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: $0
Family: $0
Out of network
Individual: $0
Family: $0
Coinsurance
In network
You pay 30% for most services.
You pay 50% for bariatric, temporomandibular joint, infertility, prosthetic and orthotic, and durable medical equipment services.
Out of network
You pay 50% for most services.
You pay 70% 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
Specialist
Urgent care center
Emergency Room
Prescriptions
Copays start at $15. See the prescription tab for more details.
Dental
Vision
Medical
In-network benefits
When you go to a doctor or hospital that accepts this plan, that's called getting your care in network. Look for doctors and hospitals that take this plan.
Because this plan is a PPO, you're covered when you go to a doctor or hospital that doesn't take this plan, but you'll pay more. That's called getting your care out of network.
If you have an emergency or accidental injury outside of Michigan, your care is covered with in-network cost sharing. Any scheduled services you receive outside of Michigan have out-of-network cost sharing as long as you see a participating out-of-state provider. To find a participating out-of-state provider, call the number on the back of your Blue Cross ID card.
Online visits and prescription drugs have nationwide coverage with in-network cost-sharing.
Preventive care
Medical exams, prescription drugs and immunizations
Preventive medical care includes but is not limited to certain prescription drugs, immunizations, health maintenance exams, certain laboratory services, pre-natal visits, gynecologic exams, pap smear screening, mammogram screening, certain female contraceptives, female voluntary sterilization, screening colonoscopy, well baby and well-child visits and pediatric vision.
Out of network
You pay 50%.
Office visits
This plan's coinsurance applies to allergy testing, diagnostic and laboratory services you get during the office visit. Some diagnostic services require prior authorization.
In network
Primary care: You pay 30% including retail health and post-natal.
Specialist: You pay 30%.
Out of network
You pay 50%.
Online visits
In network
You pay 0% for Blue Cross medical online visits.
You pay 30% for Blue Cross behavioral health online visits.
Out of network
You pay 50%.
Emergency Services
Emergency room visit
Transportation by ambulance
Urgent care center visits
Emergency services and accidental injuries have in-network cost-sharing.
Out of network
You pay 50%.
Hospitalization and other services
Inpatient hospital care, maternity, delivery & newborn care, surgery, chemotherapy
Blue Cross-participating facilities only. Certain services require prior authorization.
Out of network
You pay 50%.
Rehabilitative services
Outpatient physical and occupational therapy
Physical, occupational, chiropractic and osteopathic manipulative therapy limited to a combined maximum of 30 visits per member per calendar year.
Out of network
You pay 50%.
Chiropractic spinal manipulation and osteopathic manipulative therapy
Physical, occupational, chiropractic and osteopathic manipulative therapy limited to a combined maximum of 30 visits per member per calendar year.
Out of network
You pay 50%.
Speech therapy
Limited to a maximum of 30 visits per member each calendar year.
Out of network
You pay 50%.
Habilitative services
Outpatient physical and occupational therapy
Limited to a maximum of 30 visits per member each calendar year.
Out of network
You pay 50%.
Speech therapy
Limited to a maximum of 30 visits per member each calendar year.
Out of network
You pay 50%.
Applied Behavior Analysis for specified autism spectrum disorder
Needs prior authorization.
Out of network
You pay 50%.
Mental health/substance use
Inpatient and residential mental health
Blue Cross-participating facilities only. Needs prior authorization.
Out of network
You pay 50%.
Outpatient mental health services
Additional services are subject to the plan's coinsurance. Blue Cross approved providers and facilities only. Includes Blue Cross online visits.
Out of network
You pay 50%.
Inpatient and residential substance use
You pay 30%. Blue Cross-approved facilities only. Needs prior authorization.
Outpatient substance use services
You pay 30%. This plan's coinsurance applies to additional services you get during the office visit. Blue Cross-approved providers and facilities only.
Prescriptions
In-network benefits
Using an in-network pharmacy will help keep your costs as low as possible.
You can get 30- or 90-day prescriptions from retail or mail-order pharmacies. You can get 60-day prescriptions from mail-order pharmacies only. Quantity limits per fill may apply for 30-day retail, 90-day retail and 90-day mail order. Opioid-containing medications are limited to no more than a 30-day supply per fill and first fills of select opioid containing medications will be limited to a 5-day supply. Refer to drug list for quantity limits and other exclusions.
Find a pharmacy.
Out-of-network benefits
When you use an out-of-network pharmacy, you pay the full cost of the prescription up front. After you pay the copay, we'll reimburse 80 percent of the Blue Cross-approved amount for that drug. You pay the difference between the Blue Cross-approved amount and what the pharmacy charges.
Out-of-network drugs are limited to a 30-day supply. Mail order is not available.
Covered drugs
What you pay for your medication depends on whether your plan covers the drug and which cost tier it falls under. Certain drugs may need prior authorization. Look on this list to find a drug (PDF).
Tier 1 - Generic
30-day supply: You pay $15.
60-day supply (mail order only): You pay $30.
90-day supply: You pay $45.
Commonly prescribed, generic versions of brand-name medications available for the lowest copay.
Tier 2 - Preferred Brand
30-day supply: You pay 25% (at least $40 and no more than $100).
60-day supply (mail order only): You pay 25% (at least $80 and no more than $200).
90-day supply: You pay 25% (at least $120 and no more than $300).
Brand-name drugs not yet available as a generic.
Tier 3 - Nonpreferred Brand
30-day supply: You pay 50% (at least $80 and no more than $150).
60-day supply (mail order only): You pay 50% (at least $160 and no more than $300).
90-day supply: You pay 50% (at least $240 and no more than $450).
Brand-name drugs that have generic or preferred brand alternatives.
Tier 4 - Preferred Specialty
You pay 40%.Specialty drugs are limited to a 30-day supply. Some specialty drugs are limited to a 15-day supply.
Generic and brand-name drugs used to treat complex health conditions. They usually need special handling and approval. You'll need to use AllianceRx Walgreens Prime to fill prescriptions within this tier.
Tier 5 - Nonpreferred Specialty
You pay 45%.Specialty drugs are limited to a 30-day supply. Some specialty drugs are limited to a 15-day supply.
Because there are less expensive alternatives available for the drugs in this tier, you'll pay more for them at the pharmacy. You'll need to use AllianceRx Walgreens Prime to fill prescriptions within this tier.
Features
Discounts
Through Blue365®, Blue Cross members can save on a variety of products and services, including:
• Weight management programs, organic groceries and fresh produce.
• Yoga classes, workout gear and gym memberships.
• Discounted admission to Michigan attractions.
Online doctor visits
This plan includes online health care.
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