MEMBER GUIDE   Fully Insured

By choosing Kansas City's health insurance leader, you've started on the path
toward a healthier life.
Besides giving you healthcare choices that fit the way you live, Blue Cross and Blue Shield of Kansas City (Blue KC) helps you navigate your
healthcare process, and shows you how to get the greatest benefits from your plan.

Let's get acquainted.
The materials in this enrollment booklet were compiled for you, and represent your health plan. Please review the following pages
thoroughly, and file this in a safe place for reference later.

The information contained in this Member Guide is intended for summary purposes only. For full details regarding the terms and conditions of your specific health plan and benefits,
please consult the Plan document for your plan which is available from Blue KC or your employer.



The Blue Cross and Blue Shield of Kansas City
(Blue KC) member ID Card is your key to unlocking
all the coverage and benefits your plan has to offer.
You can present your card anytime you visit
your doctor, receive healthcare services or fill                        2                                                                   6

a prescription. It contains information healthcare                      3
professionals need to make sure your care
is covered.

Understand Your Member ID Card
1.   Member ID Number – This is the number we use to identify               You can quickly view, print or email a copy of your member ID card
     you and your policy. It’s also what providers use to file claims                  from your member portal at
     on your behalf.
2.   Group Number – This number is used to classify our
     members into groups, usually by the employer they receive
     their plan from.
3.   Plan Type – This describes what type of insurance plan you
     have (for example, a PPO plan).
4.   Customer Service Phone Number – Call this number when
     you have a question about your Blue KC policy. Our Customer
     Service staff is available Monday through Friday from 8 a.m.
     to 8 p.m. Central Time.
5.   Network Name – This is the network of hospitals, physicians
     and pharmacies that accept your Blue KC policy. It’s important
     that you see healthcare providers who are in your network to
     ensure you maximize the benefits of your policy.
6.   Copayment – The amount you pay each time you receive a
     covered healthcare service.
7.   Suitcase – Some Blue KC members have access to our
     “BlueCard” program, which extends the benefits of your Blue
     KC plan to all 50 states.

Find a Doctor
The Blue KC Doctor and Hospital Finder makes finding an in-network doctor, hospital or other healthcare provider quick and easy. In addition
to viewing basic information, such as medical school attended, residency completed and board certification status, you can also read patient
reviews, rate your doctor and view costs and treatment timelines for common procedures.

To view the most accurate information related to your network, be sure to first log in to By doing so, the results from the
Doctor and Hospital Finder will be tailored to your specific Blue KC network.

Important Resources

You deserve to enjoy all the benefits of being a Blue KC member, and our member portal can help you find
just what you need. Simply register online at to take advantage of the tools and information
available to you.






1.   Plan Benefits – View your medical contract, summary of             4.   Find Care – This is where you can access the Blue KC Doctor
     benefits and coverage, and more. If your Blue KC policy                 and Hospital Finder. See which healthcare providers are
     includes pharmacy benefits, you'll have tools to help you               covered by your network, and search for ones who can meet
     locate a pharmacy, learn about the differences between                  your specific needs. From this section you can also search for
     generic and brand name medications, save on prescriptions               a pharmacy or dentist.
     and access the Blue KC Prescription Drug List.                     5.   Ask Us – Get answers to questions about your Blue KC policy
2.   Claims & Usage – Check the status of your claims and export             or health insurance in general.
     a list of past claims. You can view a copy of your Explanation
     of Benefits, which you receive after every visit to a healthcare
     provider. This section also includes graphs to illustrate your
     plan usage.
3.   Health & Wellness – We’re proud to offer a variety of
     resources to help you stay healthy and live well. Learn more
     about our A Healthier YouTM wellness program and Healthy
     CompanionTM condition management program.


When you visit a doctor or hospital, they work with Blue KC to file a claim on your behalf. These claims are
outlined on your EOB. It’s your go-to reference for important information like how much of your care was
covered and how much you may still need to pay.






                                                                    6          8            11   12
                                                                           7       9   10


Important Resources

1.    Member Information Section – Information about you and            8.   Allowable Charges – This is the total of the claim after all
      your recent claim.                                                     discounts and other reductions. Deductible and coinsurance
                                                                             amounts are calculated from this figure.
2.    This Is Not A Bill – Your EOB is just a documentation of how
      Blue KC has processed your claim. If you do receive a bill from   9.   Copay – The amount a member must pay each time a
      your provider, you can use your EOB to ensure the amount               specific covered service is received, if your policy includes
      billed is correct based on your Blue KC coverage.                      copayments.
3.    Narrative – A brief overview of how your claim was                10. Deductible – The portion of the claim being applied to your
      processed.                                                            plan deductible. This amount must be paid by you before
                                                                            benefits become payable by Blue KC.
4.    Claim-at-a-Glance – A simple equation to show how your
      claim is paid. Please review the Detailed Explanation section     11. Coinsurance – The percentage of an allowable charge you
      for further details.                                                  must pay for a covered service. Generally, the deductible
                                                                            must be met before your coinsurance applies.
5.    Detailed Explanation of this Claim – This area combines
      critical payment information into one convenient summary.         12. Plan Payment – This is the amount that Blue KC will pay to
      Please review this carefully as it clearly outlines the Blue KC       the provider or member for the claim.
      negotiated savings as well as any fees and services for which     13. Deductible Information – This area documents what your
      you are responsible.                                                  deductible status was at the time the claim was processed.
6.    Blue KC Member Savings – Blue KC has negotiated these                 Many times, this information will be outdated by the time you
      savings with providers on your behalf. This is one of the most        receive an EOB. You can get your most recent and up-to-date
      valuable aspects of having coverage with Blue KC.                     deductible information in your member portal at
                                                                   under the Benefits section.
7.    Other – Amounts deducted from the Billed Charges for a
      variety of reasons. Amounts in this column may reduce your
      out-of-pocket expenses.

                     Your Explanation of
                    Benefits (EOB) online
               Your EOBs are always available in your
                 member portal on,
                 under the Claims & Usage section.


     If you want to opt-out of receiving paper copies of your
     EOB, simply manage the communication preferences in the
     profile section of your member portal on


Across the Country and Around the Globe
With your Blue KC member ID card, you can stay covered no matter where life takes you.

                                                                         Available for Blue KC
                                                                         PPO & EPO plans only

Your Blue Cross and Blue Shield of Kansas City (Blue KC) membership gives you a world of healthcare choices across the country
and around the globe. Follow these simple steps to put the power of Blue KC coverage to work for you.

