Fax: 248-524-2752, https://dev.michigan.local/som/json?sc_device=json, State Health Plan Preferred Provider Organization (PPO), State High Deductible Health Plan (HDHP) with Health Savings Account (HSA), Catastrophic Benefits (Effective January 1, 2023 this plan is no longer available to employees and their dependents), OptumRx is the Pharmacy Benefit Manager for the State Health Plan PPOand will administer all retail, mail-order, and specialty, State High Deductible HealthPlan (HDHP) with, dministered by Blue Cross Blue Shield of Michigan (BCBSM),HSA a, The federal government issued the "transparency in coverage" final rule under the Federal No Surprises Act. When an out-of-area Blue plan member seeks medical care from your office, use our tools to simplify claims submission to BlueShield of California. 14. other health care coverage 16. other policy holder's last name 19. other policy holder's date of birth 17. other policy holder's first name 20. name of other health carrier 21. other carrier policy/group number 22. other carrier street address city state zip code 23. other employer name major medical 24. type of other health insurance . The network covers all 83 Michigan counties and is the largest PPO network in Michigan. h1aMXk* Q)DDJjH$*F {07 N_Bdk A plan is considered QHC if coverage for motor vehicle accidents is not excluded and the annual deductible is $6,000 or less per covered individual. 500 Renaissance Center. The BlueCard Program links Blue plans across the United States and abroad through a single electronic network for claims processing and reimbursement. hbbd```b``z"@$D2e5A$)e,H^0 0000016284 00000 n 0000048834 00000 n 0000059211 00000 n Medical Insurance - Lansing Community College Michigan Auto Insurance Reform -- What HAP Members Should Know 0000048683 00000 n 0000010306 00000 n To help your savings grow even more, when your HSA balance reaches $1,000, you can choose a variety of investments. 0000038624 00000 n 0000030483 00000 n Health Insurance Marketplace Check out information about the Marketplace, especially if you are not eligible for coverage through LCC. 0000028854 00000 n You can log in to your online member account to see if you have a QHC letter to download. %%EOF Coordination of Benefits Questionnaire - BCBSM 0000059965 00000 n 0000027161 00000 n Oakland County's Qualified Health Coverage Letter for Retiree Notice of Qualified Health Coverage for Purposes of Michigan No-Fault Auto Law Medical Health Plans ASR Plan Documents ASR PPO 1 Plan Document ASR PPO 3 Plan Document Summary of Benefits and Coverage 2023 PPO 1 Summary of Benefits and Coverage 2023 PPO 3 Summary of Benefits and Coverage endstream endobj 14 0 obj <. 0000059656 00000 n If the provider you select doesn't participate at all with BCBSM (BCBSM has several different provider arrangements), you may also be required to pay additional charges. Claims | Benefits | Member eligibility | How to use Provider Connection | Contracts | Credentialing | You keep what you dont spend on medical expenses, even if you retire or leave state employment. This tool provides side-by-side medical plan comparisons and personalized cost modeling. (5 days ago) WebTo request a proof of qualified health coverage letter, contact Blue Cross' Customer Service department at 1-800-422-9146 from 8:30 a.m. to 5 p.m. Eastern time, Monday https://hwnr.bcbsm.com/content/dam/microsites/mpsers/2020/best-of-health-summer-nonmedicare.pdf Category: Health Show Health Filter Type: Treatment 0000007421 00000 n Effective October 1, 2019, Blue Cross Blue Shield of Michigan, in partnership with Lucet, will be replacing Magellan Health as the State Health Plan (SHP) PPO Behavioral Health/Substance Use Disorder carrier. db4H@g& C This copay is waived if Mary or her family member is admitted as a result of the ER visit. California Physicians Service DBA Blue Shield of California 1999-2023. They won't charge you the difference between their normal charge and the amount paid by the State Health Plan PPO. &yw}.$7eIw Learnyour requirements, deadline dates and more about your coverage. 0000031798 00000 n Those costs include increased copay and deductible amounts. 0000036168 00000 n 0000028187 00000 n Verify eligibility of Blue Shield of California, Blue Shield of California Promise Health Plan, other Blue plan and Federal Employee Program members, and access associated benefits information. 