PPO plan

Blue Cross® Premier PPO Bronze Extra

2020 plan year

You can buy this plan if you live in any Michigan county.

About this plan

This plan is good for people who don’t want to spend a lot on a monthly health insurance payment. You’ll have a higher deductible. But you’re covered if you get really sick or injured. Because it’s an Extra plan, you pay low copays right away on some of the benefits you use most.

Availability

You can buy this plan if you live in any Michigan county. Look for doctors and hospitals that take this plan.

Plan Type

PPO. You choose the doctors you want to see. No referrals needed.What’s the difference between HMO and PPO plans?

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Health Savings Account

This plan is not eligible to be paired with a Health Savings Account.

Related Documents

For this plan's most-used benefits, see the Summary of Benefits (PDF).

For even more details about this plan, see the Certificate of Coverage (PDF).Certificates are legal documents that describe the benefits of a health insurance plan. Your plan might have different benefits and limitations than those listed in this document.

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Check out your coverage options to find a plan that’s right for you.

Overview

Monthly Premiums

To give you an accurate price, we'll need some information. Find a plan to get a quote.

Deductible

If you have a family plan, and one member meets the individual deductible, Blue Cross will start paying covered benefits for that member only. The remainder of the family deductible has to be met by the remaining family members before Blue Cross will start paying covered benefits for the rest of the members on the plan.

In network

Individual: $7,000
Family: $14,000

Out of network

Individual: $14,000
Family: $28,000

Coinsurance

In network

You pay 40% after deductible for most services.
You pay 50% after deductible for bariatric, temporomandibular joint, infertility, prosthetic and orthotic, and durable medical equipment services.

Out of network

You pay 60% after deductible for most services.
You pay 70% after deductible for bariatric, temporomandibular joint, infertility, prosthetic and orthotic, and durable medical equipment services.

Out-of-pocket maximum

If you have a family plan, and one member meets the individual out-of-pocket maximum, Blue Cross will start paying 100% of the approved amount for covered benefits for that member only. The remainder of the family out-of-pocket maximum has to be met by the remaining family members before Blue Cross will start paying 100% of the approved amount for covered benefits for the rest of the members on the plan.

In network

Individual: $8,150
Family: $16,300

Out of network

Individual: $16,300
Family: $32,600

Office Visits

Primary Care

You pay $35.

Specialist

You pay $75.

Urgent care center

You pay $75.

Emergency Room

You pay 40% after in-network deductible.

Prescriptions

Copays start at $35. See the prescription tab for more details.

Dental

This plan doesn't include dental coverage. To view our Dental plans please click.

Vision

This plan only includes vision coverage for children. To view our Vision plans please click.

Notes

Depending on the health care services you need, your provider might have to get approval before providing that service. Use our website to find more information and a list of services that need approval.

Estimated pricing information for various procedures by in-network providers can be obtained by calling the Customer Service number listed on the back of your BCBSM ID card and providing the procedure code. Your provider can also provide this information upon request.