Locate doctors and hospitals
With your Blue KC member ID card handy, follow these steps:

  • Visit the Blue National Doctor & Hospital Finder at
  • Call BlueCard Access at 1-800-810-BLUE (2583) to get info about doctors and hospitals in your area
If you’re a PPO member, always use a BlueCard PPO doctor or hospital to make sure you receive the highest level of benefits.
HMO members only have out-of-network benefits in the case of an emergency or when prior authorized by Blue KC.

In the United States                                                                   Around the World
1.     Always carry your current Blue KC ID card.                                      1.   Verify your international benefits with Blue KC before
                                                                                            leaving the United States as coverage may be different
2.     Find a nearby doctor or hospital using the methods listed on
                                                                                            outside the country.
       previous page.
                                                                                       2.   Always carry your current Blue KC member ID card.
3.     Call Blue KC for precertification or prior authorization, if
       necessary. The phone number is located on your Blue KC                          3.   Call the Blue Cross Blue Shield Global Core (BCBS
       member ID card.                                                                      Global Core) at 1-800-810- BLUE (2583) or call collect
                                                                                            at 1-804-673-1177 to locate a doctor. An assistance
4.     When you arrive at the participating doctor’s office or hospital,
                                                                                            coordinator will arrange a physician appointment or
       show the provider your ID card. The provider will identify your
                                                                                            hospitalization if necessary. This line is available 24/7.
       benefits through one of these symbols:
                                                                                       4.   Please see below for steps that should be taken for
                                                                                            inpatient and professional services.
                                                                                       Inpatient claim: In most cases, you should not need to pay upfront
After you receive care, you should:                                                    for inpatient care at participating BCBS Global Core hospitals except
                                                                                       for the out-of-pocket expenses (non-covered services, deductible,
     • Not have to complete any claim forms
                                                                                       copay and coinsurance) you normally pay. The hospital should
     • Not have to pay upfront for medical services, except for                        submit the claim on your behalf. In addition to contacting the
       the usual out-of-pocket expenses (non-covered services,                         BCBS Global Core Service Center, call Blue KC for precertification
       deductible, copay and coinsurance)                                              or preauthorization. Refer to the phone number on your Blue KC
     • Receive an explanation of benefits from Blue KC                                 member ID card. Note: This number is different from the phone
                                                                                       number listed above.

                                                              PPO Benefits
                                                                                       Professional claim: You pay upfront for care received from a doctor
                                                                                       and/or non-participating hospital. Complete a BCBS Global Core
       BCKC NAME                                                PPO                    International claim form and send it with the bill(s) to the BCBS
       ID#: YBW08T600050
       SUFFIX: 00
                                                                                       Global Core Service Center (the address is on the form). The claim
                                                      Traditional/Indemnity Benefits
                                                                                       form is available from Blue KC, the BCBS Global Core Service
       GROUP#: 30100000                   EMERG ROOM
                                          URGENT CARE                                  Center or online at
       PLAN: HMO                          OFFICE VISIT
       SMITH, JOHN                        SPECIALIST
       816-000-0000                       INPATIENT
               CUSTOMER SERVICE:          OUTPATIENT                                   IN AN EMERGENCY, GO TO THE NEAREST HOSPITAL.
            816-000-0000 / 000-000-0000   RXBIN: 003858 PCN: A4 Group KCBA

Blue KC HMO plan members can leverage the Away From Home program, which provides convenient healthcare coverage while you are
away from your Home HMO. Contact your Blue KC Representative for more information.



Our mobile site is designed to give you access to our
most frequently used tools. Whether you simply need
to find a doctor quickly or have a moment to check
on a claim, it’s all at your fingertips. Once logged in,
take a look at how easy it is to access these tools and
manage your healthcare even when you’re on the go.

Go to on your phone
Find Care
Search for providers and find the most up-to-date and accurate
information about doctors and hospitals in your Blue KC network.

Claims & Usage
A quick way to take a look at past claims and check on the status
of current ones.

ID Cards
Quickly view, print or email a copy of your member ID card.

Important Resources

Covered by Your Blue KC Health Plan
Information about in-network routine preventive care and the related office visit.

Routine preventive services
In-network routine preventive care services and the related office visit for routine preventive care services is covered at 100%. Services must
be billed with a primary diagnosis of preventive to be covered at 100%. Routine preventive care services are subject to the terms, conditions
and limitations of your Contract/Certificate of Coverage. Not all plans will cover all preventive services at 100%, so be sure to consult your
Certificate of Coverage for details.

Your provider may order tests during your preventive care visit that are not preventive care. These tests may be subject to deductibles,
copays and/or coinsurance. Your provider may also treat an existing condition (or you may have symptoms of an illness at the time of your
visit). Treatment or tests for that existing condition are not preventive care and are subject to deductibles, copays and/or coinsurance.

 Prostate exams and prostate specific antigen (PSA) tests                       Additional examinations, testing and services:
 Pelvic exams and pap smears1, including those performed at the direction       • Hemoglobin/Complete Blood Count (CBC)
 of a Physician in a mobile facility certified by Centers for Medicare and      • Metabolic screening1
 Medicaid Services (CMS)                                                        • Hearing exams

 Mammograms if ordered by a Physician, including those performed at the         Immunizations:
 direction of a Physician in a mobile facility certified by CMS                 Covered Immunizations are limited to the parameters recommended
 Colorectal cancer exams1 and laboratory tests consisting of a digital rectal   by the Advisory Committee on Immunization Practices and/or adopted
 exam and the following: Fecal occult blood test, Fecal DNA test,               by the Center for Disease Control.1
 Flexible sigmoidoscopy, Colonoscopy; Double contrast barium enema              •   Catch-up for Hepatitis B
                                                                                •   Catch-up for varicella
 Newborn hearing screening, audiological assessment and follow-up, and
                                                                                •   Catch-up for MMR
 initial amplifications
                                                                                •   Tetanus boosters as necessary, including tetanus, diphtheria and
 Childhood Immunizations1                                                           pertussis; diphtheria and tetanus; and tetanus only
                                                                                •   Pneumococcal vaccine
 • At least 5 doses of vaccine against diphtheria, pertussis,tetanus;
                                                                                •   Influenza virus vaccine
 • At least 4 doses of vaccine against polio, Haemophilus Influenza
                                                                                •   Meningococcal vaccine
   Type b (Hib);
                                                                                •   Catch-up for Hepatitis A
 • At least 3 doses of vaccine against Hepatitis B;
                                                                                •   HPV vaccine
 • 2 doses of vaccine against measles, mumps, and rubella;
                                                                                •   Zoster vaccine
 • 2 doses of vaccine against varicella;
                                                                                •   Polio vaccine
 • At least 4 doses of vaccine against pediatric pneumococcal (PCV7);
                                                                                •   Haemophilus Influenza Type b (Hib) vaccine
 • 1 dose of vaccine against influenza;
 • At least one dose of vaccine against Hepatitis A;                            Urinalysis
 • 3 doses of vaccine against Rotavirus;                                        Glucose screening
 • Such other vaccines and dosages as may be prescribed by the State
   Department of Health                                                         Thyroid stimulating hormone screening
                                                                                Lipid cholesterol panel
 Lead testing
                                                                                HIV screening
 Outpatient physician examinations1
                                                                                HPV testing2
 Chest x-ray
                                                                                Chlamydia Trachomatis testing
 Electrocardiogram (EKG)
                                                                                Gonorrhea testing


