ADDITIONAL STATE HEALTH PLAN ADVANTAGE BENEFITS

The State Health Plan Advantage provides a benefit covering the medically necessary charges for the treatment of an accidental (non-occupational) injury that occurs to you or a covered member of your family. The maximum benefit payable for all of a person’s treatments resulting from one accident is $300.

This Supplementary Accident Benefit will be applied toward any expenses remaining after BASIC benefits and before MAJOR MEDICAL benefits have been applied.

This benefit covers the following services and charges relating to an accidental injury:

Supplementary Accident Benefits are not payable for:

The State Health Plan Advantage provides a benefit to cover certain hearing aid expenses you or your family members may incur.

In Michigan, benefits under this Hearing Care Benefit are payable for the services of BCBSM participating providers only. Benefits are not payable for services and supplies from nonparticipating Michigan providers. Call the BCBSM State of Michigan Customer Service Center for a listing of participating providers at 517-322-9515 (Lansing) and 1-800-643-4652 (outside the Lansing area).

Participating providers are those who have entered into an agreement to accept the BCBSM approved amount as payment in full for covered Hearing Care services and supplies. Eligible providers include:

Out-of-state participating providers also will be paid the BCBSM approved amount. Out-of-state nonparticipating providers will be paid the reasonable and customary charges made by the individual provider.

Hearing Care benefits are available only after you receive a medical examination (commonly called a "Medical Clearance Examination") by a physician to rule out the presence of a medical condition. This expense is covered as a separate MAJOR MEDICAL (office visit expense) benefit.

The following services and supplies are payable for each covered member once in every 36 consecutive months:

Hearing Care benefits are NOT payable for hearing aid repairs or for the replacement of parts (including batteries and ear molds). Benefits also are not payable for the replacement of lost or broken hearing aids.

This benefit is available to you and your spouse and is free of charge if the screening is provided by the Office of the State Employer (OSE) Health Screening Unit. You will be contacted when your screening date is scheduled.

You also can directly contact the OSE Health Screening Unit about arranging your screening appointment:

If you have the health screening tests listed below performed by your personal physician (instead of the OSE Health Screening Unit), and if all of these tests are completed within 30 consecutive days (from start to finish), this benefit will cover your physician’s charges up to the current cost of such an OSE health screening ($114).

If you see your personal physician for this screening, you should contact the OSE Health Screening Unit to get an authorization form that you can submit to the BCBSM State of Michigan Customer Service Center, along with your doctor’s bill and a completed "State of Michigan Group Health Plan Claim Form."

Multiphasic Health Screening benefits will not be payable for more than one set of such services performed during any consecutive 12-month period. This benefit will not be payable under any other part of the State Health Plan Advantage beyond what is payable under this benefit.