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How to use your HMO benefits

Who is this for?

Michigan Health Insurance – Customer Service – HMO Plans

If you're a new Blue Care Network (HMO) member, this information can help you learn how to get care under your plan.

As a new Blue Care Network (HMO) member, there is so much to learn about your health care benefits that it can seem overwhelming. To make it easier, we have summarized below how you can best use your HMO coverage. 

How to get services

Carry your enrollee ID card with you at all times and show it each time you need health care. Be sure to see your primary care physician first. All services should be handled through your primary care physician. Care you seek on your own may not be covered.

Types of care we offer

We offer comprehensive health care to help your entire family stay healthy, and taking care of you when you’re sick or injured. 

Basically, there are three categories of care: primary care, urgent care and emergency care. Click on the links below to find out more details about each type of service.

  1. Primary care is scheduled through your primary care physician and includes: 
    • Preventive care, which refers to care given to help prevent an injury or illness such as a annual physical exam or immunizations 
    • Routine care, which you would receive for non-life threatening illnesses like a sore throat, fever, cold or rash.
    • Follow-up care, which refers to visits with your doctor to monitor a previously diagnosed condition such as an ear infection.
  2. Urgent care: when you have a condition that isn’t life-threatening yet it needs to be taken care of right away, then urgent care may be the right choice for you. Your care is typically covered as long as you choose from one of the approved urgent care centers.
  3. Emergency care: when you have a sudden and unplanned emergency and taking the time to call your primary care physician may mean permanent damage to your health, call 9-1-1 or go directly to the nearest hospital emergency room. Emergency care is a covered benefit.
  4. Mental health services: we help those who are struggling with substance abuse or mental health conditions. Our care managers evaluate your needs and help arrange for services.
  5. Pain management: we not only treat diseases, but we also help you manage your pain. We consider pain management services an important part of a complete disease treatment plan.

Special care for women

  • Breast reconstruction following a mastectomy: your health coverage complies with the Women’s Health and Cancer Rights Act of 1998. It includes important protections for you when you are having surgery and reconstruction of the breast.
  • Obstetrical care: when you are having a baby, you are not limited to a hospital stay of less than 48 hours following a vaginal delivery or 96 hours following a cesarean section. Your doctor or certified nurse midwife, may discharge you earlier if everything goes well.

Services that aren't covered

Some services aren't covered by your plan. Please review your member handbook for your particular plan's examples.

  • Acupuncture
  • Care related to a military injury
  • Cosmetic services or supplies
  • Custodial care
  • Experimental treatment
  • Investigational treatment
  • Self-help programs

Where you can go for care

Blue Care Network works with qualified doctors throughout Michigan. Our statewide and regional health plans are offered in more counties than any other HMO in Michigan.

If you haven’t already done so, you will want to choose a primary care physician from the Blue Care Network. You can see a specialist, but you will need to get a referral first from your primary care physician in order for your care to be covered.

If you will be traveling out-of-state, The BlueCard® program, a national network of Blues plans, lets you to get care when you travel or temporarily live outside of Michigan.

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