                                            One-time screening for abdominal aortic aneurysm by ultrasonography in men ages 65 to 75 years who have
 Abdominal aortic aneurysm screening: men
                                            ever smoked.

                                            Clinicians screen adults age 18 years or older for alcohol misuse and provide persons engaged in risky or
 Alcohol misuse: screening and counseling
                                            hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse.

                                            Initiating low-dose aspirin use for the primary prevention of cardiovascular disease and colorectal cancer in
 Aspirin to prevent cardiovascular          adults aged 50 to 59 years who have a 10% or greater 10-year cardiovascular risk, are not at increased risk
 disease: adults                            for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at
                                            least 10 years.

                                            Screening for asymptomatic bacteriuria with urine culture in pregnant women at 12 to 16 weeks’ gestation or
 Bacteriuria screening: pregnant women
                                            at the first prenatal visit, if later.

                                            Screening for high blood pressure in adults age 18 years and older obtaining measurements outside of the
 Blood pressure screening: adults
                                            clinical setting for diagnostic confirmation before starting treatment.

                                            Primary care providers screen women who have family members with breast, ovarian, tubal, or peritoneal
                                            cancer with one of several screening tools designed to identify a family history that may be associated with
 BRCA risk assessment and
                                            an increased risk for potentially harmful mutations in breast cancer susceptibility genes (BRCA1 or BRCA2).
 genetic counseling/testing
                                            Women with positive screening results should receive genetic counseling and, if indicated after counseling,
                                            BRCA testing.

                                            Clinicians engage in shared, informed decision making with women who are at increased risk for breast cancer
                                            about medications to reduce their risk. For women who are at increased risk for breast cancer and at low risk
 Breast cancer preventive medication
                                            for adverse medication effects, clinicians should offer to prescribe risk-reducing medications, such as tamoxifen
                                            or raloxifene.

                                            Screening mammography for women, with or without clinical breast examination, every 1 to 2 years for women
 Breast cancer screening
                                            age 40 years and older.

 Breastfeeding interventions2               Provide interventions during pregnancy and after birth to promote and support breastfeeding.

                                            Screening for cervical cancer in women ages 21 to 65 years with cytology (Pap smear) every 3 years or, for
 Cervical cancer screening                  women ages 30 to 65 years who want to lengthen the screening interval, screening with a combination of
                                            cytology and human papillomavirus (HPV) testing every 5 years.

                                            Screening for chlamydia in sexually active women age 24 years or younger and in older women who are at
 Chlamydia screening: women1
                                            increased risk for infection.

 Colorectal cancer screening                Screening for colorectal cancer starting at age 45 years and continuing until age 75 years.

                                            All FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling for
 Contraceptive methods and counseling2
                                            women with reproductive capacity.

                                            Application of fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth
 Dental caries prevention: infants and
                                            eruption in primary care practices. Primary care clinicians prescribe oral fluoride supplementation starting at
 children up to age 5 years
                                            age 6 months for children whose water supply is fluoride deficient.

                                            Screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years. Screening should be
 Depression screening: adolescents          implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and
                                            appropriate follow-up.

                                            Screening for depression in the general adult population, including pregnant and postpartum women. Screening
 Depression screening: aduts                should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and
                                            appropriate follow-up.

Important Resources

                                                 Screening for abnormal blood glucose as part of cardiovascular risk assessment in adults aged 40 to 70
Diabetes screening                               years who are overweight or obese. Clinicians should offer or refer patients with abnormal blood glucose to
                                                 intensive behavioral counseling interventions to promote a healthful diet and physical activity.

Falls prevention in older adults: exercise or    Exercise or physical therapy to prevent falls in community-dwelling adults age 65 years and older who are at
physical therapy                                 increased risk for falls.

                                                 Vitamin D supplementation to prevent falls in community-dwelling adults age 65 years and older who are at
Falls prevention in older adults: vitamin D
                                                 increased risk for falls.

                                                 All women who are planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg (400
Folic acid supplementation
                                                 to 800 µg) of folic acid.

Gestational diabetes mellitus screening2         Screening for gestational diabetes mellitus in asymptomatic pregnant women after 24 weeks of gestation.

                                                 Prophylactic ocular topical medication for all newborns for the prevention of gonococcal
Gonorrhea prophylactic medication: newborns
                                                 ophthalmia neonatorum.

                                                 Screening for gonorrhea in sexually active women age 24 years or younger and in older women who are at
Gonorrhea screening: women
                                                 increased risk for infection.

Healthy diet and physical activity counseling    Offering or referring adults who are overweight or obese and have additional cardiovascular disease (CVD)
to prevent cardiovascular disease: adults with   risk factors to intensive behavioral counseling interventions to promote a healthful diet and physical activity
cardiovascular risk factors                      for CVD prevention.

Hemoglobinopathies screening: newborns           Screening for sickle cell disease in newborns.

Hepatitis B screening: nonpregnant adolescents
                                                 Screening for hepatitis B virus infection in persons at high risk for infection.
and adults

Hepatitis B screening: pregnant women            Screening for hepatitis B virus infection in pregnant women at their first prenatal visit.

                                                 Screening for HCV infection in persons at high risk for infection. Also recommends offering a 1-time
Hepatitis C virus infection screening: adults
                                                 screening for HCV infection to adults born between 1945 and 1965.

HIV screening: nonpregnant adolescents           Clinicians screen for HIV infection in adolescents and adults ages 15 to 65 years. Younger adolescents and
and adults1                                      older adults who are at increased risk should also be screened.

