0000004500 00000 n i' *eW Blue Cross Blue Shield of Michigan: Understanding member ID cards Need a Health Care Plan Verification Letter for Your Auto Insurance hbbd```b``z"@$D2e5A$)e,H^0 When you combine Mary's cost to have and use the HSA Plus Plan, her total cost is $5,306. Blue Cross Blue Shield of Michigan. Find information about Promise Medi-Cal and Cal MediConnect, our policies, procedures and programs. Physician Qualification Form (PDF) Healthy Blue Achieve Form 0000004937 00000 n General Inquiries. Follow the instructions on the page to have your letter created. Qualification Forms | Managing My Account | bcbsm.com Representatives are available 8:00 a.m. to 5:00 p.m., Monday through Friday. Employees can also make pre-tax HSA contributions by payroll deductions. 0000007628 00000 n Each letter serves a distinct and specific purpose: Notice of qualified health coverage for auto personal injury protection (PIP) benefits: Changes to Michigan's no-fault auto insurance law that . 0000031798 00000 n 0000020133 00000 n You must be in pay status to receive this payment. Once logged in, navigate to the https://www.bcbsm.com/index/health-insurance-help/faqs/topics/other-topics/no-fault-changes.html 159 0 obj <>/Filter/FlateDecode/ID[<38505CF35D4D814CB849C61D42F0BD2C>]/Index[140 54]/Info 139 0 R/Length 99/Prev 142241/Root 141 0 R/Size 194/Type/XRef/W[1 3 1]>>stream Important Legal and Privacy Information | Important Information About MedicarePlans | Privacy Practices | Site Map | Feedback | Download Adobe Acrobat Reader, Important Information About MedicarePlans. 0000008905 00000 n 0000035745 00000 n Qualified Health Coverage & Michigan No-Fault Insurance 0000026848 00000 n The HSA Plan is still the less costly option for Mary because the total cost to have and use the plan is lower in the HSA Plan. Co-insurance is a percentage of the cost you share with the plan. Take a look at what Blue Cross plans offer, then choose the one that's right for you. View detailed plan information in this document. Don't have a member account? 0000059965 00000 n This copay is waived if Mary or her family member is admitted as a result of the ER visit. OptumRx is the Pharmacy Benefit Manager for the State Health Plan PPOand will administer all retail, mail-order, and specialty prescription services for active employees and both Medicare-eligible and non-Medicare eligible retirees. 0 Difs Qualified Health Care Letter And with the HSA Plus Plan, Ford will also contribute to your HSA. Standard Qualification Form If you have a Blue Cross Blue Shield of Michigan plan other than Healthy Blue Achieve that requires a qualification form, please use the form below. Health Plan Details Preventive care benefits are covered 100 percent when received from a TRUST PPO network provider. 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? To help you compare and select your 2021 medical plan, Ford has provided Benefits Mentor powered by IBM Watson Health. SM. 0000011869 00000 n If the provider you select doesn't participate at all with BCBSM (BCBSM has several different provider arrangements), you may also be required to pay additional charges. If your auto insurance is requesting a QHC letter to issue or renew a policy, you may request a QHC letter by contacting yourhealth carrier. 0000016573 00000 n If you choose to do so, you will be responsible for both deductibles. Be sure to turn off pop-up blocker and private browsing prior to opening your Auto Health verification letter. 0000007421 00000 n Callers to our phone lines are currently experiencing long wait times. 172 0 obj Under the new legislation, residents may select different levels of PIP coverage. db4H@g& C 0000022361 00000 n Available for commercial, Shared Advantage, and BlueCard. Thank you for viewing. Identified standard preventive services are covered at 100%, but most other services have a 20% in-network coinsurance after meeting the deductible. You're now aware you have a choice between two HSA eligible medical plans in 2021. 0000027316 00000 n Health Insurance Coverage | Health Services | Michigan State University Your coverage is considered qualified if it: When making a decision, keep in mind that PIP has coverage that goes beyond traditional health insurance. You can now file disputes, attach supporting documents, and retrieve letters for submitted disputes online! 1200 N. Telegraph Road Where does my client go to get a Qualified Health Coverage (QHC) letter Pontiac, MI 48341. 500 Renaissance Center. lC]n8\! Log in to get your questions answered by a live representative, Monday through Friday, 6 a.m. to 6:30 p.m. 0000024600 00000 n Questions About Your Benefits? "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. You can log in to your online member account to see if you have a QHC letter to download. startxref This tool provides side-by-side medical plan comparisons and personalized cost modeling. 