0000008674 00000 n Members should direct specific questions about PIP coverage to their auto insurer. Health Trust Learn More Questions? NO - YES - Please complete entire form, sign at the bottom and return sign at the bottom and return . hb```5,|z cbD{600T|txGyG{T8"W3\baah4p1$$ v3Kx4@6@ 1 And you don't have to use the money by the end of the year, your account balance will not expire. To file a Blue Cross Blue Shield Global Core eClaim online, log in with your username and password or register for access. We provide health insurance in Michigan. You can log in to your online member account to see if you have a QHC letter to download. State Health Plan PPO - Administered by Blue Cross Blue Shield of Michigan (BCBSM). Your co-insurance amount for in-network services is 20%. For the HSA Plus Plan because Mary met her deductible and a portion of her service costs are paid at the 20% co-insurance, she would be responsible for $3,006 out of pocket to use this plan. 0000049165 00000 n Under the new law, youll no longer be required to purchase unlimited personal injury protection (or PIP) if you have a certain level of health insurance coverage. %PDF-1.6 % <> <<674A7177E0417F4590EC384E93D00AED>]>> 0000042215 00000 n You may enroll in an authorized HMO plan serving your residential area. Detroit, MI 48243. We're making your EOB easier to understand. MSU Student Health Insurance Plan. 0000009279 00000 n The account and money are yours. hb``b``f`c`Taa@ V(-) Q>hL)[ley|800pt Pn`K Al@8m@@3J31k=21@=3 F%&hWfpdbm]` If you are 55 or older, you can make an additional catch-up contribution of $1,000 per year until you are enrolled in Medicare. 0000026848 00000 n Simply . 0000060222 00000 n Please see below for further information. 120 0 obj To find the most up-to-date information about current medical and pharmacy claims, you can use the Blue Cross app or log into your BCBSM member account at bcbsm.com. This letter shows whether your health insurance plan meets the requirements to be considered QHC under the new no-fault auto law. 0000016573 00000 n Qualified Health Coverage Documents DIFS Bulletin 2020-01-INS advises health plans should develop a document that indicates whether a person's coverage is "qualified health coverage" or QHC for purposes of the new no-fault law. Under the plan documents section, click Michigan Auto Reform to request a letter be mailed to the subscriber's address. PIP is the part of an auto insurance plan that covers the health care costs from a car . Health Insurance Coverage | Health Services | Michigan State University If you don't have a Provider Connection account, you will need to register before logging in. Under the new legislation, residents may select different levels of PIP coverage. The state will make an annual HSA contribution of $750 for an eligible individual employee enrolled in the State HDHP or $1,500 for an eligible employee who enrolls with one or more eligible dependents in the State HDHP,* effective January 1. It has a deductible of $6,000 or less per person. 0000031112 00000 n 0000004148 00000 n 866-503-3158 b|=b}#Aif3TRD0;@NHkQ#`VEQxD 0000006680 00000 n %PDF-1.7 % 0000025874 00000 n We're sorry, but the attestation service is temporarily unavailable. Michigan - Blue Cross and Blue Shield's Federal Employee Program Let's start with Mary who selected a plan to cover her family. Or, call the number on the back of your member ID card. To request your QHC confirmation letter: Log in to your member account. 0000012476 00000 n Health insurance plans may contain auto exclusions (meaning they don't provide coverage for car accident-related injuries); may fail to cover the treatment, care and services needed by car accident victims; may limit such treatment, care and services in ways that No-Fault does not; and/or may involve managed care or HMOs which require Under the State Health Plan PPO, members choose their in-network providers from the BCBSM Community Blue/Blue Preferred PPO Network. View the eGuide to see the Ford resources available all year long. Your coverage is considered qualified if it: When making a decision, keep in mind that PIP has coverage that goes beyond traditional health insurance. Respond promptly to the carrier to complete the final phase of the enrollment process. Don't have a member account? This tool provides side-by-side medical plan comparisons and personalized cost modeling. Each letter serves a distinct and specific purpose: Notice of qualified health coverage for auto personal injury protection (PIP) benefits: Changes to Michigan's no-fault auto insurance law that . trailer It has more than 20,000 physicians, including specialists, and more than 140 all acute care hospitals in Michigan. 