                                                 Clinicians screen all pregnant women for HIV, including those who present in labor who are untested and
HIV screening: pregnant women1
                                                 whose HIV status is unknown.

Hypothyrodism screening: newborns                Screening for congenital hypothyroidism in newborns.

                                                 Clinicians screen women of childbearing age for intimate partner violence, such as domestic violence, and
Intimate partner violence screening: women of
                                                 provide or refer women who screen positive to intervention services. This recommendation applies to women
childbearing age2
                                                 who do not have signs or symptoms of abuse.
                                                 Annual screening for lung cancer with low-dose computed tomography in adults aged 55 to 80 years who
                                                 have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening
Lung cancer screening
                                                 should be discontinued once a person has not smoked for 15 years or develops a health problem that
                                                 substantially limits life expectancy or the ability or willingness to have curative lung surgery.

                                                 Screening all adults for obesity. Clinicians should offer or refer patients with a body mass index of 30 kg/m2
Obesity screening and counseling: adults
                                                 or higher to intensive, multicomponent behavioral interventions.

Obesity screening and counseling: children       Clinicians screen for obesity in children and adolescents age 6 years and older and offer them or refer them
and adolescents                                  to comprehensive, intensive behavioral interventions to promote improvement in weight status.

                                                 Screening for osteoporosis in women age 65 years and older and in younger women whose fracture risk is
Osteoporosis screening: women
                                                 equal to or greater than that of a 65-year-old white woman who has no additional risk factors.


 Phenylketonuria screening: newborns                       Screening for phenylketonuria in newborns.

                                                           Use of low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation in women who are
 Preeclampsia prevention: aspirin
                                                           at high risk for preeclampsia.

 Rh incompatibility screening:                             Rh (D) blood typing and antibody testing for all pregnant women during their first visit for
 first pregnancy visit                                     pregnancy-related care.

 Rh incompatibility screening:                             Repeated Rh (D) antibody testing for all unsensitized Rh (D)-negative women at 24 to 28 weeks’ gestation,
 24–28 weeks’ gestation                                    unless the biological father is known to be Rh (D)-negative.

                                                           Intensive behavioral counseling for all sexually active adolescents and for adults at increased risk for sexually
 Sexually transmitted infections counseling2
                                                           transmitted infections.

                                                           Adults without a history of cardiovascular disease (CVD) (i.e., symptomatic coronary artery disease or
 Statin preventive medication: adults ages 40–75           ischemic stroke) use a low- to moderate-dose statin for the prevention of CVD events and mortality when
 years with no history of CVD, 1 or more CVD risk          all of the following criteria are met: 1) they are ages 40 to 75 years; 2) they have 1 or more CVD risk factors
 factors, and a calculated 10-year CVD event risk          (i.e., dyslipidemia, diabetes, hypertension, or smoking); and 3) they have a calculated 10-year risk of a
 of 10% or greater                                         cardiovascular event of 10% or greater. Identification of dyslipidemia and calculation of 10-year CVD event
                                                           risk requires universal lipids screening in adults ages 40 to 75 years.

                                                           Counseling children, adolescents, and young adults ages 10 to 24 years who have fair skin about minimizing
 Skin cancer behavioral counseling
                                                           their exposure to ultraviolet radiation to reduce risk for skin cancer.

 Syphilis screening: nonpregnant persons                   Clinicians screen persons at increased risk for syphilis infection.

 Syphilis screening: pregnant women                        Clinicians screen all pregnant women for syphilis infection.

                                                           Clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral
                                                           interventions and U.S. Food and Drug Administration (FDA)–approved pharmacotherapy for cessation to
 Tobacco use counseling and interventions:
                                                           adults who use tobacco. This includes two tobacco cessation attempts per year (both prescription and
 nonpregnant adults
                                                           over-the-counter medications) for a 90-day treatment regimen when prescribed by an in-network health care
                                                           provider without prior authorization.
                                                           Clinicians ask all pregnant women about tobacco use, advise them to stop using tobacco, and provide
                                                           behavioral interventions for cessation to pregnant women who use tobacco. This includes two tobacco
 Tobacco use counseling: pregnant women
                                                           cessation attempts per year (both prescription and over-the-counter medications) for a 90-day treatment
                                                           regimen when prescribed by an in-network health care provider without prior authorization.
                                                           Clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco
 Tobacco use interventions:                                use in school-aged children and adolescents. This includes two tobacco cessation attempts per year (both
 children and adolescents                                  prescription and over-the-counter medications) for a 90-day treatment regimen when prescribed by an in-
                                                           network health care provider without prior authorization.

 Tuberculosis screening: adults                            Screening for latent tuberculosis infection in populations at increased risk.

                                                           Vision screening at least once in all children ages 3 to 5 years to detect amblyopia
 Visual screening: children
                                                           or its risk factors.

Out-of-network services
All services received from an out-of-network provider are subject to the out-of-network deductible and coinsurance, except for childhood
immunizations, which are paid at 100%. This summary is being provided for informational purposes only, and is subject to change.

1 Indicates services that are required by the Affordable Care Act (ACA), but are already covered by Blue KC.
2 Indicates services that are required by the ACA as part of the Preventive Services for Women.
This information is intended as a reference tool for your convenience and is not a guarantee of payment. Your provider has access to current diagnosis and procedure codes
associated with these services for correct claims submission.



Where to Go for Medical Care
Know your care options so you can make the best decision for you and your family.

Your health and wellness are important to us. We want to help you
make the best decision about where to go for medical care.

The following guidelines and chart can help you determine when
and where you should go to seek medical care.

First Option: Primary Care Physician
If you need medical care, but it is not an emergency, you should
always call your Primary Care Physician (PCP) for an appointment. If
you are not sure if your symptoms require emergency care, contact
your PCP to help you evaluate your symptoms and determine
where you need to go.

Whether you receive care in an emergency room or at an urgent
care center, you should notify your PCP of your visit when you can.
Keeping your PCP informed is the best way to ensure he or she is
aware of your medical history.

