Large group coverage that puts your business and employees first

The freedom of choice. With Preferred-Care Blue PPO, employees can access a broad network of healthcare providers and choose their deductible and level of benefits.

• Employees can see in-network or out-of-network providers
• Choose the deductible and level of benefits that match your budget and healthcare needs
• Employees have the freedom to choose their own doctors and hospitals from our extensive local and nationwide network of healthcare providers

A healthcare quarterback. This plan allows employees to choose a Primary Care Physician (PCP) who will coordinate their medical care and be a champion for their health.

• Employees select a Primary Care Physician (PCP) who monitors their health and helps coordinate medical care
• No referrals are required for employees to see an in-network specialist and there is no deductible

Lower premiums wanted. This high-deductible health plan has lower premiums and can be paired with a Health Savings Account (HSA) which provides tax-savings benefits.

• Employer contributions: employers may choose to contribute to employees’ HSAs
• Pre-tax savings: employees can have part of their pre-tax earnings deposited into an HSA and can use their HSA money to pay for qualified medical expenses
• Funding options: employees can use savings, employer contributions or individual contributions to fund their HSA
• Health plan coverage: once an employee meets the deductible for covered healthcare expenses, BlueSaver begins paying some or all additional healthcare expenses employees incur during that plan year, depending on the plan design
• HSA resources: learn more about the tax benefits of a Health Savings Account
• Preventive Care: In-network, routine preventive care services are covered at 100% (deductible does not need to be met first)

Quality care at a lower cost with a simplified experience. Plan options with Spira Care are built on an Exclusive Provider Organization (EPO) or Preferred Provider Organization (PPO) insurance model. Eligible members will have the option to go to Spira Care for their primary care needs but also have access to providers and hospitals in their plan’s network (where costs are subject to their deductible or applicable copay).

• Eligible members enrolled in a plan without a Health Savings Account (HSA) with exclusive access to Spira Care will have no additional cost for any appointment or service provided at a Spira Care Center. Eligible members enrolled in a plan with a HSA with exclusive access to Spira Care will incur a $60 charge for non-preventive medical appointments at Spira Care. Once they meet their deductible, any future primary care needs at Spira Care are at no additional cost. Preventive services are covered at no additional cost¹.
• The Spira Care Team is a doctor-led, multidisciplinary group of healthcare professionals providing patient-centered primary care. 
• For other medical needs like specialty care or hospitalization, plans with Spira Care work much like a traditional health plan with an annual deductible or applicable copay. 
• Outside of Spira Care Centers, members have access to their plan’s network for things like a visit to a specialist or an emergency room where costs are subject to their plan’s deductible or applicable copay.

• You pay a set monthly premium.
• Blue KC accepts the risk for all costs of the health plan.

• Allows you to receive a refund at the end of the contract year for a portion of the paid premium if your claims experience is lower than projected.
• If claims experience is higher than projected, Blue KC absorbs the loss.

• A reserve fund of 10% of the annual premium is established from any surpluses in the health plan.
• The reserve account is held by Blue KC to offset against future costs.
• Any surplus over the 10% reserve is paid to you.
• Should you cancel your health plan, you would receive any amount held in the reserve account.

• Allows you to pay a reduced portion of the insured premium.
• At the end of the contract year, if the reduced premium covers net claims plus expenses, you are not liable for any additional premium.
• If reduced premium does not cover net claims plus expenses, you are required to pay for any shortfall up to the amount of the full premium.
• If the costs exceed the amount of the full premium, Blue KC absorbs the loss.

• Provides you with the opportunity for your payment obligations to be based on claims-related costs.
• There are two payment components: a fixed cost component payable at the beginning of the month which includes service fees and premiums for specific and aggregate pooling coverage, and a claims and network access fees component payable after the end of the month.
• The aggregate pooling coverage protects against unexpectedly high aggregate claims costs, and the specific pooling coverage protects against shock claims on individual members.

• Blue KC handles the administration of your health plan, helping to eliminate paperwork.
• Employees can check their claims, update personal information, and obtain provider information via a secure website. They can also enroll online via BluesEnroll.
• A dedicated ASO representative will meet with you regularly, and you’ll receive regular electronic reports on utilization, claims accounting, network savings, and more.