefits Comparison - BCBSKC Plan
January 1, 2017
Copy of USE 2017 Benefit Summary Blue Cross Renewal.xlsx
MEDICAL
USE
USE
BCBSKC Cost Plus
BCBSKC Cost Plus
Carrier Website
www.bluekc.com www.bluekc.comPlan Type & Network
Preferred Care Blue
Blue Saver
In Network
Out of Network
In Network
Out of Network
Annual Deductible (calendar year)
Individual
$1,000
$3,000
$9,000
Family
$2,000
$6,000
$18,000
Coinsurance
Member Pays
20%
0%
20%
Maximum Out-of-pocket (calendar year)
(1)
Individual
$3,500
$4,000
$18,000
Family
$7,000
$8,000
$36,000
Lifetime Maximum
Per Individual
Preventive Care
Adult and Child Routine Physicals
Covered at 100%
Covered at 100%
Ded. Then 40%
Physician Services
Office Visits
$25 Copay / $50 Spec.
Ded. Then 0%
Ded. Then 40%
Urgent Care
$75 Copay
Ded. Then 0%
Vision Exam
Occupational & Speech Therapy
Short Term Rehab (speech, physical, occupational)
(2)
Ded. The 20%
Ded. Then 0%
Ded. Then 40%
Outpatient Cardiac Rehab
$25 Copay / $50 Spec.
Ded. Then 0%
Ded. Then 40%
Chiropractic Care Services
Ded. The 20%
Ded. Then 0%
Ded. Then 40%
Hospital Services
Inpatient Care
Ded. Then 20%
Ded. Then 0%
Ded. Then 40%
Outpatient Surgery
Ded. Then 20%
Ded. Then 0%
Ded. Then 40%
Outpatient Nonsurgical Care
Ded. Then 20%
Ded. Then 0%
Ded. Then 40%
Emergency room
Advanced Radiological Imaging (MRI, MRA, CAT & PET
scans)
$0 Copay
Ded. Then 0%
Ded. Then 40%
Prescription Drugs
Deductible
Medical Plan Deductible then:
Level 1 / Level 2 / Level 3 / Level 4
$15/$40/$80
$15/$40/$80
Mail Order (90 Day Supply)
2.5X
2.5X
(1) Out-of-pocket amount includes coinsurance, deductible and copays.
(2) 40 day maximum for PT and OT, 20 day maximum for Speech and Hearing
$15/$40/$80 then 50%
$150 Copay
Ded. Then 0%
Ded. Then 50%
$2,000
$4,000
50%
$7,000
$14,000
Unlimited
Unlimited
CBIZ Benefits & Insurance Services has been and will continue to be committed to acting in our client’s best interest by providing services and products that meet our client’s needs as communicated to CBIZ. From time to time, CBIZ may participate in agreements with one or more
insurance companies or third party vendors, in connection with the insurance related transactions, to receive additional compensation or consideration. These compensation arrangements are provided to CBIZ as a result of the performance and expertise by which products and
services are provided to the client and may result in enhancing CBIZs ability to access certain markets and services on behalf of CBIZ clients. More information regarding these agreements and the consideration received pursuant to these agreements is available upon written
request.
Ded. Then 50%
Ded. Then 50%
Ded. Then 50%
Ded. Then 50%
Ded. Then 50%
Ded. Then 50%
$15/$40/$80 then 50%
Medical Deductible then:
Ded. Then 40%
N/A
N/A
Ded. Then 50%
Ded. Then 50%
Ded. Then 50%
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