Blue Care Network HMO Non-Medicare
This is a Blue Care Network HMO plan for State of Michigan retirees who are not eligible for Medicare.
Plan highlights
- Choosing a primary care provider, or PCP, to coordinate your care means less paperwork and lower out-of-pocket costs
- You need a referral from your PCP before seeing a specialist except in an emergency
- Out-of-network services are usually not covered
In-network Individual Deductible
$125
In-network Family Deductible
$250
What this plan offers
- In-network preventive services are 100% covered
- Manage your account 24 hours a day, seven days a week with the BCBSM app
2025 plan details
See what's covered and how much you'll pay.
In-network deductible
$125 per individual, $250 per family
In-network out-of-pocket maximum
$2,000 per individual, $4,000 per family
PCP office visit copay
$20 per visit
Individual deductible
In network
$125
Family deductible
In network
$250
Individual out-of-pocket maximum
In network
$2,000
Family out-of-pocket maximum
In network
$4,000
Coinsurance
In network
None
Office and urgent care visits, referral physician visits and outpatient and home visits
In network
$20 copay
Emergency room
In network
$200 copay (waived if admitted as inpatient)
Hospital care
In network
100% after deductible
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$125 | ||
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$250 | ||
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$2,000 | ||
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$4,000 | ||
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None | ||
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$20 copay | ||
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$200 copay (waived if admitted as inpatient) | ||
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100% after deductible |