0000013426 00000 n Employees can now get a Health Care Plan Verification letter through Wolverine Access by selecting Employee Self-Service > Benefits > Health Care Plan Verification. 0000028187 00000 n Under the plan documents section, click Michigan Auto Reform to request a letter be mailed to the subscriber's address. Health Benefit Plans | Oakland County, MI Even though this law has to do with your auto insurance, a lot of people have questions about what it means for your. 0000016284 00000 n 0000048349 00000 n 0000025874 00000 n They areresponsible for the deductible, then the hospital is reimbursed according to the plan design. 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 0000009647 00000 n 0000060222 00000 n If you are 55 or older, you can make an additional catch-up contribution of $1,000 per year until you are enrolled in Medicare. 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. 0000049102 00000 n 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. Medicare | Claim Forms | bcbsm.com You still have the freedom to go out-of-network to see any physician, hospital or other provider of your choice. For the HSA Plus Plan, her yearly contributions, which is her cost to have the plan would be $3,300. To obtain a coordination of benefits letter, call the number on the back of your Enrollee ID card. Blue Care Network Qualification Form - BCBSM 0000018771 00000 n Coordination of Benefits | Human Resources University of Michigan California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. NO - YES - Please complete entire form, sign at the bottom and return sign at the bottom and return . 93gpm},|P gaToY%+IzO96`%n'`Pll@BJa Letters for your auto insurance carrier - MESSA Members enrolled in the HSA plan will be responsible for paying an ER copayment after the deductible has been met. 141 0 obj Contact your auto insurance agent with questions and to learn more about your options. 0000008243 00000 n No-fault auto insurance changes in Michigan | bcbsm.com <. It can help treat minor illnesses such as colds, sinus or respiratory infections, sprains, or rashes, making it perfect when your primary care physician is unavailable or leaving the house is difficult. 0000012102 00000 n 0000059887 00000 n This copay does not apply to the out of pocket maximum for the HSA Plan, so Mary will be responsible for this copay each time she or a family member visits the ER, after the deductible is met. 1996-2023 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. Please enable JavaScript in your browser for a better user experience. The rule provides protection against balance or "surprise" billing under certain circumstances, and phases in new transparency requirements on most group health plans and health insurers. 0000019892 00000 n 0000029225 00000 n For example: a single person chooses an in-network hospital for surgery. Qualified Transportation Fringe Benefits (QTFB). You can log in to your online member account to see if you have a QHC letter to download. 0000018138 00000 n PDF Hospital Coverage Letter - Bcbstx View the eGuide to see the Ford resources available all year long. 0000027006 00000 n PDF State of Michigan John's annual paycheck deduction for the HSA Plan is zero. You can choose your own primary care physician who will provide direct care or make referrals from within the network. We provide health insurance in Michigan. \8/$z You may enroll in an authorized HMO plan serving your residential area. PIP pays for services that health insurance may or may not cover. The web Browser you are currently using is unsupported, and some features of this site may not work as intended. 0000027161 00000 n Those costs include increased copay and deductible amounts. Learn more about your Blue Cross Blue Shield of Michigan plan options. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. It has more than 20,000 physicians, including specialists, and more than 140 all acute care hospitals in Michigan. You can also opt-out if you qualify for that provision. 0000033132 00000 n 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. 0000027473 00000 n 0000047030 00000 n 0000007258 00000 n Select Claims on the menu bar. xref %PDF-1.7 % Later in the year, that same person needs an MRI and chooses an out-of-network provider. A plan is considered QHC if coverage for motor vehicle accidents is not excluded and the annual deductible is $6,000 or less per covered individual. 0000039800 00000 n 0000019721 00000 n All rights reserved. You can also take a closer look at your current plan to help you make the best choice for your 2021 plan. In 2021, you'll have a choice between two HSA eligible medical plans, HSA Plan and HSA Plus Plan. %%EOF You can log in to your online member account to see if you have a QHC letter to download. The HSA balance belongs to the employee and can be carried over from year to year. The Plan also covers most of your community-based care (office visits), as well as necessary medical equipment and supplies (crutches, hearing aids, etc.). 