Page 8 - 2013-14 NCACU Benefits & Notices

North Central Area CU 2013-14

Medical Coverage

NCACU offers a PPO medical plan to its eligible employees.

PPO Option

 The PPO plan is offered through Blue Cross Blue
Shield of Michigan (BCBSM). “PPO” stands for
Preferred Provider Organization.

 Approximately 95% of the US population is within
reach of a BCBS PPO provider.

 You do not need to choose a Primary Care
Physician (PCP) with a PPO – you may see any
provider you want to see, even a specialist.

 You receive the most benefits when you receive care from participating BCBS PPO providers.
You may see a non-BCBS PPO provider, but your benefits will be reduced and you’ll pay more
out of pocket.

 For a list of BCBSM PPO providers visit www.bcbsm.com or call 800.637.2227

 For a list of BCBS PPO providers outside of the MI visit www.bcbs.com & click Find a Doctor or
Hospital

Additional Plan Information

 The medical plan has a deductible, which is the amount you must pay before the plan begins
paying for most routine or emergency medical care.

 Preventive services are covered at 100% in network with no deductible. The benefit summaries
on the following pages show an abbreviated list of preventive benefits we cover.

 The PPO plans have an out-of-pocket maximum. Once you have spent this out-of-pocket amount
on coinsurance following your deductible, the plan will pay 100% of any medical charge which
would otherwise have a coinsurance for the remainder of the plan year.

 This medical plan does not have a pre-existing condition limitation.

Waiver of Medical Coverage – Opt Out Option

You may elect to waive medical coverage from NCACU if you have and can provide proof of existing
coverage from another source (spouse, parent, etc.). When proof of coverage is provided to Human
Resources and validated, you will be eligible to enroll in the dental and vision plans. The Opt Out Option
does not provide a monetary subsidy to the eligible employee.

Should you suffer a HIPAA status change event, you may be added to NCACU’s medical plan mid-year
only if notification is given to Human Resources no later than 31 days of the event.

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