Meritain Health, an Aetna company, offers the Copay Plan through the KC Care Network, providing affordable healthcare with predictable costs. The plan includes fixed copayments for services such as doctor visits, prescriptions, and specialist care. It gives members access to the KC Care Network’s wide range of healthcare providers, ensuring quality, comprehensive care. This plan is ideal for individuals and families seeking straightforward, affordable healthcare coverage with a focus on managing out-of-pocket expenses.
KCOI is continuing a Domestic Tier, which allows employees to take advantage of services done at KCOI.
| Per Pay Period Premium | |
|---|---|
| Copay Plan KC Care | |
| Employee | $71.50 |
| Employee + Spouse | $301.50 |
| Employee + Child(ren) | $238.00 |
| Employee + Family | $376.00 |
| Copay KC Care | |
|---|---|
| Network | KC Care Network |
| Domestic Tier: benefits when using KCOI or KCOA physicians & services | |
| Annual Deductible (Individual/Family) | $1,250 / $2,500 |
| Out-of-Pocket Maximum (Individual/Family) | $3,500 / $7,000 |
| Co-Insurance (Member's Responsibility) | 20% |
| Covered Services (Outpatient Specialis | 0% |
| General Services (In-Network) | |
| Annual Deductible Individual | $1,250 |
| Annual Deductible Family | $2,500 |
| Annual Out-of-Pocket Limit Individual | $3,500 |
| Annual Out-of-Pocket Limit Family | $7,000 |
| Co-Insurance (Member’s Responsibility) | 20% |
| Office Services (In-Network) | |
| Office Visits/Exam | $25 Co-pay |
| Specialist Visit | $50 Co-pay |
| Urgent Care | $50 Co-pay |
| Preventive Care | No charge |
| Outpatient Diagnostic (lab / X-ray) |
Lab: No charge X-Ray: $50 copay |
| Complex Imaging (MRI, CT / PET scans) | Deductible, then 20% |
| Hospital Services (In-Network) | |
| Ambulance | $200 Copay, then deductible |
| Emergency Room | $200 Copay, then deductible |
| Inpatient Hospital Stay | Deductible, then 20% |
| Outpatient Surgery | Deductible, then 20% |
| Prescription Drugs (through Payer Matrix & Magellen - Tiers 1 / 2 / 3 / 4) | |
| Retail Pharmacy (30-day supply) | $3 / $12 / $40 / $65 |
| Mail Order (90-day supply) | 2.5x Retail |
| Preferred Specialty | 30% up to $150 |
| Non-Preferred Specialty | 30% up to $250 |
Our four medical plan options are offered through Meritain Health an Aetna Company. Need to connect?
Meritain Aetna Network
Technical support: 800-925-2272
Meritain portal support: servicehelp@meritain.com