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844-655-0355Choice Silver 6000 with Spira Care
Choice Silver 6000 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.
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 | $6,000 | |
| Family Deductible | $12,000 | |
| 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 | $75 | |
| Specialist Visits | $100 | |
| Hospital | Ded/Coins | |
| Emergency Room | Ded/Coins | |
| Prescription Drugs3 RxSelect Network | ||
| Generic Drug | $20 | |
| Preferred Drug | $75 | |
| Non-Preferred Drug | $250 | |
| Generic Specialty Drug and Preferred Specialty Drug | $350 | |
| 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.
