How to Use Your HMO Benefits

As an HMO member, you’ll choose a primary care physician who will coordinate your health care services. You can read about our process and how to get started.

You should always carry your Blue Cross ID card with you. You’ll have to show it each time you get care. If you need to see a specialist, your doctor will have to give you a referral. Read "How do referrals work in my HMO plan" to learn more.

Going away? The BlueCard® program lets you get care when you travel or temporarily live outside of Michigan. Refer to your Certificate of Coverage and riders or call customer service to find out about limitations to travel coverage.

There are three basic categories of care that your plan covers: primary, urgent and emergency. Some services, like acupuncture or experimental treatments, your plan doesn't cover. Your member handbook will list those services.

Primary care

Your regular doctor will provide care for primary services. There are three types of primary care you’ll get from your physician:

  • Preventive care such as screenings or immunizations that could prevent illness or injury
  • Routine care for illnesses that aren’t life threatening like a sore throat or common cold
  • Follow-up care for your doctor to monitor a condition such as an ear infection
Urgent care

You should visit an urgent care center when you have a condition that isn’t life threatening but could be dangerous. An urgent care center can treat issues like high fever or unusual pain or injury. Your plan will cover urgent care as long as you go to an approved center.

Emergency care

When you have a sudden and unplanned health emergency, you should call 911 or go to the nearest emergency room right away. Injuries such as broken bones or illness with severe pain or fever that could cause permanent damage to your health need immediate care.

Tell your primary care physician about your emergency room visit. They can arrange follow-up care if you need it.

Most hospitals will send us the bill for your emergency services. If you happen to get a bill, send it to us with an explanation of services, your paid receipt and the member reimbursement form (PDF).

Mental health services

We cover services for people struggling with substance abuse or mental health conditions. Our care managers evaluate your needs and help arrange services. Learn more about our mental health services and what you can expect.

Pain management

You get coverage for services to help you manage pain. We consider pain management services an important part of a complete disease treatment plan.

Your primary care physician will coordinate your pain management treatments. Find out more in your benefits booklet.

Breast reconstruction

Your health coverage complies with the Women’s Health and Cancer Rights Act of 1998. It includes important protections for you when you're having surgery and reconstruction of the breast following a mastectomy.

We'll cover you for the following:

  • Reconstruction of the breast where the mastectomy is performed for treatment of cancer 
  • Surgery and reconstruction of the other breast to produce a symmetrical appearance 
  • Prostheses and other care to relieve physical complications of all stages of a mastectomy
Obstetrical care

After you have a baby, you'll be able to stay in the hospital for care. This is called an obstetrical stay. We won't restrict this stay to less than 48 hours following a vaginal delivery. If you have a cesarean section, we give you 96 hours. 

Your doctor or other health provider doesn't need to authorize an obstetrical stay within these time limits. The attending physician or certified nurse midwife might work with you to decide to discharge you earlier than that.

Woman's Choice Program

When you're a Blue Care Network member, you don't need a referral to see a gynecologist or obstetrician, or to get a mammogram. You can choose which provider in our network you want to see.

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