Alternative Options: Urgent Care
Center, Walk-In Clinic or Telehealth
If you need to take care of a problem right away because you feel
sick or uncomfortable, and you do not have a PCP or your PCP is
not available, an urgent care center, walk-in clinic or telehealth visit      Emergency Option: Emergency Room
may be the next best option.                                                  Emergency rooms are set up to focus on medical emergencies,
                                                                              and not routine healthcare. When you go to the emergency room,
Generally, urgent care centers offer walk-in service and are often            a healthcare provider, who may not be familiar with your medical
open before and after regular business hours and weekends. In                 history, will determine whether you need emergency care. We also
most cases, an appointment is not necessary.                                  want you to be aware that if you go to the emergency room for a
                                                                              problem that is not an emergency, it may cost you more.
Additionally, Blue Cross and Blue Shield of Kansas City (Blue KC)
expanded our network to include American Well (Amwell*), bringing
you care wherever you are 24/7 – right in the palm of your hand.              IMPORTANT – Members with serious or life-threatening injuries
The Amwell mobile app can be downloaded directly to your phone                or illnesses should be taken directly to an emergency room, or
or tablet. Or, if you prefer the Web, visit After creating        call 911. You must notify Blue KC of any emergency hospital
an account, you can view a list of available doctors and select one to        admission within 48 hours of the admission time, or as soon
engage in a secure live video visit. Tip: Be sure to select Blue KC           as reasonably possible.
from the plan drop-down list.
*American Well’s online Care Group is an independent provider contracted to
 participate in Blue KC’s commercial provider networks.

Finding A Provider

Guide to Finding the Best Care Option
                                                                    Primary Care         Retail Walk-in         Telehealth/          Urgent Care           Emergency
                                                                     Physician               Clinic              Amwell                Center                Room

 Mild Asthma

 Minor Headaches

 Sprains, Strains

 Nausea, Vomiting, Diarrhea

 Bumps, Cuts, Scrapes

 Burning with Urination

 Coughs, Sore Throat

 Ear and Sinus Pain

 Eye Swelling, Irritation,
 Redness or Pain

 Minor Allergic Reactions

 Minor Fevers, Colds

 Rashes, Minor Burns


 Animal bites



 Back Pain

 Any life-threatening or disabling condition including
 difficulty breathing

 Sudden or unexplained loss of consciousness

 Chest pain, numbness in face, arm or leg; difficulty

 Severe shortness of breath

 High fever with stiff neck, mental confusion or
 difficulty breathing

 Coughing up or vomiting blood

 Cut or wound that won’t stop bleeding

 Major injuries

 Possible broken bones

* For many members, deductibles and coinsurance may also apply, which can make an even greater difference in the cost between an emergency room and other care options.


Access to High-Quality Healthcare Providers
                                                                         After logging in – Click Find Care on the left and then click
                                                                         Find a Doctor to access the Blue KC Doctor and Hospital Finder.

                                                                         Complete the following search fields:

                                                                         A                               B


                                                                                     A. Your Location – Select your search location
                                                                                        (city, ZIP, etc.).

                                                                                     B. Your Plan – Your plan’s network should display, but
                                                                                        if it does not, you can find your network name at the
                                                                                        top of your Blue KC member ID card.

                                                                                     C. Select a Category – Search using many
The Blue KC Doctor and Hospital Finder helps you make more
                                                                                        categories, such as:
informed decisions using many features like search filters,
cost estimates, comparison options, provider reviews and                                • Doctors by name or specialty - Search by first
quality information.                                                                      or last name, or a specialty, such as “primary care
                                                                                          physician” or “OB/GYN”
Start your search                                                                       • Places by name or specialty - Enter the name of
Log into the Blue KC Doctor and Hospital Finder on                           a hospital or clinic, or types of facilities near you
to find the most up-to-date search results for doctors, hospitals or
                                                                                        • Costs for procedures - Get cost estimates for
other healthcare providers in your network. If this is your first time
                                                                                          medical procedures, such as “MRI,” “flu shot” or
logging in, you will need your Blue KC member ID card to reference.
                                                                                          “eye exam”
                                                                                        • Treatment timelines - Search treatment
                                                                                          information for long-term medical conditions that
                                                                                          include stages of healing, such as “total knee
                                                                                          replacement” or “coronary bypass surgery”
                                                                                        • Condition information - Search conditions such
                                                                                          as “deviated septum” or "lumbar (low back pain)"
                                                                                          and read medical information to find treatment
                                                                                          options and doctors, which can provide insights
                                                                                          into how you can lower your total costs and the
                                                                                          support you might need

Finding A Provider

Narrow your search results                                               Compare providers
Use filters to narrow your search results, such as by provider
gender, distance, specialty and/or languages spoken.

                                                                         With your search results, you can select various providers or
                                                                         facilities to compare.

                                                                             • From your search results, select providers to compare.
               Use the “BDTC” filter to search for a                         • After selecting providers, view a side-by-side comparison of
               Blue Distinction Total Care doctor.                             each profile so you can see how they rank.

                                                                         Provider reviews
                                                                         Easily read and write provider reviews and rate your care on a scale
Use the BDTC filter to find a Blue Distinction Total Care provider.
                                                                         of one to five stars. Your feedback helps doctors and staff make
Use the Blue Distinction Specialties filter to find a healthcare         improvements, plus, by rating your doctor, you will help others
facility recognized for specialty care, such as cardiac care, knee/hip   locate physicians with high patient satisfaction scores. Surveys are
replacement, etc. NOTE: you must use the search term “hospital”          confidential – doctors will not know you rated them.
on the previous page in order to display these results.

              Blue Distinction Total Care (BDTC) doctors go
              above and beyond to enhance the overall health
              of their patients, providing preventive services               Having Trouble?
              and health coaching, and supporting patients with              Please call the Customer Service number found on your
              chronic conditions to better manage their care.                Blue KC member ID card.

                                                                           Designation as a Blue Distinction Total Care Provider means the Provider or Facility has met
                                                                         the established national criteria. To find out which services are covered under your policy,
                                                                         please log into your member portal to access your member certificate. To
              Blue Distinction Centers (BDC) are facilities              find out which providers are in your network, please use the Doctor and Hospital Finder on
                                                                Blue KC is not responsible for any damages, losses, or non-covered charges
              awarded the Blue Distinction Centers and Blue              that may result from using Blue Distinction or receiving care from a Blue Distinction or other
              Distinction Centers+ designations for their proven
                                                                          Blue Distinction Centers (BDC) met overall quality measures for patient safety and outcomes,
              history of delivering better quality and results for       developed with input from the medical community. Blue Distinction Centers+ (BDC+) also
              the following areas of specialty care:                     met cost measures that address consumers’ need for affordable healthcare. Each provider’s
                                                                         cost of care is evaluated using data from its Local Blue Plan. National criteria for BDC and
                                                                         BDC+ are displayed on Individual outcomes may vary. For details on a
                 • Bariatric Surgery, Cardiac Care, Complex              provider’s in-network status, log into your member portal and use the Doctor
                                                                         and Hospital Finder. To find out which services are covered under your policy, please log into
                   and Rare Cancers, Knee/Hip Replacement,               your member portal to access your member certificate. Neither Blue Cross
                                                                         and Blue Shield Association nor any Blue Plans are responsible for non-covered charges or
                   Maternity Care, Spine Surgery and Transplants         other losses or damages resulting from Blue Distinction or other provider finder information or
                                                                         care received from Blue Distinction or other providers.



