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The State Health Plan PPO provides reimbursement for medical care and prescribed medication expenses when you need treatment for an illness, injury, or disease. The plan covers inpatient hospital care, as well as other outpatient services received at a hospital (including emergency room care). The Plan also covers most of your community-based care (office visits), as well as necessary medical equipment and supplies (crutches, hearing aids, etc.). 

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 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 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.  (S)he is 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. (S)he is responsible for the out-of-network deductible. After that deductible is met, out-of-network charges are paid according to the plan design. 

Benefit Summaries for the State sponsored insurance plans and customer service contacts for State insurance providers are listed below:

• Benefits Summary Brochure for hired prior to 4-1-10
• Benefits Summary Brochure for hired on or after 4-1-10
• State Insurance Providers & Customer Service Contacts

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. There are no deductible requirements. 

You may enroll in an authorized HMO plan serving your residential area . Refer to Section 5 for a listing of HMOs by zip code. Contact the HMO that interests you to request their benefit booklet. If you select a new 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. 

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