Page 9 - 2015 Advia CU Benefits & Notices
P. 9
Advia CU - MI 2015
Medical Coverage
Advia CU offers two PPO medical plan options to its all employees and two HMO medical plan options to
its employees in Michigan employees.
PPO Options
Both PPO plans are 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
HMO Options
The HMO plans in MI are 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.
All Plans
All four medical plans have 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.
None of these medical plans have a pre-existing condition limitation.
Salus Group© Copyright 2014 Page | 9
Medical Coverage
Advia CU offers two PPO medical plan options to its all employees and two HMO medical plan options to
its employees in Michigan employees.
PPO Options
Both PPO plans are 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
HMO Options
The HMO plans in MI are 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.
All Plans
All four medical plans have 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.
None of these medical plans have a pre-existing condition limitation.
Salus Group© Copyright 2014 Page | 9
