In-network benefits

When you see your primary care physician, or get a referral to a doctor or hospital that takes this plan, that's called getting your care in-network. Other care isn't covered except:

  • In an emergency.
  • When you're traveling outside of Michigan. Learn more.

Your deductible

Be sure to compare your before and after deductible costs. It makes a big difference in what you have to pay. This plan's deductible is:

  • $1,650 for an individual
  • $3,300 for a family (two or more members)
What we call it What it is When you pay What you pay
Preventive services Exams, prescriptions, tests and shots you get when you're well to prevent illness and injury Anytime $0
Pediatric services
Children can get pediatric benefits until the end of the calendar year in which they turn 19.
Checkups children get when they're well Anytime $0
Vision care for children: Exam and glasses or contacts Once a year $0
Ambulatory services Office visit to your primary care physician
Anytime $30
Office visit to a specialist with a referral
Before deductible All costs
After deductible $50
Laboratory and diagnostic services Lab tests Anytime $0
Radiology services like X-rays, EKGs and ultrasounds

Allergy testing and shots
Before deductible All costs
After deductible 30%
Imaging services like MRIs Before deductible All costs
After deductible $200 + 30%
What we call it What it is When you pay What you pay
Maternity and newborn care

Doctor office visits while pregnant

  • Tests and ultrasounds you get during the visit are billed under laboratory services
Anytime $0
Care you get when you deliver your baby in the hospital Before deductible All costs
After deductible $500 + 30%
Emergency services Emergency room visit
Before deductible All costs
After deductible $250 + 30%
Transportation by ambulance Before deductible All costs
After deductible 30%
Urgent care center visit
Anytime
$40
Hospitalization and other services Care you get when you're in the hospital for at least one night Before deductible All costs
After deductible $500 + 30%
Hospice care Before deductible All costs
After deductible $0
Most other services, like inpatient and outpatient surgery, chemotherapy, home health care and sleep studies Before deductible All costs
After deductible 30%
What we call it What it is When you pay What you pay
Rehabilitative and habilitative services and devices

Services that help you recover from or manage an injury or illness, like:

  • Physical and occupational therapy
  • Spinal manipulation from a chiropractor
  • Speech therapy
  • Diabetes supplies
Before deductible All costs
After deductible 30%
Durable medical equipment, like a wheelchair, walker or oxygen tank Before deductible All costs
After deductible 50%
Mental health/substance abuse Care you get at a mental health or substance abuse facility as an inpatient Before deductible All costs
After deductible $500 + 30%
Office visit to an outpatient mental health or substance abuse facility Before deductible All costs
After deductible 30%