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December 2017

We’re offering 28 products for the individual marketplace in 2018

Blue Cross Blue Shield of Michigan and Blue Care Network are offering a total of 28 products for the individual marketplace in 2018, including:

  • Nine PPO products and 19 HMO products
    • 15 products in 63 rural counties
    • 22 products in two West Michigan counties
    • 28 products in three Southeast Michigan counties
    • 22 products in 15 urban counties

We’ve modified some plans and made deductible and out-of-pocket changes to most plans. We’re closing 13 plans, effective Dec. 31, 2017: the EPO network, PPO Multi-State Plans, Personal Plus HMO plan, Select Gold HMO plan and Partnered HMO network.

Some of the key product changes for 2018 include:

  • HMO plans will have limited BlueCard coverage. For out-of-state care, these plans cover only urgent and emergency care.
  • PPO plans will have out-of-network cost sharing for out-of-state scheduled services in-network cost sharing for out-of-state urgent and emergency care.
  • Specialty prescription coinsurance moves from 20 to 25 percent to 40 to 45 percent for preferred and non-preferred plans.
  • The Premier PPO Bronze Extra plan (the Centers for Medicare & Medicaid Services standard plan) will be modified to include lower copays for primary care office visits, specialty office visits, urgent care visits and generic prescription drugs — all covered before the deductible.
  • The Gold Metal tier is limited to the Preferred HMO Network and the Premier PPO Network.
  • Silver Extra is modified to conform with the 2018 version of the CMS Silver Standard Plan.
  • The Bronze (basic) Health Savings Account has been modified as follows:
    • Closed the HSA option for these plans.
    • Opened a Bronze (basic) plan that isn’t HSA-eligible in the Select and Metro Detroit HMO networks. The plan covers primary care physician visits, laboratory services and urgent care before deductible.
    • An HSA option will only be available with Bronze Saver plans on the HMO network.
    • The PPO network HSA options are the Bronze and Silver Saver plans.
  • All preferred plans will now be available statewide.
  • All IBU PPO and HMO plans will offer behavior health online visits with each plan’s primary care visit copay.

With the Silver Extra plan (the CMS standard plan), the prescription drug deductible applies only to specialty prescription drugs. Generics, preferred brand and non-preferred brands are covered with a copayment and no deductible.

As always, check member eligibility and benefits at every visit before providing
services. You can do this through web-DENIS or by calling our Provider Automated Response System.

Note: Member ID cards will be reissued for individual products in 2018. Check prefixes carefully when checking benefits and eligibility.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2016 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.