The Blues to offer a variety of individual products for 2015

When the Health Insurance Marketplace opens on Nov. 15, Blue Cross Blue Shield of Michigan and Blue Care Network and will have many new products available for coverage beginning Jan. 1, 2015, or later.

The Blues are offering 41 individual products, 24 of which are BCN HMO plans and 17 of which are Blue Cross PPO plans. Keep in mind that some plans are closing.

Note: Blue Care of Michigan’s Personal Plus^SM will remain open in 2015, but it will not be available to new contracts.

Plans that are being discontinued

• BCBSM’s Keep Fit^SM will no longer be offered. Keep Fit members will need to have purchased another individual plan that becomes effective January 2015.
• Blue Cross Partnered Value and Blue Cross Preferred Value plans will be discontinued, effective Dec. 31, 2014.

New plans for 2015

• Blue Cross^® Metro Detroit EPO — an exclusive provider organization in six counties offered by Blue Cross (For more information, see article titled “We’re preparing to launch new local network called Metro Detroit EPO,” also in this issue.)
• Blue Cross^® Metro Detroit HMO — a local network HMO in three counties offered by Blue Care Network. Members must reside in Wayne, Oakland or Macomb counties (For more information, see the November-December issue of BCN Provider News.
• New “Extra” plans — plans that include a basic individual product benefit design plus the following:
• The plan pays the first four specialist office visits per member before the deductible; copayments will apply.
• The plan pays Tier 1A and Tier 1B generic prescription drugs before the deductible; copays will apply.

Highlights of cost-sharing changes for the “Extra” plans include:

• Simplified cost sharing — Copays have been removed for imaging services (such as CT scans, PET scans and MRIs) and outpatient mental health and substance abuse.
• Inpatient copay — No $500 copay for a stay in a hospital, mental health, substance abuse or skilled nursing facility. Also, no copay for delivery and all inpatient maternity services. Coinsurance will continue to apply.
• Office visits — Primary care physician office copay is reduced to $20 for Silver and Gold Extra plans. For Bronze Extra plans, the primary care physician office copay is $40 and the specialist office copay is $75. (Applies to Blue Care Network only)

Blue Cross will continue to offer the Premier and Multi-State PPO. The plan gives members a broad choice of doctors and hospitals in the Blue Cross statewide PPO network, including nationwide coverage. Members may receive services from hospitals or doctors outside the network, but will pay less if they use in-network providers.

New Medicare Advantage product

BCN Advantage^SM ConnectedCare HMO is a new individual Medicare Advantage HMO product with an exclusive provider network developed primarily around Southeast Michigan and Kalamazoo County. Open enrollment for Medicare Advantage^SM began on Oct. 1, 2014 for a Jan. 1, 2015 effective date. (For details about BCN Advantage^SM ConnectedCare HMO, see the November-December issue of BCN Provider News.

Check member eligibility and benefits

Providers should be sure to check eligibility and benefits before providing services. It’s important to check both the plan name and the network associated with the plan. For local plans, such as the Metro Detroit EPO or HMO, you should always refer within the local network.

Finding your Blues plans and provider networks

For information about how to find the Blues plans you’re contracted to provide services for, check out the new document that’s been posted on web-DENIS:

• From the web-DENIS homepage, click on BCBSM Provider Publications and Resources.
• Click on Newsletters & Resources.
• Click on Finding Blues plans and networks at the top of the page.