In 2021, you'll have a choice between two HSA eligible medical plans, HSA Plan and HSA Plus Plan. There are different levels of PIP coverage that you can choose from. Mary would pay nothing from her paycheck to have the HSA Plan. %PDF-1.6 % Links to all provider websites can be found on our Benefit Carrier Contact Information page. You're eligible for an HSA if you enroll in the State HDHP and have no other non-HDHP health care coverage, including coverage through your spouse or any other person, and you are not claimed as a dependent on another persons tax return. To request a proof of qualified health coverage letter, contact Blue Cross' Customer Service department at 1-800-422-9146from 8:30 a.m. to 5 p.m. Eastern time, Monday through Friday. A QHC letter must contain the following: The full names and dates of birth of all individuals covered under the policy or plan; and A statement that includes whether the coverage provided constitutes "Qualified Health Coverage" as defined in MCL 500.3107d (7) (b) (i), or that the coverage: Does not exclude coverage for motor vehicle accidents, and You can call the number on the back of your member ID card. Ford offers an accelerated contribution option. There are several ways you can request a QHC letter. 248-524-0454 ATTENTION: To ensure individuals with disabilities have an equal opportunity to access enrollment services for Qualified Health Plans, if you have a disability (such as visual or hearing impairment) auxiliary aids and alternative formats are available free of charge by contacting HealthCare.gov or calling 1-800-318-2596 to speak with HealthCare.gov. Qualification Forms | Managing My Account | bcbsm.com We appreciate your understanding. Please provide the following information about the policy holder of the other health coverage. 0000006389 00000 n 0000060102 00000 n 0000016573 00000 n 0000012102 00000 n If you absolutely need to call, please try again at a later date. The HSA Plus Plan requires a monthly contribution that's different depending on whether the plan will cover you, you and your spouse, you and your children, or your entire family. 0000015249 00000 n 0000006930 00000 n In the HSA Plus Plan, you're also responsible for all medical and prescription costs until your deductible is met. 0000034448 00000 n 0000030725 00000 n PDF Blue Cross Blue Shield of Michigan: Understanding member ID cards You can also take a closer look at your current plan to help you make the best choice for your 2021 plan. endobj 0000048349 00000 n An HMO provides necessary hospital and medical treatment when you are sick or injured, prescription medicine services, substance abuse treatment, short-term mental health care, and routine preventive health maintenance services such as immunizations. 0000014702 00000 n [Narrator] Hello again, and welcome to Blue Cross Blue Shield of Michigan. The HSA balance belongs to the employee and can be carried over from year to year. Healthcare includes your Medical (ASR, BCBS, or HAP), Prescription (Navitus or HAP), Dental (Delta Dental), and Vision (NVA). Need a Health Care Plan Verification Letter for Your Auto Insurance %%EOF 0000048683 00000 n Both plans offer the largest doctor and hospital network as well as benefits, including prescription drug coverage and in-network preventive care at no additional cost. These scenarios are simple, and there are many other ways you can consider managing your out-of-pocket costs with your health savings account. 0000007848 00000 n 0000004148 00000 n This plan didn't cover prescription charges, office visit charges, medical equipment, psychiatric services, or other major medical services. With the total of all her family services and prescriptions, the HSA Plan costs $3,030 to use. Current SHP PPO enrollees will be automatically transitioned with no gap or changes in coverage. 0 db4H@g& C This provides cost and other information related to your plan options. Co-insurance is a percentage of the cost you share with the plan. 0000026848 00000 n 0000049102 00000 n Your co-insurance amount for in-network services is 20%. Before you select a medical plan, consider your total costs, including the costs to have and use the plan. So when we consider the total cost to have and use the plans, the HSA Plus Plan is the less costly option. 