13 0 obj <> endobj 0000034422 00000 n They areresponsible for the deductible, then the hospital is reimbursed according to the plan design. }v".VrTAmk$NJ+ y{i-Y#gds7D `+DO>|5%Nqdws=0y';L a66[OIe,%EqtRS&54Qvw"E$iu3:G+x+II^ UTT"9W!4XuYS6Ly}l&!2 This copay does not apply to the out of pocket maximum for the HSA Plan, so Mary will be responsible for this copay each time she or a family member visits the ER, after the deductible is met. 0000045752 00000 n The network covers all 83 Michigan counties and is the largest PPO network in Michigan. Bcbsm Qualified Health Coverage Letter OptumRx is the Pharmacy Benefit Manager for the State Health Plan PPOand will administer all retail, mail-order, and specialty prescription services for active employees and both Medicare-eligible and non-Medicare eligible retirees. To request a proof of qualified health coverage letter, contact Blue Cross' Customer Service department at 1-800-422-9146from 8:30 a.m. to 5 p.m. Eastern time, Monday through Friday. %PDF-1.6 % | _1S}9M{T=o9B^>.!a8Znpk9(6_ These scenarios are simple, and there are many other ways you can consider managing your out-of-pocket costs with your health savings account. 0000032373 00000 n 0000034485 00000 n %PDF-1.7 % Your auto insurer may also ask for a letter about how your health coverage coordinates with your auto insurance for auto accident medical claims (i.e., which coverage pays primary in an auto accident). 0000024600 00000 n 0000017849 00000 n Available for commercial, Shared Advantage, and BlueCard. You can also review your current plan to help make the best choice for 2021. 0rtq]%g=z.#i0\*m(D2q;t2}$kX[-+G-0hdA9r*8!jcsfEdRyV0=bLzf']q[6F"h.wB)^wvDH =/OC; f'e$GVi]G}//xTw)9]y(kkxU*uXT) 0ajx[k jK`8P1(GU=. If you have additional BCBSM contracts, pleas e include this as other coverage. Go paperless by submitting claims and managing payments online for free. 0000010017 00000 n This contribution will be prorated for employees who enroll mid-year. Learn about our tools and how to use them in our upcoming webinars. An HMO provides necessary hospital and medical treatment when you are sick or injured, prescription medicine services, substance abuse treatment, short-term mental health care, and routine preventive health maintenance services such as immunizations. You can log in to your online member account to see if you have a QHC letter to download. #G:&#WeKo]b287X]4 fd!n>X3jG[)GW%0.{1,JqA]Vf,fyf#Ji+OvDUpe!K|\"e2{g3ePW?/p Click My Plan and Spending. You don't need to wait until your new plan year starts to see your doctor. First, let's look at the cost to have a medical plan. Since John has individual coverage, he gets a $500 HSA contribution from Ford if he selects the HSA Plus Plan, Ford doesn't make a contribution towards the health savings account for the HSA Plan. 0000035745 00000 n To get reimbursed for a flu or pneumonia shot, you'll need to fill out our Member Flu and Pneumonia Shots Reimbursement Form (PDF). lo%x9d,oqM lzgw'TK6oB~+d; {qi.B/ R`]Hcq6~s_]=y&|9]Fl2b\o9Vp"(5Z9lb.dx;@? *Mii lkSW+0XI~'kT`C>?wlvR No-fault auto insurance changes in Michigan | bcbsm.com 0000007628 00000 n XYQ This product provides comprehensive PPO coverage with costsharing features. 800-229-2210 After the deductible and coinsurance are applied for the HSA Plus Plan, James will be responsible for $3,480. Be sure to turn off pop-up blocker and private browsing prior to opening your Auto Health verification letter. The document must: Create an account now. Uses standard Blue Cross ID card. 0000044573 00000 n startxref Co-insurance is a percentage of the cost you share with the plan. 0000021457 00000 n 0000009647 00000 n Log in to continue with member verification. The rule provides protection against balance or "surprise" billing under certain circumstances, and phases in new transparency requirements on most group health plans and health insurers. Its important to know that in order to opt-out of PIP coverage under the new Michigan law, you must have health insurance that is considered qualified health coverage. 0 PDF Sample Qualified Health Coverage Documentation - Michigan If you choose to do so, you will be responsible for both deductibles. Pontiac, MI 48341. 