State Health Plan PPO
Blue Cross Blue Shield
of Michigan (BCBSM)
800-843-4876
www.bcbsm.com/som
CY2023
CY2022
Behavioral Health/Substance Use Disorder (BH/SUD) Administrator for the State Health Plan PPO
Blue Cross Blue Shield of Michigan (BCBSM) in partnership with Lucet
Inquiries for Benefits, Claims, or ID Cards
800-843-4876 (BCBSM)
Authorizations or Referrals
866-503-3158 (Lucet)
Optum Rx (SHP PPO)
www.optumrx.com/SOM
Specialty Pharmacy FAQs
Copay Structure
Active Employees and Non-Medicare Retirees
866-633-6433
Medicare Eligible Retirees
866-635-5941
State HDHP with HSA
Blue Cross Blue Shield
of Michigan (BCBSM)
800-843-4876
www.bcbsm.com/som
CY2023
State HDHP with HSA Benefit Booklet
State HDHP with HSA Benefits-at-a-Glance
CY2022
State HDHP with HSA Benefit Booklet
State HDHP with HSA Benefits-at-a-Glance
Behavioral Health/Substance Use Disorder (BH/SUD) Administrator for the State HDHP
Blue Cross Blue Shield of Michigan (BCBSM) in partnership with New Directions
Inquiries for Benefits, Claims, or ID Cards
800-843-4876 (BCBSM)
Authorizations or Referrals
866-503-3158 (New Directions)
Optum Rx (State HDHP with HSA)
www.optumrx.com/SOM
Copay Structure
Active Employees
866-633-6433
HealthEquity Health Savings Account (HSA)
877-284-9840
Log in at www.bcbsm.com/som to manage your HSA from HealthEquity.
Catastrophic Health
Blue Cross Blue Shield of Michigan (BCBSM)
800-843-4876
Discontinued effective 1/1/23
CY2022
C.O.P.S. Health Trust
(MSPTA-represented only)
800-229-2210
248-524-0454
Fax: 248-524-2752
www.bluewaterbenefitsadmin.com
Rates
CY2023
CY2022
To determine individual eligibility for HMO health plans, use the HMO ZIP Code Tool.
HMO ZIP Code Coverage Maps:
Delta Dental of Michigan
800-524-0150
www.deltadentalmi.com/som
2023 State Dental Plan
Active and MSPTA Plan Booklet
Dental Plan Comparison Chart
Preventive Dental Plan
Plan Booklet
2022 State Dental Plan
Active and MSPTA Plan Booklet
Dental Plan Comparison Chart
Preventive Dental Plan
Plan Booklet
Flexible Savings Account (FSA)
Health Care & Dependent Care
www.healthequity.com/wageworks
877-924-3967
Eligible Expenses:
Note: HealthEquity acquired WageWorks.
You will be seeing co-branding across their
web platforms and resources, including
www.healthequity.com/wageworks, the
member portal, emails, and other materials.
Long Term Disability (LTD)
Sedgwick
800-324-9901
Employee & Dependent Life Insurance
Securian Financial Group, Inc.
Underwritten by Minnesota Life Insurance Company
877-867-5781
Note: These booklets are not a contract. Rather, they are intended to be a summary description of benefits. Every effort has been made to ensure the accuracy of this information. However, if statements in this description differ from the applicable coverage documents, then the terms and conditions of those documents will prevail.
