BUSINESSES WITH 1-50 EMPLOYEES

2015

BLUE OPTIONS?

BUSINESSES WITH 1-50 EMPLOYEES

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BLUE OPTIONS

All Blue & U plans apply all in-network member cost sharing (copays, deductibles,

Blue Cross and Blue Shield of Kansas City (Blue KC) can help you sort out what's best for your company and how to get the benefits and coverage you need for your employees and their families.

coinsurance, and prescription drugs) to the out-of-pocket maximum and include 100% in-network coverage of preventive services.

Our Blue & U products comply with Affordable Care Act (ACA) benefit, rating and other regulations. Choose the plan that best fits your company's needs and budget and enjoy the peace of mind that comes from knowing you made the right choice to protect your employees and their families.

OUR NETWORKS

Preferred?Care Blue

Preferred?Care Blue? offers Blue KC members the largest selection of providers within our 32-county service area.

BlueSelect BlueSelect offers affordability by using a smaller hospital and provider network than Preferred-Care Blue. BlueSelect is best for employees who reside in the 5-county Kansas City metropolitan area, which includes Clay, Jackson and Platte counties in Missouri, and Johnson and Wyandotte counties in Kansas. Those outside the metropolitan Kansas City area are eligible to enroll, but must visit a BlueSelect hospital or provider for benefits to be paid at the in-network level. Outside the 32-county Blue KC service area, BlueSelect members are covered under BlueCard PPO coverage.

BlueCard All Blue KC plans allow you to take your healthcare benefits with you? across the country and around the world ? with the BlueCard? program. BlueCard gives you access to doctors and hospitals almost everywhere. Outside of the U.S., you have access to doctors and hospitals in nearly 200 countries and territories through the BlueCard Worldwide? program.

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FIND AN IN-NETWORK PROVIDER

When your employees select a Blue KC product, it's important for them to also understand the provider network they have chosen.

Provider Networks

Blue KC negotiates with providers to help keep coverage affordable while also ensuring our members have access to high quality healthcare services by ensuring those providers meet our quality of care standards.

In-network providers offer benefits covered at the highest level. By choosing to visit an in-network provider, your employees will pay less than they would if they visit an out-of-network provider. Their plan may not cover, or may not pay as much of, their medical costs billed by out-of-network providers, meaning that they will pay more out-of-pocket than if they had chosen an in-network medical provider.

The Blue KC Doctor & Hospital Provider Finder on can help find the most up-to-date and accurate information when your employees are looking to find, or get basic information about, an in-network doctor, hospital, or other healthcare provider.

Provider Finder Features Here are just a few of the features your employees will find when using the Blue KC Doctor & Hospital Provider Finder:

? Ability to search for in-network doctors and providers by name, procedure, specialty and more

? One search tool to find doctors and providers in your neighborhood or across the country

? Helpful filters, including hospital affiliation and network

Blue KC offers a choice of provider networks your employees can access to find medical professionals who meet their specific healthcare needs.

To find an in-network doctor or provider in the:

Preferred-Care Blue Network ? Visit ? Select Find a Doctor from the top of our home page ? Under the heading Choose Your Network, click the down arrow and check the box next to Preferred-Care Blue Network (PCB)

BlueSelect Network ? Visit ? Select Find a Doctor from the top of our home page ? Under the heading Choose Your Network, click the down arrow and check the box next to BlueSelect Network (Select)

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THE BLUE KC PRODUCT FAMILIES

Blue & U Basic* This product is an affordable plan that provides a great option for your employees and their families in the Kansas City metro area.

? Lowest cost Blue KC plan offered to small group employees.

? Provides two visits to Primary Care Physician (PCP) at a low copayment before deductible or coinsurance applies.

? Available only on the BlueSelect network serving Johnson and Wyandotte counties in Kansas and Clay, Platte and Jackson counties in Missouri.

Blue & U Classic This product is great for employees who want to know their coverage up front. Our Classic plans provide predictable coverage with clearly defined copays on the most common services.

? Designed for employees who want cost certainty when they need commonly used services, along with coverage for unexpected accidents or illness.

? Eliminates uncertainty on the cost of office visits and other frequently accessed services.

? Copays on prescription drugs.

? Deductible and coinsurance reserved for less commonly used services.

? Available only on the Preferred-Care Blue network.

Blue & U First First plans are attractive for employees who want 100% coverage for in-network services after they have paid their deductible.

? Appeals to employees who expect to use preventive care plus a few office visits, but also provides peace of mind that coverage will be there in the event of unexpected accidents or illnesses.

? Your employees' first four office visits include a $0 copay, and are not subject to the deductible.

? Low cost generic prescription drugs.

? Available only on the Preferred-Care Blue network.