0000012102 00000 n Callers to our phone lines are currently experiencing long wait times. View the Telemedicine Benefit Summary to see your State-sponsored health insurance carrier's telemedicine coverage. Share & Bookmark, Press Enter to show all options, press Tab go to next option, Retirement and Deferred Compensation Board, Upcoming Individual Consultations & Seminars, Oakland County's Qualified Health Coverage Letter for Active Employees, Oakland County's Qualified Health Coverage Letter for Retiree, Notice of Qualified Health Coverage for Purposes of Michigan No-Fault Auto Law, 2023 PPO 1 Summary of Benefits and Coverage, 2023 PPO 3 Summary of Benefits and Coverage, Summary of Information for Preventive Care, 2023 PPO 2 Summary of Benefits and Coverage, 2023 Traditional Summary of Benefits and Coverage, 2023 HAP Summary of Benefits and Coverage, BCBSM Approved Autism Evaluation Centers and Behavioral Analysts. This plan provides health benefits using providers and facilities that are in-network, meaning the providers and facilities have agreed to accept a discounted fee from BCBSM in order to be in-network. Questions About Your Benefits? 0000018138 00000 n 0000017479 00000 n Once logged in, navigate to the https://www.bcbsm.com/index/health-insurance-help/faqs/topics/other-topics/no-fault-changes.html You must be in pay status to receive this payment. endobj The new Michigan No-Fault insurance law defines qualified health coverage in two ways: It is "health or accident coverage" that "does not exclude or limit coverage for injuries related to motor vehicle accidents" and its "annual deductible for coverage" must be "$6,000 or less per individual." (MCL 500.3107d (7) (b) (i)) Or it is Medicare coverage. 0000017188 00000 n Once they've been met, the plan generally pays the full amount of your in-network medical and prescription costs. %%EOF 0000007848 00000 n To find the most up-to-date information about current medical and pharmacy claims, you can use the Blue Cross app or log into your BCBSM member account at bcbsm.com. Health Plan Details 0000031415 00000 n 0000027945 00000 n 0000006389 00000 n em4MVRpH ~*.V%s^5h}R,uJXP;6s@bH{{J 4aWS8r *W~oKMwSV-Kl^voIb #TY^hAP38HUR{mv8azF`lAQm8yiKm77!}1nW www.bcbsm.com/som, State High Deductible HealthPlan (HDHP) withHealth Savings Account (HSA)- HDHP administered by Blue Cross Blue Shield of Michigan (BCBSM),HSA administered by HealthEquity. Click continue to proceed with verification. 606 0 obj <>stream If you're asked to provide your auto insurer with a QHC letter, you will either need to contact your health plan (like Blue Cross) or your employer to request the letter. (tJ)Dpdd5* 7YG1}[X3C=Yvou*tdU`{NRGqZy3Cv{c.W+5gE|7?)z The deductible is the amount you pay before your plan contributes to your costs. State and Federal Privacy laws prohibit unauthorized access to Member's private information. This means you have the option to increase your payroll contributions so you can reach the maximum contribution amount earlier in the year. 0000048540 00000 n 0000029515 00000 n endstream But, if you receive services from a provider not in the PPO network, you may be responsible for paying additional out-of-pocket costs. Please keep in mind that PIP coverage pays for some items that health insurance doesnt, such as attendant care, lost wages and vehicle or housing modifications. PDF Blue Cross Blue Shield of Michigan: Understanding member ID cards For more info, visitwww.mi.gov/AutoInsurance, emailAutoInsurance@mi.gov, or call 833-ASK-DIFS (275-3437). TVxZOEhL5wV/yZP^',UP1ko}87M@p_[8Sq^R/ Now let's imagine Mary and her family had a year with a lot of medical and prescription expenses where they meet the out-of-pocket maximum for both plans. Even though this law has to do with your auto insurance, a lot of people have questions about what it means for your. Blue Care Network Qualification Form - BCBSM GradCare Member Reimbursement Form U-M Premier Care Member Reimbursement Form You also have an out of pocket maximum, that's the maximum amount you pay in deductibles and applicable co-insurance during one plan year. This plan covered inpatient hospital expenses, as well as certain other services received at the hospital on an outpatient basis (including emergency room care). 0000048349 00000 n These plans also allow you to set aside tax-free funds that you can use for qualified medical expenses. With the HSA Plan, you pay 100% of medical and prescription costs until your deductible is met. If you're asked to provide your auto insurer with a QHC letter, you will either need to contact your health plan (like Blue Cross) or your employer to request the letter. 373 0 obj <>stream 0000051836 00000 n i' *eW endobj 0000018397 00000 n The Plan also covers most of your community-based care (office visits), as well as necessary medical equipment and supplies (crutches, hearing aids, etc.). Preventive care benefits are covered 100 percent when received from a TRUST PPO network provider. Qualified health coverage is health or accident insurance that doesn't exclude or limit coverage for injuries from auto accidents. 