Health Plan Details

This plan provides health benefits using providers and facilities that are in-network, meaning the providers and facilities have agreed to accept a discounted fee from Blue Cross 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, co-insurance, and copays.

Under the State Health Plan PPO, members choose their in-network providers from the Blue Cross 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 see 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 copay and deductible amounts. If the provider you select doesn't participate at all with Blue Cross (Blue Cross 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 see both in-network and out-of-network providers. If you choose to do so, you will be responsible for both deductibles. For 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 an MRI and chooses 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.

Prescriptions

OptumRx is the Pharmacy Benefit Manager for the State Health Plan PPO and will administer all retail, mail-order, and specialty prescription services for active employees and both Medicare-eligible and non-Medicare eligible retirees.

• Copay Structure
• Specialty Pharmacy FAQs

Behavior Health/Substance Use Disorder Administrator

Blue Cross Blue Shield of Michigan
866-503-3158
www.bcbsm.com/som

State High Deductible Health Plan (HDHP) with Health Savings Account (HSA) - HDHP administered by Blue Cross Blue Shield of Michigan (Blue Cross), HSA administered by HealthEquity

• State HDHP with HSA Fact Sheet
• CY24 State HDHP with HSA Benefit Booklet
• CY24 State HDHP with HSA Benefits-at-a-Glance
• OptumRx Prescription Formulary
• OptumRx Preventive Drug List
• Copay Structure
• Health Savings Account (HSA) Q&As

The State High Deductible Health Plan (HDHP) with Health Savings Account (HSA) provides a different way for employees to cover health care costs while still being able to access the entire Blue Cross PPO network. An HDHP offers a lower biweekly premium in exchange for higher deductibles and out-of-pocket limits. Identified standard preventive services are covered at 100%, but most other services have a 20% in-network coinsurance after meeting the deductible.

Enrollment in the State HDHP will also provide access to an HSA, which is a tax-advantaged savings account that can be used to pay only eligible health, prescription, dental, and vision-related expenses incurred for services not covered by insurance (e.g., deductibles, copays, and coinsurance).

The state will make an annual HSA contribution of $750 for an eligible individual employee enrolled in the State HDHP or $1,500 for an eligible employee who enrolls with one or more eligible dependents in the State HDHP,* effective January 1. This contribution will be prorated for employees who enroll mid-year. Employees can also make pre-tax HSA contributions by payroll deductions. The HSA balance belongs to the employee and can be carried over from year to year. You keep what you don’t spend on medical expenses, even if you retire or leave state employment. Earnings on an HSA fund balance are tax-free, and you can withdraw your money tax-free anytime, as long as you use it for qualified medical expenses for yourself or your tax dependents.

You're eligible for an HSA if you enroll in the State HDHP and have no other non-HDHP health care coverage, including coverage through your spouse or any other person, and you are not claimed as a dependent on another person’s tax return.

Review plan materials carefully to understand the advantages and risks associated with the plan.

*Note: DROP employees and Other Eligible Adult Individuals (OEAIs) and their dependents are not eligible for this benefit.

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 copays.

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 Carriers and Benefit Plans page 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.

• Understanding CY24 HMO Insurance Premium Rates

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, 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).