Telehealth Online Doctor Visits
Live and immediate 24/7 access to care for common medical issues.

Blue Cross and Blue Shield of Kansas City (Blue KC) wants to improve your access to care. That’s why we’ve
expanded our networks to include American Well (Amwell)1, a service that can bring you care from the comfort
and convenience of your home or wherever you are. Amwell is available to most Blue KC members (Medicare
Advantage members do not have access).
                                                                                          Use this service for easy access to care for common medical issues
                                                                                          like cold, flu, fever, abdominal pain, migraines, possible ear infection,
                                                                                          rash and sinusitis.

                                                                                          Amwell visits are considered “urgent care” and will process according to
                                                                                          your urgent care benefits, cost sharing or copay unless otherwise noted
                                                                                          in your member certificate.2

                                                                                          Get started today
                                                                                          1.    Download the Amwell Mobile App or visit
                                                                                          2.    Create an account in a few simple steps. Be sure to use your Blue
                                                                                                KC member ID card in order to input your insurance information.
                                                                                                Also be sure to choose Blue KC from the plan drop-down list.
                                                                                          3.    View a list of available doctors, their experience and ratings, and
                                                                                                then select one that works for you.
                                                                                          4.    Stream a live visit directly from the Web or your mobile device.

                                    Open 24 Hours                                                                      Safe & Secure
                                    Doctors are available 24                                                           Your information is kept
                                    hours a day, 365 days a year.                                                      private throughout the visit.

                                    Care that Goes Anywhere
                                    Install the Amwell mobile app and                                                   No Appointments
                                    access healthcare from anywhere,                                                    Just sign in – no more
                                    anytime.                                                                            waiting rooms.

        To learn more about Amwell, visit

    American Well's Online Care Group is an independent provider contracted to participate in Blue KC's commercial provider networks.
    If special Amwell benefits apply, this will be noted as a “Designated Telehealth” benefit on your certificate. You can access your certificate on

Bringing Home Great Care

Support for Chronic Health Conditions

Education and support
Healthy Companion helps you understand your condition and                   HEALTHY COMPANION TOOLS
treatment options with access to nurses, tools, resources and                    AND RESOURCES
one-on-one support.

Condition management
The level of support you receive from the program will be based
                                                                                             ONLINE TIPS
on your needs and preferences. Our nurses may contact you
occasionally to assist with your care plan, answer your questions,         EDUCATIONAL                         CLINICAL
and provide support and encouragement. Updates are provided to              REMINDERS                          SUPPORT
your doctor so they stay informed of your health status.

Members who have been identified with any of the conditions
                                                                     If you have recently been diagnosed, and would like to sign up
listed below are automatically enrolled.
                                                                     for immediate support, contact Healthy Companion.
  • Asthma
  • Chronic Obstructive Pulmonary Disease (COPD)
                                                                       CALL: 816-395-2076 | Toll Free 1-866-859-3813
  • Depression
  • Diabetes                                                           EMAIL:
  • Heart Disease
  • Heart Failure
  • High Blood Pressure
  • Metabolic Syndrome
  • Stress and Anxiety



A Quality, Cost-Efficient Alternative
Using a generic instead of a brand name drug can help save you money.

Understanding generics                                                   WHAT IS THE DIFFERENCE BETWEEN A GENERIC AND
                                                                         BRAND NAME DRUG?
WHAT ARE GENERIC DRUGS?                                                  Just the name and the price. The generic drug has the same active
A generic drug is a less expensive version of its brand name             ingredients and same medical effect. Generic drugs just have a
counterpart. Generic drugs are made with the same active                 name based on the chemical compound that makes up the drug
ingredients and are available in the same strength and dosage as         and cost you less.
the brand name version.

A generic drug has to meet the same strict standards the U.S.            HOW CAN I GET GENERIC DRUGS?
government sets for a brand name drug. The U.S. government               Call your doctor and ask if any prescriptions you are currently taking
strictly regulates the manufacturing process of all drugs, and all       can be filled with a generic version.
manufacturers have to meet the same standards.                           GENERIC DRUG PRESCRIPTION?
DO ALL DRUGS HAVE GENERIC EQUIVALENTS?                                   You can receive the highest level of coverage on prescription drugs
No. A generic version does not exist for every brand name drug.          through your Blue Cross and Blue Shield of Kansas City (Blue KC)
Some brand name drugs are protected by patents for up to 20              health plan by remembering to ask your doctor for a generic version
years, so a generic cannot be produced immediately. However,             of the prescription. Double check with your pharmacist that you’re
about half of all prescription drugs currently on the market do have a   receiving the most cost-effective prescription medication.
generic version available.

Your Prescriptions

There are new ways to save on prescription medications. Blue                    Some of the ways you might save include:
KC has partnered with Rx Savings Solutions to bring cutting-edge
                                                                                  • Switching pharmacies
technology that will notify you via text message and/or email when
you and your family can save at the pharmacy.                                     • Trying a generic or a different generic medication
                                                                                  • Trying therapeutic alternatives

                                                                                                                        DID YOU KNOW?

                 STEP 1                                                                                                 Rx Savings Solutions was created
                                                                                                                        by a pharmacist who found ways
                                                                                                                        to help consumers save money.
                 GET TEXT AND
                 EMAIL ALERTS                                                                                           Prescription prices can vary widely,
                                                                                                                        even within the same ZIP code.


            A      Visit                       Once logged in, click on         Once on the Rx Savings page,
                                                         B                               C
                   If you are a first-time visitor,          Plan Benefits on the             fill in your email address and
                   click REGISTER NOW. Please                left. Then click                 mobile phone number.
                   have your member ID card                  Pharmacy Plan Info          Start receiving email and/or text alerts
                   available to reference.                   and then Spend Less         from Rx Savings Solutions!
                                                             at the Pharmacy.

