These documents provide information about our Medicare Plus Blue℠ PPO plans for individuals and groups in our enhanced benefit policies. The policies are separated into three versions: active, archived and retired.
Information about adult diapers and incontinence liners for PPO members only
Ambulance response and treatment without transport covers emergency medical services even if the member isn’t transported to a facility.
Annual physical examinations information for PPO members only
Information about blood and blood components for PPO members only
Determination of refractive state for PPO members only. This is necessary for obtaining glasses and includes specification of lens type.
Foreign travel: Nonemergent, nonurgent care for PPO members only. This information is for care outside of the United States or its territories for non-emergency and non-urgent medical care.
Information about full body skin examinations for PPO members only
Gradient compression stockings information for PPO members only
Information about LASIK and radial keratotomy for PPO members only
Mobile crisis and crisis stabilization (MC/CS) for behavioral health improves care for people who are in crisis.
Information about outpatient rehabilitation therapy caps for PPO members only
Information for remote patient monitoring for PPO members only
Information about the SilverSneakers® fitness program for PPO members only
Information about acupuncture for State Health Plan Medicare Advantage members
Information about behavioral health substance abuse IOP for State Health Plan Medicare Advantage members
Information about continuous blood glucose monitors for State Health Plan Medicare Advantage members
Information about orthopedic shoes and orthotic shoe inserts for State Health Plan Medicare Advantage members
Information about preventive care services for State Health Plan Medicare Advantage members
Information about self-administered drugs for State Health Plan Medicare Advantage members
Information about TMJ dysfunction treatment for State Health Plan Medicare Advantage members
Information about 5th level hospice care for UAW Retiree Medical Benefits Trust PPO members only
Information about UAW Retiree Medical Benefits Trust podiatry services, PPO only
Information about U of M - Assisted reproductive techniques, PPO only
Information about U of M - Autism spectrum disorder, PPO only
Information about U of M - contraceptive devices and sterilization
Information about U of M - Gender reassignment and gender affirming procedures, PPO only
Information about U of M - Nutritional counseling related to approved medical conditions, PPO only
Information about U of M - Orthopedic shoes and orthotic inserts, PPO only
Information about U of M - Pregnancy terminations - medical and surgical, PPO only
Information about U of M - Routine ophthalmological exam including refraction, PPO only
Information about U of M - Weight reduction / bariatric surgery, PPO only
Information about U of M - Well-woman visit / gynecological exam, PPO only
Information about worldwide coverage for emergency and urgent care for PPO members only
This is the archived version for Information about adult diapers and incontinence liners for PPO members only
This is the archived version for Information about annual gynecological exams for PFFS members only
This is the archived version for Information about annual gynecological exams for PPO members only
This is the archived version for Information about annual physical exams for PFFS members only
This is the archived version for Information about annual physical exams for PPO members only
This is the archived version for Information about bathroom safety items for PPO members only
This is the archived version for Information about adult diapers and incontinence liners for PPO members only
This is the archived version for Information about blood and blood components for PPO members only
This is the archived version for Information about chiropractic care information for PPO group members
This is the archived version for Information about chiropractic care information for PPO individual members
This is the archived version for Information about contraceptive devices for PPO members only
This is the archived version for dental care information for PPO members only
This is the archived version for information about determination of refractive state for PPO members only. This is necessary for obtaining glasses and includes specification of lens type.
This is the archived version for emergency department care information for PPO members only
This is the archived version for Information about adult diapers and incontinence liners for PPO members only
This is the archived version for Information about full body skin examinations for PPO members only
This is the archived version for Information about gradient compression stockings for PPO members only
This is the archived version for Information about hearing services for PPO members only
This is the archived version for home infusion therapy information for PPO members only
This is the archived version for information about hospice care for PPO members only
This is the archived version for information about human organ transplant for PPO members only
This is the archived version for inpatient hospital care information for PFFS members only
This is the archived version for inpatient hospital care information for PPO members only
This is the archived version for information about LASIK and radial keratotomy for PPO members only
This is the archived version for information about online visits for PPO members only
This is the archived version for information about private duty nursing for PPO members only
This is the archived version for information about remote patient monitoring for PFFS members only
This is the archived version for information about remote patient monitoring for PPO members only
This is the archived version for information about routine physical examinations for PPO members only
This is the archived version for information about the SilverSneakers® fitness program for PPO members only
This is the archived version for skilled nursing facility information for PFFS members only
This is the archived version for skilled nursing facility information for PPO members only
This is the archived version for information about sterilization for PPO members only
This is the archived version for information about total body skin examination
This is the archived version for travel and lodging information for PPO members only
This is the archived version for vision care information for PPO members only
This is the archived version for information about worldwide coverage for emergency and urgent care for PPO members only
This is the retired version for Information about bathroom safety items for PPO members only
This is the retired version for Information about consultation services by a clinical psychologist
This is the retired version for information about dental care for PPO members only
This is the retired version for information for determination of refractive state. This is necessary for obtaining glasses and includes specification of lens type.
This is the retired version for information about emergency department care
This is the retired version for information for non-emergency and non-urgent medical care outside of the United States or its territories
This is the retired version for information about gradient compression stockings
This is the retired version for information about inpatient hospital care
This is the retired version for information about LASIK and radial keratotomy
This is the retired version for information about routine hepatitis C screening
This is the retired version for information about pap tests and pelvic exam screenings
This is the retired version for information about skilled nursing facilities
This is the retired version for information about temporomandibular joint appliances