How to use your HMO benefits

Who is this for?

Michigan Health Insurance – Customer Service – HMO Plans

If you're a Blue Care Network member, this information can help you learn how to use your plan.

You pay for your health insurance every month, so it’s important to know how to use it. Your HMO plan can make it easy for you to keep yourself and your family healthy, no matter what you’re facing. Here are some basics on how to use your benefits.

How to get services

Carry your Blues ID card with you at all times and show it each time you need health care. All services should be handled through your primary care physician. Health care you get from a specialist without a referral may not be covered.

For more information about the referral system, read How do referrals work in my HMO plan?

Types of care we offer

There are three basic categories of care: primary care, urgent care and emergency care. 

  • Primary care is scheduled through your primary care physician and includes: 
    • Preventive care, such as health screenings, wellness exams or immunizations, may prevent illness or injury.
    • Routine care, which you'd get for non-life-threatening illnesses like a sore throat, fever, cold or rash.
    • Follow-up care, which refers to visits with your doctor to monitor a previously diagnosed condition such as an ear infection.
  • Urgent care is for conditions that need to be dealt with quickly, but aren't life-threatening. Urgent care is typically covered as long as you go to an approved urgent care center.
  • Emergency care is needed for sudden and unplanned emergencies when taking the time to call your primary care physician may mean permanent damage to your health. Call 911 or go directly to the nearest hospital emergency room. Emergency care is a covered benefit.

Special services

  • Mental health services: We cover services for people struggling with substance abuse or mental health conditions. Our care managers evaluate your needs and help arrange for services.
  • Pain management: You get coverage for services to help you manage pain. We consider pain management services an important part of a complete disease treatment plan.

Special care for women

  • Breast reconstruction following a mastectomy: Your health coverage complies with the Women’s Health and Cancer Rights Act of 1998. It includes important protections for you when you're having surgery and reconstruction of the breast.
  • Obstetrical care: When you're having a baby, you're not limited to a hospital stay of less than 48 hours following a vaginal delivery or 96 hours following a cesarean section. Your doctor or certified nurse midwife may discharge you earlier if everything goes well.
When you're a Blue Care Network member, you don't need a referral to see a gynecologist or obstetrician, or to get a mammogram. You can choose which provider in our network you want to see.

Services that aren't covered

Some services aren't covered by your plan. Please review your member handbook for your particular plan's examples.

  • Acupuncture
  • Care related to a military injury
  • Cosmetic services or supplies
  • Custodial care
  • Experimental or investigational treatment
  • Self-help programs

Where you can go for care

Blue Care Network works with qualified doctors throughout Michigan. Our statewide and regional health plans are offered in more counties than any other HMO in Michigan.

If you haven’t already done so, you'll want to choose a primary care physician from the Blue Care Network. You can see a specialist, but you'll need to get a referral first from your primary care physician in order for your care to be covered.

The BlueCard® program, a national network of Blues plans, lets you get care when you travel or temporarily live outside of Michigan.

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