HMO plan

Blue Cross® Metro Detroit HMO Silver Saver - 94

2020 plan year

You can buy this plan if you live in Macomb, Oakland or Wayne county.

About this plan

With this plan, you choose a primary care doctor who refers you to other doctors in our wide HMO network. Some of your benefits start right when your plan does, including $30 primary care physician visits.

Coverage Level

70 percent    73 percent    87 percent     94 percent

This is a Silver 94 plan. That means it covers about 94 percent of your health care costs. Depending on your income, you may be eligible for a silver plan that covers more of your costs. Find a plan to see if you qualify.

Availability

This is our most affordable silver plan for residents of Macomb, Oakland and Wayne counties. You'll get a good balance of cost and coverage, and you'll be able to use some benefits right away.Look for doctors and hospitals that take this plan

Plan Type

Metro Detroit HMO. You'll choose a primary care physician from the Metro Detroit HMO network who will refer you to other doctors in this plan's network. What’s the difference between HMO and PPO plans?

Find a doctorView map

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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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: $400
Family: $800

Out of network

Not Covered

Coinsurance

In network

You pay 10% after deductible.
You pay 50% after deductible for bariatric, temporomandibular joint, infertility, prosthetic and orthotic, and durable medical equipment services.

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: $750
Family: $1,500

Out of network

Not Covered

Office Visits

Primary Care

You pay $10.

Specialist

You pay $30 after deductible.

Urgent care center

You pay $40.

Emergency Room

You pay $100 after deductible, then 10%. Copay waived if you're admitted to the hospital.

Prescriptions

Copays start at $4 after 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.