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 Its important to know that in order to opt-out of PIP coverage under the new Michigan law, you must have health insurance that is considered qualified health coverage. Michigan - Blue Cross and Blue Shield's Federal Employee Program Detroit, MI 48243. Since John has individual coverage, he gets a $500 HSA contribution from Ford if he selects the HSA Plus Plan, Ford doesn't make a contribution towards the health savings account for the HSA Plan. [Narrator] Hello again, and welcome to Blue Cross Blue Shield of Michigan. Ready to enroll? 0000021457 00000 n 0000027783 00000 n (MSPTA-represented only) SECTION 2 OTHER HEALTH COVERAGE INFORMATION . Members should direct specific questions about PIP coverage to their auto insurer. And for the HSA Plus Plan, it's $1,020. If your spouse's (non-State) employer will not cover you under their group plan because you are enrolled in any of the State-sponsored health care options,you can "opt out" completely and still receive the $50 biweekly payment (select "Health Waiver with Rebate"). 120 0 obj Your co-insurance amount for in-network services is 20%. 0000014991 00000 n Member logins offer many on-line tools, such as access to claims information, viewing Explanation of Benefits, printing replacement ID cards, etc. 0000006389 00000 n Other costs to use the HSA Plan will vary depending on whether you select plan coverage for you or for your family. Let's start with Mary who selected a plan to cover her family. 0000021696 00000 n 0000043394 00000 n 0000026163 00000 n 0000031415 00000 n It has a deductible of $6,000 or less per person. The network covers all 83 Michigan counties and is the largest PPO network in Michigan. Current SHP PPO enrollees will be automatically transitioned with no gap or changes in coverage. *Blue Shield of California member plans only. 0000049042 00000 n If your auto insurance is requesting a QHC letter to issue or renew a policy, you may request a QHC letter by contacting your health carrier. PDF Sample Qualified Health Coverage Documentation - Michigan 163 0 obj <>stream Enroll when you're ready. 0000012476 00000 n What does PIP cover? James wouldn't have to pay anything from his paycheck to have the HSA Plan. Field Service. 0000048834 00000 n They are responsible for the out-of-network deductible. 0000006930 00000 n &yw}.$7eIw We'll accept a qualification form from an office visit that occurred up to 180 days before the start of your plan year. Visit myfordbenefits.com and make your plan selection for 2023. 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. 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). See your 2023 Benefits-at-a-Glance (PDF) for more plan details. 0000051836 00000 n 0000014041 00000 n Please provide the following information about the policy holder of the other health coverage. Visit Federal No Surprises Act (michigan.gov)for more information. Look for the chat icon at the bottom right corner of the screenon any page of this website. Click My Plan and Spending. 0000014702 00000 n 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. 577 0 obj <>stream 373 0 obj <>stream 0000006680 00000 n endobj TTY users should call 711. 0000044573 00000 n If you're asked to provide your auto insurer with a QHC letter, you will either need to contact your health plan (like Blue Cross) or your employer to request the letter. Submit and confirm authorizations and approval of medical and pharmacy services prior to services being rendered. endstream endobj 14 0 obj <. This plan provides health benefits using providers and facilities that are in-network, meaning the providers and facilities have agreed to accept a discounted fee from BCBSM in order to be in-network. If you need information about eligibility, benefits or claims, or want to submit or review an authorization, the best way to get up-to-date information is through our on-line resources. To get reimbursed for a flu or pneumonia shot, you'll need to fill out our Member Flu and Pneumonia Shots Reimbursement Form (PDF). James has arthritis, so he needs to take a higher cost maintenance drug. Demographics |Electronic Data Interchange (EDI) | Recoveries, Need help with Provider Connection: Blue Shield Provider Connection Guide Provider Connection training. Effective October 1, 2019, Blue Cross Blue Shield of Michigan, in partnership with Lucet, will be replacing Magellan Health as the State Health Plan (SHP) PPO Behavioral Health/Substance Use Disorder carrier. An HSA is a smart way to save for your future qualified health expenses, including those that may come up in retirement. 