     STEP 2                                           REVIEW YOUR SAVINGS OPTIONS AND
                                                      SHARE WITH YOUR DOCTOR                                    STEP 3
                                                                                                                    START SAVING ON

                                     PHARMACY B

   Example: Switch from
   Pharmacy A to Pharmacy B.                                        Example: Switch to a different,
                                                                    equally effective medication.

  DON’T WANT TO WAIT?                                                                                                         For more
  You don’t have to wait for a savings notification.                                                                          information, call
  Take a look for yourself and start saving today.                                                                            the Customer
     • Log in to                                                                                                Service number
                                                                                                                              listed on your
     • Click on Plan Benefits on the left, then click the
                                                                                                                              member ID card.
       Pharmacy Plan Info and Spend Less at the Pharmacy.
     • Check your Rx Savings Solutions home page for savings
       opportunities or use the search feature to view different


Save on Prescription Costs
Express Scripts pharmacy handles millions of prescriptions each year through home delivery.

Express Scripts, the company that manages your prescription plan for Blue KC, wants to ensure you are doing
all you can to save on your maintenance prescription costs.

                   Maintenance prescription drugs are                                              HOME DELIVERY HELPS!
                   considered those taken on a regular
                   basis and are appropriate for up to a
                   102-day supply.
                                                                                                                        TAKE YOUR
Transfer your maintenance medications                                                                                  MEDICATIONS
to home delivery                                                                                                      AS PRESCRIBED

  • Log into Click Plan Benefits on the left.                                   SAVE ON                                 SAVE TIME WITH
                                                                                            PRESCRIPTION                                NO TRIPS TO
  • Then select the Pharmacy Plan Info. From that screen click                                 COSTS                                  THE PHARMACY
    the Visit Express Scripts button to be redirected to the
    Express Scripts website.
  • Once redirected, the screen will display a message that says
    “We’ll do the work for you.” Click on the link in the message to                       CONTACT EXPRESS SCRIPTS
    view your prescriptions that are eligible for home delivery.                           If you do not have internet access, or if you would
                                                                                           like Express Scripts to assist you in transferring your
  • Complete the steps and submit your form. Once received,                                routine medications to home delivery, or if you have any
    Express Scripts will reach out to your doctor to obtain an                             questions, please call: (toll free) 855-812-7198
    updated prescription to initiate home delivery.

Express Scripts is an independent company which serves as the Pharmacy Benefits Manager (PBM) on behalf of Blue KC.



Personalized Online and Mobile Wellness
Take Control of Your Health. Get Healthy and Earn Chances to Win Great Prizes

The Blue Cross and Blue Shield of Kansas City (Blue KC) A Healthier You program gives you convenient online
and mobile access to several wellness tools that allow you to get healthy and earn chances to win great prizes.


 First-time users will be prompted to
 complete registration personalization
 questions. Please have your member
 ID card available to reference.

 POINTS AND GET SUPPORT                                              Take the Health Risk Assessment and
                                                                     receive your personal health summary.

                                                                     Get answers or search symptoms within
               Configure your Personalized Care plan and
                                                                     your Personalized Care plans.
               view your screening results (if available).

                                                                     Complete health actions and earn points to
               Connect and manage your devices and
                                                                     enter monthly sweepstakes drawings.
               apps for more points.

Information and In-Network Providers
If you have a breast pump benefit on your plan, Blue KC will cover the allowable charge.

Breastfeeding is one of the best ways you can protect your baby’s      3.) ORDER
health. And if you’ve decided to do so, your Blue KC health plan may   At about 30 weeks, order your breast pump by contacting one of
have coverage for a breast pump.                                       the in-network local or mail-order breast pump providers listed on
                                                                       the following page.
Learn More                                                             Please allow roughly four weeks to receive your breast pump in the
Find out if you have a breast pump benefit and how to order            mail. Contact your breast pump provider with ordering questions as
by taking these steps:                                                 they can best assist you.

1.) INQUIRE                                                            If you have a breast pump benefit on your plan, Blue KC will cover
Call Blue KC Customer Service at the number on your member             the allowable charge for a manual or electric breast pump, either
ID card.                                                               double or single to meet the needs of you and your baby. The
                                                                       allowable benefit coverage may vary if you live outside the Blue KC
2.) GET A PRESCRIPTION                                                 service area.
If your plan includes a breast pump benefit, ask your doctor for
a prescription for a breast pump once you reach 26-28 weeks.           In-network breast pump providers will have certain types of brands
                                                                       on hand. You are limited to one breast pump per pregnancy.

                                                                       If you have benefit-related questions, contact Blue KC Customer
                                                                       Service by calling the phone number on your member ID card.

                                                                                                                                            33                                                                                                                                                               Living Healthy

In-Network Breast Pump Providers
Helpful Tips:
 • If you have not obtained a prescription from your doctor for a                                  • There are walk-in locations within the Blue KC service area, or
     breast pump, you can ask the breast pump provider to request                                    you may contact an in-network mail-order provider.
     the prescription for you.                                                                     • You will need your Blue KC member ID card on hand when
                                                                                                     you place your order.

     *For a complete listing of local walk-in locations, call Blue KC Customer Service at the number listed on your member ID card.

                                                                 Phone                                                               Network and                    BlueSelect and
 Covered Network                Location                                                 Blue and               Blue-Care
                                                                 Number                                                              Freedom                        BlueSelect Plus
                                                                                                                                     Network Select

 Medical                        Lenexa, KS                        (913) 745-4468               X                       X                         X
 American Care
                                Overland Park, KS                 (913) 383-3456               X                       X                         X                           X
 Elite Medical
                                Lenexa, KS                        (913) 940-0491               X                       X                         X                           X
                                Kansas City, KS                   (913) 789-9573               X                       X                         X
 Medical Services

 Mobility First                 Independence, MO                  (816) 350-7600               X                       X                         X                           X

                                Nevada, MO                        (800) 562-8876               X                       X                         X
                                Rich Hill, MO                     (800) 410-9184               X                       X                         X
 Wilkinson                      Lebanon, MO                       (888) 383-4431               X                       X                         X
                                Lamar, MO                         (888) 986-3784               X                       X                         X
 (7 locations in Missouri)      Holden, MO                        (888) 660-6103               X                       X                         X
                                El Dorado Springs, MO             (800) 824-6098               X                       X                         X
                                Camdenton, MO                     (888) 573-0014               X                       X                         X

                                                              In-Network Mail Order Providers*
                   *State access varies; please call the listed provider to ensure breast pumps are available for your location.
Edgepark                                                                                      Better Living Now
Web: / Phone: (800) 321-0591                                                     Web: / Phone: (800) 854-5729
When prompted for “breast pump,” press 1.                                                     Better Living Now is not a contracted provider in our BlueSelect network.

