| The
Comprehensive Major Medical option is administered by BCBSM.
Of all your medical insurance options, this one offers the
most limited benefits and has the lowest monthly cost.
You are free to
use the provider of your choice, but your out-of-pocket costs are lower if you
use a participating BCBSM provider. That is because benefits are limited to a
BCBSM fee schedule, and nonparticipating providers may charge more than the fee
schedule allows. You pay 100% of any charges in excess of the fee schedule.
No
matter which provider you use, you must meet your deductible
of $500 per individual or $1,000 per family before benefits
are paid. Once you satisfy your deductible, the plan will
pay 80% of most eligible services, while you pay the remaining
20%. Once you have paid $3,000 individual or $6,000 for
your family out of your own pocket, including the deductible,
the plan will pay 100% of approved covered services. The
out-of-pocket maximum does not include non-covered charges,
expenses paid at a 50% co-insurance, and costs that exceed
the plan's fee allowance for a particular service. Prescription
drug co-pay amounts do not apply to the CMM out-of-pocket
maximum.
The plan does not
pay for charges that exceed the BCBSM fee schedule. Co-pays paid for
private duty nursing and psychiatric care do not count toward the out-of-pocket
limit.
The
plan pays a $1 million lifetime maximum in benefits for
each covered member.
Coordination
of Benefits
When you first enroll, you will need to complete a BCBSM
Coordination of Benefits (COB) form before any claims are
paid. All your claims will be denied until the form is received
by BCBSM. At that time, you will have to refile all rejected
claims. COB Forms will be sent to you in January, but they
are also available for download from the Medical
Insurance Forms page and from the Blue Cross Blue Shield
Web site at http://www.bcbsm.com/forms/members/pdf/cob.pdf
(PDF).
International
Claim Filing
View the BlueCard Worldwide®
section for information on filing a claim when you need
medical care outside the U.S. |
