Page 3 - Michigan Economic Development Corp 2021 Renewal Information
P. 3
Michigan Economic Development Corporation
Current Benefit Offerings
BCBSM - Community Blue PPO
No Deductible, 100% coinsurance to an annual maximum of $6350
Single/$12,700 Family, $40 Office Visit, Urgent Care, and Online Visit
Copays, $250 Emergency Room Copay, $10 Generic/$40 Preferred Brand
Name/$80 Non-Preferred Brand Name Prescription Drug Copays
VSP: $5 Copay for Exam, $10 For Lenses/Frames to $150 Allowance;
Frequency: 12/12/12
Blue Care Network - HMO
$500 Single/$1000 deductible per family, 100% coinsurance to an annual
maximum of $1000 Single/$2000 pre Family, $20 PCP Office Visit and
Online Visit Copays, $30 Specialist Copay, $35 Urgent Care and $250
Emergency Room Copay after deductible, $10 Generic (Tier 1)/$30
Generic (Tier 2)/$60 Preferred Brand Name/$80 Non-Preferred Brand
Name/20% Specialty Preferred and Non-Preferred Prescription Drug
Copays
VSP: $5 Copay for Exam, $10 For Lenses/Frames to $150 Allowance;
Frequency: 12/12/12
Delta Dental PPO
No Deductible
Annual Maximum - $1,000 per member
Lifetime Ortho Maximum -$1,500, per member – Child & Adult
Orthodontics
100% -Preventative, 90% -Basic, 50% -Major, 50% -Ortho
Two-Year Rate lock: 1/1/21 – 1/1/23
