Medical Plans at a Glance
2017/18 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 | $500 per person; $1,000 family maximum | $1,500 if you have single coverage; $3000 if you have two-person or family coverage |
Primary Care office visits | $20 copay. Not subject to deductible. | 80% coverage after deductible is met. |
online office visits | $10 copay. Not subject to deductible. | $40 fee. Not subject to deductible. |
urgent care and Specialist Office Visits | $40 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 | $150 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 | $2,500 per person; $5,000 family maximum | $4,000 if you have single coverage. $6,650 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) FAQ? |
Yes, applicable. |
Yes, applicable. |
Benefits at a glance | Blue BAAG | Orange BAAG |
summary of benefits and coverage (for review of both in-network and out-of-network coverage) | BCBSM Plan Blue | BCBSM Plan Orange |
Employee premiums (per pay period, two times/month) *additional spouse surcharge (+$50 per pay) may apply |
Salary <$29K Single: $31.53 Two-Person*: $86.05 Family*: $113.76 Salary $30K-$70K Single: $38.28 Two-Person*: $103.86 Family*: $137.30 Salary $70K–$100K Single: $43.91 Two-Person*: $115.73 Family*: $152.98 Salary >$100K Single: $45.03 Two-Person*: $118.70 Family*: $156.90 |
Single: $8.22 Two-Person*: $21.96 Family*: $29.03 |
Provider Informaiton
Blue Cross Blue Shield of Michigan
1.877.671.2583