Common questions about our
ACA plans and benefits

Yes. 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.

Behavioral health consultations are offered. We provide brief and focused interventions for members as well as consultation sessions where both a medical provider and behavioral health clinician work with you to help you address your behavioral healthcare need. If you have an ongoing or long-term behavioral health need (such as therapy), we can work with you to identify a provider in your plan's network.

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.

Yes, Blue KC offers our members a number of virtual care services – our app, Blue KC Virtual Care, or BlueKCVirtualCare.com (from a computer with camera and sound enabled), allows members to choose from either 24/7 urgent care visits or scheduled 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.

If your doctor doesn’t offer a telehealth video option, and you can’t/don’t want to leave home or you are traveling, you can still see another doctor with the Blue KC Virtual Care app (or BlueKCVirtualCare.com with camera and sound enabled) for common sick care needs.

Often times the cost for virtual visits are the same as seeing a doctor in their office. All plans are different, please refer to your benefits for what you may owe.

However, many virtual care PCP and behavioral health therapy visits are available for a $10 copay. These $10 virtual visits are when you use the Blue KC Virtual Care app, your in-network primary care doctor, and for behavioral health therapy visits. For any other therapy, specialists, or provider virtual visit the cost will be the same as in your in-office copay.

In addition, for our Spira Care members, virtual visits are at no cost with Spira Care providers, the Blue KC app, and in-network behavioral health providers. If Spira Care members visit an in-network PCP, those virtual visits are $10.

Blue KC offers $10 virtual care visits for the following:

• through our app, Blue KC Virtual Care, or on your computer at BlueKCVirtualCare.com (with camera and sound enabled
• your in-network primary care provider (BlueSelect or BlueSelect Plus)
• in-network behavioral health providers

For virtual visits with a specialty provider or other types of therapy your cost will be the same as an in-office visits. Please refer to your benefits for what you may owe.

In addition, many of our in-network providers offer virtual visits and their technology varies. Please talk with your doctor’s office to understand how they deliver virtual care.

No appointment is needed for convenient, secure, 24/7 access to urgent care providers. We encourage you to download the Blue KC Virtual Care app on your smartphone before you need a visit, that way you are ready when sick happens. Or you can use your computer and go to BlueKCVirtualCare.com. Please note when using the website, your computer or laptop needs to have both a camera and microphone enabled.

For behavioral health therapy visits, an appointment is needed.

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 couch or when you’re travelling away from home.

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 Blue KC Virtual Care App or at BlueKCVirtualCare.com.

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.

Our wellness programs include Livongo for help managing diabetes, 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.

Preventive care for ACA members is covered at no cost based on CMS guidelines (details available via our preventive care publication).

Individual dental plans are available. We do not have vision plans available through the ACA.

You can shop for and enroll in an ACA health plan during the annual Open Enrollment Period which runs from November 1, 2021 to January 15, 2022.

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.

Due to COVID-19, you will be able to shop for and enroll in an ACA health plan during the extra open enrollment period. This extra open enrollment period will last from February 15th to August 15th. When you enroll during this time, your coverage will begin on the first day of the month following your enrollment date.

You can shop for and enroll in an ACA health plan during the annual Open Enrollment Period which runs from November 1, 2021 to January 15, 2022.

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.