Page 8 - 2013 Salus Group Benefits and Notices

Benefits Partner, LLC dba Salus Group 2013

Medical Coverage

Salus Group offers a HMO medical plan to its eligible employees.

HMO Option

 The HMO plan is offered through Blue Care
Network of Michigan (BCN). “HMO” stands for
Health Maintenance Organization.

 You must choose a participating Primary Care
Physician (PCP) for each covered person with an
HMO. Care required from a specialist must be
referred by the PCP in order to be covered by the
HMO plan, even if the specialist is a participating
provider.

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.

Patient Protection Notice

The Salus Group HMO Group Health Plan through Blue Care Network of Michigan (BCN)
requires the designation of a primary care provider. You have the right to designate any primary
care provider who participates in our network and who is available to accept you or your family
members. Until you make this designation, BCN designates one for you. For information on how
to select a primary care provider, and for a list of the participating primary care providers, contact
the BCN at www.bcbsm.com or call 800.662.6667.

For children, you may designate a participating pediatrician as the primary care provider.

You do not need prior authorization from BCN or from any other person (including a primary care
provider) in order to obtain access to obstetrical or gynecological care from a health care
professional in our network who specializes in obstetrics or gynecology. The health care
professional, however, may be required to comply with certain procedures, including obtaining
prior authorization for certain services, following a pre-approved treatment plan, or procedures for
making referrals. For a list of participating health care professionals who specialize in obstetrics
or gynecology, contact the BCN website at www.bcbsm.com and call 800.662.6667.

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