FREQUENTLY ASKED QUESTIONS
The answers to these questions are designed to assist you in understanding the basics of a particular issue. In some cases you will need to speak with one of our health care experts to go over the specifics involved in answering the question.

QUESTIONS:
• How do I know if my firm qualifies for Group coverage?

• What types of plans and coverages are available to firms?

• Do I qualify for group coverage options if my wife and children are going to covered under my plan?

• How are my rates determined?

• How long will it take for my firm to obtain coverage?

• Are pre-existing conditions covered under these plan?

• Are my rates guaranteed for 12 months?

• Can I make changes to my plan?

•Can I change physicians during my coverage period?

•How can I find out if my physician participates with my specific plan?

•What if my physician does not participate with Blue Cross, can I still get coverage?

• If I am traveling out of state, can I use my coverage?

• Can my firm choose to cover some employees under the PPO plan and other
employees under the HMO plan?

• Can contraceptive drugs be covered under my firms plan?

• I am turning 65, what will happen to my coverage?

ANSWERS:
How do I know if my firm qualifies for Group coverage?
There are a number of requirements that a firm must be met in order to apply for coverage. All firms must be headquartered in Michigan and have two or more full-time employees enrolling. There must be an employer/employee relationship, have Workers Compensation coverage, contribute to the Michigan Unemployment Insurance Fund, and withhold payroll taxes.

There are also participation requirements that must be met.

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What types of plans and coverages are available to firms?
There are 4 different types of coverage available to firms that have two or more full-time employees enrolling. Please note, the plans available are subject to change without notice. Please call our office for an up-to-date look at the available plans

Community Blue PPO – This plan combines the benefits of traditional care with the wellness and prevention features of managed care. You may elect to use an in-network physician with low out-of-pocket expenses and preventative care. Or you may choose an out-of-network physician with higher out-of-pocket expenses
There are 8 PPO plans to choose from with varying in-network and out-of-network deductibles and co-pays.

Flexible Blue HSA– These high deductible plans are designed to be used with a Health Savings Account. There are 3 plans to choose from with varying in-network and out-of network deductibles.

Blue Care Network HMO – These Health Maintenance Organization plans emphasize preventative care, provide services for hospital care, physician services (including routine care), diagnostic testing and prescription drugs with minimal co-payments.

There are 9 plans to choose from with varying deductible and co-pays.

Do I qualify for group coverage options if my wife and children are going to covered under my plan?
No, you can only qualify for group coverage if your plan will include 2 or more eligible full time employees. In this circumstance, the owner would be considered a eligible full-time employee. Also, the fact that you belong to an association does not qualify you for group coverage unless there are 2 or more employees covered under the plan.

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How are my rates determined?
Rate for group plans are based on a number of factors including the geographical areas (there are 8 rating areas in Michigan), industry, and ages of the individual members in the firm. For a specific quote please contact our office at 800-632-4591.

How long will it take for my firm to obtain coverage?
After all the proper materials have been submitted to Blue Cross Blue Shield of Michigan, the underwriting process takes about 30 days. Upon approval, coverage is effective on the 1st of the month following the 30-day processing period.

Are pre-existing conditions covered under these plan?
In some case pre-existing conditions may be covered. Please contact our office at 800-632-4591 for the specific Blue Cross Blue Shield of Michigan and Blue Care Network requirements that must be met.

Are my rates guaranteed for 12 months?
All rates will be adjusted each year on your annual rate renewal date.

Can I make changes to my plan?
There are two types of changes that can be made, a benefit change and a maintenance change.

A benefit change would be when you wish to make a change to the type of plan you have. For example you are currently insured through a BCBSM Community Blue PPO plan and want to change to the Flexible Blue High Deductible plan. This type of change can be made at any time, however you can only make a benefit change once every 12 months. You should also note that you can only change to a plan that is currently available and not an old plan.

A maintenance/membership change would include such changes as adding a newborn, adding a spouse through a marriage, and an address change. Adding a newborn or spouse can be made on the date of the event and address changes can be done at any time.

Certain types of changes can also be made once per year during the plans open enrollment period. For specific information concerning open enrollment please contact our office at 800-632-4591

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Can I change physicians during my coverage period?
For BCBSM plan the answer is yes. It is recommended that you confirm that the new physician participates with your specific BCBSM plan in order to receive in-network benefits.

You can also change physicians if you have a Blue Care Network HMO plan. This change must be reported before any services are rendered, and can be done on-line or by calling BCN customer service.

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How can I find out if my physician participates with my specific plan?
You can visit the Blue Cross web site (go to the links section on this site), however the best way to know for sure is to simply ask your current physician.

What if my physician does not participate with Blue Cross, can I still get coverage?
If you choose the Community Blue or Flex Blue plan and use a non-participating physician, you will be subject to out-of-network deductibles and co-pays.

If you choose the Blue Care Network HMO plan, you must use a participating physician.

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If I am traveling out of state, can I use my coverage?
If you are covered by Blue Care Network HMO, you must follow specific guidelines and receive treatment from a participating physician. If you are covered by Community Blue PPO or Flex Blue you have the same flexibility as if you were being treated in state.

Blue Cross does provide an 800# that can be used to locate a participating physician or facility.

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Can my firm choose to cover some employees under the PPO plan and other employees under the HMO plan?
Yes, as long as certain requirements are met.Your firm must have at least 11 employees enrolled, with a minimum of 2 employees in the second plan. For example if your firm has 11 employees and 9 elect to enroll in the PPO and the remaining 2 enroll in the HMO, this would meet the requirements.

Will some of my employees be excluded due to certain medical conditions?
No, Blue Cross Blue Shield of Michigan does not underwrite any firm based on the medical condition of individuals enrolling in the firm’s plan.

Can contraceptive drugs be covered under my firms plan?
Yes, if you purchase the contraceptive drug rider.

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I am turning 65, what will happen to my coverage?
When you turn 65 you coverage will transfer to a Medicare supplement plan. The plan that you transfer into is determined by your current plan and you will maintain the same prescription co-pay as your current plan. To discuss this process and other options please contact our office at 800-632-4591.

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