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844-655-0355Community Gold 1500
Community Gold 1500
Plan Overview
Provides predictable coverage with clear copays on the most common services, paired with a low deductible.
Key benefit
- Lowest deductible for peace of mind
- Predictable coverage with clear copays on common services
- Large provider network with $0 copay for Blue KC Virtual Care App
Benefits
| Benefit Item | Value | |
|---|---|---|
| Single Deductible | $1,500 | |
| Family Deductible | $3,000 | |
| Coinsurance | 20% | |
| Single Out-of-Pocket Max | $5,000 | |
| Family Out-of-Pocket Max | $10,000 | |
| Access to Spira Care | No | |
| Spira Visits | N/A | |
| Virtual Care5 | $0 | |
| PCP Network Visits1 | $30 | |
| Urgent Care | $60 | |
| Specialist Visits | $60 | |
| Hospital | Ded/Coins | |
| Emergency Room | Ded/Coins | |
| Prescription Drugs3 RxSelect Network | ||
| Generic Drug | $10 | |
| Preferred Drug | $55 | |
| Non-Preferred Drug | $250 | |
| Generic Specialty Drug and Preferred Specialty Drug | $250 | |
| Non-Preferred Specialty Drug | Ded & 50% | |
1 Primary Care Physicians include General Practice, Family Practice, Internal Medicine and Pediatrics.
3 Specialty medications should be filled at an Optum Specialty Pharmacy to receive the lowest member cost-sharing. You may pay more if filling a specialty prescription at a retail location.
5 Copay is $0 via Blue KC Virtual Care app; $10 copay with an in-network eligible provider.
