What to consider when shopping for health insurance
Picking the right health insurance plan is a personal choice. Knowing what to look for and what questions to ask can help you feel more confident and make an informed decision.
What does the plan offer?
- Include the doctors you see and the hospitals or clinics you visit in the plan’s network?
- Give you a choice of doctors?
- Cover hospital care?
- Include immunizations?
- Cover maternity care?
- Include medical tests and X-rays?
- Include mental health care?
- Cover visits to doctors and specialists?
- Include prescription drug coverage and how comprehensive is its prescription coverage?
- Include travel coverage if you get sick or hurt while you’re traveling?
- Include dental or vision coverage for members over 19 years old?
- Cover well-child care?
- Include wellness programs and care at no extra cost?
Does your doctor participate in-network?
Knowing if your doctor participates “in-network” for the plan you’re looking at is important. This can minimize the need to find a new primary care provider (PCP).
If you choose a plan where your PCP is outside of your network it will generally cost you more so be sure to use an in-network doctor to get the most out of your plan benefits.
The Prescription Drug List
The Prescription Drug List – also known as a formulary – is a list of prescription medications covered under your Blue KC health insurance plan. It categorizes drugs based on factors like effectiveness, safety, and cost, including both brand-name and generic medications approved by the Food and Drug Administration (FDA). Each medication is assigned a tier level that affects your out-of-pocket costs. This list is carefully reviewed and recommended by Blue KC’s Medical and Pharmacy Management Committee to ensure you have access to safe, effective treatments.
How to use the
Prescription Drug List
Using the Prescription Drug List is as easy as 1, 2, 3.
One
Find the page number for your drug by searching the alphabetical index at the end.
Two
Locate your drug and identify the Drug Tier. You will also want to note restrictions and preferred alternatives if applicable.
Three
Refer to the Drug Tier description tables at the end of the introduction to identify the tier copay for your drug (based on the benefit schedule described in your member certificate or in your Blue KC benefit summary).
