PPO plan

Blue Cross® Premier PPO Silver Extra - 94

2020 plan year

You can buy this plan if you live in any of the 68 counties in Michigan's Lower Peninsula.

About this plan

This plan costs more each month than bronze plans, but has a much lower deductible. Your plan will start paying more of your medical bills sooner. If you're eligible for a subsidy, your monthly payment and out-of-pocket costs can be even lower.

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

You can buy this plan if you live in any of the 68 counties in Michigan's Lower Peninsula. 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?

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.

Ready to choose a plan?

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: $500
Family: $1,000

Out of network

Individual: $1,000
Family: $2,000

Coinsurance

In network

You pay 5% for most services after deductible.
You pay 50% after deductible for bariatric, temporomandibular joint, infertility, prosthetic and orthotic, and durable medical equipment services.

Out of network

You pay 25% for most services after deductible.
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: $1,300
Family: $2,600

Out of network

Individual: $2,600
Family: $5,200

Office Visits

Primary Care

You pay $5.

Specialist

You pay $10.

Urgent care center

You pay $25.

Emergency Room

You pay 5% after in-network deductible.

Prescriptions

Copays start at $3.

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.