HMO plan

Blue Cross® Select HMO Value

2020 plan year

You can buy this plan if you live in one of 20 counties (Bay, Calhoun, Clinton, Eaton, Genesee, Ingham, Kalamazoo, Kent, Livingston, Macomb, Monroe, Muskegon, Oakland, Ottawa, Saginaw, Shiawassee, St. Clair, Van Buren, Washtenaw, Wayne).

About this plan

With this plan, you have a low monthly premium. But you pay more for health care services before we start sharing the cost with you. You choose a primary care physician from our Select network.

Availability

You can buy this plan if you live in one of 20 counties (Bay, Calhoun, Clinton, Eaton, Genesee, Ingham, Kalamazoo, Kent, Livingston, Macomb, Monroe, Muskegon, Oakland, Ottawa, Saginaw, Shiawassee, St. Clair, Van Buren, Washtenaw, Wayne). Look for doctors and hospitals that take this plan

Plan Type

Select HMO. You'll choose a primary care physician from the Select network. Your doctor refers you to specialists in the broader HMO network. Except for emergencies or accidental injuries, you aren't covered out-of-network. 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 theSummary 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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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:$8,150
Family:$16,300

Out of network

Not Covered

Coinsurance

In network

You pay 0%.

Out of network

Not Covered

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

Not Covered

Office Visits

Primary Care

You pay $30.

Specialist

You pay $0 after deductible.

Urgent care center

You pay $40.

Emergency Room

You pay $0 after deductible.

Prescriptions

You pay $0 after you meet your deductible.

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 BCN ID card and providing the procedure code. Your provider can also provide this information upon request.