Key Benefits

This plan includes benefits that help you and your family at no extra cost.

- Free annual visit
- Free laboratory and pathology tests
- Free wellness visits for kids
- Free vaccinations
- Free Blue Cross online visits (medical urgent care visits)
- Free diabetes test strips, lancets and connected devices with diabetes, pre-diabetes & hypertension management programs
- Free maternity and family planning programs
- Free Blue Cross personalized medicine program

- Free app – access to cost and transparency tools
- Free app – myStrength by Livongo® for Behavioral Health
- Primary and mental health office visits including virtual with a copay before deductible
- Retail health visit with a copay before deductible (same as primary office visit copay)
- Urgent care with a copay before deductible
- Discounts at gyms ($29 per month fee for access to over 10,000 gyms)
- Blue 365 discounts on vitamins, food, retailers, etc.

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 Macomb, Oakland or Wayne county. 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 doctor

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.

Metro Detroit Network

Key Benefits

This plan includes benefits that help you and your family at no extra cost.

- Free annual visit
- Free laboratory and pathology tests
- Free wellness visits for kids
- Free vaccinations
- Free Blue Cross online visits (medical urgent care visits)
- Free diabetes test strips, lancets and connected devices with diabetes, pre-diabetes & hypertension management programs
- Free maternity and family planning programs
- Free Blue Cross personalized medicine program

- Free app – access to cost and transparency tools
- Free app – myStrength by Livongo® for Behavioral Health
- Primary and mental health office visits including virtual with a copay before deductible
- Retail health visit with a copay before deductible (same as primary office visit copay)
- Urgent care with a copay before deductible
- Discounts at gyms ($29 per month fee for access to over 10,000 gyms)
- Blue 365 discounts on vitamins, food, retailers, etc.

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 Macomb, Oakland or Wayne county. 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 doctor

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.


Open enrollment is coming soon.

Enroll from Nov. 1 to Dec. 15, 2022, for coverage beginning Jan. 1, 2023. Enroll from Dec. 16, 2022, to Jan. 15, 2023, for coverage beginning Feb. 1, 2023.

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Plan details

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.
Any coupon, rebate or other credits received directly or indirectly from the drug manufacturer may not be applied to a consumer's deductible, cost-sharing or out-of-pocket maximum.

In network

Individual: $300
Family: $600

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.
Any coupon, rebate or other credits received directly or indirectly from the drug manufacturer may not be applied to a consumer's deductible, cost-sharing or out-of-pocket maximum.

In network

Individual: $700
Family: $1,400

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%.

Prescriptions

Copays start at $4 after deductible. See the prescriptions tab for more details.

Dental

This plan doesn't include dental coverage. View our Dental plans.

Vision

This plan only includes vision coverage for children. View our Vision plans.

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.
Any coupon, rebate or other credits received directly or indirectly from the drug manufacturer may not be applied to a consumer's deductible, cost-sharing or out-of-pocket maximum.

In network

Individual: $300
Family: $600

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.
Any coupon, rebate or other credits received directly or indirectly from the drug manufacturer may not be applied to a consumer's deductible, cost-sharing or out-of-pocket maximum.

In network

Individual: $700
Family: $1,400

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%.

Prescriptions

Copays start at $4 after deductible. See the prescriptions tab for more details.

Dental

This plan doesn't include dental coverage. View our Dental plans.


Vision

This plan only includes vision coverage for children. View our Vision plans.


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.

Conditions covered by workers’ compensation or similar law; services or supplies not specifically listed as covered under your benefit plan; services received before your effective date or after coverage ends; services you wouldn’t have to pay for if you did not have this coverage; services or supplies that are not medically necessary; physical exams for insurance, employment, sports or school; any amounts in excess of BCN’s approved amount; cosmetic surgery, admissions and hospitalizations; dental care, dental implants or treatment to the teeth except as specifically stated in your benefit plan; hearing aids; infertility-related drugs; private duty nursing; telephone, fax machine or any other type of electronic consultation; educational services, except as specifically provided or arranged by BCN or specifically stated in your benefit plan; care or treatment furnished in a nonparticipating hospital, except as specifically stated in your benefit plan; personal comfort items; custodial care; services or supplies supplied to any person not covered under your benefit plan; services while confined in a hospital or other facility owned or operated by state or federal government, unless required by law; voluntary abortions or vasectomy reversals; RK, PRRK, or Lasik; services provided by a professional provider to a family member; services provided by any person who ordinarily resides in the covered person’s home or who is a family member; any drug, medicine or device that is not approved by the Food and Drug Administration, unless required by law; vitamins, dietary products and any other nonprescription supplements except as specifically stated in your benefit plan; dental services, except for dental injury; appliances, supplies or services as a result of war or any act of war, whether declared or not; communication or travel time, lodging or transportation, except as stated in your benefit plan; foot care services, except as stated in your benefit plan; health clubs or health spas, aerobic and strength conditioning, work-hardening programs and related material and products for these programs; hair prosthesis, hair transplants or implants; experimental treatments, except as stated in your benefit plan; and alternative medicines or therapies.

This document is intended to be an easy-to-read summary. It is not a contract. Additional limitations and exclusions may apply to covered services. A complete description of benefits is contained in the applicable Blue Care Network certificate and riders. In the event of a conflict between this document and the applicable certificate and riders, the certificate and riders will rule. Payment amounts are based on the BCN-approved amount, less any applicable deductible, copay and/or coinsurance amounts required by the plan. This coverage is provided pursuant to a contract entered into in the state of Michigan and shall be construed under the jurisdiction and according to the laws of the state of Michigan.

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