Health Plan Details
State Health Plan Preferred Provider Organization (PPO)
State Health Plan PPO - Administered by Blue Cross Blue Shield of Michigan (BCBSM)
The State Health Plan PPO provides reimbursement for medical care 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.).
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 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, co-insurance, and copays.
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 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 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 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.
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.
Behavior Health/Substance Abuse Administrator
Effective October 1, 2019, Blue Cross Blue Shield of Michigan, in partnership with New Directions, will be replacing Magellan Health as the State Health Plan (SHP) PPO Behavioral Health/Substance Abuse carrier. Current SHP PPO enrollees will be automatically transitioned with no gap or changes in coverage. New SHP PPO membership ID cards will be mailed in September 2019.
Blue Cross Blue Shield of Michigan, in partnership with New Directions
State Health Plan PPO – Behavioral Health/Substance Abuse Frequently Asked Questions
State High Deductible Health Plan (HDHP) with Health Savings Account (HSA)
State High Deductible Health Plan (HDHP) with Health Savings Account (HSA) - HDHP administered by Blue Cross Blue Shield of Michigan (BCBSM), HSA administered by HealthEquity
- State HDHP with HSA Fact Sheet
- State HDHP with HSA Benefit Booklet
- State HDHP with HSA Benefits-at-a-Glance
- OptumRx Prescription Formulary
- OptumRx Preventive Drug List
- Copay Structure
- HealthEquity HSA Member Brochure
- Health Savings Account (HSA) FAQs
- HealthEquity HSA Member Investment Guide
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 BCBSM 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: MSPTA-represented (T01) employees and Other Eligible Adult Individuals (OEAIs) and their dependents are not eligible for this benefit.
Health Maintenance Organizations (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 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 Insurance 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. Respond promptly to the carrier to complete the final phase of the enrollment process.
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).
The State will cover the full premium cost of this plan,* and you will receive a $50 biweekly payment for being enrolled in the Catastrophic Health Plan. Please refer to the 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). Be sure to check the terms of coverage under any other plan to ensure coverage rules allow primary coverage under that plan. 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.
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.
Federal No Surprises Act: The federal government issued the "transparency in coverage" final rule under the Federal No Surprises Act. The rule provides protection against balance or "surprise" billing under certain circumstances, and phases in new transparency requirements on most group health plans and health insurers. Visit Federal No Surprises Act (michigan.gov) for more information.
Automobile No-Fault Insurance Changes: Prior to July 2, 2020, Michigan’s Automobile No-Fault Insurance Law required individuals to purchase unlimited Personal Injury Protection (PIP) through their auto insurer. PIP pays for services that health insurance may or may not cover. For auto insurance policies issued or renewed after July 1, 2020, Michigan's Automobile No-Fault Insurance Law will change. Under the new legislation, residents may select different levels of PIP coverage. Contact your auto insurance carrier for specific questions regarding PIP coverage.
State-sponsored health insurance carriers are prepared to send a letter to State employees or retirees, upon request, confirming their health plan is considered Qualified Health Coverage (QHC)*. A plan is considered QHC if coverage for motor vehicle accidents is not excluded and the annual deductible is $6,000 or less per covered individual. If your auto insurance is requesting a QHC letter to issue or renew a policy, you may request a QHC letter by contacting your health carrier.
*The Catastrophic Health plan is not considered QHC.