0000005259 00000 n Enter the three letters of your "Enrollee ID" found on your Blue Cross Blue Shield member ID card, and then click Go. Detroit, MI 48243. 0000028854 00000 n The BlueCard Program links Blue plans across the United States and abroad through a single electronic network for claims processing and reimbursement. Log in now myfordbenefits.com HELPS YOU: View personalized benefits PIP is the part of an auto insurance plan that covers the health care costs from a car . 310 0 obj <>/Filter/FlateDecode/ID[<4C51D19B138643B1A2CB07133610D1D7>]/Index[258 116]/Info 257 0 R/Length 203/Prev 1461330/Root 259 0 R/Size 374/Type/XRef/W[1 3 1]>>stream 0000059211 00000 n %PDF-1.7 % 0000025504 00000 n The document must: Thank you for viewing. 0000031798 00000 n 0000041020 00000 n You keep what you dont spend on medical expenses, even if you retire or leave state employment. General Inquiries. The BlueCard Program links Blue plans across the United States and abroad through a single electronic network for claims processing and reimbursement. 0000027006 00000 n 0000027316 00000 n 0000003382 00000 n hbbd```b``z"@$D2e5A$)e,H^0 You don't need to wait until your new plan year starts to see your doctor. `+DO>|5%Nqdws=0y';L a66[OIe,%EqtRS&54Qvw"E$iu3:G+x+II^ UTT"9W!4XuYS6Ly}l&!2 "Qualified Health Coverage" means your health coverage: Does not exclude or limit coverage for motor vehicle accidents; and Has an annual deductible of $6,000.00 or less per covered individual. 0000027783 00000 n An HDHP offers a lower biweekly premium in exchange for higher deductibles and out-of-pocket limits. 0000018397 00000 n hb``b``f`c`Taa@ V(-) Q>hL)[ley|800pt Pn`K Al@8m@@3J31k=21@=3 F%&hWfpdbm]` The Plan also covers most of your community-based care (office visits), as well as necessary medical equipment and supplies (crutches, hearing aids, etc.). Michigan Auto Insurance & Coordination of Benefits Explained IS IBCQ-]97T5dUa{ugdcg`\o'.Nu }n|7G|ZXXMf9I\RTt K{d\H3$]S^-}h C6PDI^7|[N$G3y\80-~/T2;D->>DRUw_ F=(8#l9o&.fy66tK~yUR~YZOa.y=jYh8MfH3eXg]s#2H`pw$]Nx8p&`1l)v1]\Ib`wO6+1OLn@{hE +vA3LSY+o(*_6]o. This is the amount taken from your pay each month. In accordance with state and federal law, contracted providers and facilities must attest to the accuracy of their directory information at least every 90 days. 0000021457 00000 n To help you compare and select your 2021 medical plan, Ford has provided Benefits Mentor powered by IBM Watson Health. Important Legal and Privacy Information | Important Information About MedicarePlans | Privacy Practices | Site Map | Feedback | Download Adobe Acrobat Reader, Important Information About MedicarePlans. This tool provides side-by-side medical plan comparisons and personalized cost modeling. This was a hospitalization-only plan intended as an option if you had coverage elsewhere (for example, through a spouse who works for another employer). PDF Sample Qualified Health Coverage Documentation - Michigan 0000021168 00000 n This amount does not count toward the plan's out-of-pocket maximum. You can use the money if you leave the company, change your plan, or retire. i' *eW 0000024839 00000 n | _1S}9M{T=o9B^>.!a8Znpk9(6_ Learn More Questions? 0000049042 00000 n 1200 N. Telegraph Road You may enroll in an authorized HMO plan serving your residential area. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. %%EOF For instance, you can make your own before tax paycheck contributions to your HSA, use the accelerated HSA contribution option to ensure savings are available sooner, or simply plan to pay yourself back later in the year once your HSA savings has time to build. You also have an out of pocket maximum, that's the maximum amount you pay in deductibles and applicable co-insurance during one plan year. Automobile No-Fault Insurance Changes: Prior to July 2, 2020, Michigans Automobile No-Fault Insurance Law required individuals to purchase unlimited Personal Injury Protection (PIP) through their auto insurer. An HMO is a managed care plan that provides medical care through its network of physicians, pharmacies, contracted hospitals, and medical care suppliers. PPO. Learnyour requirements, deadline dates and more about your coverage. 0000014332 00000 n Be informed about all your Blue Cross plan has to offer. 0000023276 00000 n 0000020133 00000 n PDF BCBSM Master Medical Claim Form b|=b}#Aif3TRD0;@NHkQ#`VEQxD Benefits under this plan were payable only after you had paid expenses equal to one month's basic salary (your deductible). 