Blue & U Saver This product is a great way to secure an affordable plan for your budget-minded employees. ? Deductible set at a level that balances affordable

premium and comparable coverage. ? Eligible for use with a tax advantaged Health Savings

Account (HSA). ? Except for preventive care, the deductible must be met

before Blue KC pays benefits. ? Available only on the Preferred-Care Blue network.

Blue & U HRA This product provides employers choice and control over healthcare expenditures. ? A Health Reimbursement Arrangement (HRA) must be

established for each covered employee and funded by the employer. ? Funds available in the tax-favored HRA are applied toward any deductible or coinsurance an individual may owe for covered medical services. ? Office visit and prescription drug copays are not reimbursable from the HRA.

? Available only on the Preferred-Care Blue network.

* Benefits under Basic products are limited for Missouri residents to services provided by BlueSelect providers. Services provided by Non-Preferred (i.e., out-of-network) providers are not covered except for Emergency Services and certain Mental Health office visits. If you choose to offer Basic products to your employees, you must also offer a non-Basic product.

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UNDERSTANDING METAL LEVELS

The ACA requires new plans offered on and off the Small Business Health Option Programs (SHOP) Exchange to provide coverage at designated coverage, or "metal," levels.

The defined metal levels are platinum, gold, silver and bronze. You can select a plan level that best suits your preferences. Generally, premiums are higher for platinum plans, and employees pay less in deductibles, coinsurance and copays. With bronze plans, premiums are generally lower, and employees pay more in deductibles, coinsurance and copays. Blue KC offers gold, silver, and bronze level plans in its 2015 product offerings.

Gold ? plans pay 80% of covered costs on average Silver ? plans pay 70% of covered costs on average Bronze ? plans pay 60% of covered costs on average

HOW TO BUY BLUE KC PLANS

Small businesses can purchase health insurance directly from a broker or on the SHOP Exchange. However, if you think you may be eligible for the Small Business Health CareTax Credit, you must pay premiums on behalf of employees enrolled in a qualified health plan offered through the SHOP Exchange or you must qualify for an exception to this requirement.

Regardless of where you choose to purchase your health insurance, we encourage you to contact your broker or Blue KC representative to help guide you through the process.

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YOU HAVE CHOICES

When choosing a health plan, the first thing you want is plenty of choices. While that seems obvious, not every insurance company offers the range of plans and options that are available through Blue KC.

It's what nearly one million members have come to expect from the area's only local, not-for-profit health insurance company.

Directly from Blue KC

Preferred-Care Blue

Blue & U Basic Silver Bronze Blue & U Classic (Copay Plan) Gold Silver Blue & U First (First Visit Plan) Gold Silver Bronze Blue & U Saver (HSA-Compatible Plan) Gold Silver Bronze Blue & U HRA Gold Silver

BlueSelect1

Small Business Health Options (SHOP) Marketplace Exchange*

Preferred-Care Blue

Minimum Essential Coverage 2

* Blue Cross and Blue Shield of Kansas City is a Qualified Health Plan issuer on the SHOP Exchange.

1 BlueSelect network uses a smaller hospital network than Preferred-Care Blue, and is only available to residents of the 5-county Kansas City metropolitan area, which includes Clay, Jackson and Platte counties in Missouri, and Johnson and Wyandotte counties in Kansas.

2 The checkmark denotes that a product qualifies as Minimum Essential Coverage under the ACA, meaning your covered employees and their family members will not be subject to the individual mandate penalty for any months they are enrolled in the product.

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BLUE & U BASIC*

Basic products are affordable plans designed specifically for employees and their families in the Kansas City metropolitan area. Basic plans utilize the BlueSelect provider network, which is exclusively inside the metro area; there are no in-network providers in the other 27 counties in Missouri that are in the Blue KC service area.

Network:

What You Pay: Deductible Individual Family Out-of-Pocket Maximum Individual Family Coinsurance

In-Network

$3,500 $7,000

$5,000 $10,000 40%

Silver BlueSelect

Out-of-Network

In-Network

KS Employer MO Employer

$3,500

NO BENEFIT

$6,000

$7,000

NO BENEFIT

$12,000

$25,000 $50,000 60%

NO BENEFIT NO BENEFIT NO BENEFIT

$6,600 $13,200 40%

Bronze BlueSelect

Out-of-Network

KS Employer MO Employer

$6,000

NO BENEFIT

$12,000

NO BENEFIT

$25,000 $50,000 60%

NO BENEFIT NO BENEFIT NO BENEFIT

PCP Visits

$10 copay for first 2 visits, Deductible then 40% for 3+ visits

Deductible then 60%

NO BENEFIT

$25 copay for first 2 visits, Deductible then 40% for 3+ visits

Deductible then 60%

NO BENEFIT

Urgent Care Specialist Visits Inpatient Hospital Emergency Room High Tech Imaging Routine Preventive Care