0000027625 00000 n 0 TTY users should call 711. 0000030241 00000 n Important Legal and Privacy Information | Important Information About MedicarePlans | Privacy Practices | Site Map | Feedback | Download Adobe Acrobat Reader, Important Information About MedicarePlans. a health reimbursement arrangement which helps members pay for qualified medical expenses. In the HSA Plus Plan, you're also responsible for all medical and prescription costs until your deductible is met. Member logins offer many on-line tools, such as access to claims information, viewing Explanation of Benefits, printing replacement ID cards, etc. Benefits under this plan were payable only after you had paid expenses equal to one month's basic salary (your deductible). An HSA is a smart way to save for your future qualified health expenses, including those that may come up in retirement. 0000007258 00000 n In 2021, you'll have a choice between two HSA eligible medical plans, HSA Plan and HSA Plus Plan. An HMO is a managed care plan that provides medical care through its network of physicians, pharmacies, contracted hospitals, and medical care suppliers. 'TMjZ}dM`V;hO0 45o` T@> $0,Tkpp9~#@="-toen7=u-J 3P6sO1v 0IA||$IRs3R6o'j*vU#;B!FL5O,hBtA7|$xVv)*09KTOM8Gh6CAIT,[*6a8 wz If your spouse's (non-State) employer will not cover you under their group plan because you are enrolled in any of the State-sponsored health care options,you can "opt out" completely and still receive the $50 biweekly payment (select "Health Waiver with Rebate"). Enrollment in the State HDHP will also provide access to an HSA, which is a tax-advantaged savings account that can be used to pay onlyeligiblehealth, prescription, dental, and vision-related expenses incurred for services not covered by insurance (e.g., deductibles, copays, and coinsurance). 0000026478 00000 n Other costs to use the HSA Plan will vary depending on whether you select plan coverage for you or for your family. 0000005441 00000 n So in this scenario, the total cost to have and use the plans makes the HSA Plan the less costly option for Mary and her family. What to Know About Changes to Michigan's Car Insurance Law 1tv Health Benefit Plans | Oakland County, MI Visit, Go to Qualified Transportation Fringe Benefits (QTFB), Active Employee State Health Plan PPO BCBSM Plan Booklet, Retiree State Health Plan PPO With Medicare Booklet, Understanding HMO Insurance Premium Rates. HSA Plan and HSA Plus Plan. 0000014991 00000 n Follow the instructions on the page to have your letter created. The HSA Plan is still the less costly option for Mary because the total cost to have and use the plan is lower in the HSA Plan. Field Service. You can use the money if you leave the company, change your plan, or retire. PDF Blue Cross Blue Shield of Michigan: Understanding member ID cards Under the State Health Plan PPO, members choose their in-network providers from the BCBSM Community Blue/Blue Preferred PPO Network. 248-524-0454 Select Claims on the menu bar. To help you compare and select your 2021 plan based on your personal needs, Ford has provided Benefits Mentor powered by IBM Watson Health. 0000015914 00000 n Auto insurance reform | Priority Health Here's how these plans work. PDF Hospital Coverage Letter - Bcbstx 0000049102 00000 n Blue Cross Blue Shield of Michigan. 0000013667 00000 n endobj Employees can also make pre-tax HSA contributions by payroll deductions. You have certain tasks to complete within specific . For Medicare Members: No-fault auto law changes Health (Just Now) WebThere are several ways you can request a QHC letter. Letters for your auto insurance carrier - MESSA Mail Code 1112. [Narrator] Hello again, and welcome to Blue Cross Blue Shield of Michigan. Give us a call to discuss your plan options. 0000034448 00000 n endstream 0000003382 00000 n When we look again at the total cost of having and using the plans, the HSA Plan is the lower cost option for John. 0000049042 00000 n Access tools to prescreen, submit and check the status of submitted claims. California Physicians Service DBA Blue Shield of California is an independent member of the Blue Shield Association. And for the HSA Plus Plan, it's $1,020. Standard Qualification Form If you have a Blue Cross Blue Shield of Michigan plan other than Healthy Blue Achieve that requires a qualification form, please use the form below. 13 151 0000037572 00000 n <>stream 0000027006 00000 n 0000019892 00000 n PPO. For all other claims, choose your health plan on this page to find the form and instructions for sending it in. For Medicare Members: No-fault auto law changes bcbsm.com Health (Just Now) WebThere are several ways you can request a QHC letter. For example: a single person chooses an in-network hospital for surgery. 