0000032373 00000 n He paid the full $800 cost of his medical services because the cost is less than the deductible for either plan. SECTION 2 OTHER HEALTH COVERAGE INFORMATION . 0000019892 00000 n When asked to log in, choose Continue as a guest. 0000027473 00000 n When an out-of-area Blue plan member seeks medical care from your office, use our tools to simplify claims submission to Blue Shield of California. And he pay $2,280 annually to have the HSA Plus Plan. hb```5,|z cbD{600T|txGyG{T8"W3\baah4p1$$ v3Kx4@6@ 1 Earnings on an HSA fund balance are tax-free, and you can withdraw your money tax-free anytime, as long as you use it for qualified medical expenses for yourself or your tax dependents. GradCare Member Reimbursement Form U-M Premier Care Member Reimbursement Form <. 0000032096 00000 n 0000035230 00000 n Per state and federal law, providers and facilities must attest to accuracy of directory information to stay visible in find a Doctor. Health Plan Forms and Documents | Human Resources University of Michigan Now let's imagine Mary and her family had a year with a lot of medical and prescription expenses where they meet the out-of-pocket maximum for both plans. Uses standard Blue Cross ID card. Need new coverage? 0000024311 00000 n This letter shows whether your health insurance plan meets the requirements to be considered QHC under the new no-fault auto law. 0000004500 00000 n You can choose your own primary care physician who will provide direct care or make referrals from within the network. 0000029999 00000 n Qualified Transportation Fringe Benefits (QTFB). 172 0 obj This plan covered inpatient hospital expenses, as well as certain other services received at the hospital on an outpatient basis (including emergency room care). %PDF-1.7 % Your doctor will submit the form by following the instructions on the back. Pontiac, MI 48341. Learn more about your Blue Cross Blue Shield of Michigan plan options. xref To find the most up-to-date information about current medical and pharmacy claims, you can use the Blue Cross app or log into your BCBSM member account at bcbsm.com. The State Health Plan PPO provides reimbursement for medical care expenses when you need treatment for an illness, injury, or disease. 0000034485 00000 n Your email address will not be published. 0rtq]%g=z.#i0\*m(D2q;t2}$kX[-+G-0hdA9r*8!jcsfEdRyV0=bLzf']q[6F"h.wB)^wvDH =/OC; f'e$GVi]G}//xTw)9]y(kkxU*uXT) 0ajx[k jK`8P1(GU=. Blue Care Network Qualification Form - BCBSM 866-503-3158 0000028562 00000 n Enroll when you're ready. Individuals attempting unauthorized access will be prosecuted. 0000027945 00000 n $"mY_%Be66y=\"QI Share & Bookmark, Press Enter to show all options, press Tab go to next option, Retirement and Deferred Compensation Board, Upcoming Individual Consultations & Seminars, Oakland County's Qualified Health Coverage Letter for Active Employees, Oakland County's Qualified Health Coverage Letter for Retiree, Notice of Qualified Health Coverage for Purposes of Michigan No-Fault Auto Law, 2023 PPO 1 Summary of Benefits and Coverage, 2023 PPO 3 Summary of Benefits and Coverage, Summary of Information for Preventive Care, 2023 PPO 2 Summary of Benefits and Coverage, 2023 Traditional Summary of Benefits and Coverage, 2023 HAP Summary of Benefits and Coverage, BCBSM Approved Autism Evaluation Centers and Behavioral Analysts. And with the HSA Plus Plan, Ford will also contribute to your HSA. 0000036168 00000 n Telemedicine Benefit Summary:Telemedicine visits allow you to meet with a US board-certified doctor online using a video-chat tool. More from MIBluesPerspectives.com: MI Blues Perspectives is sponsored by Blue Cross Blue Shield of Michigan, a nonprofit, independent licensee of the Blue Cross Blue Shield Association, Blue Cross Helps Primary Care Practices Survive Pandemic, Blue Cross, Blue Care Network to Return $21M to Individual Plan Members, Increasing Access to Behavioral Health Care in the Face of COVID-19, Concussions: The Warning Signs You Need to Know, Are You the Default Parent? Because the deductible for the HSA plan is higher, James is responsible for paying the full cost of his health care services, including his medications.
Zeta Phi Beta Stereotypes,
Why Wasn't Jascha Washington In Big Momma 3,
Articles B
