Health Care Benefits - Staff (Exempt and Nonexempt)
Health Care Benefits - Staff (Exempt and Nonexempt)
The University's Community Blue PPO health plan is administered by Blue Cross Blue Shield of Michigan. Health care benefits also include dental, vision, and prescription drug coverage.
Summary of Benefits and Coverage
View your Summary of Benefits and Coverage (PDF), which shows medical and prescription drug benefits and coverage.
For health care benefit details, access Your Benefit Chart at www.bcbsm.com (see below). Your current benefit enrollment information is available through Self Service. (For help, visit Self Service Instructions.)
View your Summary of Benefit Changes effective January 1, 2013 (PDF).
View your Health Care Benefit Rates for 2013 (PDF).
Your Benefit Chart
Issued by Blue Cross Blue Shield of Michigan, Your Benefit Chart provides information on how to use the Community Blue PPO, benefits and services covered by the plan, and ways you can minimize out-of-pocket medical costs. Details of your prescription drug, dental, and vision coverage are also included in this guide.
To access Your Benefit Chart:
- Go to www.bcbsm.com.
- Select LOGIN in the upper right corner, then select Log in as a: Member.
- Enter your user name and password and click LOGIN. Tip for first time users: Have your Blue Cross Blue Shield card handy to establish your user identity.
- Once on the Manage My Plan page, select Benefits to open Your Benefit Chart.
Community Blue PPO network providers
Members can find Community Blue PPO network providers on www.bcbsm.com. Simply select the Find a Doctor button on the lower left side of the page. Search for physicians, hospitals, and other health care providers in the PPO network. Members can also search for providers who participate in Blue Cross Blue Shield of Michigan's traditional network.
Coverage varies by provider type as follows. Par providers are those who participate with Blue Cross Blue Shield of Michigan.
In-Network vs. Out-of-Network Coverage: Par vs. Non-Par |
|||||
| Provider Type | PPO |
Traditional BCBSM, out-of-network, with referral |
Traditional BCBSM, out-of-network, no referral |
Non-Par BCBSM, out-of-network, with referral |
Non-Par BCBSM, out-of-network, no referral |
| Coverage | 100% after in-network deductible | 100% after in-network deductible | 75% after out- of-network deductible | 100% of approved charge, after in-network deductible; employee liable for balance |
75% of approved charge, after out-of-network deductible; employee liable for balance |
On-campus health care
Health care services are also available on campus at Sindecuse Health Center and WMU Unified Clinics to members of the Community Blue PPO through the WMU Health Services Plan.
Prescription drug coverage
Your prescription drug benefit is provided through Blue Cross Blue Shield of Michigan's 90-day retail prescription drug program. Your Benefit Chart contains detailed information about your prescription drug coverage (see above for access instructions). You may also find the following resources helpful:
Pharmacy - Blue Cross Blue Shield of Michigan
Submitting claims
Typically, in-network providers submit your claim for you; some out-of-network providers may also do so. For claims that you must submit yourself, send them to:
Attn: WMU Claims
Blue Cross Blue Shield of Michigan
PO Box 230555
Grand Rapids, MI 49523-0555
Pre-addressed claim envelopes are available for pick-up in Human Resources.
Need help?
Contact Blue Cross Blue Shield of Michigan for coverage and claims information concerning the Community Blue PPO:
- BCBSM Customer Service: (877) 671-2583
- A BCBSM representative is available to meet with employees in Human Resources each Thursday. Please call Human Resources to make an appointment.
Additional resources
The Health Insurance Portability and Accountability Act (HIPAA) establishes certain privacy rights regarding employees' personal health information. Detailed Information is located in the Human Resources Policies and Procedures Manual's Health Insurance Portability and Accountability Act (HIPAA) Section.