Medical Benefits

Blue Care for Kids offers multiple medical deductible options, a limited out-of-pocket and the highest level of benefits when services are provided by a Network Provider. Physician benefits include a primary care and specialist co-pay.

The Deductible does not apply where there is a co-pay amount. Co-pay amounts do not accrue toward the Medical Deductible amount. (Co-pay amounts are still applicable after the Out-of-Pocket is satisfied.)

** Also applies to office visits with an allied primary care professional (i.e. nurse practitioner, physician assistant). Co-pay does not apply to any other services rendered in the office. Other services (i.e. surgery, diagnostic services, etc.) rendered in the physician's office are subject to the Benefit amounts.

All services are subject to the Network Provider and Non-Network Provider Benefits. Some benefits are not covered when rendered by a Non-Network Provider. See Benefit Plan for details.

Prior authorization is required for all non-emergency services provided outside the state of Mississippi.

For more detailed information about Blue Care Kids benefits click here.

Our Network Providers can help you get the most out of this valuable wellness benefit. You can see the many healthcare providers in Network Provider Search.

This Blue Care for Kids Medical Benefit summary is designed for the purpose of presenting general information about the Blue Care for Kids Health and Wellness Benefit Plan and is not intended as a guarantee of benefits. All services referenced in this Health and Wellness Benefit Plan are subject to Medical Policy and Medical Necessity review to determine if the services are covered. This is not a Summary Plan Description and in the event of a conflict between this document and the actual Health and Wellness Benefit Plan, the terms of the Health and Wellness Benefit Plan will prevail.

Prescription Drugs

Making smart prescription drug choices is one of the best ways to manage your healthcare costs. The Blue Care for Kids prescription drug benefits are based on a drug formulary especially for kids and a 4-category co-pay that encourages generics and low-cost drug alternatives. Prescription drugs are only covered if on the formulary and the lowest cost drugs are in Category 1. The prescription drug deductible does not apply Category 1 drugs.

* Benefits are provided only when prescription drugs are purchased at a Community PLUS Network Pharmacy.

For more detailed information about Blue Care Kids benefits click here.

This Blue Care for Kids Prescription Drug Benefit summary is designed for the purpose of presenting general information about the Blue Care for Kids Health and Wellness Benefit Plan and is not intended as a guarantee of benefits. All services referenced in this Health and Wellness Benefit Plan are subject to Medical Policy and Medical Necessity review to determine if the services are covered. This is not a Summary Plan Description and in the event of a conflict between this document and the actual Health and Wellness Benefit Plan, the terms of the Health and Wellness Benefit Plan will prevail.

Blue Health Management

To keep you healthy, our Health and Wellness Team will work with your Network Provider to make sure your necessary care is provided in the most cost-effective setting, to include our Centers of Excellence. Based on your health status, you may also qualify for our Blue Health Management program.

Being healthy can be a lot of fun! You feel good and have lots of energy when you eat healthy and stay active. The Good Health Club promotes the 5-2-1-0 plan:

• Eat 5 servings of fruits and vegetables every day
• Limit screen time to 2 hours
• Get at least 1 hour of physical activity
• Limit sweetened drinks to 0

myBlue

The myBlue web portal gives members 24/7 access to everything related to their benefit plans. With myBlue, members can access claims history, prescription drug information, electronic EOBs and more. Here are additional details:

• Registration is quick, easy, secure and useful. You have access to the health benefit information you want, when you want it.
• You can view claims history for the previous 15 months, including payments, co-pay and deductible amounts. You can go green and stop the mailing and delivery of paper EOBs.
• You can give us important information online at any time – no need to call during business hours only. You can update your phone number or email, and you can order a new ID card on myBlue.

When you apply for Blue Care for Kids health and wellness coverage, you will also be asked questions that will be used to determine your eligibility for optional life coverage through Bluebonnet Life. Bluebonnet Life Insurance Company is an independent life insurance company that does not provide Blue Cross & Blue Shield of Mississippi products or services, and is solely responsible for the life insurance coverage referenced above.