Progressive Medical                                                                           Yummy Mummy
Web: / Phone: (913) 685-5861                                                        Web: / Phone: (855) 879-8669
Email:                                                      Yummy Mummy is not a contracted provider in our BlueSelect network.
Progressive Medical is not a contracted provider in our BlueSelect network.
Byram Healthcare Centers, Inc.                                                                Medline Industries, Inc.
Web: / Phone: (877) 773-1972                                              Web: / Phone: (877) 436-8522
Email:                                                       Medline Industries is not a contracted provider in our BlueSelect network.
Byram Healthcare Centers, Inc. is not a contracted provider in our BlueSelect network.
Mobility First                                                                                Aeroflow
Web: / Phone: (816) 350-7600                                                Web: / Phone: (888) 973-0279
                                                                                              Aeroflow is not a contracted provider in our BlueSelect network.

Join Blue365® and start saving today!

With Blue365, great deals are yours for every aspect
of your life – like 20% off at, discounted                                              CHECK OUT THESE TOP BRANDS
products through Jenny Craig, or a gym membership                                                  WITH DISCOUNTS JUST FOR YOU
for only $25 a month.

Register now at to take advantage
of Blue365. It’s an online destination featuring healthy deals and
discounts exclusively for our members.

Just have your Blue KC member ID card handy. In a couple of
minutes, you will be registered and ready to shop. Every week we
will send a special deal straight to your email inbox.

© 2000-2018 Blue Cross Blue Shield Association – All Rights Reserved. The Blue365 program is brought to you by the Blue Cross Blue Shield Association. The Blue Cross Blue Shield
Association is an association of independent, locally operated Blue Cross and/or Blue Shield Companies. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue
Cross Blue Shield Association. Blue365 offers access to savings on health and wellness products and services and other interesting items that Members may purchase from independent
vendors, which are different from covered benefits under your policies with your local Blue Company, its contracts with Medicare, or any other applicable federal healthcare program.
To find out what is covered under your policies, contact Blue KC. The products and services described on the Site are neither offered nor guaranteed under your Blue Company’s contract
with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding your health insurance products and services may be subject to
your Blue Company’s grievance process. BCBSA may receive payments from vendors providing products and services on or accessible through the Site. Neither BCBSA nor any Blue
Company recommends, endorses, warrants, or guarantees any specific vendor, product or service available under or through the Blue365 Program or Site.



           As a current or prospective member of Blue Cross and Blue Shield of Kansas City (Blue KC),
           we believe it is important for you to fully understand all aspects of your health plan. This
           information is provided to help you understand your rights and your coverage. Please read the
           following information carefully.

           About your Benefit Summary
           Your benefit summary is for informational purposes only and contains only a partial, general
           description of plan benefits. This summary is provided to give you a brief outline of your
           benefits. It does not constitute a contract. Consult your plan documents (Schedule of Benefits
           and Certificate of Coverage) to determine governing contractual provisions, including
           procedures, exclusions and limitations relating to your plan. As with all healthcare plans, there
           are certain services that are not covered. Some services are subject to limitations. All the terms
           and conditions of your plan are subject to the terms of the contract and to applicable law and
           regulations. The availability of a plan or program may vary by geographic service area.

           Member Rights and Responsibilities
           As a member of Blue KC you have certain rights and responsibilities. For your benefit we have
           outlined the rights and responsibilities of our members for the various plans we offer.

           You have the right to:
             • Receive considerate and courteous care with respect and recognition of personal privacy,
                dignity and confidentiality.
             • Have a candid discussion of medically necessary and appropriate treatment options or
                services for your condition from any participating physician, regardless of cost or benefit.
             • Receive medically necessary and appropriate care or services from any participating
                physician or other participating healthcare provider from those available as listed in your
                managed care plan directory or from any nonparticipating physician or other healthcare
             • Receive information and diagnosis in clear and understandable terms, and ask questions
                to ensure you understand what you are told by your physician and other medical
             • Participate with Providers and practitioners in making decisions about your healthcare,
                including accepting and refusing medical or surgical treatments.
             • Give informed consent to treatment and make advance treatment directives, including the
                right to name a surrogate decision maker in the event you cannot participate in decision

 MCM_ Important Info – Insured 03/16                                                                            03/16
•   Discuss your medical records with your physician and have health records kept
                 confidential, except when disclosure is required by law or to further your treatment.
             •   Be provided with information about your managed healthcare plan, its services and the
                 practitioners and providers providing care, as well as have the opportunity to make
                 recommendations about your rights and responsibilities.
             •   Communicate any concerns with your managed healthcare plan regarding care or services
                 you received, receive an answer to those concerns within a reasonable time, and initiate
                 the complaint and grievance procedure if you are not satisfied.

          You have the responsibility to:
            • Respect the dignity of other members and those who provide care and services through
               your managed healthcare plan.
            • Ask questions of your treatment physician or treatment provider until you fully
               understand the care you are receiving and participate in developing mutually agreed upon
               treatment goals to the degree possible.
            • Follow the mutually agreed upon plans and instructions for care that you have discussed
               with your healthcare practitioner, including those regarding medications. Comply with all
               treatment follow-up plans, and be aware of the medical consequences of not following
            • Communicate openly and honestly with your treatment provider regarding your medical
               history, health conditions, and the care you receive.
            • Keep all scheduled healthcare appointments and provide advance notification to the
               appropriate provider if it is necessary to cancel an appointment.
            • Know how to use the services of your managed healthcare properly.
            • Supply information (to the extent possible) that the organization and its practitioners and
               providers need in order to provide care.

          How to Obtain Care After Hours
          If you need to obtain care after normal business hours, on the weekend or on a holiday, use the
          following options:
            1) Emergency care – If you are in need of emergency care, seek services at the nearest
                network emergency department, if possible. If the situation is critical, visit the nearest
                non-network emergency department.
            2) Urgent care – If you are in need of urgent care, call the physician office to speak to an on-
                call doctor after regular hours.
            3) Non-urgent care – If the need for care is not urgent or an emergency, we encourage you to
                wait and call during normal business hours.

          Online (Website) Security Policy
          Blue KC has implemented numerous security features to prevent the unauthorized release of or
          access to personal information. Please see for further information about online


MCM_ Important Info – Insured 03/16                                                                        03/16
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