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Young Adult BlueSM

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Finally! An affordable medical health care program for young adults

To stay healthy, you want to make sure you have access to the best health care possible. Young Adult Blue offers a wide range of benefits to provide the protection you need, when you need it.


Young Adult Blue Benefits-at-a-Glance

Download Young Adult Blue Benefits (77K PDF)
  In-network Out-of-network
Benefits
Annual deductible $1,000 per individual contract, per calendar year $1,000 per individual contract, per calendar year
Copayment 30% of the BCBSM-approved amount 50% of the BCBSM-approved amount
Annual copay dollar maximum $2,500 per individual contract The out–of–network annual copay dollar maximum is unlimited. Out–of–network copays contribute to the in–network copay dollar maximum.
Annual out-of-pocket maximum: The annual out-of-pocket maximum limits the amount members are responsible for paying each calendar year. Once the annual out-of-pocket maximum is met, most services are payable at 100% of the BCBSM-approved amount. $3,500 per individual contract No out–of–pocket maximum
Lifetime maximum per member $5 million
Fourth-quarter deductible
carry-over		 Any amount you pay toward your deductible during the last three months of the calendar year will be applied to your deductible for the following calendar year. We will not apply amounts paid under other contracts toward your deductible.
Preventive services
Includes health maintenance exam, routine laboratory and radiology, fecal occult blood screening, flexible sigmoidoscopy, gynecological exam, childhood immunizations (through age 15), Pap smear screening, prostate specific antigen screening, well-baby and well-child exams (6 visits per year through age 1; 2 visits per year, ages 2 through 3; 1 visit per year, ages 4 through 15) Not covered
Mammography screening Covered — 70% after deductible Covered — 50% after deductible
Preventive dental Not covered
Preventive vision (VSP provider network only) Not covered
Physician office services
Office visits Not covered
Outpatient presurgical second opinion consultations Covered — 100% after deductible Covered — 50% after deductible
Office consultations Not covered
Emergency and urgent care services
Medical emergencies and accidental injuries Covered — 70% after in-network deductible
Ambulance service: medically necessary, emergency ground transport and air ambulance Covered — 70% after in-network deductible
Urgent care Not covered
Diagnostic and radiation services
Ultrasound Covered — 70% after deductible Covered — 50% after deductible
Laboratory tests and pathology Covered — 70% after deductible Covered — 50% after deductible
EKGss Covered — 70% after deductible Covered — 50% after deductible
Diagnostic radiology and X-rays Covered — 70% after deductible Covered — 50% after deductible
Colonoscopies (diagnostic) Covered — 70% after deductible Covered — 50% after deductible
CT scans and MRIs (BCBSM-participating facilities only) Covered — 70% after deductible Covered — 50% after deductible
Radiation therapy Covered — 70% after deductible Covered — 50% after deductible
Maternity services
Delivery and newborn exam Not covered
Pre and postnatal exams (office visits) Not covered
Inpatient hospital care
Semi private room: 120 days with 60-day renewal (BCBSM-approved facilities only) Covered — 70% after deductible Covered — 50% after deductible
Inpatient consultations Covered — 70% after deductible Covered — 50% after deductible
Complications of pregnancy Covered — 70% after deductible Covered — 50% after deductible
Surgical care — hospital or outpatient
Inpatient surgical care Covered — 70% after deductible Covered — 50% after deductible
Outpatient surgical care Covered — 70% after deductible Covered — 50% after deductible
Physician surgical services Covered — 70% after deductible Covered — 50% after deductible
Gender reassignment surgery and services Not covered
Bariatric surgery and services Not covered
Alternatives to hospitalization
Home health care: up to the annual maximum (BCBSM-participating providers only) Covered — 70% after in-network deductible
Hospice care: up to the annual dollar maximum (BCBSM participating programs only) Covered — 100% no deductible
Outpatient services
Outpatient physical, occupational and speech therapy:
60 consecutive days per condition		 Covered — 70% after deductible Covered — 50% after deductible
Chemotherapy (IV and oral) Covered — 70% after deductible Covered — 50% after deductible
Home infusion therapy (BCBSM participating providers only) Covered — 70% after in-network deductible
Voluntary sterilization Covered — 70% after deductible Covered — 50% after deductible
Prosthetics (BCBSM-participating providers only) Covered — 70% after in-network deductible
Other medical benefits
Insulin, disposable needles and syringes dispensed with insulin, diabetic testing supplies Covered — 70% after deductible Covered — 50% after deductible
Outpatient diabetes management program Covered — 70% after deductible Covered — 50% after deductible
Contraceptives Not covered
Organ transplantation
Bone marrow transplants Covered — 70% after deductible Covered — 50% after deductible
Kidney, cornea and skin transplants Covered — 70% after deductible Covered — 50% after deductible
Specified organ transplant:
$1 million lifetime maximum per transplant type, included in the $5 million lifetime maximum (BCBSM-designated facilities only)		 Covered — 100% no deductible
Mental health and substance abuse treatment
Inpatient mental health (BCBSM-approved facilities only) Covered — 70% after deductible, 30 days with 60-day renewal Covered — 50% after deductible, 30 days with 60-day renewal
Outpatient mental health Not covered
Substance abuse: inpatient (residential) and outpatient: up to state-mandated benefit (BCBSM-approved facilities only) Covered — 70% after deductible Covered — 50% after deductible
Prescription drugs
You are eligible for the BCBSM Affinity Rx Program, which allows you to purchase prescription drugs at the BCBSM-negotiated rate rather than at full retail price.
Note: Out-of-network and nonparticipating providers may bill members for the difference between BCBSM's approved amount and the provider's charge, even when referred.

