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Member FAQs

When will my automatic payment be deducted from my account? (Auto payment is only available to individually billed members at this time)

We withdraw your automatic payment five business days before the due date.

Why did I receive an Explanation of Benefits (EOB) saying my claims were rejected because I didn't respond to a letter about other health insurance coverage?

We periodically mail a letter asking if you have other health insurance coverage. This letter assists us in coordinating your benefits. The form must be completed, signed and returned within 15 days of receiving the letter or submitted claims may be rejected indicating that we have not received this information.

Please call your customer service center and let them know if you have other coverage. They will take your information over the phone and re-process any rejected claims.

Do I need to inform Blue Cross Blue Shield of Michigan if I have other health insurance?

Yes, because Blue Cross Blue Shield of Michigan coordinates benefits between health plans. Through coordination of benefits, we make sure the proper plan (the "primary plan") pays first on a claim. The secondary plan may then pay an additional amount. This helps us maximize your benefits.

In order to do this, we require updated information from you. If your coverage has changed and you now have other coverage through more than one group health plan (for example, through a spouse's job or through Medicare), be sure to contact your customer service center or submit a Coordination of Benefits form.

How do I change my address, phone number or the dependents on my coverage?

Contact customer service to change your address and phone number. To update your dependants, you must either contact your employer's benefit representative or contact customer service if you have individual coverage.

  • If you have Blue Cross Blue Shield of Michigan coverage through your job, contact your benefits representative at work to change information. Your organization will pass the information along to BCBSM.
  • For BCBSM Individual Billed customers, contact customer service to request addition of dependents, address changes and name changes. For removal of dependents, please send a request in writing.

It is very important to report any change in your contract to BCBSM within 30 days of an event such as the birth of a child, adoption or legal guardianship, marriage, divorce, death, name change, a new address or telephone number, Medicare eligibility or a new job.

My child will be going to college. Can I keep his or her coverage active?

Yes, provided your group health plan has our "family continuation" (FC) or "dependent continuation" (DC) rider. Be sure to check your benefit guide or ask at work to see if your group health plan includes one of these riders.

If your organization offers one of the riders, you must apply for continuation coverage before December 31st of the year your dependent turns 19. Let us know your dependent is attending college, and we will send a letter annually to verify that his or her enrollment continues. Between the ages of 19 and 25, dependents can remain covered if they are:

  • Unmarried
  • Related to you by blood, marriage or legal adoption
  • Full-time students for at least five months of the year or have a gross income of less than four times the personal exemption amounts as defined by the Internal Revenue Service's current code

How does my coverage work when I am out-of-state?

When you need health care while away from Michigan, you can reduce your out-of-pocket expenses by receiving services from a participating provider. Participating providers accept payment for covered medical services as payment in full. To find a participating provider, members should visit Where You Can Go For Care, or call 800-810-BLUE (2583).

Treatment by providers in states who don't participate with Blues Plans is likely to mean additional out-of-pocket costs to members.

  1. Take along your most current Blues ID card — one that includes a three-digit alpha prefix before your contract number (e.g., XYZ 123 456 789).
  2. Present your Blues ID card to the participating doctor or hospital.
  3. That provider submits a claim to the local Blue Cross Blue Shield Plan with which he or she participates.
  4. The local plan receives the claim, then verifies the provider relationship and participation status and supplies the necessary information to Blue Cross Blue Shield of Michigan in order to apply your benefits.
  5. After we complete our review, we communicate with the local Blue Cross Blue Shield Plan to finalize claim benefits with the provider.

For more information on out-of-state coverage, including dental, vision and hearing coverage, call customer service or read Home is Where Your BlueCard® Is (PDF).

What are the differences between the health plans?

In the past, the main difference between plans was coverage. Today, the difference relates more to how you obtain care and who provides it. Here are the highlights of our products to help you make the best selection of options that may be available to you (depending on the coverage offered by your organization):

Managed Traditional — Under our Managed Traditional plans, you can choose any physician or hospital, but you minimize your out-of-pocket costs when you choose Blue participating providers.

These plans cover hospital and medical services including inpatient hospital care, surgery and diagnostic testing. Some plans also cover office visits and preventive care. Out-of-pocket costs vary, with some plans requiring little or no cost sharing while others require deductibles and copayments.

Preferred Provider Organization (PPO) — With PPO coverage you can choose any doctor — even a specialist — as long as he or she is in our PPO network and is accepting new patients. By staying in-network, you have a higher level of benefits and lower out-of-pocket costs. If your doctor refers you outside the PPO network, there is no penalty. If you choose to visit a non-network provider without a referral, you will have higher out-of-pocket costs and some benefits may not be covered.

These plans cover hospital, medical and surgical services plus, depending on the type of plan you and your organization have selected, additional services such as office visits, annual exams and well-baby care.

Your network of providers depends on the plan offered by your organization. You may have a statewide PPO, such as our Community Blue or Blue Preferred plans, or you may have a PPO with a network of local providers, such as our Regional Community Blue Plan (available in the Lansing, Lapeer, and Flint areas). While the networks may differ, the plans offer similar benefits.

Point of Service (POS) — With POS, you choose a primary care physician to coordinate your health care within the network. By staying in-network, you have a higher level of benefits and lower out-of-pocket costs. Our POS plan also gives you the freedom to receive services without a referral from your primary care physician, but your out-of-pocket costs may be higher and some benefits may not be covered.

Our POS plan provides a wide range of covered benefits, including annual wellness and preventive care.

Health Maintenance Organization (HMO)Visit the Blue Care Network of Michigan Web site for more information about HMO coverage.

I will be 65 soon and want to know what to do about Medicare and Blue Cross Blue Shield of Michigan coverage.

Generally, you can enroll in a Medicare plan during a seven-month initial enrollment period from three months before your 65th birthday month through three months after your birthday month. For example, if your birthday is July 29th, you can enroll from April 1st until October 30th of your 65th year. To avoid delays in your coverage, it's best to apply at the beginning of your initial enrollment period.

Visit the Medicare area of our Web site to learn about our Medicare plan options for individuals and choose the BCBSM Medicare plan that's best for you.

Or, if you are a member of a group, your group may offer you a Blue Cross Blue Shield of Michigan Medicare supplemental plan or a Medicare Plus BlueSM Group Medicare Advantage plan. Check with your group's benefit administrator to find out what Medicare plans are available to you through your group.

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