Medical Plans at a Glance
2024–25 in-network Plans
Blue (Traditional) Plan | Orange (HDHP) Plan | |
---|---|---|
Preventive Care (per BCBSM Guidelines) | 100% coverage. Not subject to deductible. | 100% coverage. Not subject to deductible. |
Deductible | $700 per person; $1,400 family maximum | $1,700 if you have single coverage; $3,400 if you have two-person or family coverage |
Primary Care office visits | $25 copay. Not subject to deductible. | 80% coverage after deductible is met. |
online office visits | $10 copay. Not subject to deductible. | $49 fee until deductible met, then 80% coverage. |
urgent care and Specialist Office Visits | $50 copay. Not subject to deductible. | 80% coverage after deductible is met. |
Ambulance | $50 copay. Not subject to deductible. | 80% coverage after deductible is met. |
Emergency room visits | $250 copay. Not subject to deductible | 80% coverage after deductible is met. |
Most other covered services (see Benefits at a Glance below for exceptions of services covered at lower percent) | 80% coverage after deductible is met. | 80% coverage after deductible is met. |
Annual out-of-pocket maximum | $3,000 per person; $6,000 family maximum | $4,000 if you have single coverage. $7,150 if you have two-person or family coverage. |
auto accident exclusion (benefits are not payable under the plan for injuries received
in a accident involving a motor vehicle) FOR MORE INFO REVIEW: FAQ |
Yes, applicable. |
Yes, applicable. |
Benefits at a glance | Blue BAAG | Orange BAAG |
Summary of Benefits and Coverage: | Blue SOB&C | Orange SOB&C |
Employee premiums (per pay period, two times/month) *additional spouse surcharge (+$80 per pay) may apply |
Salary <$33,500K Single: $37.43 Two-Person*: $108.70 Family*: $158.66 Salary $33,500K–$70K Single: $47.93 Two-Person*: $139.71 Family*: $205.65 Salary $70K–$100K Single: $57.82 Two-Person*: $163.59 Family*: $240.62 Salary >$100K Single: $62.29 Two-Person*: $177.79 Family*: $258.94 |
Single: $16.00 Two-Person*: $38.50 Family*: $55.00 |
Provider Informaiton
Blue Cross Blue Shield of Michigan
1.877.671.2583