0000000016 00000 n View detailed plan information in this document. 0000026660 00000 n For Ford Employees: 2023 Health Plans | BCBSM To find the most up-to-date information about current medical and pharmacy claims, you can use the Blue Cross app or log into your BCBSM member account at bcbsm.com. An HDHP offers a lower biweekly premium in exchange for higher deductibles and out-of-pocket limits. Visit Federal No Surprises Act (michigan.gov)for more information. See your 2023 Benefits-at-a-Glance (PDF) for more plan details. 0000014041 00000 n It can help treat minor illnesses such as colds, sinus or respiratory infections, sprains, or rashes, making it perfect when your primary care physician is unavailable or leaving the house is difficult. 0000023020 00000 n Please enable JavaScript in your browser for a better user experience. ATTENTION: To ensure individuals with disabilities have an equal opportunity to access enrollment services for Qualified Health Plans, if you have a disability (such as visual or hearing impairment) auxiliary aids and alternative formats are available free of charge by contacting HealthCare.gov or calling 1-800-318-2596 to speak with HealthCare.gov. 0000059434 00000 n If you need information about eligibility, benefits or claims, or want to submit or review an authorization, the best way to get up-to-date information is through our on-line resources. If you have any questions, call the phone number on the back of your Blue Cross ID card and we'll help. We'll accept a qualification form from an office visit that occurred up to 180 days before the start of your plan year. Employees selecting the HSA Plan are responsible for a fixed amount copayment of $200 for each visit to the emergency room after your deductible has been met. endstream endobj 141 0 obj <>/Metadata 11 0 R/Pages 138 0 R/StructTreeRoot 21 0 R/Type/Catalog/ViewerPreferences 160 0 R>> endobj 142 0 obj <>/MediaBox[0 0 612 792]/Parent 138 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 143 0 obj <>stream 0000015249 00000 n C.O.P.S. We can help. You can keep your unlimited PIP coverage. You still have the freedom to go out-of-network to see any physician, hospital or other provider of your choice. In accordance with state and federal law, contracted providers and facilities must attest to the accuracy of their directory information at least every 90 days. Once logged in, navigate to the https://www.bcbsm.com/medicare/help/faqs/other/auto-law.html Category: Health Show Health $"mY_%Be66y=\"QI Members enrolled in the HSA plan will be responsible for paying an ER copayment after the deductible has been met. Qualified Healthcare Coverage Letter Blue Cross Blue Shield of Michigan: Understanding member ID cards All rights reserved. PDF BCBSM Master Medical Claim Form 0000013426 00000 n Now let's look at what a single person with relatively few healthcare needs might experience. Difs Qualified Health Care Letter 0000047030 00000 n 0000021168 00000 n If your auto insurance is requesting a QHC letter to issue or renew a policy, you may request a QHC letter by contacting yourhealth carrier. 0000008905 00000 n 600 Lafayette East. The HSA Plan is available to you at no cost. 0000048613 00000 n 0000048976 00000 n Use the Find-a-Doctor tool to verify provider participation in one of our plan networks. 140 0 obj <> endobj If your no-fault insurance carrier requests or requires confirmation of your university health plan's position for coordination with no fault, please call the SSC Contact Center at 734-615-2000 or 1-866-647-7657 (toll free). Your email address will not be published. To quickly and easily find out if you, the provider, or a provider referral, participate in the member's plan network*, either log in or register for Provider Connection. 0000014332 00000 n Submit and confirm authorizations and approval of medical and pharmacy services prior to services being rendered. For the HSA Plan, your deductible and out-of-pocket maximum amounts for in-network services are the same. ^0} SX XD00{03pi`p. 0000023941 00000 n BlueCard Program home page. For the HSA Plus Plan, Ford contributes $1,000 towards Mary's health savings account, which further reduces her cost to use this plan. 310 0 obj <>/Filter/FlateDecode/ID[<4C51D19B138643B1A2CB07133610D1D7>]/Index[258 116]/Info 257 0 R/Length 203/Prev 1461330/Root 259 0 R/Size 374/Type/XRef/W[1 3 1]>>stream
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