0000015249 00000 n Use the Find-a-Doctor tool to verify provider participation in one of our plan networks. Telemedicine Benefit Summary:Telemedicine visits allow you to meet with a US board-certified doctor online using a video-chat tool. 0000015914 00000 n In the HSA Plus Plan, you're also responsible for all medical and prescription costs until your deductible is met. [Instructor] Hello, and welcome to Blue Cross Blue Shield of Michigan. Your doctor will submit the form by following the instructions on the back. How to Recognize Signs and Ease the Burden, PEARS Increases Early Autism Identification in Toddlers with Play-Based, Rapid Interactive Screening System, Its My Duty: How Doctors are Working to Reduce Health Disparities Among Black Patients, Does not exclude or limit coverage for injuries related to motor vehicle accident and has an annual deductible of $6,000 or less per individual, Or if your coverage is Medicare Parts A & B. Ford offers an accelerated contribution option. 14. other health care coverage 16. other policy holder's last name 19. other policy holder's date of birth 17. other policy holder's first name 20. name of other health carrier 21. other carrier policy/group number 22. other carrier street address city state zip code 23. other employer name major medical 24. type of other health insurance . But, if you receive services from a provider not in the PPO network, you may be responsible for paying additional out-of-pocket costs. 13 151 Now let's look at what a single person with relatively few healthcare needs might experience. 0000023941 00000 n 0000012767 00000 n 0000026660 00000 n If you don't have a Provider Connection account, you will need to register before logging in. bcbsm.com. 0000048277 00000 n 0000048472 00000 n Provided in a vehicle qualified as an ambulance and part of a licensed ambulance operation Give us a call to discuss your plan options. 0000005259 00000 n 0000008674 00000 n After your deductible is met, co-insurance applies to medical and prescription costs until your out-of-pocket maximum is met. 0000029999 00000 n 0000036634 00000 n The BlueCard Program links Blue plans across the United States and abroad through a single electronic network for claims processing and reimbursement. The maximum deductible for two or more covered persons in your family was limited to 1 months of your basic salary. And you don't have to use the money by the end of the year, your account balance will not expire. #G:&#WeKo]b287X]4 fd!n>X3jG[)GW%0.{1,JqA]Vf,fyf#Ji+OvDUpe!K|\"e2{g3ePW?/p 0000032373 00000 n 0000045752 00000 n 0 Health Trust 0000048755 00000 n 0000004052 00000 n 0000048207 00000 n We're making your EOB easier to understand. 0000006145 00000 n 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. Depending the level of PIP you choose, your auto insurer may request a letter stating whether you have qualified health coverage, or QHC. 258 0 obj <> endobj You keep what you dont spend on medical expenses, even if you retire or leave state employment. Qualified Healthcare Coverage Letter 1tv Visit myfordbenefits.com and make your plan selection for 2023. PDF Blue Cross Blue Shield of Michigan: Understanding member ID cards 0000034422 00000 n 0000038624 00000 n 0000016814 00000 n 0 .r~'J ms-oA&@i 9k2 J4T{Yt;cu6J_Fs"6r|(Z? N'JV|DI]Ea:%*&[|{;z^HzwD/L_d?D/q|',W2tKpcukU;Bxc%w37XeNh{%_hl@zPMy * uAd;{i6pmn'D=6e Cvy"ngpdh6 s/8bG. 0000019062 00000 n If you have additional BCBSM contracts, pleas e include this as other coverage. `+DO>|5%Nqdws=0y';L a66[OIe,%EqtRS&54Qvw"E$iu3:G+x+II^ UTT"9W!4XuYS6Ly}l&!2 An HMO is a managed care plan that provides medical care through its network of physicians, pharmacies, contracted hospitals, and medical care suppliers. %%EOF lo%x9d,oqM lzgw'TK6oB~+d; {qi.B/ R`]Hcq6~s_]=y&|9]Fl2b\o9Vp"(5Z9lb.dx;@? *Mii lkSW+0XI~'kT`C>?wlvR You have certain tasks to complete within specific . To request your QHC confirmation letter: Log in to your member account. Employees selecting the HSA Plan are responsible for a fixed amount copayment of $200 for each visit to the emergency room after your deductible has been met. To find the most up-to-date information about current medical and pharmacy claims, you can use the Blue Cross app or log into your BCBSM member account at bcbsm.com. 0000035230 00000 n 0000008045 00000 n Contact your auto insurance carrier for specific questions regarding PIP coverage. *Note: MSPTA-represented (T01) employees, DROP employees, and Other Eligible Adult Individuals (OEAIs) and their dependents are not eligible for this benefit. h1aMXk* Q)DDJjH$*F Go paperless by submitting claims and managing payments online for free. GradCare Member Reimbursement Form U-M Premier Care Member Reimbursement Form Once logged in, navigate to the https://www.bcbsm.com/medicare/help/faqs/other/auto-law.html Category: Health Show Health To help your savings grow even more, when your HSA balance reaches $1,000, you can choose a variety of investments. 'TMjZ}dM`V;hO0 45o` T@> $0,Tkpp9~#@="-toen7=u-J 3P6sO1v 0IA||$IRs3R6o'j*vU#;B!FL5O,hBtA7|$xVv)*09KTOM8Gh6CAIT,[*6a8 wz 0000017849 00000 n This letter shows whether your health insurance plan meets the requirements to be considered QHC under the new no-fault auto law.
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bcbsm qualified health coverage letter 2023