Health Care OptionsYou may select one of the following options.
Information describing specific plan benefits, exclusions, limitations, toll free numbers, and web addresses are available at the insurance plans page this website.
STATE HEALTH PLAN
(administered by Blue Cross Blue Shield of Michigan (BCBSM))
2014-2015 Active Employee State Health Plan PPO BCBSM Plan Booklet
The State Health Plan PPO provides health benefits using providers and facilities that are in-network, meaning the providers and facilities have agreed to accept a discounted fee from BCBSM in order to be in-network. They won't charge you the difference between their normal charge and the amount paid by the State Health Plan PPO. When you see a PPO network provider for covered services, your out-of-pocket costs are limited to deductibles, coinsurance and co-payments.
Under the State Health Plan PPO, members choose their in-network providers from the BCBSM Community Blue/Blue Preferred PPO Network. The network covers all 83 Michigan counties and is the largest PPO network in Michigan. It has more than 20,000 physicians, including specialists, and more than 140 all acute care hospitals in Michigan. Please refer to www.bcbsm.com/som for the list of providers.
You still have the freedom to go out-of-network to any physician, hospital or other provider of your choice. But if you receive services from a provider not in the PPO network, you may be responsible for paying additional out-of-pocket costs. Those costs include increased co-payment and deductible amounts. If the provider you select doesn't participate at all with BCBSM (BCBSM has several different provider arrangements), you may also be required to pay additional charges.
An important note regarding the State Health Plan PPO deductibles:
You have the freedom to go to both an in-network and out-of-network provider. If you choose to do so, you will be responsible for both deductibles. An example: a single person chooses an in-network hospital for surgery. They are responsible for the deductible, then the hospital is reimbursed according to the plan design. Later in the year, that same person needs lab tests performed and chooses to use an out-of-network provider. They are responsible for the out-of-network deductible. After that deductible is met, out-of-network charges are paid according to the plan design.
Benefit Information for the State group insurance plans and customer service contacts for State insurance providers are listed below:Prescription services under the State Health Plan PPO are managed and all claims are handled by MedImpact for active and non-Medicare eligible retirees for retail prescription services. Mail order prescriptioon services are managed by NoviXus.
2014-2015 MedImpact Co-Pay Structure
2014-2015 MSPTA MedImpact Co-Pay Structure
MedImpact Plan Formulary
NoviXus Mail Order Prescriptions Online Registry
Mental health/substance abuse treatment services under the State Health Plan PPO are managed and all claims handled by Magellan Behavioral of Michigan for all bargaining units.
Magellan has developed a website for use by the State of Michigan employees and retirees covered under the State Health Plan PPO. Please visit this site at the following address: www.magellanassist.com. When you access this site, select New or Unregistered Users. Enter the Magellan toll free number (866-503-3158) and select Continue. You then have the option to register by completing the necessary fields or you can select Skip Registration to access information, tools and other resources to support you with work, home, and daily life needs.
HEALTH MAINTENANCE ORGANIZATION PLANS (HMOs)
An HMO is a managed care plan that provides medical care through its network of physicians, pharmacies, contracted hospitals, and medical care suppliers. You can choose your own primary care physician who will provide direct care or make referrals from within the network. An HMO provides necessary hospital and medical treatment when you are sick or injured, prescription medicine services, substance abuse treatment, short-term mental health care, and routine preventive health maintenance services such as immunizations. When you see a HMO in-network provider for covered services, your out-of-pocket costs are limited to deductibles (starting October 12, 2014), and co-payments.
You may enroll in an authorized HMO plan serving your residential area. You may look up HMOs in your residential area using the zip code tool. Utilize the Insurance Plans page of this site to review plan summaries or contact the HMO that interests you to request their benefit booklet. If you are new to an HMO, that HMO may ask you to select your primary care physician. Respond promptly to the carrier to complete the final phase of the enrollment process.
CATASTROPHIC HEALTH PLAN (BCBSM)
The State will cover the full premium cost of this plan,* and you will receive a $50 payment biweekly for being enrolled in the Catastrophic Health Plan. Please refer to the FY 2014-2015 Insurance Rates Page.
This is a hospitalization-only plan intended as an option if you have coverage elsewhere (for example, through a spouse who works for another employer). Benefits under this plan are payable only after you have paid expenses equal to one month's basic salary (your deductible). The maximum deductible for two or more covered persons in your family is limited to 1½ months of your basic salary. If you are covered by a spouse who works for a non-State employer, that plan will generally cover those expenses not covered by this plan if it is your primary plan (for example, the expenses you incur in meeting this plan's deductible requirement, community-based services, prescriptions, etc.)
This plan covers inpatient hospital expenses, as well as certain other services received at the hospital on an outpatient basis (including emergency room care). This plan does not cover prescription charges, office visit charges, medical equipment, psychiatric services, or other Major Medical services.
If your spouse's (non-State) employer will not cover you under their group plan because you are enrolled in any of the State-sponsored health care options, including the Catastrophic Plan, you can "opt out" completely and still receive the $50 biweekly payment (select "Health Waiver with Rebate"). You must be in pay status to receive this payment.
*Except for those employees in certain bargaining units who are hired on or after 1/1/00 who have a regular work schedule of 40 hours or less per bi-weekly pay period (not permanent-intermittent positions).