State Health Plan PPO Non-Medicare
The State Health Plan PPO Non-Medicare health plan is a self-insured benefit plan administered by Blue Cross Blue Shield of Michigan under the direction of the Michigan Civil Service Commission.
Plan highlights
- The flexibility to see specialists without a referral from a primary care provider
- Staying inside the network means lower out-of-pocket costs
- Many services are covered outside of your network for higher out-of-pocket costs
In-network Individual Deductible
$400
In-network Family Deductible
$800
What this plan offers
• Retirees get access to our extensive PPO network as well as out-of-network doctors and hospitals
• Coverage is included for emergency room care and behavioral health services including substance use disorders
• Value-added services such as Blue Cross Coordinated Care, Blue Cross Health & Well-BeingSM and 24-Hour Nurse Line
• Manage your account 24 hours a day, seven days a week with the BCBSM app
2023 plan details
See what's covered and how much you'll pay.
In-network deductible
$400 per individual, $800 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
$400
Out of network
$800
Family deductible
In network
$800
Out of network
$1,600
Individual out-of-pocket maximum
In network
$2,000
Out of network
$3,000
Family out-of-pocket maximum
In network
$4,000
Out of network
$6,000
Coinsurance
In network
10% for most services
Out of network
20% for most services
Office and urgent care visits, medical eye exam, medical hearing exam, osteopathic, and chiropractic manipulation
In network
$20 copay
Out of network
80% after deductible
Emergency room
In network
$200 (waived if admitted as inpatient)
Out of network
$200 (waived if admitted as inpatient)
Hospital care
In network
90% after deductible
Out of network
80% after deductible
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|---|---|---|---|
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$400 | $800 | |
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$800 | $1,600 | |
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$2,000 | $3,000 | |
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$4,000 | $6,000 | |
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10% for most services | 20% for most services | |
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$20 copay | 80% after deductible | |
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$200 (waived if admitted as inpatient) | $200 (waived if admitted as inpatient) | |
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90% after deductible | 80% after deductible |