High Deductible Plan

North Kansas City Hospital offers you and your dependents health insurance through BlueCross BlueShield South Carolina.You may review the features and benefits of the High Deductible Plan below.

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Preventative Drug Info

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Provider Choice

North Kansas City Hospital Outpatient Pharmacy

MedTrak Participating Pharmacies

Prescription plan deductible per calendar yearNo deductible for prescriptions filled at NKCH Outpatient Pharmacy$100 per person up to $250 per family
Generic prescriptions$4 copay per 30-day supply
$8 copay per 90-day supply
$12 copay per 30-day supply
$36 copay per 90-day supply
Brand name prescriptions with no available generic substitute$50 copay per 30-day supply
$100 copay per 90-day supply
$65 copay per 30-day supply
$195 copay per 90-day supply
Brand name with generic substitute$80 copay per 30-day supply plus the difference in cost between the brand prescription and generic equivalent

$160 copay per 90-day supply plus the difference in cost between the brand prescription and generic equivalent
$90 copay per 30-day supply plus the difference in cost between the brand prescription and generic equivalent

$270 copay per 90-day supply plus the difference in cost between the brand prescription and generic equivalent
Specialty drugsYou pay 20% coinsurance; only covered at the NKCH retail pharmacyNot Covered
Rx out-of-pocket maximum Individual: $2,150
Family: $4,300
This maximum combines with the medical plan out-of-pocket maximum not to exceed $7,150/individual & $14,300/family.
Over-the-counter preventative medicationsAspirin, Fluoride Supplements, Folic Acid, Iron Supplements, Breast Cancer Prevention; Covered in Full; from an In-Network Retail Pharmacy, not subject to calendar year deductible. Requires written prescription from the physician. Breast Cancer prevention for ages 35 or older; OTC and legend generics
Smoking deterrentsCovered in full; limited to two treatment cycles per year. Over-the-counter, generic, and brand smoking deterrents; requires written prescription from the physician.
ContraceptivesCovered in full: Hormonal, Barrier, Emergency, Implants; includes Generic and over-the-counter products; requires written prescription from the physician