Exclusions and limitations: Conditions covered by workers’ compensation or similar law; services or supplies not specifically listed as covered under your benefit plan; services received before your effective date or after coverage ends; services you wouldn't have to pay for if you did not have this coverage; services or supplies that are not medically necessary; physical exams for insurance, employment, sports or school; any amounts in excess of BCBSM's approved amount; cosmetic surgery; dental care, dental implants or treatment to the teeth except as specifically stated in your benefit plan; hearing aids; infertility services; private duty nursing; eyeglasses or contact lenses; telephone, facsimile machine or any other type of electronic consultation; educational services, except as specifically provided or arranged by BCBSM; nutritional counseling; care or treatment furnished in a nonparticipating hospital, except as specifically stated in your benefit plan; personal comfort items; custodial care; services or supplies supplied to any person not covered under your benefit plan; services while confined in a hospital or other facility owned or operated by state or federal government, unless required by law; services provided by a professional provider to a family member; services provided by any person who ordinarily resides in the covered person's home or who is a family member; any drug, medicine or device that is not FDA–approved, unless required by law; vitamins, dietary products and any other nonprescription supplements; dental services, except for dental injury; appliances or supplies; war or any act of war, whether declared or not; communication or travel time, lodging or transportation, except as stated in your benefit plan; foot care services, except as stated in your benefit plan; health clubs or health spas, aerobic and strength conditioning, work hardening programs and related material and products for these programs; hair prosthesis, hair transplants or implants; experimental treatments, except as stated in your benefit plan; weight loss programs; and alternative medicines or therapies.

This document is intended to be an easy–to–read summary. It is not a contract. Additional limitations and exclusions may apply to covered services. A complete description of benefits is contained in the applicable Blue Cross Blue Shield of Michigan certificate and riders. Payment amounts are based on the BCBSM–approved amount, less any applicable deductible and/or copay amounts required by the plan. All covered benefits are subject to a pre–existing conditions waiting period, unless noted otherwise. This coverage is provided pursuant to a contract entered into in the state of Michigan and shall be construed under the jurisdiction and according to the laws of the state of Michigan.
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