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2018 Select by Medica

Select by Medica

Plan Highlights

Select by Medica plans include:

  • Access to a localized network of doctors, clinics and hospitals    
  • 100% coverage of routine preventive exams
  • Gold, silver and bronze metal level plan options
  • Copay, copay plus, health savings account compatible or catastrophic plan options
  • Access to Mayo Clinic through the Centers of Excellence Program

2018 Plan Options at a Glance


Plans that are right for you

Copay Plus and Copay - For individual and families

Network Benefits Gold Copay Plus Gold Copay
Deductible Individual: $1,000
Family: $3,000 shared family
Individual: $750
Family: $2,250 shared family
Out-of-pocket maximum Individual: $5,000
Family: $5,000 per family member or $10,000 for the entire family*
Individual: $6,000
Family: $6,000 per family member or $12,000 for the entire family*
Office visits Primary care: $30 copay
Urgent care: $30 copay
Specialty care: $30 copay
Primary care: $30 copay
Urgent care: $30 copay
Specialty care: $60 copay
Prescription drugs (Medica Drug List) Preferred generic: $5 copay
Generic: $5 copay
Preferred brand: $35 copay
Non-preferred brand:$150 copay
Preferred generic: $5 copay
Generic: $10 copay
Preferred brand: 30% coinsurance after deductible
Non-preferred brand: 50% coinsurance after deductible
Other eligible health care services 30% coinsurance after deductible 30% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Kansas SBC (PDF) View Kansas SBC (PDF)

*Cost Sharing Details:
Family plans have an embedded individual out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tipsheet

Network Benefits Silver Copay
Deductible Individual: $3,500
Family: $10,500 shared family
Out-of-pocket maximum Individual: $7,000
Family: $7,000 per family member or $14,000 for the entire family*
Office Visit Copay Primary care: $30 copay
Urgent care: $30 copay
Specialty care: $60 copay
Prescription drugs (Medica Drug List) Preferred generic: $5 copay
Generic: $10 copay
Preferred brand: 40% coinsurance after deductible
Non-preferred brand: 60% coinsurance after deductible
Other eligible health care services 40% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Kansas SBC (PDF)

*Cost Sharing Details:
Family plans have an embedded individual out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tipsheet

Network Benefits Bronze Copay
Deductible Individual: $6,850
Family: $13,700 shared family 
Out-of-pocket maximum Individual: $7,350
Family: $7,350 per family member or $14,700 for the entire family*
Office visits Primary care: $80 copay
Urgent care: $80 copay
Specialty care: $150 copay
Prescription drugs (Medica Drug List) Preferred generic: $10 copay
Generic: $20 copay
Preferred brand: 50% coinsurance after deductible
Non-preferred brand: 70% coinsurance after deductible
Other eligible health care services 50% coinsurance after deductible
Summary of Benefits and Coverage (SBC)

View Kansas SBC (PDF)

*Cost Sharing Details:
Family plans have an embedded individual out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tipsheet

Health Savings Account (HSA) Compatible - For individuals and families

Network Benefits Bronze HSA Plus   Bronze HSA
Deductible Individual: $2,600
Family: $5,200 shared family
Individual: $6,000
Family: $12,000 shared family
Out-of-pocket maximum Individual: $6,650
Family: $6,650 per family member or $13,300 for the entire family*
Individual: $6,650
Family: $6,650 per family member or $13,300 for the entire family*
Office visits Primary, urgent, and specialty care: 40% coinsurance after deductible Primary, urgent, and specialty care: 20% coinsurance after deductible
Prescription drugs (Medica Drug List) Preferred generic, generic, preferred brand, non-preferred brand: 40% coinsurance after deductible Preferred generic, generic, preferred brand, non-preferred brand: 20% coinsurance after deductible
Other eligible health care services 40% coinsurance after deductible 20% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Kansas SBC (PDF) View Kansas SBC (PDF)

*Cost Sharing Details:
Family plans have an embedded individual out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tipsheet

Cost Sharing Reduction (CSR) - For individuals & families who meet certain income requirements

Network Benefits Silver Copay 94% CSR Silver Copay 87% CSR Silver Copay 73% CSR
Deductible Individual: $100
Family: $300 shared family
Individual: $500
Family: $1,500 shared family
Individual: $2,500
Family: $7,500 shared family
Out-of-pocket maximum Individual: $1,000
Family: $1,000 per family member or $2,000 for the entire family*
Individual: $2,000
Family: $2,000 per family member or $4,000 for the entire family*
Individual: $5,850
Family: $5,850 per family member or $11,700 for the entire family*
Office visits Primary care: $30 copay 
Urgent care: $30 copay
Specialty care: $60 copay
Primary care: $30 copay 
Urgent care: $30 copay
Specialty care: $60 copay
Primary care: $30 copay
Urgent care: $30 copay
Specialty care: $60 copay
Prescription drugs (Medica Drug List) Preferred generic: $5 copay
Generic: $10 copay
Preferred brand: 5% coinsurance after deductible
Non-preferred brand: 25% coinsurance after deductible
Preferred generic: $5 copay
Generic: $10 copay
Preferred brand: 20% coinsurance after deductible
Non-preferred brand: 40% coinsurance after deductible
Preferred generic: $5 copay
Generic: $10 copay
Preferred brand: 30% coinsurance after deductible
Non-preferred brand: 50% coinsurance after deductible
Other eligible health care services 5% coinsurance after deductible 20% coinsurance after deductible 30% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Kansas SBC (PDF) View Kansas SBC (PDF)
View Kansas SBC (PDF)

*Cost Sharing Details:
Family plans have an embedded individual out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tipsheet

Catastrophic - For individuals and families under age 30 or those with an eligible exemption

Network Benefits Catastrophic
Deductible Individual: $7,350
Family: $7,350 per family member or $14,700 for the entire family
Out-of-pocket maximum Individual: $7,350
Family: $7,350 per family member or $14,700 for the entire family*
Office visits Primary care: $30 copay for the first 3 visits per person per calendar year. After 3rd, 0% coinsurance after deductible
Urgent care: 0% coinsurance
Specialty care: 0% coinsurance
Prescription drugs (Medica Drug List) Preferred generic, generic, preferred brand, non-preferred brand : 0% coinsurance after deductible
Other eligible health care services 0% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Kansas SBC (PDF)

*Cost Sharing Details:
Family plans have an embedded individual deductible and out-of-pocket maximum.


2018 Network Information


Who and Where Your Care Comes From

 

Find a Physician or Facility

The Select network is a large care system-based network that provides access to Saint Luke’s Health System doctors plus others in the Kansas City region. The network includes:
800+ Primary and specialty care doctors
12+ Online and convenience care clinics
10+ Hospitals

Pioneering health care innovation, Saint Luke's offers:
-Adult heart transplant program with one of the nation's top 35 cardiology and heart surgery programs
-Recognized liver and kidney transplant programs
-One of the nation's leading stroke reversal program dedicated to preventing and treating stroke
-A nationally recognized children's behavioral health center

It’s important to note that unless it’s an emergency, there is no coverage if you visit a provider who is not in the Select network. This means you will be responsible for the full cost of any care.

Search for a physician, clinic, hospital or pharmacy

 

 

Centers of Excellence Program featuring Mayo Clinic

This program allows members to receive care for certain transplants, rare cancers and other complex medical conditions at Mayo Clinic. An allowance for transportation, lodging and living expenses for the patient and one travel companion is included.

 

Get care anytime, anywhere with Saint Luke's 24/7 App

Visit with a physician or nurse practitioner by phone or secure video. It's health care where you need it most.

Sales Area

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Plan Documents

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