AFSCME insurance changes in effect for 2019

Changes in 2019

After Jan. 1 2019, WMU's AFSCME employees, their surviving spouses, covered dependents, and retirees covered by the Blue Cross Community Blue PPO plan will notice some insurance changes when they visit Sindecuse Health Center. These include

  • A $30 copay will be charged for most non-preventive office visits
  • Preventive care visits, like flu shots, travel immunizations or diabetic supplies do not require a copay

At Checkout 

  • Patients may choose to pay by payroll deduction, cash or credit card
  • To set up payroll deductions, complete and sign the payroll deduction enrollment form and return it to Sindecuse staff

After a Visit

If a balance is owed for services received after insurance has settled the claim,

  • Patients will receive an Explanation of Benefits (EOB) from BCBS
  • The University will send an invoice with a line that reads “Health Center” or “SMC” (Sports Medicine Clinic) for charges not covered
  • WMU adds a late fee to balances not paid on time and a convenience fee for payments made by credit card
  • To make a payment, visit the Faculty/Staff tab on GoWMU. Under My Self Service show all links and click on “Payments and Account Information”

Please consult your plan agreement for deductible, copay and pharmacy benefit information.

Some other changes AFSCME Members MAY notice:

The following changes applied to AAUP faculty members and staff compensation system employees in 2018, and now apply to AFSCME members after Jan. 1.

Lab and X-ray

  • We send most lab work to Borgess for testing 
  • Lab services not covered by insurance will be billed to the patient by Borgess
  • In the PPO plan, a patient is responsible for the full amount of externally-billed diagnostic services until a deductible is met, then 10% coinsurance (20% coinsurance for aviation associates or R3 research associates) 

Sports Medicine Clinic

  • Deductibles or co-insurance are not applied toward physical therapy. The visits are covered at no cost to the patient up to the allowed number of visits. Outside providers may charge PT patients until a deductible is met.
  • Sports medicine doctor, podiatrist, and orthopedic specialist visits have a $40 copay
  • Massage therapy – no copay, patient pays full amount until $300 deductible is met, then 10% coinsurance (20% coinsurance for aviation associates or R3 research associates)

Advantages of Using WMU's Health Center

PPO plan members enjoy advantages when receiving services at Sindecuse, including

  • Radiology studies (X-rays) and lab tests processed at the health center (except for STI testing done in-house) are also exempt from deductibles and co-insurance
  • We offer low-cost brand name prescriptions and over the counter medications
  • Quick access to appointments with caring clinicians, sports medicine doctors, physical therapists, massage therapists and athletic trainers
  • Laboratory and X-ray services on site
  • Outside prescriptions, and lab or X-ray orders for services accepted
  • Convenient one-stop location on campus means less time in traffic, fewer stops to get medical care and diagnostic services or prescriptions

If you have questions, please contact Terri Andrews at Sindecuse Health Center at (269) 387-4219.

Healthy Blue Living HMO Eligibility

WMU employees on the Healthy Blue Living HMO plan offered by Blue Care Network are invited to use Sindecuse pharmacy services, but should note that copays are different than the PPO plan. HMO members are not covered by insurance for any other health center services, except flu shots.

Thank You

Our dedication to health care excellence and service to WMU students, faculty and staff does not change. We are committed to your health and academic success in the new year. For more information about insurance benefits, employees should consult the human resources website  or call HR at (269) 387-3620 for more details.