Deductible then 40%

Deductible then 40%

Deductible then 40%

Deductible then 40%

Deductible then 40%

$0

Deductible then 60%

Deductible then 60%

Deductible then 60%

Deductible then 40%

Deductible then 60%

Deductible then 30%

NO BENEFIT

NO BENEFIT

NO BENEFIT Deductible then 40% NO BENEFIT

NO BENEFIT

Deductible then 40%

Deductible then 40%

Deductible then 40%

Deductible then 40%

Deductible then 40%

$0

Deductible then 60%

Deductible then 60%

Deductible then 60%

Deductible then 40%

Deductible then 60%

Deductible then 30%

NO BENEFIT

NO BENEFIT

NO BENEFIT Deductible then 40% NO BENEFIT

NO BENEFIT

Maternity + Newborn Care

Deductible then 40%

Prescription Drugs at a Retail Pharmacy 1

Deductible then 60%

NO BENEFIT

Deductible then 40%

Deductible then 60%

NO BENEFIT

Generic: $4/10

Rx Deductible $1,000 then:

Preferred: $40/80 Non-Pref: $60/120 Specialty: 40%

Rx Deductible $1,000 then 50%

NO BENEFIT

Generic: $20/30

Rx Deductible $600 then:

Preferred: $60/100 Non-Pref: $90/150 Specialty: 40%

Rx Deductible $600 then 50%

NO BENEFIT

* Employees who live in the metropolitan Kansas City area can benefit from the savings of BlueSelect when they visit a BlueSelect hospital or provider. Those outside the metropolitan Kansas City area are eligible to enroll, but must visit a BlueSelect hospital or provider for benefits to be paid at the in-network level. Outside the 32-county Blue KC service area, BlueSelect members are covered under BlueCard PPO coverage; there are no in-network providers in 27 counties in Missouri. If you choose to offer Basic products to your employees, you must also offer a non-Basic product.

1 The BlueSelect network includes a tiered pharmacy network. The first set of copays for Blue & U Basic in-network applies to Walmart and Sam's Club pharmacies and the second set of higher copays applies to all other in-network pharmacies. The copayment for mail order long-term prescriptions is 2.5 times the listed copayment.

NEED RATES? Visit us online at or call 816-395-2939.

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BLUE & U CLASSIC

Also known as "Copay" plans, these products offer cost certainty to individuals who want copayments on common services. Generally, other services not listed are subject to deductible and coinsurance.

Network:

Gold Preferred-Care Blue

What You Pay:

In-Network

Deductible

Individual

$1,500

Family

$3,000

Out-of-Pocket Maximum

Individual

$3,500

Family

$7,000

Coinsurance

10%

Out-of-Network

$2,500 $5,000

$7,000 $14,000 30%

Gold Preferred-Care Blue

In-Network

Out-of-Network

$2,000 $4,000

$2,000 $4,000

$3,400 $6,800 0%

$6,800 $13,600 30%

Silver Preferred-Care Blue

In-Network

Out-of-Network

$5,000 $10,000

$5,000 $10,000

$6,250 $12,500 10%

$12,500 $25,000 30%

PCP Visits 1

$15 PCMH copay, $25 copay for all others

Deductible then 30%

$15 PCMH copay, $25 copay for all others

Deductible then 30%

$20 PCMH copay, $40 copay for all others

Deductible then 30%

Urgent Care

$35 copay

Specialist Visits Inpatient Hospital Emergency Room

$50 copay

$400 copay/day, max 5

$300 copay

High Tech Imaging

$200 copay

Routine Preventive Care

$0 copay

Maternity + Newborn Applicable cost-

Care

sharing applies

Prescription Drugs at a Retail Pharmacy 2

Generic: $10 Preferred: $50 Non-Pref: $80 Specialty: $100

Deductible then 30% Deductible then 30% Deductible then 30%

$300 copay

Deductible then 30% Deductible then 30%

Deductible then 30%

Deductible then 50%

$35 copay

$50 copay $400 copay/day, max 5 $300 copay

$200 copay

$0 copay

Applicable costsharing applies

Deductible then 30%

Deductible then 30%

Deductible then 30%

$300 copay

Deductible then 30%

Deductible then 30%

Deductible then 30%

Generic: $10 Preferred: $50 Non-Pref: $80 Specialty: $100

Deductible then 50%

$60 copay

$80 copay $500 copay/day, max 5 $400 copay

$200 copay

$0 copay

Applicable costsharing applies

Deductible then 30%

Deductible then 30%

Deductible then 30%

$400 copay

Deductible then 30%

Deductible then 30%

Deductible then 30%

Generic: $10 Preferred: $50 Non-Pref: $80 Specialty: $100

Deductible then 50%

1 Preferred-Care Blue uses the lower copayment for Patient-Centered Medical Home (PCMH) visits and the higher copay for all others. 2 The copayment for mail order long-term prescriptions is 2.5 times the retail copayments.

NEED RATES? Visit us online at or call 816-395-2939.

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