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844-655-0355Choice Bronze 7000 with Spira Care
Choice Bronze 7000 with Spira Care
Plan Overview
$0 copay at Spira Care
Spira Care centers combine integrated primary care and coverage in one personal, affordable place, along with the benefits of the BlueSelect EPO or BlueSelect Plus EPO network.
Key benefit
- $0 copay for services received at Spira Care centers*
- $0 copay for Spira Care Virtual Care, $0 copay for Blue KC Virtual Care App and $10 copay for in-network eligible provider offering telehealth
- Predictable coverage with clear copays on common services in the plan network
*Select prescriptions are offered at Spira Care Centers at your regular copy level.
Benefits
| Benefit Item | Value | |
|---|---|---|
| Single Deductible | $7,000 | |
| Family Deductible | $14,000 | |
| Coinsurance | 50% | |
| Single Out-of-Pocket Max | $8,700 | |
| Family Out-of-Pocket Max | $17,400 | |
| Access to Spira Care | Yes | |
| Spira Visits | $0 | |
| Virtual Care5 | $0 | |
| PCP Network Visits1 | $0/$75 | |
| Urgent Care | $100 | |
| Specialist Visits | $125 | |
| Hospital | Ded/Coins | |
| Emergency Room | Ded/Coins | |
| Prescription Drugs3 RxSelect Network | ||
| Generic Drug | $25 | |
| Preferred Drug | $100 | |
| Non-Preferred Drug | $250 | |
| Generic Specialty Drug and Preferred Specialty Drug | $400 | |
| 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.
