St. Joseph School District

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Your 2012 Benefit Plans Offer:

Comprehensive medical coverage Choice of Traditional PPO and HMO Plans Routine/Preventive Care covered at 100% Full coverage prescription benefits One of the nation’s largest PPO networks (wide selection of

providers)

Hospital Locator www.bluekc.comHospital Name HMO

Blue Care NetworkPPO - Preferred Care

Blue Network

Heartland Regional Medical Center (St. Joseph)

X X

St. Francis Hospital (Maryville) NO X

Center Point Medical Center X X

Children’s Mercy Hospitals X X

KU Medical Center X X

Lee’s Summit Hospital X X

Liberty Hospital X NO

Menorah Medical Center X X

North Kansas City Hospital X X

St. Luke’s (All Locations) NO X

Olathe Medical Center X X

Overland Park Regional X X

Providence Medical Center X X

Research Medical Center X X

Shawnee Mission Medical Center X X

St. Joseph Medical Center X NO

St. Mary’s Medical Center X NO

Truman Medical Center (Hospital Hill and Lee’s Summit)

X NO

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Welcomed in over 200 countries Worldwide

Worldwide Network of PPO Healthcare Providers

BlueCard PPO Network

National Network Access through BlueCard®

1,177,194 Physicians 6,776 Hospitals Access in ALL 50 States

Finding a Provider is Easy…

• Kansas City Metro Area www.BlueKC.comFind Blue KC Doctors, Hospitals,

PharmaciesSELECT A PROVIDER DIRECTORY

Local BlueKC Provider Directory

MY INSURANCE PLAN Select Your Plan

Blue-Care HMOPreferred-Care Blue PPO

SELECT A PROVIDER TYPEo Doctorso Hospitalso Pharmacies, Facilities, Labso Dentalo Urgent Care and Retail Health

Centerso Mental Healtho Other ProvidersClick CONTINUE

• All Other Areas www.BlueKC.comFind Blue KC Doctors, Hospitals,

PharmaciesSELECT A PROVIDER DIRECTORY

BlueCard Provider Directory

CONTINUESelect Guest TabChoose Product

PPO/EPOFIND PROVIDERSo Physicianso Hospitalso Behavioral Healtho All Types

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Traditional PlansBlue-Care HMO

Preferred-Care Blue PPO

www.bluekc.com Blue-Care HMOSelect a PCP (FP, GP, IM, Ped) YES

Office Visits $25 PCP* copay$50 Specialist** copay

Routine Preventive Care Covered at 100%Routine Vision Care $10 copay

One exam per yearInpatient Hospital Services /Outpatient Surgery

$400 copay per day up to $1,200 per member per calendar year

(applies to inpatient services at a hospital and outpatient surgeries at a hospital or an outpatient facility)

MRI, MRA, CT and PET Scans – Physician’s Office, Imaging Center, Outpatient Setting

$100 copayOnly one copay will apply for each provider on a specified date of

service even if multiple scans are performed

Urgent Care(Minute Clinics, Take-Care Centers)

$50 copay(office visit/lab only)

Emergency Care $100 copay if treated and released(copay waived if admitted to hospital)

*PCP: GP, FP, IM, PED

**Specialist: Allergist, ENT, Dermatologist, OB/GYN

www.bluekc.com Preferred-Care Blue PPOSelect a PCP NOAnnual Deductible $1,000 individual / $2,000 familyNetwork CoinsuranceNon-Network Coinsurance

Member pays: 20%/BCBSKC pays: 80%Member pays: 50%/BCBSKC pays: 50%

Out-of –Pocket Maximum $2,500 individual / $5,000 family$7,500 individual / $15,000 family

(Includes Deductible + Coinsurance)Office Visits $25 copay*Routine Preventive Care Covered at 100%MRI, MRA, CT and PET Scans Deductible then coinsurance

Urgent Care(Minute Clinics, Take-Care Centers)

$25 copay*(office visit/lab only)

Emergency Care $100 copay* then deductible then 80%

*Copays do not apply to deductible or OOP maximum

*Lab services performed in a Hospital or Outpatient setting and all Radiology Services subject to Deductible and Coinsurance

Paid at 100%

PSA Tests Pelvic Exams and Pap Smears

MammogramsChildhood Immunizations

Lead Testing Colorectal Cancer Exams

Newborn Hearing Screening

Paid at 100%Physician Examinations

CBC Metabolic ScreeningUrinalysis

Glucose Screening Thyroid Stimulating Hormone

ScreeningLipid Cholesterol Panel

HIV ScreeningHPV Screening

Chest X-rayEKG

Preventive Care

All Plans

Costco’s, CVS, Hy-Vee, K-Mart, Price Chopper, Sam’s Club, Sun Fresh, Target, Walgreen’s,

Wal-MartRetail (up to a 34 day supply)

Tier 1 $8 copay

Tier 2 $25 copay

Tier 3 $45 copay

Express Scripts - Mail Order Prescription Program

Long Term Maintenance DrugsMail-Order (up to a 102 day supply)

Tier 1 $16 copay

Tier 2 $50 copay

Tier 3 $90 copay

Prescription DrugsRetail and Mail-Order

To get started on EXPRESS SCRIPTS

get a NEW Prescription from

your Doctor!

Prescription Drug copays DO NOT go towards Deductible

or Out-of-Pocket Maximum

Categories In the Step Therapy Program

For some medication classes, multiple generic medication alternatives now exist.Members will be required to try a generic medication before initiating therapy with a brand name medication. This will apply to the following medication classes:

• NSAIDs: (Anti-Inflammatory medications for Arthritis and pain)• Calcium Channel Blockers: (CCB for hypertension)• ACE Inhibitors/ARBs: (Medications for hypertension) • Statins: (Medications for cholesterol) • SSRIs/NDRIs: (Medications for Depression) • Nasal Steroids: (Medications for Allergies)• Sedative Hypnotics: (Medications for Sleep)• Proton Pump Inhibitors (PPIs): (Medications for gastroesophageal reflux disease

[GERD] or stomach acid)• Antibotics: (Medications for Acne)

The Points to Blue Incentive Program:• Designed to engage employees for participation in health and

wellness activities as well as reward behavior change.• Members can earn points for taking HRA, screenings, classes,

calling health coach, using the ePHIT tools, etc. Earn up to 250,000 points per year or cash equivalent of $250. Minimum redemption of $25. Redeem points for gift cards for charities or from more than 350

merchants including retailers, sports and fitness goods, restaurants, travel, arts and entertainment providers, or debit card.

Online Health ResourcesRewards

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24-Hour Nurse Line

Available 24 hours a day, 7 days a week, 365 days a year

Care Advisors help you with symptoms or answer a health-related question

Registered nurses available 24-hour access to an Audio Health

Library containing more than 1,500 topics in English and Spanish. Health topics include adult, pediatric, and women’s health.

Register via www.bluekc.co

m

Choose the Right Health Care Setting

Generics vs. Brand Name

Drugs.

Visit the website

bluekc.com to find an In-Network Provider

Call Nurseline

Communicate with your

Doctor

Participate in a Flexible

Spending Account

Participate in a Wellness Program

Consumer-Driven Tools

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Thank you!

Questions?