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FAQ
Questions about our ACA plans and benefits
You’re not alone
If you’d like to know more about Blue KC benefits or plan details, you have plenty of company. And here, you have answers to the most commonly asked questions—from Spira Care specifics to behavioral health services to value-added benefits. You’ll find answers to your general health insurance questions at our helpful Insurance Basics page.
Spira Care
$0 primary care copays. A care team committed to your health. All the services you need under one roof.
Spira CareBlue KC Choice Plans give members exclusive access to nine Spira Care Centers across the Kansas City metropolitan area. Members enrolled in a Blue KC Choice Plan will have no additional cost* for any appointment or service provided at a Spira Care Center. Spira Care offers advanced primary care for newborns, infants, children, adolescents, and adults that gives you easy, convenient access to advanced primary care services, behavioral health support, lab draws, preventive care, immunizations, sick care and more.
*Blue KC members enrolled in plans with exclusive access to Spira Care Centers and no Health Savings Account (HSA) will have no costs. For costs and further details of the coverage, including exclusions, any reductions or limitations and the terms under which the policy may be continued in force, see your insurance producer or write Blue KC.
There are nine Spira Care Centers across the Kansas City metro area. Each of these Care Centers offers a variety of primary care services under one roof, including multidisciplinary Care Teams working together to take exceptional care of you. Spira Care was designed with you and your family at the heart of everything they do. Their goal is to eliminate stress, confusion and the feeling of being rushed in and out of your doctor’s office.
There are currently nine Care Centers – Crossroads, Lee’s Summit, Overland Park, Liberty, Olathe, Shawnee, Independence, Tiffany Springs, and Wyandotte.
Spira Care Centers offer advanced primary care services for the whole family including:
- Treatment of common medical conditions and minor injuries
- Wellness appointments, also known as annual physicals or checkups, for infants, children, teens, and adults
- These appointments can include well-child visits, completing health forms for school or sports, routine vaccinations, and more
- Health screenings to help identify potential health problems early or prevent them all together
- Sick care
- Behavioral health support
- Routine labs, x-rays and more!
Care Guides are personal guides, with nursing and benefit backgrounds, to support you on your health journey. They can help you schedule specialty care needs outside your Care Center and explain benefits. Now you have a single point of contact for both care and coverage questions to help you find the right place, right time and right people to help you on your health journey.
Blue KC members enrolled in ACA Individual and Family Plans with exclusive access to Spira Care Centers will have no additional costs* for any appointment or service provided at a Spira Care Center.
*Blue KC members enrolled in plans with exclusive access to Spira Care Centers and no Health Savings Account (HSA) will have no costs. For costs and further details of the coverage, including exclusions, any reductions or limitations and the terms under which the policy may be continued in force, see your insurance producer or write Blue KC.
While the plan is ideal for members who utilize the Care Centers members still have access to all providers in their plan’s network. Many families enjoy the convenient benefits and integrated services offered at Spira Care including adult and pediatric primary care. Families also have access to a team of Care Guides for care and coverage questions.
You have access to your plan’s network within the Kansas City metro area. For emergency situations, you are covered both in and out of your plan’s network. Services beyond Spira Care (for example, a visit to a specialist or an emergency room) are subject to a person’s plan deductible.
Visit SpiraCare.com to learn more.
Yes, Spira Care offers behavioral health support for children, teens, and adults that is integrated with your primary care. In partnership with your medical provider and a behavioral health consultant, members have access to brief and focused interventions . If you have an ongoing or long-term behavioral health need (such as therapy), Spira Care can work with you to identify a provider in your plan’s network.
Behavioral health
How to EnrollYes. The Affordable Care Act provides mental health and substance use disorder coverage. This means that most individual insurance plans, including all plans offered through the ACA, cover mental health and substance use disorder services. This law also requires coverage for rehabilitative and habilitative services that support people with behavioral health conditions.
Mindful by Blue KC is a set of new and enhanced behavioral health services to address stress, depression, anxiety, substance use and more. This ensures that Blue KC members can access and afford behavioral healthcare when needed. To learn more, members can log in at MyBlueKC.com and click on behavioral health. Not a member yet? Learn more at MindfulBlueKC.com.
The following behavioral health services are available through Mindful by Blue KC – well-being resources, online therapy, online self-guided tools, managed behavioral health, expedited access network for members in crisis, and virtual care appointments.
Telehealth
Yes, Blue KC offers our members a number of virtual care services – our mobile app, MyBlueKC, allows members to choose from either 24/7 urgent care visits and the convenience of scheduling behavioral therapy when it works for you. In addition, many of our Blue KC in-network providers have embraced virtual visits. Talk with your doctor to schedule your next appointment.
Yes! While it’s up to your doctor to determine how they deliver care, Blue KC offers the coverage. Additionally, the MyBlueKC mobile app can connect you to our network of virtual care providers so you can get care when you need it, using the same app you use to access your benefit information, view claims, download digital ID cards, and more.
Virtual visits give you the convenience of seeing a doctor privately and securely over your smartphone, tablet, or computer – no matter if it’s from the comfort of your home or when you’re travelling.
You can also benefit from a more diverse group of providers and the ability to learn more about your doctor by reading their bio in the MyBlueKC app.
Virtual visits allow you the flexibility to receive care easily and conveniently within your busy schedule. With a virtual visit, there is no time spent driving to and from an office, taking hours off work, or being confined to regular office hours.
Additional plan benefits
Our wellness programs include Mindful by Blue KC for behavioral health, Healthy Companion Programs for proving support for chronic health conditions and a diabetes prevention program.
There is no additional cost to members to participate in these programs.
Health coaches are available for members enrolled in Spira Care plans.
Individual dental plans are available. We do not have vision plans available through the ACA. See dental coverage options.
Yes, Blue KC offers a program called SmartShopper. SmartShopper helps you save on qualified healthcare procedures and earn cash rewards when you shop and choose cost-effective, eligible procedures.
Enrollment details
You can enroll in an ACA health plan during the annual Open Enrollment Period which runs from November 1, 2024 to December 15, 2024. Enrolling by the December 15 deadline will put your plan into effect January 1, 2025. If you miss the December 15 deadline, you can still enroll by January 15, 2025 for an effective February 1, 2025 date.
For health coverage needs outside of the Open Enrollment Period, you may still sign up for an ACA health plan throughout the year if you qualify for a Special Enrollment Period. A Special Enrollment Period allows you to sign up for, or change, an ACA health plan for you and your family outside of the annual Open Enrollment Period. To qualify for a Special Enrollment Period, you must experience a qualifying life event such as having or adopting a baby, getting married or divorced, moving, or losing your health coverage to name a few.
The Open Enrollment Period has ended. You can enroll in or change your plan because of life changes during a Special Enrollment Period. You may qualify if, during the past 60 days, you’ve gotten married, had a child, moved, lost coverage due to divorce or job change, or if someone on your plan has died.
For more details on specific Blue KC ACA plans available in your area, explore plans here. If you’re ready to enroll, get a quote and complete the enrollment process.
Get in touch
Have questions? Our local experts can help you find the right Blue KC plan for you. Give us a call at 844-655-0355.
We’re available Monday – Friday from 8a.m. – 5p.m. or contact your broker or agent if you are working with one.
Complete the form below to have a Blue KC expert contact you
Look for your free member guide, delivered to the email you provided
We’ll reach out to within 3 business days to discuss plan options
Complete the form below to have a BlueKC expert contact you
Look for your free member guide, delivered to the email you provided
We’ll reach out to within 3 business days to discuss plan options
Our Local Experts are ready to help with all of your questions.
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